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Why Complex PTSD Should Remain A Fictional Diagnosis

Updated on January 17, 2010

Because when we all need the same for the same reason, why separate us?


Some therapists are diagnosing people with a fictional mental illness called Complex PTSD. The diagnosis, or dare I say misdiagnosis, of complex PTSD is not included in the Diagnostic and Statistical Manual (DSM) by the American Psychiatric Association. I seriously hope it is never included as an official diagnosis.

Complex PTSD is a diagnosis that someone made up to categorize people with PTSD due to long-term abuse during which the person had little to no control for an extended period of time. Examples of this type of situation are being held hostage in a POW camp, being kidnapped and forced into the sex trade, or long-term or ritualistic child sexual abuse.

Am I saying that people who have experienced those conditions should not be diagnosed with PTSD or that those experiences aren’t absolutely horrific? I’m not saying that at all. If the person is experiencing symptoms of PTSD due to a trauma, they should definitely be diagnosed with PTSD.

My issue with the diagnosis of complex PTSD is that it does no good. I have only seen it cause division among people with PTSD and confusion for those who are diagnosed with it. Why is it necessary?

For it to be a necessary diagnosis, I would expect the symptoms to be different than a regular PTSD diagnosis. The problem is that the symptoms are no different. A person with PTSD from any trauma can experience the exact same symptoms as someone with “complex PTSD.”

Symptoms of Complex PTSD:

·         Alterations in Emotional Regulation

·         Alterations in Consciousness such as Flashbacks and Forgetting Part of the Trauma

·         Changes in Self-esteem and the Person’s Self-concept

·         Altering Perception of the Perpetrator

·         Sense of Hopelessness or Loss of Faith

·         Changes in Personal Relationships

·         Avoiding Discussing the Trauma

·         Self-harm  

·         Unhealthy Coping Methods to Numb the Feelings like Drinking or Drug Use


Every single one of those symptoms is common in anyone with PTSD, whether the PTSD was caused by being in a concentration camp or ongoing child sexual abuse as complex PTSD describes or if the trauma was a single event. So, what is the purpose of the diagnosis? So far, the only thing that I have seen it do is make people who are diagnosed with PTSD feel as though their experiences with the disorder are being belittled. If there is a complex PTSD, it is implied that regular PTSD is Simple PTSD. There is nothing simple about PTSD.

Some proponents of a diagnosis of complex PTSD have supported their views by saying that complex PTSD is different, because the victim is often blamed or considered to have a personal weakness for either the abuse or developing PTSD. How is that different from a rape victim who has PTSD and is blamed for the assault? Many, many people with PTSD are blamed for either the trauma or for developing the PTSD. I think these professionals are out of touch with what it is like to live with PTSD and lose friends over it. It’s happened to me and is quite common with people with PTSD.

Personally, if I went to a therapist and the therapist gave me a fictional diagnosis, I’d get up and walk out. I’d think it was time to look for a new therapist.

What does categorizing PTSD do? Has it led to new treatments? Not that I am aware of. Has it led to the development of new medication for PTSD? No. Has it confused people who are diagnosed with the condition? Well, yes, it has done a good job of that. Does it cause division among people with PTSD and Complex PTSD diagnoses? Certainly. One only has to look at a PTSD forum to see arguments about the Complex PTSD diagnosis.

If we are going to start categorizing PTSD, where does it end? Should we have Combat PTSD, 9/11 PTSD, Rape PTSD, Domestic Violence PTSD, Car Accident PTSD, etc? There could literally be hundreds of causes of PTSD. Complex PTSD, PTSD, and all the other categories based on causes of PTSD can cause the exact same symptoms of PTSD, so if we are going to separate Complex PTSD, why not have separate categories for each? Yes, that’s silly, and so is having a diagnosis of Complex PTSD.



