Editorial Note: Our friends at Brooks Healing Center have provided an extensive guide to understanding and treating a malady affecting 8% of adults—POST-TRAUMATIC STRESS DISORDER (PTSD). Even though 30 million people are affected by PTSD, many do not even realize the harm of post-traumatic stress disorder. However, a complex PTSD diagnosis can help put an end to the psychological and physical harm that occurs with prolonged trauma. The impact of this disorder is broad-reaching and, consequently, we’ve elected to post the content of this guide here, with full permission from the originating source.

Treating Complex PTSD During Rehab

Sometimes, an event that occurs within minutes can affect people for the rest of their lives. For example, a car accident, robbery, or natural disaster are time-limited situations. These occur once and only for a short duration, but the trauma may remain with the affected individuals. On the other hand, some experiences happen repeatedly or last for months — even years — at a time. For these situations, the trauma can also remain for prolonged periods, but it may present a different set of risks for the affected individual.

What Is Trauma?

According to the American Psychological Association (APA), trauma is an emotional response to a distressing event, like a violent attack, a severe accident, rape, or a natural disaster. Feelings like shock and denial are typical after traumatic events. Most people who go through these events experience a temporary period of adjustment and learning to cope.

Eventually, traumatic memories become less vivid, and negative emotions subside. However, long-term effects from trauma like flashbacks, relationship issues, and mood swings can have a lasting impact on someone’s life. For some people, traumatic events can lead to post-traumatic stress disorder (PTSD).

POST-TRAUMATIC STRESS DISORDER

The long-term effects of psychological trauma are often pervasive and destructive, influencing a  person’s mental and physical well-being. If an individual with trauma doesn’t receive treatment and the symptoms persist, the person may develop post-traumatic stress disorder (PTSD). People with PTSD continue to experience vivid memories of their trauma and feel distressing emotions long after the event occurred.

Signs and Symptoms of PTSD

Individuals who have PTSD may relive the trauma in their minds. Memories of the event can get in the way of daily life and keep people from fully engaging in their surroundings. Symptoms of PTSD include reliving the trauma by:

  • Experiencing flashbacks of the event
  • Nightmares, often relating to the trauma 
  • Scary thoughts 
  • Stress response such as racing heartbeat, fast breathing, and high blood pressure

Because PTSD symptoms might get triggered by random encounters, people with the disorder may start avoiding people, places, and situations. The avoidance symptoms include shying away from places, events, or even objects that bring back memories of the trauma and avoiding emotions or thoughts that are linked to the event.

PTSD raises a person’s arousal and reactivity, keeping them feeling worried and “keyed up,” which can make them angry or irritable. The constant state of hyper-alertness can also become tiring on the mind and body. The following are symptoms of hyperarousal and mood changes in PTSD:

  • Feeling tense
  • Being easily startled or frightened
  • Being Irritable
  • Angry outbursts
  • Difficulty remembering key information about the traumatic event
  • Negative thoughts processes
  • Distorted feelings of shame or guilt
  • Loss of interest in activities previously enjoyed

The effects of trauma are mainly attributed to the human body’s stress response,  or the “fight or flight” response. 

Fight or Flight

The body’s fight-or-flight response stems from the need to manage the threat of predators. Ancient humans needed to react swiftly to danger, so the body developed mechanisms to respond to life-threatening situations.

As a response to a dangerous situation, the body’s nervous system releases hormones that trigger adrenaline. The rush of energy increases heart rate, breathing, and blood pressure — priming the body to either fight or flee from the threat. This same stress response enables modern-day humans to deal with pressure. By releasing energy, the stress response lets us handle a variety of stressors, from school exams to traumatic events.

The stress response is a vital part of a person’s survival. It’s ultimately necessary, but sometimes it can become triggered by perceived or imaginary threats. In the case of PTSD, it can remain triggered for prolonged periods, well after the danger has passed. A few examples of traumatic events that can cause PTSD are:

  • Warfare or military engagements
  • Serious accidents
  • Natural disasters like tornadoes or tsunamis
  • Terrorist attack or active shooter event
  • Violence
  • Rape
  • Life-threatening illness
  • Loss of a loved one
  • Victim of a crime
  • Sexual assault
  • Domestic violence
  • Child abuse or neglect

A type of PTSD called “complex PTSD” or C PTSD may occur if traumatic events happen repeatedly, like sexual assault, child abuse, or neglect.

What is Complex PTSD?

A complex PTSD diagnosis captures the psychological and physical harm that occurs with prolonged and continuous trauma. When trauma recurs for months or years, it can affect people in very specific ways. For example, repeated childhood trauma like sexual abuse or neglect can manifest in distinct symptoms. When repeated trauma occurs during a child’s formative years, it can lead to problems with forming healthy relationships with others, reacting appropriately to stress, or dealing with authority figures.

COMPLEX PTSD VS PTSD

Although C PTSD is not listed as a separate diagnosis in the Diagnostic and Statistical Manual of Mental Disorders (DSM), it is recognized as part of the PTSD chapter in the two most recent versions of the DSM (DSM-IV and DSM-V). The DSM classifies and organizes mental disorders, and is utilized by mental health professionals worldwide.

