What is C-PTSD?

It’s likely you may already be familiar with PTSD. You may know it as the condition that affects war veterans and survivors of car accidents, natural disasters, and isolated acts of violence. Complex PTSD (C-PTSD) however, is specific to severe, repetitive trauma that typically happens in childhood.

The label Complex post-traumatic stress disorder (C-PTSD) has been given to describe the set of symptoms that can develop in response to prolonged, repeated experience of interpersonal trauma.

Symptoms span the following domains:

• Attachment – “problems with relationship boundaries, lack of trust, social isolation, difficulty perceiving and responding to others’ emotional states”
• Biology – “sensory-motor developmental dysfunction, sensory-integration difficulties, somatization, and increased medical problems”
• Affect or emotional regulation – “poor affect regulation, difficulty identifying and expressing emotions and internal states, and difficulties communicating needs, wants, and wishes”
• Dissociation – “amnesia, depersonalization, discrete states of consciousness with discrete memories, affect, and functioning, and impaired memory for state-based events”
• Behavioral control – “problems with impulse control, aggression, pathological self-soothing, and sleep problems”
• Cognition – “difficulty regulating attention, problems with a variety of ‘executive functions’ such as planning, judgement, initiation, use of materials, and self-monitoring, difficulty processing new information, difficulty focusing and completing tasks, poor object constancy, problems with ’cause-effect’ thinking, and language developmental problems such as a gap between receptive and expressive communication abilities”
• Self-concept – “fragmented and disconnected autobiographical narrative, disturbed body image, low self-esteem, excessive shame, and negative internal working models of self”

C-PTSD is a relatively new diagnostic label. Some of the symptoms of C-PTSD are very similar to those of borderline personality disorder (BPD), and not all mental health professionals are aware of C-PTSD. As a result, some people are given a diagnosis of BPD or another personality disorder when C-PTSD is more appropriate.

People on the C-PTSD spectrum may experience the following difficulties:

• Experiencing ongoing physical anxiety—what Dr John Arden calls “auto stress”
• Living in a state of hypervigilance—being extremely sensitive to your surroundings and easily irritated
• Being prone to mental anxiety or what psychologists refer to as “cognitive distortions“
• Experiencing intense and/or rapidly changing emotions
• Sleep disturbances
• Problems with feeling and/or expressing emotions
• Difficulties in developing and maintaining relationships
• Feeling as though you’re inherently flawed or damaged; experiencing chronic shame
• Feeling as though you’re completely different to other people
• Having an unclear sense of identity; relying on other people to define who you are and how we should behave
• Finding it difficult to trust others
• Problems with assertiveness, asking for help and saying no
•  Problems with memory and concentration
•  Feeling sensations (such as abdominal pain) that have no obvious physical cause
•  Impulsive and/or risk-taking behaviours
•  Experiencing derealisation and/or depersonalisation
•  Problems with sensory processing and hand-eye coordination
•  Experiencing hallucinations
•  Self-harming and/or suicidal thoughts
•  Eating problems
•  Problems with drugs or alcohol
•  Struggling with parenting

ACE Study

Conducted from 1995 to 1997, The CDC-Kaiser Permanente Adverse Childhood Experiences (ACE) Study, is a groundbreaking study that investigated the impact of (ACE’s) childhood abuse, neglect and household dysfunction on physical and mental health problems in over 17,000 adults. These adults competed physical exams as well as confidential surveys regarding their childhood experiences and current health status and behaviors.

The outcome of the study was crucial to the understanding of how devastating the consequences of Childhood Trauma are, throughout those children’s future and adult life.

 The study showed a strong relationship between Adverse Childhood Experiences (ACEs) and future acts of violence, victimization, perpetration, health, even low life expectancy.

Since this study, we’ve not only learned more about the psychological effects of ACEs on young minds, but also the long-term health complications that can come from recurring exposure to ACEs.

For people who have four types of child- hood adversity — an ACE score of 4 — alcoholism risk increases 700 percent; attempted suicide increases 1200 percent. Heart disease and cancer nearly double. People with high ACE scores have more marriages, more broken bones, more depression, more prescription drug use, more obesity.

How Trauma Affects The Brain

One thing you may not know is that trauma physically changes our brains. When you experience a traumatic event, your mind changes. Areas of your brain that once worked in a particular way change based on hyperarousal due to trauma.

The Nervous System

We can break down the Nervous System into different bits to make it easier to talk about. But keep in mind it is a wildly interconnected system.

Think of your Nervous System as an octopus with its tentacles reaching into every other conceivable body system. The tentacle that we are mainly talking about hacking is called the Autonomic Nervous System (ANS) which famously has two big parts: Sympathetic and Parasympathetic. Innervating all of the major organs and glands, the main job of the ANS is to be aware and responsive to changes in both our external and internal environments, and move us effortlessly back and forth between engaged and resting states. It’s incredibly susceptible to being hacked both “unconsciously”, when say a car is swerving towards us or you’re on your third hour of watching cable news, and more “consciously”, when we choose to take a deep breath or partake in certain Yoga breathing techniques.

“FIGHT OR FLIGHT” VS “REST AND DIGEST”

We might be a little more familiar with the terms “fight or flight” and “rest and digest”. These phrases are usually used to describe a Sympathetic or Parasympathetic Nervous System activation. the Sympathetic Nervous System is turned all the way up it sets off a cascade of chemical activity in the body that allows us to “fight or flight” our way out of a scary scenario.

