Understanding Complex PTSD

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By Stephanie White, PsyD, PhD, LCSW, DCSW, BCD

I have treated and diagnosed many clients with this PTSD and complex PTSD. As a result, I often get asked what this condition may present as and how to understand such symptoms.

It is imperative to understand that this condition, which is really a stress syndrome, pervades all domains of a person’s life and can have serious ramifications on one’s functioning. There is emotional numbing, shifts in one’s perception of the abuser(s), shifts in the beliefs of oneself, and the sufferer may even entertain fantasy ideation, such as revenge fantasies against the perpetrator or others. The person may also experience panic attacks, increased anxiety, an eating disorder, depression, and anger outbursts.

There are even cognitive changes that may ensue, for example, distortions in how one views others, the perpetrator, or even the people in the world. The person with complex PTSD may either go from idealizing the perpetrator to having revenge fantasies. There may be such distorted thoughts about themselves as well, such as that s/he is not good enough to be in the world, as well as assumptions about how others see the person, such as being “damaged goods.”

Let me point out these are erroneous perceptions about the self and others. For example, these thoughts on how the person evaluates him/herself in the world are false thoughts. We need to understand that abuse impacts body image, sense of self, and even the ability to trust others intentions.

When we think about the cognitive signs, we want to give careful attention to how one thinks or conceptualizes the self. People who have complex PTSD tend to see themselves as damaged, helpless, fractured, and unable to perform tasks in many domains in their lives. As far as the perceptions, these are aberrant perceptions that have been learned over time. They tend to experience traumas over and over again, and that can lead to the reemergence of trauma symptoms.

So, what leads to this stress-related hyperarousal state? It can be the occurrence of a sound, the configuration of a person’s face that reminds someone of another person, a scent, or a song, any of which can lead to a mild dissociative state, e.g., a trance-like state, or the flooding of trauma memories where they feel they are experiencing flashbacks of the past traumas in the present moment.

It’s important to understand that the trauma experience truly rewires the brain’s central and autonomic nervous systems, which does impact one’s cognitive, psychological, emotional, attention, and social domains. People report problems with concentration, motivation, socializing with others, and feeling safe.

Remember, because this condition also consists of dissociation and severe anxiety states, of which dissociation is a symptom of the disorder, people with this syndrome may appear as if they are zoning out or that they are not paying attention. People with complex PTSD may be misdiagnosed as being angry, or as having attention problems, such as ADHD. While these may be additional underlying diagnosises, it is important to understand the true background and history of a person with a trauma diagnosis.

People with trauma may present symptoms in a myriad of ways, not just through amnesia dysfunction or inattention. It may manifest through sleep disturbances, behavioral problems, angry episodes, and other psychological disturbances, which is why anyone experiencing anything related to trauma symptoms will want to seek out treatment services for a full evaluation from a licensed mental health professional to discuss stress reduction and coping strategies.

Dr. Stephanie White, LLC

PsyD, PhD, LCSW, DCSW, BCD

Teletherapy Counseling Services
Licensed Clinical Social Worker/Psychotherapist
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