What is Complex post-traumatic stress?
It has been known for a long time that trauma, abuse, neglect or other severe ongoing stress in childhood means that the brain and behaviour develop within a context of on-going threat. In this context, the threat / self-protection system in the body, also know as the fight/flight/freeze/appease system, is much more active. This automatic, defensive behaviour aimed at 'survival' is helpful to cope when the threat is present, but the same patterns of behaviour become unhelpful in later life. Chronic trauma also leads to the development of beliefs about the self (e.g I am not worthy of care and safety), others (e.g are dangerous) and the world (e.g is unsafe).
When children are in stressful or traumatic situations and cannot get away from them, their brain learns to escape mentally by switching off or "dissociating". Another way of mentally escaping is to go into a fantasy world in various ways, making up a different reality or imagining things that only you can see or hear.
If you have had ongoing traumatic experiences as a child, you may learn not to trust other people. You may build up barriers around yourself and do not let people get too close. This makes it difficult to have healthy relationships or a tendency to be in relationships that are abusive.
Ongoing trauma experiences can make you alert and on the lookout for danger, always on edge or anxious and jumpy, even when the threat is no longer present.This heightened stress makes you react more strongly to everyday problems. Life is full of little problems so these strong reactions can make your emotions, your thinking and what you do very changeable and extreme.
Because this extreme distress is very painful it can lead people to numb pain, for example taking drugs, drinking alcohol, causing physical harm to drown the mental pain or by just shutting down mentally (dissociating). Traumatic experiences can produce feelings of low self-worth, poor self-esteem and make it hard to feel stable and secure in yourself.
Out of the Storm is a very helpful website to look at if you want to understand complex post traumatic stress further.
Is this just the way I am and cannot be changed?
No. The first step is to recognise that there is something about the way you perceive and relate to others that results in behaviour that is not healthy or helpful for you. Other mental health difficulties, such as anxiety and low mood, often co-occur, and the root cause of trauma may be overlooked and the wrong treatment given. Understanding that mood and behaviour are linked to previous chronic trauma means that the right treatment can be tried.
Recognising unhelpful behaviour patterns and the fears, thoughts and feelings that drive them is the key to change.
What was complex post traumatic stress previously known as?
In the past, and still quite commonly now, it has been called "Borderline Personality Disorder". A very unhelpful name.
After this the term "Emotionally Unstable Personality Disorder" started to be used more commonly. This slightly better describes the instability of emotional regulation but says nothing about where the problem comes from.
Most recently, researchers and clinicians have come to understand that defensive behaviour, once useful to protect from chronic abuse, stress or trauma in childhood, was similar to the behaviour seen in people who have experienced trauma in adulthood, for example, soldiers in war situations. This was called Post Traumatic Stress Disorder (PTSD). Chronic trauma from childhood is now called Complex post traumatic stress.
What treatments are available?
The major difficulties in life and the distress that complex post traumatic stress causes can be reduced by addressing the rapid and extreme changes emotions and behaviour and replacing these with soothing and regular, steady routines, thinking ahead and predicting difficulties and more helpful ways of dealing with thoughts and situations.
The first step in learning to change this is noticing unhelpful patterns. After that, there are techniques you can learn that will train you to manage your threat/self-protection system and behvaiour in more helpful ways Some of these techniques are called Emotional Coping Skills. These are best learnt in a group situation with other people who have the same difficulties and are learning the same techniques. This is often very difficult for people with C-PTS and, to start with, you may need to work with an individual professional to help you get ready for learning in a group. A more intense therapy that teaches the same emotional coping skills is called Dialectic Behaviour Therapy (DBT). This is also done individually and/or in a group. It can be extremely effective in helping people achieve major change and improvement in the quality of their lives. This sort of therapy is usually only available from specialist mental health services.
Trauma focussed therapies, such as trauma focussed CBT or Eye Movement, Desensitisation and Reprocessing (EMDR) have also a strong evidence base for overcoming past trauma and developing helpful ways of managing and improving mood, behaviour and relationships.
Why is it important to recognise complex post traumatic stress and treat it?
C-PTS causes a lot of impact and suffering, not just for people who suffer from it but for other people around them. This makes it very important to recognise the problem and treat it appropriately. Treatment can be difficult as much of the threat/self protective behaviour is automatic, pervasive and difficult to recognise to begin with. Trauma focussed work can also unlock past trauma experience. However, if this kind of work is right for you, it is safe and effective, and can lead to a healthier, happier life.
Here are some of the different way you can access help and support locally:
Need help right now?
NHS 111
Samaritans
To find your local peer support groups click here.
Your GP
Click here to find your local talking therapies service
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Video description: What is C-PTSD?
