What Are the Symptoms of Complex PTSD?

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As a child, Olivia, who never knew the identity of her father, was consistently abused and neglected by her mother. Her mother’s emotional temperament was highly variable—shifting from dark moods during which she was verbally and physically abusive to her daughter, and manic periods during which arm she left Olivia to fend for herself for days at a time.

When Olivia was 9, a teacher made a report to Child Protective Services (CPS). Olivia had arrived in her fourth-grade class with a black eye and a large bruise on her in the pattern of an adult-sized hand. After the CPS investigation, Olivia was pulled from her mother’s home and placed in a group home with other girls and teenagers. There, her trouble only continued. Olivia was bullied for a number of years by several older, bigger girls and more than once required medical attention as a result of their deliberate tormenting. During the eight years that Olivia moved from group home to foster home and back, her mother rarely called, visited only once, and made no efforts to have the custody of her child returned to her.

Finally, Olivia was on her own; she managed to graduate from high school and land a job and a place to live. Money was tight, but Olivia was good at keeping a roof over her head and even managed to save a little of her income; nothing mattered to her as much as security. Still, she spent her 20s and 30s moving from one chaotic experience to another. It seemed to her as if life were happening to her; she felt out-of-control and filled with anxiety much of the time. The emotions and behaviors of other people were intolerable to her—even of mere acquaintances such as the other tenants in the house where she rented a room.

Olivia believed people had negative intentions toward her, and was highly defensive as a result. She had difficulty concentrating and jumped at the slightest sounds or provocation. She experienced chronic migraines and frequently reacted to everyday situations with tears or intense and unreasonable anger. Her memory was spotty, and she suffered sleep disturbance, often waking from nightmares, unable to self-sooth. She felt incapable of making an emotional commitment and remained single. She had established a pattern of making what she believed to be poor sexual decisions. Each time after such an episode, Olivia committed to be more careful, to take fewer risks with people she didn’t really know, but she invariably broke those promises to herself. Around age 22, she began to use marijuana daily in an attempt to cope with anxiety. She smoked in the mornings before going to work as a receptionist for a car rental company as well as on her lunch breaks and as soon as she returned home. Using marijuana had become a way for Olivia to escape.

By her late 20s, Olivia was having panic attacks, and by 38, her episodes of clinical depression had grown harder and harder to recover from.

Symptoms of Complex PTSD

What makes complex post-traumatic stress disorder (PTSD) different from other types of PTSD is that its sufferers experience prolonged trauma—such as exposure to long-term childhood abuse or long-term domestic violence—along with the consequences of chronic stress. The American Psychiatric Association’s (APA) Diagnostic and Statistical Manual of Mental Disorders lists the criteria for complex PTSD diagnosis this way:

(I) Alteration in Regulation of Affect and Impulses
(A and one of B to F required)

  1. affect regulation
  2. modulation of anger
  3. self-destructive behavior
  4. suicidal preoccupation
  5. difficulty modulating sexual involvement
  6. excessive risk-taking

(II) Alterations in Attention or Consciousness
(A or B required)

  1. amnesia
  2. transient dissociative episodes and depersonalization

(III) Alterations in Self-Perception
(Two of A to F required)

  1. ineffectiveness
  2. permanent damage
  3. guilt and responsibility
  4. shame
  5. nobody can understand
  6. minimizing

(IV) Alterations in Relations with Others
(One of A to C required)

  1. inability to trust
  2. revictimization
  3. victimizing others

(V) Somatization
(Two of A to E required)

  1. problems with the digestive system
  2. chronic pain
  3. cardiopulmonary symptoms
  4. conversion symptoms
  5. sexual symptoms

(VI) Alterations in Systems of Meaning
(A or B required)

  1. despair and hopelessness
  2. loss of previously sustaining beliefs

Recovery Is Possible

Many who suffer from complex PTSD go years, sometimes decades, without understanding the cause of their symptoms—from sensitivity to sounds, mood dysregulation and chronic physical pain. Making the connection between their symptoms and the lived-experience of chronic stress and trauma is highly significant in the healing process. There is treatment for complex PTSD, and many people are able to overcome it.

As for Olivia, she began to read about the effects of early trauma and long-term stress and, after seeing a therapist, was properly diagnosed with the disorder. Finally having a more grounded idea as to what was “wrong,” Olivia was able to be more compassionate with herself for what she’d too long thought of as personal failures. She began to seek and find ways to reduce her stress and improve her well-being. Her journey had been long and difficult, but she was able to move out of the past and to begin focusing on a healthier, more meaningful present.





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