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    • Zachrichardson profile image

      Zachrichardson 2 years ago

      I think this is a really interesting Article. It seems like to me that you have some good points that reflect a need for more support in general for PTSD. My only concern is that there might be some merit to specifying a more specific sub-diagnosis to lessen the broadness of the diagnosis. I myself have been diagnosed from my time in the Middle East and I find my symptoms to easily fit the mold of the diagnosis, but I will say that it afflicts me in a much different way than it does one of my fellow battle buddies. We have done some in depth talking on the subject and I think it's important to be able to distinguish the differences as the treatment plan for both of us is so different. A one sized fits all diagnosis method leads to a one size fits all treatment option. Anyone who has dealt with the VA knows the struggle of the politics. "Well we need to try this treatment on you before I am allowed to give you this treatment, although I know you won't gain much from it." -My VA pcp. That conversation translated into over 6 more months of waiting and treatment before they gave me an MRI and realized that I had a brain hemorrhage...

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      Judy653 3 years ago

      Holy Cow! In my old age I finally found something that describes my experience and now you're saying it's bunk. I give up. PTSD never did quite fit my feelings of fear, shame and abandonment because trauma was ongoing throughout my life. Each event though different, brought up the same negative feelings about myself. PTSD always seemed tied to a single terrible event instead of a chain of the different less horrible scenarios occurring over a lifetime. These events together cultivated a belief that something must be very wrong with me being in this life at this time. I have tried many things but can't say I've done much with me being ashamed of who I am and all. I already know it wasn't fair, but how can I deny it when so many have worked so hard to create such a negative view of me.

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      Dan 3 years ago

      Although I appreciate your contribution to the debate regarding CPTSD, differences in the severity of symptoms, the type of trauma, the duration, the age of exposure, all of these things and many more make the treatment of trauma that much more challenging. Personally, I believe CPTSD must include repeated exposure during early developmental years which has influenced the developing brain, particularly a dominating mid-brain disrupting normal developmental of the prefrontal lobes. This causes a developing brain to remain in a surviving mode and not normally transition into a learning, discovering brain. I also have a notion the degree to which a developing mind is capable of achieving an organized attachment style is a factor in later life vulnerability to overwhelming trauma exposure and organizing cognitive/affective responses.

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      Jazzdame 3 years ago

      CPTSD follows the spectrum to Dissociative Personality Disorder, known previously as multiple personality. It shares many things with PTSD, but it's outcome can be more difficult to treat, as it starts so young the whole personality is changed

    • Sheila Wilson profile image

      Sheila Wilson 3 years ago from Pennsylvania

      Since writing this article, I went through a pretty intense therapy called Dialectical Behavior Therapy (DBT). Though this therapy was designed for borderline personality disorder, some have found it helpful for PTSD. It has been the best therapeutic treatment that I've had so far. I mention that here because people with complex PTSD often have borderline personality disorder as well. Anyway, though I don't have borderline personality disorder or complex PTSD, I thought I'd mention it since it's seems to be a treatment that can help people with PTSD and complex PTSD.

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      foundherintheflames 3 years ago

      As far as I'm aware, the most simple difference is that cptsd is normally caused by traumatic experiences in childhood , to the extent that it effects certain aspects of emotional development. Whereas anyone who experiences a traumatic event can develop ptsd. Symptoms are mostly the same, but cptsd is simply put, more complex to deal with (not more severe) as it has altered the way the mind works from childhood.

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      traumasurvivor 4 years ago

      I believe that Complex PTSD should be a diagnosis of it's own, not because it is "more serious" than "PTSD", but because it is different.

      There is Diabetes Type I and Diabetes Type II. They are not treated exactly the same because they have differences. Cancers have differences.

      When I was first diagnosed with "PTSD", it was the closest thing to being correct throughout my entire psychiatric history, but there was still something amiss: the missing "sense of self", the low self-esteem, the self-harming behaviors, the hypersensitivity to rejection. I related to the physical manifestations of PTSD, but the emotional damage which can cause BPD. And this is the "C" part of the disorder.

