Have you also changed after a severe, long-term trauma? Let's talk about CPTSD (Complex PTSD)!

We all have to face difficult and painful experiences in our lives that we can't even imagine, right? But there are some experiences that don't end in a day or two. They torment us for a long time, digging into our hearts. Today, we are going to talk about a mental problem that can arise from severe traumatic situations that have been going on for a long time. This is called CPTSD or Complex Post-Traumatic Stress Disorder . Maybe you have heard of this, or you feel these symptoms yourself. Let's see what it is.

What is CPTSD (Complex PTSD)? Simply put...

Simply put, CPTSD is a mental condition that can develop if you are exposed to chronic trauma over a long period of time. This can cause significant changes not only in your mind but also in your behavior. Think about it, just as a wound takes time to heal, severe emotional wounds also take time to heal, and sometimes they can lead to a variety of distressing situations in the mind.

There are several main stress responses that can be seen in CPTSD:

• Constantly feeling worried or afraid (Anxiety): You may constantly feel like something bad is going to happen.
• Flashbacks or nightmares: You may feel like the traumatic event is really happening again, or you may have frequent nightmares related to it.
• Avoiding places, people, and things associated with the traumatic event: You may not feel like being around or going to places that remind you of the event.
• Difficulty controlling emotions (Heightened emotional responses): You may become easily angry, agitated, act impulsively, and even become aggressive over small things.
• Persistent difficulties in sustaining relationships: Difficulty connecting with people, trusting them, and forming bonds.

Imagine, there is a person named Nilanthi. Since she was a child, there were always fights at home, and her father abused her mother and her a lot. Years passed like this. Even though Nilanthi is young now, she always feels afraid, has difficulty trusting people, and gets angry over small things. She often dreams about the things that happened to her when she was a child. That kind of situation could be an example of CPTSD.

What are the chronic traumas that can cause CPTSD?

• Long-term child physical or sexual abuse.
• Long-term domestic violence.
• Being a victim of human or sex trafficking.
• Living in a warlike environment for a long time (War).
• Frequent community violence.

This condition is not only common in those who experienced severe trauma in childhood, but can also develop CPTSD in adulthood if they experience such long-term trauma.

Is CPTSD medically recognized?

This is a bit of a complicated issue. Even among psychologists, there are differing opinions on whether CPTSD is a separate condition or part of PTSD (Post-Traumatic Stress Disorder).

Consider this: The World Health Organization (WHO) has named CPTSD as a separate condition in its latest book, the `International Classification of Diseases (ICD-11),` in 2019. However, the American Psychiatric Association (APA) does not recognize CPTSD as a separate condition in its `Diagnostic and Statistical Manual of Mental Disorders (DSM-5) . However, the DSM-5 does include a condition called `dissociative PTSD` as a subset of PTSD, and its symptoms are very similar to CPTSD.

Some experts believe that CPTSD, PTSD, and BPD (Borderline Personality Disorder) may all be trauma-related mental health conditions on the same spectrum. That is, they may be related to each other in terms of the severity of their symptoms.

So what is the difference between CPTSD and PTSD?

This is a question that many people ask. The main differences are the duration of the shock and the symptoms.

We used to think that PTSD was caused by short-term trauma, such as an accident or a natural disaster. But research has found that people who are exposed to long-term, repeated trauma develop additional symptoms in addition to PTSD. It is with these additional symptoms that CPTSD is diagnosed.

In both CPTSD and PTSD,

• Re-experiencing the event (flashbacks),
• Hypervigilance (being constantly and unnecessarily vigilant about one's surroundings),
• Mental and behavioral stress responses may be seen, such as avoiding things that remind you of the traumatic event.

However, people with CPTSD also experience other problems :

• Chronic and pervasive problems with emotion regulation: Getting angry easily over small things, feeling sad, and unable to control emotions.
• Issues with identity and sense of self: Negative thoughts about who you are and what your worth is. Feelings of shame, guilt, and failure are common.
• Problems maintaining relationships: It is very difficult to build and maintain strong, meaningful relationships with others.

What is the difference between CPTSD and BPD (Borderline Personality Disorder)?