The concept of complex PTSD was introduced in the early 1990s to distinguish the difference between PTSD and the symptoms shown in victims of recurring trauma like childhood trauma.  Complex PTSD is also known as complex trauma and complex trauma disorder.

Signs and Symptoms of Complex PTSD

People who have complex PTSD often struggle with typical PTSD signs as well as the defining complex PTSD symptoms:

EMOTIONAL DYSREGULATION

Living with complex PTSD can bring about mood changes and make it difficult to control emotions. A person’s feelings also increase in intensity, causing them to be extremely angry or very sad.  

NEGATIVE SELF-IMAGE

Feelings of guilt, helplessness, and shame can cause people with C PTSD to see themselves as different from others or feel abnormal. They may also consider themselves undeserving or inferior, causing feelings of helplessness, guilt, shame, or self-loathing.

PREOCCUPATION WITH AN ABUSER

Someone living with complex PTSD may develop an obsession with their abuser. They may perseverate about their abuser and can develop strong feelings toward that individual. They may allow the abuser complete control over their life, or they may become obsessed with revenge.

DETACHMENT FROM THE TRAUMA

When a person has C PTSD, they may not recall the trauma or they may dissociate from the event. Dissociation is a feeling of detachment, often seeing oneself as outside of the body or not a part of the environment.  

CHANGES IN WORLDVIEW

Complex PTSD symptoms may include a change in the way someone sees the world. People with CPTSD can become despondent about the state of the world and incorporate a negative worldview. For example, they might perceive all people as selfish and corrupt.

UNSTABLE RELATIONSHIPS

Many people with this disorder have trust issues in relationships and may avoid or sabotage relations. Due to the feeling of inadequacy, they may have challenges in forming healthy attachments to other people. They may also remain in abusive relationships because it feels familiar to them. 

How is Complex PTSD Diagnosed?

Because complex PTSD is a relatively new diagnosis, some doctors may not identify the disorder immediately. A doctor or therapist might give a person a diagnosis of PTSD instead of CPTSD.  However, by working closely with their doctor and providing as much information as possible, a person with CPTSD can obtain the correct diagnosis.

MISDIAGNOSIS OF COMPLEX PTSD

The complex PTSD symptoms are often confused with traumatic grief or borderline personality disorder. These disorders have similar symptoms — like unstable moods and relationships — but are not the same. An individual might visit a few doctors or undergo many assessments before an accurate diagnosis is made.

People with complex PTSD may feel vulnerable while talking about their past and their symptoms, so they must find a doctor they feel comfortable with.

Comprehensive client history is necessary for an accurate diagnosis. Clients may feel more open to discussing their past if they have an excellent rapport with their doctor or therapist.

There’s no definitive C PTSD test. Doctors typically make their diagnosis by asking about symptoms and conducting a thorough history interview and physical assessment.

A doctor or therapist can also make a diagnosis by asking about the following subjects:

  • Family history of mental illness
  • Relationship history
  • History of any traumatic events
  • Any recreational drug use
  • Symptoms
  • Work and family history

PTSD and Addiction

Along with disturbing flashbacks and emotion-related issues, PTSD also increased the risk for addiction or substance use disorder (SUD). Of the people with any type of lifetime PTSD, men (51%) were more likely than women (27.9%) to have a substance use disorder. Almost half (46.4%) of individuals with PTSD also struggle with some kind of addiction. The numbers are much higher for individuals with PTSD who have served in the military. A variety of studies show that almost all veterans with PTSD have had a co-occurring episode of substance abuse disorder.

Unfortunately, individuals with both PTSD and SUD have, on average, poorer treatment outcomes and functional impairments in work, finances, legal, medical, and social life when compared to individuals with only one disorder. PTSD and SUD, when present simultaneously, places an individual at a greater risk for problems in their daily life.

The human brain reacts and adapts to its environment. The brain adapts to protect itself, often tweaking chemicals to respond appropriately to any given situation. This ability to change, called neuroplasticity, allows humans to learn and grow. Neuroplasticity shapes how people think and behave. It is also why trauma can lead to PTSD and addiction.

As noted earlier, in an attempt to manage danger, the brain unleashes its fight-or-flight response. In PTSD, however, the brain remains in that fight-or-flight mode, even after the initial threat is gone. In addition, the brain attempts to adapt, taking on thought processes and behaviors that it believes will help alleviate and prevent any more pain.

SELF-MEDICATION

Individuals with PTSD may turn to substance use to self-medicate. In their effort to deal with painful memories and feelings, they may drink alcohol or start using drugs — which opens the door to substance abuse. Using drugs to cope with the symptoms of PTSD places PTSD sufferers at a much higher risk for addiction.

Although addiction and PTSD can occur independently of one another, they are often diagnosed together. Addiction can prolong and exacerbate PTSD, placing an individual in risky situations and isolating them from the support systems they need. PTSD can also make a person more prone to risk-taking behaviors, increasing the probability of addiction.