      PTSD occurs usually from a single traumatic event and it's usually caused by a tragic event. Complex PTSD has symptoms similar to PTSD and BPD. The damaged self of BPD and the flashbacks and hyperarousal of PTSD comprise what I believe to be CPTSD. Sufferers of CPTSD have a poor self-image, as well as incredible trauma, mostly childhood trauma. This damages the developing brain, arresting development of your emotional maturity, whereas PTSD does not. There are differences, so they are two separate illnesses, no better, no worse, just different.

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      Ari 4 years ago

      People who grew up being abused have very different experiences than those who grow up healthy and then experience trauma in adulthood. The diagnoses of Complex PTSD is an important step toward acknowledging the unique needs of survivors of long-term child abuse.

      The key difference is that people who are traumatized as adults can remember being healthy. Their healing process is about rehabilitating and restoring health.

      Whereas, people who have never known anything but abuse have nothing to restore. They have never experienced health and cannot rehabilitate because they were never habilitated in the first place.

      The diagnoses of Complex PTSD is usually used to acknowledge this difference. Though the symptoms may be similar, appropriate treatments are very different.

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      HealingINProgress 4 years ago

      John, I just read your post. I have just recently begun my journey of healing from C-PTSD. You sounded so alone and hopeless. I want you to know that you really are not alone. Many people, including myself, can relate to the mess your prolonged trauma has left of your life. The most important thing I can tell you that there IS, in fact, hope for a relatively normal life again, after proper therapy that specifically addresses the many additional problems we face as a consequence of the prolonged nature of our traumas, on top of the already debilitating PTSD symptoms. I highly recommend reading Dr. Pete Walker, M.D. 's website. He is a psychologist who is also a well-functioning survivor of early long-term trauma, with C-PTSD. I have spent hundreds of hours researching what the heck was wrong with me, when doctor after doctor failed to recognize and properly diagnose me, and finally came across literature describing C-PTSD, including that doctor's site. The more I read, the more I felt like these authors had been following ME around my whole life and had written down everything that was observed about me, specifically. This diagnosis fits me like a glove, unlike PTSD, and I now, finally, have understanding that gives me so much insight into my behaviours, which until now were incomprehensible to others as well as myelf. I now realize that I am actually reacting in a totally normal way, taking my very abnormal formative years into account. I finally make sense to me!! You are still early in what will undoubtedly be a long journey to wellness. There is unfortunately, no quick fix for this complex condition, but there IS help and hope. Hang in there.

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      John 5 years ago

      Coming from someone who has C-PTSD I'd like to respectfully agree to disagree with the initial statement.

      What's the difference? People with PTSD can eventually get over it.

      I can't. I don't remember anything from my life before Utah. From the ages 12-15 (Three Years), I was held over a thousand miles away from home in an abusive Psyche Ward. I and 150 other KIDS were beaten, raped, drugged, and tortured on a regular basis, primarily from other patients who had also been there for years and finally gave up at any attempt at controling their reality. SWAT Teams were called from time to time, a few kids have died, there's riots everyday, and every night, all night, kids are screaming bloody murder and you can't sleep and if you do you risk getting Blanket Partied (Having a blanket thrown over you and then getting either gang raped or a beat down.

      Who I was before died there. While I was gone I forgot what my house looked like, relationships. WHen I came back my former friends either rejected me because they were afraid of me, had moved away, or had died. I always saw home as a fairy tale place in Utah, and when it finally came time (Which I at first thought was some kind of sick joke on the Facility's behalf), I realized the brutal truth in the statement you can never go home again. No one was there to save me in Utah and no one is now, in many ways what happened made me so much more. I'm seventeen today and for years I have been training in every discipline available to me. I became obsessed with training my mind, body, and spirit towards the peaks of perfection, I went through a major crazy period but now I have become an expert in my fields; guerilla warfare, IED Construction, Espionage Tactics, Shinobi-no-mono tactics of Feudal Japan, Combat survival systems including Krav Maga, Kapap, Lotar, Keysi, Shoalin Kempo Karate, Aikido, Budo, and Pressure Point Combat, as well as training in combat shooting with handguns and AR-15 primarily, and many other areas expanding upon various eastern philosophies, metaphysics, mind-brain research and altered states of consciosness via breathing matra and meditation, incorporating the use of Chi (or Ki) and it may sound cool, but it's a nightmare. I'm never satisfied with myself. I'm always scared, because no matter how hard I push myself, no matter how much I train, there's always going to be something I can't handle and the thought of that still terrifies me because I don't ever want to be a victim again. It's a blessing and a curse; it will never end. I am so, alone. I have met only two people who can relate, and neither of them are even from this planet. I often forget I'm just a kid, and sometimes that bit of truth hits me like a ton of frickin bricks, because I don't know how I'll ever be able to handle all that's happened and all that's happening in my life now and the mistakes I've made and feeling like I will never live up to what certain groups of people expect of me. But, I've recently in the last year just accepted it. I have come a long way, but it scares me how much more there is to do, what else is just around the corner and the thought I may not be ready for it.

