Complex PTSD: Putting a Dent in Our Understanding of Trauma-Induced Psychiatric Disorders

traumaWhen we think of Post Traumatic Stress Disorder (PTSD), the first image that comes to mind is of a soldier returning from war; but while combat does indeed often produce PTSD, it’s not the only way that people develop the life-changing disorder.

A deepening understanding of how a wide variety of traumatic experiences can result in changes in both brain and behavior has yielded a new category of proposed PTSD diagnosis: Complex Post Traumatic Stress Disorder or C-PTSD:

Complex Post-Traumatic Stress Disorder has not yet been listed in the Diagnostic and Statistical Manual, so it is not technically an official diagnosis. Yet most therapists agree that prolonged or repeated exposure to trauma causes a type of post-traumatic stress disorder that is more disabling and results in symptoms that are more numerous and often of greater intensity than those caused by a single trauma.

C-PTSD differs from what we think of as “regular” PTSD in cause, severity, and symptoms:

An individual can develop “simple” post-traumatic stress from a single traumatizing event, such as a serious car accident. The development of complex PTSD requires more protracted and severe trauma. Additionally, it is more likely to occur when the repeated traumas were interpersonal and occurred early in life.

Survivors of totalitarian regimes, torture victims, prisoners of war, religious cult survivors, and victims of concentration camps or child pornography/prostitution are especially prone to the development of complex PTSD symptoms. Children or spouses who have been severely abused over long periods of time are also likely to exhibit the disease, even if they block some or all of the abuse out of their consciousness.

Researchers are continuing to examine complex trauma; both its causes and potential treatments. As they do so, changes may take place in the way that clinicians conduct differential diagnosis. It seems that many cases of Complex PTSD are misdiagnosed as either Borderline Personality Disorder or Bipolar II because they share many features.

Some want to go a step further in re-categorizing a variety of mental health issues. Dr. John Briere, a Professor of Psychiatry and Psychology at USC, has argued that the vast majority of mental disorders are really the result of some form of childhood trauma. “If we could somehow end child abuse and neglect,” says Briere, “the eight hundred pages of Diagnostic and Statistical Manual would be shrunk to a pamphlet in two generations.”

Given the human and economic cost of mental illnesses (mental health-related absences cost American businesses more than $23 billion dollars each year), getting to a clearer understanding of the causes and treatments for mental illness in general, and trauma in particular, should be on everyone’s radar.

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