CPTSD and BPD share many of the same symptoms, such as impulsive behavior, feelings of worthlessness, and difficulty maintaining stable relationships. This has led some experts to question whether the two are actually separate conditions.

According to the current criteria, the main difference is that CPTSD requires a chronic trauma to develop. While BPD does not necessarily require a trauma to develop , BPD is often strongly associated with traumatic experiences, such as childhood abuse or neglect.

Another difference is that BPD usually appears in young adulthood, but CPTSD can occur at any age.

How common is CPTSD?

Because CPTSD is a relatively newly identified condition, there is still not enough research on how common it is. However, experts estimate that the condition may affect between 1% and 8% of the world's population. This means that there may be people in Sri Lanka who suffer from this condition.

What are the symptoms of CPTSD?

According to the World Health Organization's `ICD-11` classification, CPTSD includes many of the core symptoms of PTSD. That is:

• Flashbacks: Feeling as if the traumatic event is really happening again.
• Avoidance and detachment from people, events, and environmental stimuli that caused the trauma.
• Hypervigilance is a constant state of excessive alertness due to fear of danger.
• Frequent negative thoughts and emotions.

In addition to this, there are several other symptoms that are unique to CPTSD:

• Overreaction to negative emotional stimuli, anger, and aggressive behavior (Affective dysregulation): Simply put, getting angry quickly, getting upset, and having a hard time controlling emotions over even the smallest things.
• Having a negative sense of self: Constantly suffering from shame, guilt, feelings of failure, and worthlessness.
• Severe difficulty in forming and maintaining meaningful relationships: It is very difficult to trust people and form close relationships.

"I remember, I had a friend who suffered a lot as a child. He could never trust other people. Even if someone smiled and spoke to him, he thought he was setting up a trap. He had very few friends." – This type of situation can be seen in CPTSD.

What causes CPTSD? What happens to our brain?

According to the ICD-11, CPTSD is caused by exposure to a traumatic event or series of events of an extremely threatening nature. These events are usually long-lasting, repetitive, and involve situations in which escape is impossible or even dangerous.

Some examples are:

• Long-term domestic violence.
• Sexual or physical abuse during childhood.
• Torture.
• Facing genocide.
• Being enslaved.

This type of severe, long-term traumatic stress can cause changes in the chemistry and structure of your brain . Research has shown that trauma can cause permanent changes in several key parts of our brain. These parts are:

• `Amygdala`: This is the main part of our brain that processes fear and other emotions. It's like a little center that controls our emotions, especially those that recognize emotions like fear. This part can become overactive due to trauma, which is why we're always afraid and on alert.
• Hippocampus: This is the main part of our brain that stores our memories and helps us learn new things. Trauma can reduce the function of this part, which is why we sometimes have trouble remembering events and learning new things.
• Prefrontal cortex: This is where we do many important things, such as planning, making decisions, expressing our personality, and controlling social behavior. Trauma can also alter the functioning of this area, which is why it is difficult to control emotions and make impulsive decisions.

Some neuroimaging studies have shown that these changes are more visible in the brains of people with CPTSD than those with PTSD.

How do you accurately identify if you have CPTSD?

There is no specific test to diagnose CPTSD. Instead, a doctor or mental health counselor will ask you about the following:

• Your symptoms.
• Your medical history.
• Your mental health history.
• How you were exposed to trauma.

Doctors use the criteria in the World Health Organization's `ICD-11` to diagnose CPTSD. However, because CPTSD is a newly identified condition, some doctors may not be aware of it. Therefore, it can be a little difficult to get an official diagnosis. A doctor may even tell you that you have PTSD instead of CPTSD. Therefore, if you have these symptoms, it is very important to see a mental health counselor who is experienced in this field.

What are the treatments for CPTSD?

The good news is that there are treatments for CPTSD! The main treatment is psychotherapy, or "talk therapy" as we all know it. Specifically, it uses a type of cognitive behavioral therapy called trauma-focused CBT .

This treatment is provided by a trained, licensed mental health professional , such as a psychologist or psychiatrist. This treatment provides support, education, and guidance to you and your loved ones to help you function better and improve your well-being.