      Take it from someone who knows, C-PTSD individuals and ["simple'] PTSD individuals are two distinct types. C-PTSD changes everything about you; my life and identity, and everything I once loved and cared about has been stripped away by that place. It Sickens me to think they're still up and running. If anyone wants to fire-bomb them or something (or you know, get in on the petitions and soont o come class act suit) here's there address: 4501 N University Avenue, Provo, Utah 84604.

      May they burn in the fiery bowels of hell! XD know, at least go under.

      But you know...shit happens to everyone. It's nothing new, it's nothing "special" and it's certainly not something worth feeling belittled about because someone else may be a little more fucked up than yourself. That's just stupid if you ask me. But ya, just my $0.02 .

    • profile image

      Melissa 5 years ago

      I like the idea of naming C-PTSD "Compound" PTSD. That's certainly how I feel and having been diagnosed 5 years ago, I certainly recognize most of the symptoms and when I was first diagnosed with PTSD in 2003, even the panel of doctors that I went to (bless my GP's heart for caring and sending me) said that my symptoms are, to quote "PTSD exacerbated by repeated childhood abuse and domestic violence".

      I'm not going to argue the minutae of differences because, quite frankly, the thought alone tires me. However I am so incredibly grateful that this has been recognized and that there finally is a name to what I was (and am) dealing with. I was terrified that I had a personality disorder, partly because I felt I would be mistreated by the medical establishment as someone who was "beyond help", and partly because it would have felt, to me (however wrongly), that my pervasive feelings of being inherently bad and self-shaming, would have merit.

      Having asked my doctor (a leading medical professional in Canada in the field of psychiatry) if C-PTSD was just a "nicer" label of BPD, the response was an emphatic "No". C-PTSD is real, not fictional. I live it, and the symptoms are different. To those who do not suffer from it, the differences may appear small, but they are anything but.

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      AnnArmstrong 5 years ago

      It is smart to separate the two, because trauma in childhood is a trauma some of us become use to and think it wasn't when it was. Before this diagnosis I would be asked. What was the trauma? I couldn't answer because I did not know. I have received more help since this new diagnosis

    • Sheila Wilson profile image

      Sheila Wilson 5 years ago from Pennsylvania

      I think you missed my comment that mentions that I'm too afraid to answer my door. All those things that I do, I do from home. I have panic attacks in public, because I think someone else is going to attack me. I don't know if you would want to switch lives with me. lol Can you leave your house? Do you jump at every unexpected noise, light, or shadow? You may have some of those experiences. You may live in fear every day like I do. I don't know.

      But, you are right that I have learned that there is a difference between PTSD and Complex PTSD. The difference isn't in severity. The severity of the effects and how the person's life has been impacted by PTSD varies greatly among individuals. People with complex PTSD often have Borderline personality disorder or at least some of those traits. I imagine that's how they had to learn to cope with their repeated trauma. As far as I know, people with PTSD are not any more likely to have a personality disorder than the general public.

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      anonymous 5 years ago

      I have C-PTSD. I had a disgusting, despicable childhood.

