Understanding PTSD and Complex PTSD
These days, most people are familiar with the general concept of post-traumatic stress disorder. Usually, they are familiar with it as it applies to returning veterans, and to some extent as it applies to others who have experienced overwhelming distress for which they were unprepared, like earthquake survivors.
It was not until 1980 that mental health professionals seriously acknowledged the long term impact of these kinds of trauma by coining the diagnostic label of PTSD. PTSD is diagnosed after a person experiences symptoms for at least one month following a traumatic event. However, symptoms may not appear until several months or even years later.
PTSD is characterized by three main symptoms:
- Re-experiencing traumas through intrusive distressing recollections of the events, flashbacks, and nightmares.
- Emotional numbness and avoidance of places, people, and activities that are reminders of the trauma.
- Increased arousal such as difficulty in sleeping, difficulty in concentrating, feeling jumpy as well as being easily irritated and angered.
In 1992, Judith Herman pointed out that for the group of survivors of early child abuse, such as incest, the concept of PTSD does not adequately cover the injuries inflicted on these individuals. This inadequacy also covers cases of prolonged repetitive distress such as in cases of kidnap victims or political prisoners. Herman considers these cases as belonging to a special kind of PTSD that she proposed to call Complex-PTSD.
Complex-PTSD
Herman pointed out that these cases typically have a history of subjection to totalitarian control over a prolonged period (months to years). There are usually features of alterations in consciousness, including amnesia or hyperamnesia related to traumatic events as well as other dissociative features.
The repetitive nature of the assaults inevitably deepens the effect of the trauma, making it an almost indelible imprint that is destined to be long-lasting. Deeper damage affects the person in the cognitive area. A common example is in the forming of almost a delusional negative beliefs or expectations about oneself, others, or the world, e.g., “I am bad,” “No one can ever be trusted,” “The world is completely dangerous at all times and in all directions”.
Prognosis of Complex PTSD
Early childhood abuse is usually silent, hidden, ignored and/or being denied or dismissed, often even by professionals. They suffer alone. They are voiceless. Their primary fear is that their experiences are not believed. The implicit memory may be highly distorted or even forgotten. We have yet to develop unified systematic approach in how to cope with such cases.
I have come across numerous instances among my peers that, despite identifying dissociative tendencies, have:
[a] Expressed the attitude of “So what, the past is passed;” or “What can you do about it.”
[b] Failed to pursue an analysis to determine whether or not there was early childhood trauma because the emphasis is on the constitutional factors, such as how many siblings or uncles are suffering from bipolar or alcoholism etc., and diagnoses that are treatable with medication.
[c] Based diagnoses on perfunctory information gathering by simply filling in the blanks, neither yields accurate answers nor leads to correct diagnoses.
The prognosis for those patients from such colleagues is almost always bad. It is so bad that they avoided taking dissociative patients that were victims of early childhood abuse because there was no medication to prescribe. They just saw a long painful path of treatment failure and had no experience of positive outcomes. The solution for most was to note the dissociation, avoid the dissociative diagnosis and avoid working with the early childhood or other trauma material.
They often chose to diagnosis such patients with Borderline Personality Disorder or Bipolar Disorder, diagnoses that would allow them to prescribe medications despite the fact that, though the failure to address the fundamental issues, the pharmacological treatment would fail. The result was often a diagnosis of treatment resistant depression – identifying the patient’s depression as the obstacle rather than their misdiagnosis and consequent erroneous treatment.
This kind of prognosis is a failure on the part of therapists. It becomes a self-fulfilling prophecy that further damages patients seeking to heal from early childhood trauma.
