As a Complex-Trauma Survivor with many types of PTSD, I've outlined the history of these diagnoses, as well as the different kinds. Recovery and chronic health management can be improved through self-understanding and treating symptoms of survival with empathy and care.
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Conditions Prior to PTSD & Complex-PTSD
PTSD, or Post-Traumatic Stress Disorder, is a psychological condition that can occur after one or many traumatic events. Records of psychological conditions similar to PTSD have been found in literature and medical texts as far back as 1900 BCE. In Egypt, a condition called hysteria was discussed on papyruses to be caused by physiological issues, namely a spontaneous uterus movement throughout the body. Eventually, the root of hysteria came to be understood as neurological, or a condition caused by the brain.
In the 1800’s, hysteria influenced the work of Sigmund Freud and Josef Breuer out of Austria, becoming the foundation of psychoanalysis. They studied cis-gendered women who showed symptoms of hysteria like emotional outbursts. After interviewing and treating a number of cis-women, Freud and Breuer found that childhood sexual abuse caused many of these symptoms. Bertha Pappenheim, named under the pseudonym "Anna O." in the writings of Freud and Breuer, became one of their most important cases. She helped coin the phrase “talk therapy” after describing her experience in treatment as the “talking cure.”
Freud and Breuer published a study called, Studies in Hysteria, to share their findings and hoped for a celebrated reception, as they had discovered the source of this all too common condition and offered experimental treatment options. Instead, many aristocrats and other members of society shunned Freud and Breuer’s work as it suggested many of the men sexually abused their children. In response, Freud denounced his own theory, called the survivors liars, and shifted his approach to the well-known “Oedipal Complex,” which claimed that children had sexual fantasies about their parents. Florence Rush recognized the erasure of child sexual abuse by Freud in the 1970s, naming it “The Freudian Cover-Up.”
Psychological conditions like hysteria became centered again in public discourse after WWI and WWII. Symptoms like PTSD had been written about for centuries in regards to the experiences of soldiers, but called names like “nostalgia” or “soldier’s heart” — as veterans experienced symptoms such as missing home, anxiety, or panic attacks. After WWI, the condition called “Shell Shock” described more PTSD-like symptoms such as insomnia.
The Creation of PTSD & Complex-PTSD
After WWII, the name of the condition changed once again to “Combat Stress Reduction” (CSR) or “battle fatigue.” It was not until 1952, that the American Psychiatric Association (APA) published the first Diagnostic and Statistical Manual of Mental Disorders (DSM-I). PTSD was added to the DSM-III in the 1980’s from research working with Vietnam War Veterans and Holocaust survivors, as well as sexual trauma survivors in response to the outcry of gender-based violence — including rape, child sexual abuse, incest, and domestic violence — during the second wave of feminism in the 1960s and 70s.
The women’s movement made it clear that many forms of violence, not just combat, could cause long-term psychological distress. However, PTSD studies continued to focus mostly on cis-male veterans, neglecting the complexities of other gender's neurological environments especially due to hormone changes, as well as lived experiences.
In 1988, Dr. Judith Herman of Harvard University suggested that Complex-PTSD be added the DSM-5 to better differentiate between single-incident trauma — one event like a car accident — to the often more significant symptoms of long-term, repeated traumas like genocide, war, or serial child sexual abuse.
The Types of PTSD
Today PTSD and Complex-PTSD are both recognized by many in the psychological community. However, Complex-PTSD has yet to be added to the DSM-5.
PTSD
PTSD often refers to the psychological distress that lasts more than one month after a single-incident. If symptoms resolve within one month after a traumatic event, the condition is called Acute Stress Disorder (ASD). Here are a few examples of traumatic instances that can cause ASD or PTSD:
Distress caused by a rape, sexual assault, a car accident, the loss of a loved one, pregnancy, or pet, an abortion, a natural disaster, an unexpected illness or injury, or a large life adjustment like moving, etc.
The psychological distress that some birthing people experience after childbirth.
Witnessing or listening to violence against someone else by being a bystander at the event or attending to the victims as a physician, therapist, or caregiver.
Complex-PTSD
Complex-PTSD refers to the psychological distress caused by repeated instances of trauma over long periods of time. Complex-PTSD can be caused by experiencing trauma at a young age, serial traumatic incidences without intervention or rescue, or the person who harmed you being a confidant or relative. Examples include:
Repeated traumatic events that occurred during childhood like serial childhood sexual abuse, domestic violence, or childhood sex trafficking.
Interpersonal traumas involve violence with other people. Domestic violence, intimate partner violence, a mugging or robbing, being kidnapped, and sex trafficking are all examples.
Traumas that an entire society experienced together like a global pandemic, war, terrorist attack, or genocide.
Injustice trauma includes any or all types of bias or discrimination toward a person or group like racism, sexism, ableism, sizeism, classism, genderism, homophobia, transphobia, and xenophobia.
