Normally when we think about “PTSD,” our minds jump to those who’ve been in combat. While it is certainly an issue for those who’ve been in real-life war zones, Post-Traumatic Stress Disorder (PTSD) and Complex PTSD isn’t just exclusive to war veterans. In fact, many survivors of childhood emotional neglect, physical or emotional abuse, domestic violence, sexual assault and rape can suffer from the symptoms of PTSD or Complex PTSD if they endured long-standing, ongoing and inescapable trauma.
These individuals face combat and battle in invisible war zones that are nonetheless traumatic and potentially damaging. According to the National Center for PTSD, about 8 million people can develop PTSD every year and women are twice as likely than men to experience these symptoms.
What Are The Symptoms of PTSD and Complex PTSD?
There are four types of symptoms that are part of PTSD and some additional symptoms for Complex PTSD as listed below. Complex PTSD, which develops due to chronic, ongoing trauma, is more likely to occur due to long-term domestic violence or childhood sexual and/or physical or emotional abuse. Around 92% of people who meet the criteria for Complex PTSD also meet the criteria for PTSD (Roth, et. al 1997).
It is recommended that you seek professional support if you’re struggling with any of these symptoms, especially if your symptoms last longer than one month, cause great impairment or distress and/or disrupt your ability to function in everyday life. Only a licensed mental health professional can diagnose you and provide an appropriate treatment plan.
1. Reliving and Re-experiencing the Trauma
PTSD: Memories, reoccurring nightmares, persistent unwanted and upsetting thoughts, physical reactivity, vivid flashbacks of the original event can all be a part of PTSD. You may also encounter triggers in everyday life – whether it be something you see, smell, hear, that brings you back to the original event. This can look different for every survivor. A sexual assault survivor might hear the voice of someone who resembles her assailant and find herself reliving the terror of being violated. A domestic violence victim might find herself being triggered by someone raising their voice. Triggers can be seemingly minor or overwhelmingly major, depending on the severity and longevity of the trauma endured.
Complex PTSD: According to trauma therapist Pete Walker (2013), you may also suffer from emotional flashbacks where you ‘regress’ back into the emotional state of the original event and you behave maladaptively to the situation as a result. Walker states that for people with Complex PTSD, individuals develop four “F” responses when they are triggered by emotional flashbacks: they may fight, flee, fawn (seek to please) or freeze. These responses are protective, but they may end up further harming the survivor because the survivor might fail to enforce their boundaries or may use excessive force in protecting themselves.
2. Avoidance of Situations That Remind You Of The Event
PTSD: You go to great lengths to avoid anything that might potentially trigger memories or feelings associated with the traumatic events. If you were in an abusive relationship, for example, you might isolate yourself from others or stop dating in an attempt to avoid being harmed by others.
If you were raped, you might avoid situations where any form of physical contact might arise, whether it be getting a massage or being affectionate with a romantic partner. If you suffered bullying, you might avoid places where group activities are likely to happen, such as large parties or even certain careers that might require high levels of social interaction. This avoidance can include trying to avoid trauma-related thoughts, too; you might keep yourself persistently busy so you don’t have to face any thoughts regarding what you went through.
Complex PTSD: Throughout your life, you may go to excessive lengths to avoid abandonment and resort to people-pleasing or “fawning” behavior. This might result in you having trouble setting boundaries with others, standing up for yourself when your rights are violated and becoming enmeshed in codependent relationships. You might be hypersensitive to signs of disapproval or micro-signals of abandonment.
As therapist Pete Walker (2013) writes, “The Abandonment Depression is the complex painful childhood experience that is reconstituted in an emotional flashback. It is a return to the sense of overwhelm, hopelessness and helplessness that afflicts the abused and/or emotionally abandoned child. At the core of the abandonment depression is the abandonment melange – the terrible emotional mix of fear and shame that coalesces around the deathlike feelings of depression that afflict an abandoned child.”
3. Skewed Belief Systems and Negative Perceptions, Including Self-Blame and Toxic Shame
PTSD: There is a shift in your belief systems and self-perception after the traumatic events. You might suffer from low self-esteem, depression, excessive ruminations, negative self-talk, memory loss related to the trauma, decreased interest in activities you used to enjoy and a heightened sense of self-blame.
Complex PTSD: Individuals with Complex PTSD may struggle with guilt, a sense of toxic shame and feeling different from others or even defective in some way. They may have a heighted “inner critic” that develops as a result of any verbal, emotional, physical or sexual abuse they went through in their lifetime. This inner critic might judge everything you do or say, prevent you from taking risks or pursuing your goals, can lead to a sense of learned helplessness and can often mimic the voices of any abusers you encountered, especially if you had toxic parents.
4. Hyperarousal and Hypervigilance
PTSD: You develop an excessive sense of alarm concerning your surroundings. You may experience a heightened startle reaction, increased irritability or aggression, engage in risky behavior, and have difficulty concentrating or sleeping.
Complex PTSD: Survivors with Complex PTSD can struggle with emotional regulation, suicidal thoughts and self-isolation. They may engage in self-harm, develop substance abuse addictions, and have a hard time trusting themselves and their intuition. They may end up in unhealthy, abusive relationships in what trauma expert Judith Herman calls “a repeated search for a rescuer” (Herman, 1997). They may have a deep mistrust of others but also a heightened attunement to changes in their environment as well as a hyperfocus on changes in microexpressions, shifts in tone of voice or gestures in others.
Treatment for PTSD and Complex PTSD
Treatment for PTSD and Complex PTSD requires highly skilled therapy with a trauma-informed and validating counselor who can help guide you safely through your triggers. Based on research, effective treatments can include some form of trauma-focused psychotherapy such as prolonged exposure therapy (PE) which involves facing the negative feelings you’ve been avoiding, cognitive processing therapy (CPT) which teaches the client to reframe their thoughts about the trauma, or Eye-Movement Desensitization and Reprocessing (EMDR) therapy which involves processing the trauma by following a back-and-forth movement of light or sound. You can learn more about treatments for PTSD here.
Keep in mind that not every treatment is suitable for every survivor and should always be discussed with a counselor. Supplemental remedies may include trauma-focused yoga and meditation to heal parts of the brain affected by trauma and release trapped emotions in the body (van der Kolk, 2015).
Although PTSD is manageable with the right support and resources, recovery from Complex PTSD is admittedly a more lifelong process as it deals with trauma that usually originated from childhood, further exacerbated by traumas in adulthood. Grieving the losses associated with the trauma or traumas experienced is an essential part of the journey.
It is important to remember that healing has no deadline and that recovery is a cyclical, rather than linear, process. Every survivor recovers in their own way and is worthy of the support it takes to get to the other side of healing.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
Herman, J. (1997). Trauma and recovery: The aftermath of violence from domestic abuse to political terror. New York: Basic Books.
National Center for PTSD (2018). Symptoms of PTSD. Retrieved here.
Roth, S., Newman, E., Pelcovitz, D., van der Kolk, B., & Mandel, F. S. (1997). Complex PTSD in victims exposed to sexual and physical abuse: Results from the DSM-IV field trial for Posttraumatic Stress Disorder. Journal of Traumatic Stress, 10, 539-555.
Van der Kolk, B. (2015). The body keeps the score: Brain, mind, and body in the healing of trauma. NY, NY: Penguin Books.
Walker, P. (2013). Complex PTSD: From surviving to thriving: A guide and map for recovering from childhood trauma. Lafayette, CA: Azure Coyote.
Walker, P. (2013). Frequently Asked Questions About Complex PTSD. Pete Walker, M.A. Psychotherapy. Retrieved here.