      My point is..there IS a difference in PTSD and C-PTSD. You have proven it yourself, in your own words.

      "I am an art student and have studied psychology. I participated in local art shows. I'm also a poet and published author. My current projects include mixed media art and illustrated haiku.

      I have written web-content articles for years, and my work appears on numerous websites. I am co-owner of My WriteDesign which provides freelance writing and graphic design services such as logos, SEO articles, package design, and photograph editing."

      That's the difference Sheila....

      One with C-PTSD could only dream of such a full life...

      Consider yourself extremely lucky...

      I'll give you my life..... if you give me yours! :)

    • profile image

      justsayin' 5 years ago

      every "official" clinical definition begins with an non-clinically accepted notion, many of which prove helpful and useful enough to become the subject of study and peer-reviewed research. P.S. people who experience Complex PTSD are not typically startled by things like drops of water . . .

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      a person 5 years ago

      i have to disagree with you. it is important to understand the reason that the dsm-iv didn't include complex ptsd. and that is because the symptoms of complex ptsd are incredibly similar to borderline personality disorder. so similar in fact that they felt it unnecessary to include the disorder. however, it deserves recognition all the same. it is not the same as ptsd. there are people out there, myself included, who have the symptoms of complex ptsd and do not identify with ptsd. i do not identify with ptsd. for a while i have thought i was borderline. i actually had a debate with my therapist, who was telling me i have ptsd. i told her i did not identify with ptsd but i did identify with borderline. however, she knows my history of growing up and the damage that occurred there. as it turns out i do have ptsd, but complex ptsd. i don't mean to claim it is actually so much more complex, but that's what it is called, so yeah. my point is simply that all of these "disorders" are just words, labels. but it is important that when someone is labeled something, that they feel they actually identify with it. so i say it deserves to be recognized, because, as someone who identifies with the disorder 100% like i never have anything, i appreciate the accuracy of this label. it is not illegitimate just because not everyone understands it. i do and i know there are others out there who feel the same.

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      Marissa 5 years ago

      There are actually marked and distinct differences between ptsd and complex ptsd. I agree that calling it complex ptsd is not quite right, since all trauma is complex and ptsd is in no way simple. However, "complex" ptsd does need its own distinction in the dsm. Often times the surface problems (drug abuse, eating disorders, self harm, dissociation and personality disorders, etc) all get diagnosed and attempt to be treated without realizing there is an underlying history of trauma. Long-term exposure to repeated trauma causes neurological changes and core personality changes (especially if the trauma starts at a very young age and continues) that a short-term exposure or single incident trauma may not. Yes some of the symptoms may overlap, but that does not make them the same thing.

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      AnnArmstrong 5 years ago

      I was diagnosed PTSD multiple causes 25 years ago,I studied on it then always felt the diagnosis missed something. I am back in therapy and I have been diagnosed CPTSD I now understand better than ever, CPTSD. Shares cross overs from attachment disorder, borderline personality. And DID. It's almost like our repeated trauma in a certain age range brought us to a borderline of creating other personalities. Also, it will be in the DSM v. I think calling PTSD in a way to compete with CPTSD. PTSD. Is already a category.

    • Sheila Wilson profile image

      Sheila Wilson 5 years ago from Pennsylvania

      My intention is not to negate any experiences of anyone with PTSD. I know what living with PTSD is like. Yesterday, I was startled by a drop of water. I'm tired of that kind of ridiculousness with this condition. I'm just saying that the focus should be on finding more effective treatments, not dividing us up in categories.

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      Sick of this! 5 years ago

      Ptsd is a small milkshake and cptsd is a large milkshark they are both the same except the cptsd has more trama, meaning more issues to fix, making it more complex. We should not try to divide the ptsd community instead come together I have been told I had Ptsd for years and treated as such however I now understand that I have Cptsd and that is why the theripy used to treat Ptsd did not work for me. Cptsd is very real and anyone with it knows its true and more complicated to treat, as most likley Cptsd sufferers were also diagnosted Ptsd and treated to no avail. I am sorry you feel this way about cptsd, but let me ask you how do you think this page makes true cptsd sufferers feel?