Institutional betrayal trauma includes long-term social injustices caused by the harm of institutions built to support individuals like the family system, the police force, the criminal legal system, etc.
Trauma caused by experiencing long-term violence in the incarceration system.
Immigration trauma includes pre-migration, travel and transit, and post-migration traumas for individuals and families who must relocate.
Enacting or witnessing various forms of violence or torture or being victimized by military or terrorist torture and violence.
The long-term effects of trauma passed down between generations from interpersonal and institutional violence.
Trauma caused by a chronic illness.
The trauma caused by caregiving someone else during chronic illness or injury.
Comorbid PTSD
Comorbid PTSD is a third and common form of PTSD caused by multiple or co-occurring mental health conditions with PTSD, like anxiety, depression, and substance use challenges.
What Are the Symptoms of PTSD?
Everyone experiences PTSD differently. So remember to always inquire about how someone’s experience or diagnosis impacts them personally. However, some symptoms may include:
Flashbacks & Triggers
Flashbacks and triggers include the resurfacing of visual memories of the abuse, physical sensations like pressure or pain, as well as emotional episodes in response to sensory stimuli. Anything can trigger a visual, physical, or emotional flashback including reminders of the event, smells, tastes, sounds, or other sensations that recall the event.
Night Terrors & Insomnia
Often the brain processes memories during sleep. Dreams during sleep are common for many, while nightmares are often sparse. For those who have experienced a traumatic event, night terrors — or horrifying dreams that can cause someone to awake in a state of stress — may occur more frequently. Insomnia may be the result of night terrors. Or it can be a separate symptom that trauma survivors have to manage.
Hyperarousal, Depression, & Anxiety
Other psychological conditions can accompany PTSD. Hyperarousal — or irritability, paranoia, or being easily startled — can be a symptom of PTSD. Feelings of depression or anxiety can also present during episodes of PTSD.
Symptoms of PTSD from Complex Developmental Trauma
Complex-PTSD can include many or all of the symptoms of PTSD. However, the impacts are longer lasting and often more complex. Many children who have experienced long-term and serial violence develop brains that cannot understand what safety is. The development of their brains, nervous systems, and muscular systems become concerned only with the reality of violence, centering the need to survive. Often the identities and worldviews of children raised in violent environments are so deeply entangled with the trauma and its consequences that they may not be able to differentiate themselves from the trauma. Consequences can include:
Dissociative Amnesia
Dissociative amnesia is the inability to remember what happened. This often occurs with trauma survivors, especially when the events occurred at a young age.
Dissociation, Depersonalization, & Derealization
Dissociation is the disconnection from a person’s thoughts, feelings, memories, or sense of identity due to trauma. Depersonalization is the feeling that one’s feelings and bodies do not belong to them or are not real. Derealization is when one’s environment does not feel real.
Emotional Dysregulation
Frequent mood swings, anger, rage, sadness, grief, and other big feelings can also be symptomatic of Complex-PTSD.
Negative Self-Reflection & Worldview
Often people who are harmed for long periods of time, especially children, cannot defend themselves from the person or people harming them, so their defense mechanisms are instead internalized. The victim blames and attacks themselves instead of attacking the person who harms. As the world in which the child is raised is so informed by violence, survivors are often more sensitive to the violence in the world and adept at perceiving patterns of violence present in their everyday lives. However, survivors may also project on situations, assuming or reacting as if violence is present, when it is in fact not.
Psychosomatic Symptoms
Due to the long-term stress of physical, sexual, verbal, emotional, and psychological abuse on the victim, the body is flooded with hormones like cortisol and adrenaline causing it to be in an unchangeable state of “fight, flight, freeze, or fawn” trauma responses. Eventually, these frequent hormonal imbalances can have long-term effects on the shape of the brain, as well as cause auto-immune disorders like diabetes or other chronic conditions such as heart disease. Digestive stress like IBS and other physical pains are other common psychosomatic symptoms for trauma survivors.
Self-Harm & Suicidal Ideation
Long-term trauma survivors cope with the violence in any way that they can or is available to them. This may include self-harm practices like cutting, picking, biting nails, or eating or drinking more than is healthy for their bodies. Due to the inability to understand safe relating, they may also choose unsafe relationships or sexual partners. Suicidal ideation is also more common in those who experienced repeated traumas especially as a child.
Hyperactivity & Inactivity
Hyperactivity can present as an inability to rest, relax, or pace oneself, while inactivity is when a person remains largely sedentary and is unable to meet their needs due to psychological barriers. Catatonia, or the inability to function very little or in fixated ways, can also occur after long-term trauma.
Lack of Focus
The inability to focus and other ADHD symptoms can also be common with a PTSD or Complex-PTSD diagnosis.
Physical & Neurological Fatigue
The work to manage one’s internal life after repeated traumas can cause physical and neurological fatigue requiring significant amounts of sleep or mental rest and restoration.
