Complex Trauma and PTSD

Earlier this year, Dr A diagnosed me with complex PTSD (in addition to just having “simple” PTSD).   Complex PTSD is not an officially recognised diagnosis (currently) but many mental health professionals recognise it because the criteria for PTSD just doesn’t quite cover fully the experience of those who have been though complex trauma – trauma that is from long term abuse (usually childhood abuse but not always).

So what is complex PTSD?

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

  • affect regulation
  • modulation of anger
  • self-destructive behaviour
  • suicidal preoccupation
  • difficulty modulating sexual involvement
  • excessive risk-taking

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

  • amnesia
  • transient dissociative episodes and depersonalization

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

  • ineffectiveness
  • permanent damage
  • guilt and responsibility
  • shame
  • nobody can understand
  • minimizing

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

  • inability to trust
  • revictimization
  • victimizing others

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

  • problems with the digestive system
  • chronic pain
  • cardiopulmonary symptoms
  • conversion symptoms
  • sexual symptoms

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

  • despair and hopelessness
  • loss of previously sustaining beliefs

Luxenberg, Spinazzola, van der Kolk.

There are sadly psychiatrists out there who mix up the symptoms of Complex PTSD with borderline personality disorder because of the overlap of some symptoms.  Long before my diagnosis I argued with several psychiatrists about their incorrect view that they  are the same thing.  But ultimately, CPTSD and BPD are no more the same disorder than Bipolar I with psychoses and Schizophrenia are the same thing simply because they  share symptoms too.  With CPTSD and BPD, even where symptoms overlap, often the underlying cause or trigger or motivation is different.

If you can handle a rather wordy, technical article, one of the best articles I’ve found on CPTSD (called DESNOS in the article – DESNOS being what CPTSD is referred to in the DSM IV) can be found at:

I know from last few appointments with Dr C he is (was?) one of those psychiatrists who appeared to assume complex PTSD and BPD are the same disorder, even going as far as to say they are the same thing several months ago.  The logical asperger side of me has an obsessive compulsive need to correct  people on topics that I am well versed in – to the point where I’ve struggled in the past to walk away from trying to correct illogical people.  It’s something I’ve made a conscious effort to learn to walk away from trying to correct most people when they don’t listen to logic and objective evidence, especially once John began lightheartedly teasing me about how much time I was wasting debating with people who would never change their minds no matter how much logic and evidence is thrown at them.

So I’ve (mostly) stopped debating with people on the internet, but when it comes to mental health, it is my profession and my passion, and it effects me and so many people I care – friends and family.  So when I come across a mental health professional, especially one high up in the profession, I will debate them – and drown them with research proof.  Of course not all of them listen.  The first psychiatrist I tried to debate about CPTSD with wasn’t interested in evidence – instead he just shut me down by saying I was a newbie nurse and had no idea what I was talking about – and while at the time I was new to  being a registered nurse, I was not new to nursing as a whole, and he didn’t realise I had psychology and neuroscience qualifications and in many ways (if not all ways!) was more educated and experienced in the subject than he was.

But while my experience with that particular psychiatrist was pretty negative (ie he was one of those arrogant doctors who couldn’t handle being corrected by a “lowly” nurse, especially a “newbie”), I think with all the research I present Dr C with, I made him see the differences between CPTSD and BPD – at least yesterday it seemed that way.

Why do I care?  For two reasons.  As I said, it the logical asperger side of me, not being able to stand it when someone believes illogical and incorrect.  And because I’ve seen the damage done of mixing up diagnoses in mental health – the incorrect treatments, the incorrect therapies, and sometimes outright mistreatment of patients.

For me, I had no one to correct people when I was being badly mistreated from misdiagnosis 6-12 years ago.  I had no one to stick up for me and try to fix things.  So  I now try to make sure no one else has to go through what I went through.

Some people say it’s a “symptom” of CPTSD to be a campaigner to help those who have been abused – that CPTSD sufferers who have been through child abuse become passionate advocates to protect children from abuse, that sufferers who have been through domestic violence become passionate advocates against DV.  But I think it’s more than that.  I think it’s having a heart for justice and compassion, not wanting others to suffer.  It’s not a “symptom” of a “disorder”, rather it’s sign of a good, conscientious person.

I have so much more to write on this topic but I think I’ll wrap it up for now.  Personally, I still don’t know if I believe I have complex PTSD.  I have definitely been though very complex trauma, and I have some of the symptoms but not all, not enough to quite get the diagnosis I think.  It’s further complicated by the fact I only get some symptoms like thoughts of suicide and dissociative episodes when I’m having a severe episode of depression, not something I have all the time like my symptoms of “simple” PTSD like the flashbacks and nightmares and extreme fear of people and places that remind me of the abuse I went through.  My thoughts on how complex PTSD does and doesn’t fit me can wait for another day.

If you know any other good sites describing complex PTSD, feel free to leave links in the comments for others to read.


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