Treatments for Complex PTSD and SUD

The ideal recovery approach for CPTSD and substance use disorder is to treat both simultaneously. Because the two are so interrelated, treating both issues at the same time allows for an efficient and integrated approach.6 In addition, a special focus is placed on the trauma a person endured, providing the support they need to cope with the events. The following are examples of evidence-based practices for co-occurring addiction and complex PTSD treatment​​​s.

EMDR

Eye movement desensitization and reprocessing (EMDR) therapy is a psychotherapy method that helps people recover from traumatic experiences and mental disorders like anxiety, depression, and PTSD.Performed by a trained and licensed practitioner, EMDR involves a series of directed rhythmic eye movements and repetitive stimulation while bringing focus to traumatic memories. By engaging specific neural pathways, EMDR decreases the vividness and emotional stimulation brought on by past trauma.

COGNITIVE BEHAVIORAL THERAPY

Cognitive-behavioral therapy (CBT) is a psychotherapy method used to treat a range of problems like depression, anxiety, relationship issues, PTSD, and addiction. Research indicates that CBT is effective at significantly improving an individual’s quality of life and can produce measurable change. The core principles of CBT are that psychological problems are:

  • Caused, in part, by faulty ways of thinking.
  • Caused, in part, by learned patterns of behavior that are detrimental to well-being.
  • Malleable and can be changed.

CBT used for complex PTSD treatment​​ typically focuses on modifying distorted thought patterns, like catastrophic or negative thinking.  Learning to identify and stop ways of thinking and behaving that negatively impact an individual’s life can significantly reduce the symptoms of trauma and make addiction recovery successful.

EXPOSURE THERAPY

Exposure therapy, also known as prolonged exposure (PE), teaches people who have trauma-related disorders like PTSD to gradually manage their symptoms. Because trauma memories trigger overwhelming emotions, exposure therapy encourages a slow and gradual approach, allowing an individual to process memories in a way that is tolerable and manageable.

Trauma-Informed Care

Trauma-informed care (TIC) is an organizational approach to trauma, with the idea that trauma influences both the physical and mental health of an individual. When providing services for clients, a trauma-informed focused organization recognizes and enforces the 6 principles of trauma-informed care:

  • Early screening and assessment
  • Consumer-driven care and services
  • Nurturing a trauma-informed and responsive workforce
  • Evidence-based and emerging best practices
  • Creating safe environments
  • Community outreach and partnership building
  • Ongoing performance improvement and evaluation

A TIC approach doesn’t require a checklist or technique, it is more of a cultural mindset — offering attention, sensitivity, and awareness of the influence of trauma on all aspects of care. When viewed through a trauma-informed lens, complex PTSD treatment​​​s become more individualized, fostering an empathetic and patient-centered approach to care.

TRAUMA RECOVERY MODEL

Trauma recovery centers (TRCs) address the needs of trauma victims from a comprehensive perspective. They address the needs of people who struggle with trauma, through early outreach and coordinated, clinical case management centered around a person’s trauma. Many trauma recovery centers also target people who are most likely to get overlooked by the healthcare system: ethnic minorities, at-risk youth, and people in underserved communities.

Using the trauma recovery model, the continuation of patient care targets trauma management. Mental health interventions are inherent in all departments and throughout the system, allowing people with trauma histories to recover in a safe and understanding atmosphere.

Recovering from Complex PTSD and Addiction

One aspect involved in the interplay between complex PTSD and substance use disorder is a family history of addiction. Severe substance use disorders prevent parents from functioning at their best, making it more likely that the children grow up in a home exposed to complex traumatic events like extreme neglect and physical abuse. In turn, these children may struggle with addiction as adults that is caused by complex PTSD and an inherited risk for addiction. Overcoming addiction and coping with trauma as adults can assist parents in stopping the cycle of addiction and C PTSD.

New and effective trauma-focused therapy models like EMDR and trauma-informed care offer trauma victims renewed hope. Regardless of age, it’s never too late to seek help for complex PTSD or addiction. Receiving treatment for both simultaneously, in a safe trauma-focused environment, can place a person struggling with trauma and addiction on the road to healing.

Resources:

https://www.apa.org/topics/trauma

https://www.nami.org/About-Mental-Illness/Mental-Health-Conditions/Posttraumatic-Stress-Disorder

https://www.nctsn.org/what-is-child-trauma/traum

https://www.psychiatry.org/psychiatrists/practice/dsm

https://www.ptsd.va.gov/professional/treat/cooccurring/tx_sud_va.asp

https://www.samhsa.gov/sites/default/files/wcdvs-article.pdf

https://www.ptsd.va.gov/professional/treat/cooccurring/tx_sud_va.asp

https://www.apa.org/ptsd-guideline/patients-and-families/cognitive-behavioral

https://www.apa.org/ptsd-guideline/treatments/prolonged-exposure

https://www.cdc.gov/cpr/infographics/6_principles_trauma_info.htm

https://www.traumarecoverycentermodel.org/about-trauma-recovery-centers/

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