This is when the amygdala gets over-activated after a traumatic experience. When you hear the phrase “fight, flight or freeze” that’s when you have a physical and emotional response to a trigger. You remember the traumatic experience, and your amygdala becomes overactive. You’re hypervigilant, and you’re on alert, making sure that you’re safe from danger. You re-experience the trauma in real time, bodily and emotionally, and your brain is telling you that it’s reoccurring, you’re in danger and you need help. Mental health disorders, personality changes, and other symptoms might develop as a result.

But when your nervous system is managed and dialed down, it’s a very necessary system that helps us to do our jobs, be alert, and even be “in the zone”.

In fact, I hope you are in a moderate Sympathetic activation right now! This way you can take in what you’re reading, stimulate questions, and make connections. If you are drifting towards a Parasympathetic Nervous System activation you might start glazing over, getting sleepy and sliding lower in your chair.

One of the most difficult aspects for survivors in the aftermath of trauma is understanding the changes that occur, plus integrating what they mean, how they affect a life and what can be done to ameliorate them. Launching the recovery process begins with normalizing post-trauma symptoms by investigating how trauma affects that brain and what symptoms these effects create.

The 3-Part Brain

The Triune Brain model, introduced by physician and neuroscientist Paul D. MacLean, explains the brain in three parts:

• Reptilian (brain stem): This innermost part of the brain is responsible for survival instincts and autonomic body processes.
• Mammalian (limbic, midbrain): The midlevel of the brain, this part processes emotions and conveys sensory relays.
• Neommalian (cortex, forebrain): The most highly evolved part of the brain, this area outer controls cognitive processing, decision-making, learning, memory and inhibitory functions.

During a traumatic experience, the reptilian brain takes control, shifting the body into reactive mode. Shutting down all non-essential body and mind processes, the brain stem orchestrates survival mode. During this time the sympathetic nervous system increases stress hormones and prepares the body to fight, flee or freeze.

In a normal situation, when immediate threat ceases, the parasympathetic nervous system shifts the body into restorative mode. This process reduces stress hormones and allows the brain to shift back to the normal top-down structure of control.

However, for those 20 percent of trauma survivors who go on to develop symptoms of post-traumatic stress disorder, an unmitigated experience of anxiety related to the past trauma — the shift from reactive to responsive mode never occurs. Instead, the reptilian brain, primed to threat and supported by dysregulated activity in significant brain structures, holds the survivor in a constant reactive state.

The Dysregulated Post-Trauma Brain

The four categories of PTSD symptoms include: intrusive thoughts (unwanted memories); mood alterations (shame, blame, persistent negativity); hypervigilance (exaggerated startle response); and avoidance (of all sensory and emotional trauma-related material). These cause confusing symptoms for survivors who don’t understand how they’ve suddenly become so out of control in their own minds and bodies.

Unexpected rage or tears, shortness of breath, increased heart rate, shaking, memory loss, concentration challenges, insomnia, nightmares and emotional numbing can hijack both an identity and a life. The problem isn’t that the survivor won’t “just get over it” but that she needs time, help and the opportunity to discover her own path to healing in order to do so.

According to scientific research, after trauma your brain goes through biological changes that it wouldn’t have experienced if there had been no trauma. The impact of these changes are especially exacerbated by three major brain function dysregulations:

• Overstimulated amygdala: An almond-shaped mass located deep in the brain, the amygdala is responsible for survival-related threat identification, plus tagging memories with emotion. After trauma the amygdala can get caught up in a highly alert and activated loop during which it looks for and perceives threat everywhere.
• Underactive hippocampus: An increase in the stress hormone glucocorticoid kills cells in the hippocampus, which renders it less effective in making synaptic connections necessary for memory consolidation. This interruption keeps both the body and mind stimulated in reactive mode as neither element receives the message that the threat has transformed into the past tense.
• Ineffective variability: The constant elevation of stress hormones interferes with the body’s ability to regulate itself. The sympathetic nervous system remains highly activated leading to fatigue of the body and many of its systems, most notably the adrenal

How Healing Happens

While changes to the brain can seem, on the surface, disastrous and representative of permanent damage, the truth is that all of these alterations can be reversed. The amygdala can learn to relax; the hippocampus can resume proper memory consolidation; the nervous system can recommence its easy flow between reactive and restorative modes. The key to achieving a state of neutrality and then healing lies in helping to reprogram the body and mind.

Trauma-Informed Treatment Approaches

As mentioned, cognitive behavioral therapy may not always be the most helpful for childhood trauma survivors.

We may know intellectually that not all of our beliefs are rational. We understand that our physical responses are out of proportion to the situation. The real issue is that our irrational beliefs and physical responses often aren’t coming from our rational brain – they’re coming from our deep-seated emotional brain.

To change this, we need to rewire the emotional brain.

Here are seven approaches recommended by trauma experts to help rewire our emotional brain:

1. Eye Movement Desensitization and Reprocessing (EMDR)
2. Somatic Experiencing (SE)
3. Internal Family Systems Therapy (IFS)
4. Physical Movement, Breathing and Meditation Practices
5. Yoga, Tai Chi, Qi gong, Tae kwon doe
6. Neurofeedback

What Are The Benefits And Goals Of Trauma Therapy?

The following are some of the basic goals of trauma therapy:

• To successfully handle the reality of the traumatic event that occurred in the past ( it prevents it from getting a hold on you).
• To eliminate or ameliorate the symptoms of trauma
• To change the focus of the past event to the present
• To boost day to day functioning
• Getting people to know about hereditary trauma
• Helping individuals regain their “personal power”
• Helping individuals getting over addictions caused by traumatic stress
• To equip individuals with skills to help prevent deterioration or relapse