Avoidance & Numbness
Many survivors may feel nothing after the trauma as a way their system is coping with the intensity of the events. Avoidance can also be a way that survivors manage mental health to better regulate in environments suited to them, while ignoring activities, responsibilities, and people not suited to them.
Other Challenges Living with Complex Ptsd
The weight and worry of the many symptoms of PTSD or Complex-PTSD can impact the rest of a survivor's life as well. If you are experiencing symptoms of PTSD or complex trauma, you might also find that you have difficulty managing your everyday life, such as:
Self-care routines like brushing your teeth or hair.
Keeping a consistent job and steady paycheck.
Maintaining friendships and romantic relationships.
Proper executive functioning like making decisions and executing on them.
Managing life transitions and change.
Finding a suitable sexual expression.
Enjoying relaxation and leisure time.
If you notice any of these patterns in yourself, understand that they are all a part of the consequences of your trauma. They are not your fault. You can be patient with yourself and get treatment and support to help you manage your condition and life more easily.
Can PTSD Be Cured?
A number of PTSD treatments have proven to be effective. The first step is working with your healthcare provider to get an accurate diagnosis. Often PTSD, especially Complex-PTSD, can be misdiagnosed as Borderline Personality Disorder (BPD). An accurate diagnosis can help you to find the best treatment available. PTSD treatment can often take a long time and be costly. Receiving compensation for treatment may make the healing process more financially sustainable. It would be helpful if you can advocate to receive funds for recovery from your health insurance provider, state medicare/medicaid, or victim compensation services from the criminal legal system. Choosing a care provider that you can build trust with will also improve the effectiveness of treatment. Staying connected to a supportive network of empathetic people will help to support you in between sessions with physicians.
Types of PTSD Recovery Options
A number of therapeutic options exist to help victims and survivors recover from PTSD. Exploration and assessment to which ones work best for you is a great way to proceed, as all can be helpful to some but not others. These include:
Trauma-Informed Therapy
Regardless of what modality or practitioner you explore, consider choosing someone with trauma-informed training. These practitioners will have a better understanding of the unique consequences that trauma has on individuals and communities, so can better guide a path for recovery.
Culturally-Affirming Therapy
Culturally-affirming therapy seeks to understand and treat individuals from the racial, cultural, social, economic, sexual, religious, and political backgrounds they were raised in. It both honors multi-dimensional cultural strengths and resilience, as well as acknowledges the forces of injustice and oppression against those communities. It may be helpful to find a therapist who holds the same racial, cultural, and sexual identities as you. Others may have specific gender preferences. You can filter your choices for a therapist on Psychology Today’s therapist search engine, as well as find a number of therapeutic organizations or individuals who work specifically with specific communities like Inclusive Therapists.
Cognitive Behavioral Therapy (CBT)
CBT is a form of talk therapy that helps survivors to change negative thought patterns and/or unhelpful or harmful coping mechanisms and behaviors through the support of a trained therapist.
Dialectical Behavioral Therapy (DBT)
DBT is a type of CBT. However, as it helps you to change your behaviors, it also teaches you to accept yourself simultaneously.
Acceptance & Commitment Therapy (ACT)
ACT is also grounded on the foundations of CBT, then focuses on the client’s acceptance of their symptoms while encouraging them to take action to live the lives they want to. It aims to help the client to acknowledge their internal and external contexts, face their reality, distance themselves from it, remain present, and commit to their values.
Eye Movement Desensitization and Reprocessing (EMDR)
EMDR therapy uses eye-movement with an eight-step process to better help the brain to release stored memories and internalized negative narratives or self-perceptions, then replace them with positive and healing ways of thinking and self-understanding.
Emotional Freedom Technique (EFT)
EFT, or tapping, is also referred to as psychological acupressure. It invites the client to tap on the 12 meridians or energy centers of the body in order to release stuck energy that causes disease, so that it can flow freely allowing for health.
Physical Therapies
The body and brain create a feedback loop between tight muscles and fixed neurological pathways. So rewiring the brain is just as important as relaxing the body. A number of physical therapies can help clients to release trauma stored within muscles to bring better balance to their systems.
Peer-to-Peer Support
Peer-to-peer support, or communing with others who have experienced similar traumas, has proven to be as effective if not more so than clinical therapies.
Healing from Complex-PTSD
Complex-PTSD recovery can be more challenging. Standard treatments for PTSD like the ones above may be helpful, but many people who are healing from Complex-PTSD need more long-term, intensive support models to recover. Healing from complex trauma can be approached less like short-term treatment and more like a lifestyle due to the fact that the trauma is so ingrained in the survivor’s developed identity and worldview. A multi-modality approach to healing that addresses the many integrated parts of survivors may be the most effective. Try seeking out modalities in all of the areas below.
Psychological therapies
Neurological therapies
Spiritual therapies
Somatic therapies
Relational therapies
Life coaching
Community therapies
PTSD & Complex-PTSD from Incest Resources
You can find more incest survivor resources at Incest AWARE and other support organization in the Incest AWARE Alliance.
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