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      lynda 6 years ago

      how can you fix complex PTSD?

    • profile image

      Jane 6 years ago

      I think you have valid questions but also know that they are all explained, whether or not you choose to understand.

      Simple vs Complex aren't actually 'versing' each other - complex basically means multiple forms of one-time traumatic events. 'Simple' is being used in a clinical way, meaning "Composed of a single element; not compound", not in a derogatory way in order to divide people or create a "worse" version of ptsd.

      Judith Herman describes the added impact that multiple traumas can have in Trauma and Recovery. Judith Lewis Herman, M.D.. Basic Books, 1992. It includes ptsd anxiety symptoms, plus a higher risk of dissociative symptoms as well. This creates an additional barrier in recovery and processing, thus requires a slightly altered approach than is used with ptsd anxiety symptoms without a tendency to use dissociation.

      There are already subtypes of ptsd like you asked above, e.g., combat, rape-related, and domestic or child abuse (all kinds). This again is not related to wanting to make light of any single form of ptsd. Specific techniques and specific forms of funding of research and non-profit services become available. Many disorders have subtypes that include core features with each other but slight differences as well. Some are not so slight. C-ptsd was noticed because a number of people weren't responding to treatment that seemed to work for quite a few. Launching into traumatic memories and processing can do more harm than good if certain habits and safe coping techniques aren't first addressed and in place.

    • Sheila Wilson profile image

      Sheila Wilson 6 years ago from Pennsylvania

      Chronic PTSD and what is described as complex PTSD are not the same. Chronic PTSD refers to long-lasting PTSD symptoms. Complex PTSD is described as PTSD symptoms and some components of borderline personality disorder.

      Even if the DSM V, which is in the revision process now, would include complex PTSD, I would not change this article. This article is my opinion. I think it has served it's purpose well in fostering discussion about PTSD. I believe some valid points were made on both sides of the "argument."

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      Emilie 6 years ago

      It is in the DSM-V. It falls under PTSD. The DSM-V includes complex and chronic ptsd in the PTSD diagnosis, complex however has been professionally replaced by the term chronic, which makes more sense. The treatments are in fact extremely different.

      "2012 ICD-9-CM Diagnosis Code 309.81

      Posttraumatic stress disorder

      ICD-9-CM 309.81 is a billable medical code that can be used to specify a diagnosis on a reimbursement claim.

      Diagnosis Definition(s)

      acute, chronic, or delayed reactions to traumatic events such as military combat, assault, or natural disaster.

      Applies To

      Chronic posttraumatic stress disorder

      Concentration camp syndrome

      Posttraumatic stress disorder NOS

      Post-Traumatic Stress Disorder (PTSD)" -

      Yeah, it's real alright. You may want to edit your article a smidget. It's also offically recognized by by the military and Veteran's affairs.

    • Sheila Wilson profile image

      Sheila Wilson 6 years ago from Pennsylvania

      Thank you for sharing your story, Larissa. What you said makes a lot of sense.

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      Larissa 6 years ago

      This is an interesting article. I have recently been given a diagnosis of C-PTSD. It is like someone has opened the curtains on my mind. I volunteer with a group where lots of girls and women have PTSD from violent attacks. They all have something in common that I don't.

      Many of those women suffer from flashbacks and intensity that they can attribute to a single incident, whether they can remember all the details or not. For me, as an adult woman, I completely fall apart if someone even slightly raises their voice. I've fallen apart in a group of friends just sitting around playing cards, and nobody has known why. C-PTSD *is* different to normal PTSD, but that doesn't mean that those girls who were r*ped have it any easier. They aren't expected to heal faster. It's just that, with me, there is an unknown variable, an element of invisibility to the PTSD symptoms -- sets of triggers which aren't directly attributable to definite incidents of trauma.

