Humans have experienced – and been affected by – trauma for the entirety of recorded history. Sources have noted mentions of war-related trauma in The Odyssey, The Illiad, the works of Shakespeare, and the Bible.
In other words, trauma is nothing new. But the ability of healthcare professionals to identify and treat trauma has changed considerably through the centuries, and it continues to evolve and improve today. These improvements include developing more effecting terminology for describing the psychological effects of trauma.
One of the most recent advances has been the establishment of a new disorder called complex PTSD.
A Brief History of PTSD & CPTSD
As Marc-Antoine Crocq, MD, wrote in the journal Dialogues in Clinical Neuroscience, the condition that we now know as posttraumatic stress disorder (PTSD) has, at various points in history, been described as soldier’s heart, war neurosis, combat hysteria, and shell shock.
The term “posttraumatic stress disorder” (PTSD) did not appear until the third edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-3), which was published in 1980.
- In the DSM-I, which was published in 1952, the closest entry to PTSD was “gross stress reaction.” This entry was included in a section titled Transient Situational Personality Disorders.
- The DSM-II, which premiered in 1968, included an entry for adjustment reaction of adult life in the retitled Transient Situational Disturbances section.
Changes in the various editions of the DSM have also included revised descriptions for the types of experiences that can cause PTSD and the effects that this disorder can have on a person’s life.
For example, an August 2016 article in the Annals of Clinical Psychiatry reported the following:
- The description of gross stress reaction in the DSM-1 indicated that it was “as a transient response to “severe physical demands or extreme emotional stress such as in combat or in civilian catastrophe (fire, earthquake, explosion, etc.).”
- DSM-II noted that adjustment reaction of adult life could result from “unwanted pregnancy, military combat, or a death sentence.”
Also, although PTSD has remained in all versions of the DSM since it first appeared in 1980, the criteria for this disorder have continued to change. The following updates were all noted in the August 2016 Annals of Clinical Psychiatry article:
- In the DSM-III and DSM-III-R, the traumatic event that leads to PTSD was described as a stressor that was outside the range of usual human experience.
- DSM-III and DSM-III-R also noted that events that did not involve physical trauma (such as the loss of a loved one or a serious illness) did not fall under the definition of trauma.
- By the DSM-IV-R, diseases that threatened the life of the individual or the individual’s child were included as potential precursors to PTSD.
- In the DSM-5, additional PTSD causes include witnessing certain traumatic events and “developmentally inappropriate childhood sexual experience without physical violence.”
As clinicians gained greater insights into the many types of experiences that can lead to PTSD, some began to advocate for creating an additional disorder called complex posttraumatic stress disorder, or CPTSD. This effort was led by Dr. Judith Herman, who originally proposed the new diagnosis in the late 1980s.
In 2018, when the World Health Organization published the 11th version of the International Classification of Diseases (ICD-11), the new disorder made its official debut.
What Is Complex PTSD?
To develop the new complex PTSD diagnosis, mental health experts needed to answer two primary questions:
- What types of events could lead to complex PTSD?
- How does a person think or behave as a result of complex PTSD?
The National Center for PTSD, which is part of the U.S. Department of Veterans Affairs (VA), has reported that initial efforts to define complex PTSD focused on trauma – especially sexual trauma – that a person experienced during childhood.
The experts who were developing the new complex PTSD diagnosis later expanded their focus to include other types of prolonged exposure to trauma. These experiences may include long-term domestic violence, ongoing sexual abuse, being a refugee, torture, and human trafficking.
According to both the National Center for PTSD and Dr. Herman, the types of situations that lead to complex PSTD share the following elements:
- The person is in a protracted state of physical and/or emotional captivity.
- The person is under the control of a perpetrator.
- The person is unable to escape the danger.
As described by Andreas Maercker in the journal Borderline Personality Disorder and Emotion Dysregulation, there are six fundamental characteristics of the new complex PTSD diagnosis:
- Re-experiencing the event(s) in the present
- Changing behaviors to avoid traumatic reminders
- A sense of current threat
- Emotion regulation difficulties
- Avoidance or other difficulties in relationships
- Negative self-concept or sense of self
In the ICD-11, which is used by healthcare providers throughout the world, complex PTSD replaced a disorder from the ICD-10: enduring personality change after catastrophic experience (EPCACE).
The DSM, which is primarily used by clinicians in the United States, does not yet have an entry for complex PTSD. Healthcare professionals who consult this reference book may use one of the following terms for people who have complex PTSD:
- The DSM-IV had an entry for disorders of extreme stress not otherwise specified (DESNOS).
- The most recent version of this reference book, the DSM-5-TR, contains an entry for unspecified trauma- and stressor-related disorder.
Of course, mental healthcare professionals in the U.S. may also use the term complex PTSD as well. Just because a specific disorder is not listed in the DSM, this does not mean that it is not “real” or that people who are affected are not suffering from legitimate effects.
Effects of Complex PTSD
In a March 2018 article in the World Journal of Psychiatry, a team led by Evangelia Giourou of the University of Patras (Greece) discussed several aspects of this new diagnosis, including the potential effects of complex PTSD.
The Giourou team addressed how complex PTSD could lead to personality alterations, emotion dysregulation, and impaired self-organization. They also explored the biological aspect of complex PTSD.
“Structural brain abnormalities in complex PTSD seem to be more extensive with brain activity after complex trauma being distinctive than the one seen in PTSD patients who had experienced only single trauma,” they wrote.
The team noted that chronic exposure to stress can affect the hypothalamic-pituitary-adrenal (HPA) axis.
In addition to controlling how the body reacts in times of stress, the HPA axis also influences elements such as mood, emotions, digestion, the immune system, and the reproductive system. Individuals who endure prolonged exposure to childhood trauma may develop both increased activation of the HPA axis as well as adjustment dysfunction within this essential system.
In terms of behavior and quality of life, the effects of complex PTSD can include the following:
- Outbursts of anger and other inappropriate, uncontrolled emotions
- Overwhelming shame and guilt, which may include blaming yourself for the trauma
- Dissociation, or a sense of being detached from the world around you
- Depersonalization, or feeling removed from your own thoughts and feelings
- Hypervigilance due to the sense that you are constantly being threatened, even when there is not credible evidence to suggest that you are in danger
- Inability to trust other people
- Becoming obsessed with getting revenge on the person who was responsible for the trauma
- Abusing alcohol and other drugs as a means of coping with intrusive thoughts, which can lead to additional physical and psychological harm
Treatment for Complex PTSD
Complex PTSD can have a devastating impact on virtually all parts of a person’s life. But this is a treatable condition. As is the case with PTSD, treatment for complex PTSD may include prescription medication and various forms of therapy. Given the severity of the experiences that can lead to complex PTSD as well as the acuity of the symptoms that a person may experience, it is important to find a provider that can offer both comprehensive clinical services and close personal support.
To learn more about treatment options for adults who have complex PTSD or other complicated mental health concerns, contact Crownview Psychiatric Institute today.
Gianna Melendez
Jodie Dahl, CpHT