Sometimes, it’s complicated.

We have spent a good deal of time discussing the symptoms and neurobiological consequences of PTSD.  We typically consider that PTSD stems from a singular trauma inducing event.  Depending on whom you speak with, it may be called “specific trauma”, “acute trauma”, “type 1 trauma”, “uncomplicated trauma” and several others.  The main thing is that the trauma is caused by a specific event.

Another important sub-type of PTSD is what is commonly referred to as “complex PTSD” or CPTSD.  Distinct from the single-incident type of PTSD, CPTSD occurs due to repeated or chronic exposure to threatening events from which escape isn’t possible.  The traumatic events are often of greater intensity and longer duration.  Some examples might be experiencing torture, prolonged domestic violence, and prolonged captivity.  There are, of course, many other examples to numerous to mention here.  But I hope that gets the idea across.  Very frequently CPTSD is seen as the result of trauma that occurs in our younger, developmental stages such as sexual abuse, physical abuse, neglect, exposure to domestic violence, one or both parents with untreated mental illness, or one or both parents that abuse substances. 

In addition to the symptoms related to uncomplicated trauma (reexperiencing, avoidance, hyper-vigilance), CPTSD includes symptoms of affect regulation, negative self-concept, and interpersonal disturbances.  Briefly:

Affect regulation:  chronic traumatization creates imbalances in the autonomic and parasympathetic nervous systems where people may experience persistent states of arousal  where we see anger, emotional outbursts or rage; or, conversely, hypo-arousal where we find feelings of hopelessness, helplessness, and despair.

Negative self-concept: Diminished sense of self-worth.  An example might look like a person unable to escape an abusive situation may have the thought that they have failed in some way.  Often the person will have extreme difficulty learning to trust others resulting in profound loneliness.

Interpersonal disturbances:  Closely related to the negative self-concept, is the inability to develop meaningful relationships as fears of betrayal, abuse, and abandonment may create patterns of avoidance in relationships or over-dependence on others. 

While these symptoms refer to the effect CPTSD has on someone’s mental and emotional health, there can be significant impact on one’s physical health as well.  Over time, studies have linked childhood exposure to the persistent experience of trauma to leaving one much more susceptible to chronic pain and physical illness.  The clinical term for these events is Adverse Childhood Experiences (ACE for short).  We’ll look at one of the frequently used assessments in a moment, but the studies I mentioned reflected that exposure to four or more of these can result in significantly higher risk of developing substance abuse, depression, obesity, suicidality, heart, lung, and liver diseases, and even cancer. 

HOWEVER, there is help.  There is hope.  Take a moment and see if you may have experienced any of these events in your younger life.  You may be surprised.  If you think you might benefit from working with someone to resolve some of them, don’t hesitate to contact me at www.tlcincva.com. 

Before your 18th birthday:

 Did a parent or other adult in the household swear at you, insult you, put you down, humiliate you, or act in a way that made you afraid that you might be physically hurt?

Did a parent or other adult in the household push, grab, slap, throw something at, or hit you so hard that you were injured?

 Did an adult or person at least five years older than you ever touch or fondle you, make you touch their body in a sexual way, or sexually abuse you in any other way?

 Did you feel that no one in your family loved you or thought you were important or special?

Did you feel that your family didn’t feel close to or support each other?

Did you feel that you didn’t have enough to eat, had to wear dirty clothes, and had no one to protect you?

Were your parents too drunk or high to take care of you or take you to the doctor if you needed it?

Were your parents ever separated or divorced?

 Was your mother or stepmother pushed, grabbed, slapped, or had something thrown at her? Was she ever hit with something hard or threatened with a gun or knife?

Did you live with anyone who was a problem drinker or alcoholic, or who used street drugs?

Was a household member depressed or mentally ill, or did a household member ever attempt suicide?

Did a household member ever go to prison?

Add up each question to which you answered “yes” to find out your ACE score.  A higher score indicates a higher likelihood of developing the symptoms we looked at previously.