In Trauma-focused CBT, these things happen:

• You learn about how your body responds to trauma and stress.
• Learn how to manage symptoms.
• It helps identify problematic thought patterns and change them (reframing).
• Exposure therapy: People with PTSD and CPTSD often avoid things or situations associated with their trauma. As a result, they don't get a chance to learn that they can control their fear even when they are exposed to those stimuli. In exposure therapy, the therapist slowly exposes you to situations that make you afraid. They train you to stay in those situations and face them.

Another trauma-focused therapy is Eye Movement Desensitization and Reprocessing (EMDR) . In this therapy, you think about the traumatic event(s) while focusing on specific sounds or movements that the therapist introduces. The goal is to reduce the distress you feel about those events over time.

Cognitive Processing Therapy (CPT) is another type of trauma-focused therapy. This therapy focuses on addressing the distressing and often problematic thoughts and feelings that arise in your mind after a traumatic event.

Medication for CPTSD

Currently, there are no specific medications approved by the US Food and Drug Administration (FDA) to treat PTSD or CPTSD. However, doctors may prescribe medications such as these to help manage some of the symptoms of CPTSD:

• Antidepressants: Such as `Selective Serotonin Reuptake Inhibitors (SSRIs)` or `Serotonin and Norepinephrine Reuptake Inhibitors (SNRIs).`
• Anti-anxiety medications.
• Sleep medications.

These medications only relieve symptoms, not cure the disease completely. Therefore, psychotherapy is the main treatment.

What is the prognosis of CPTSD?

Because CPTSD is a newly identified condition, medical researchers have not yet had the opportunity to conduct long-term studies on it.

For many, CPTSD can be a lifelong condition. But don't worry! The best thing is that your symptoms can be managed well with psychotherapy and, if necessary, medication. This means that these treatments can help you live a normal life.

If you have CPTSD, how do you take care of yourself?

In addition to seeking treatment, there are several things you can do for your own mental well-being:

• Engage in light exercise to reduce stress and improve your mood. Even a short walk or something like yoga is good.
• Set realistic goals that you can achieve. Don't expect big things all at once. Be happy with small victories.
• Spend time with people you trust. Tell them about your experience and what triggers your symptoms may be.
• Identify moments and places that make you feel comfortable and at peace, engage in them often, and go to those places.
• Join a support group for those who have been through trauma. It's empowering to talk to people who have been through the same things as you.
• Be kind to yourself, be patient. Remember, symptoms don't go away overnight. They come slowly.

The most important thing is to understand that you are not alone. Don't be afraid to ask for help.

When should you see a doctor?

While you are being treated for CPTSD, it is very important to see your doctor and/or mental health professional regularly. If your symptoms get worse, let your doctor know right away.

When should you go to an Emergency Treatment Unit (ETU) ?

If you feel like harming yourself or are having suicidal thoughts, go to the nearest emergency room immediately, or call an appropriate emergency number in Sri Lanka (e.g. 1926 National Mental Health Helpline).

Asking for help after a traumatic event can be very difficult. But remember, getting treatment for CPTSD is essential. Over time, treatment can help you heal. Talk to your doctor about treatment options. They are here to help and support you.

Finally, things to remember (Take-Home Message)

So, we've talked a lot about CPTSD today. As you read this, you may have realized how serious and complex this mental condition is.

• CPTSD is a psychological distress caused by prolonged, severe trauma.
• In addition to PTSD, this also causes problems with emotion regulation, self-esteem, and maintaining relationships.
• This condition can be a little difficult to recognize, but an experienced professional can do it.
• The best thing is that this condition can be well managed with psychotherapy (especially Trauma-focused CBT, EMDR, CPT) and, if necessary, medication.
• If you have these symptoms, don't suffer alone and definitely seek medical advice. Asking for help is not a sign of weakness, it's one of the greatest strengths you can have for yourself.

Remember, even though you can't control what happened in your past, you can take a step today to improve your future. I wish you the strength to do so!

` CPTSD, complex post-traumatic stress disorder, mental health, trauma, stress, psychotherapy, PTSD