      I hope you don't mind me outlining a bit of my story. As a child I was in a religious group who kept me separate from people my age. I was very seriously verbally and emotionally abused. I have thousands of scars from the self-harm it caused me. I was denied an education and healthcare, I was called a demon and told I was going to destroy the world.

      But nobody ever HIT me. Nobody ever r*ped me... and so for years nobody has been able to understand why I am so "weak minded," why I collapse in a group, when I crumble at criticism, why I become desperate for someone to rescue me, when I otherwise grew into a healthy and successful adult.

      Before the C-PTSD diagnosis my life was such a mess. I'm not borderline, not histrionic, not bipolar. But there was obviously something WRONG. For years my therapists thought I was suppressing some act of violence to explain my symptoms. You just can't have PTSD without violence, they seemed to think. I felt so unwelcome in survivors' groups because I didn't have flashbacks.

      My "collapsing" is a type of EMOTIONAL flashback. Triggers I may never fully understand. Yes, I have to heal in the same way as anyone else with PTSD. But it just allows me to feel that I have the right to these symptoms, these destructive feelings that have screwed up my life and relationships in really awful ways, when I'm otherwise so strong.

      That the C-PTSD label exists at all shouldn't undermine your own trauma or recovery journey. But it might just be a LIFE saving diagnosis for those whose symptoms of dissociation, numbing, internal conflict and collapse have dominated our ENTIRE lives. We are the ones who cannot say "...before the incident." We cannot remember or rediscover "who we were." There WAS never another "we"; for some of us, our entire identity has been shaped by incomprehensible abuse, from the day we were born.

      Without C-PTSD, we just get written off as "basket cases" (as my father once so eloquently called me).

      Hope you don't mind me sharing my story.


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      Suzanne 6 years ago


      Perhaps the well-educated specialists who through research decided to differentiate between PTSD and C-PTSD are a better judge of the validity of c-ptsd then you are.

      You might call it a "fictional mental illness" but you are not a doctor, correct? You know, since these professionals have made this field their life's work and all, maybe they know just a little more then you do. Ya think?

      Seriously, do you really believe that you know more then an experienced psychiatrist who specializes in PTSD?

    • Sheila Wilson profile image

      Sheila Wilson 6 years ago from Pennsylvania

      I would never argue that one is more or less severe than the other. I don't believe they can be judged in that sense whatsoever. My PTSD from a single episode causes just as many problems for me than many people with "complex PTSD." I am on edge all the time. I jump and sometimes cry whenever I hear an unexpected noise or see something that startles me. I cannot work outside the home because I have panic attacks in public because I expect someone else to attack me. Can you go shopping alone in a store? I can't. I always have to have someone with me who I trust so I don't feel as threatened. If someone comes to my door, I run to my bedroom. Can you answer your door?

      My point was that PTSD has similarities and differences for everyone. One cause does not necessarily make the PTSD more severe than another cause. In the end, it's not even about the specific cause. It's about how the brain processes (or fails to process) trauma.

      And of course there are many dual diagnoses. I also have bipolar disorder, which I had before the PTSD. I know of people who have PTSD and major depression. Technically, PTSD can probably be a dual diagnosis for ANY mental illness since the person could have had a pre-existing condition or a predisposition for a condition that the stress of trauma aggravated.

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      Emilie 6 years ago

      If you experience a one time fire and develop PTSD, it's not as life changing and disturbing as being in a POW camp or Being sexually/physically abused every day of your childhood. So it needs to be treated differently.

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      Emilie 6 years ago

      It's symptoms are more severe. I suppose you could just say that CPTSD is a severe form of PTSD. I think that due to the extreme sensitivities of severe PTSD it makes sense for that person to hear a validation of how bad it actually is.

      I have CPTSD. I'm calling it that because PTSD doesn't account for the severity or presence of other dissociative conditions such as conversion disorder. They could say I have conversion disorder and PTSD, and make me feel totally effed up, or instead they could give it one name that encompasses it all. It can be especially problematic to not relate to the diagnoses when you are a hypochondriac as well. Trust being an issue, you need to believe what your therapist says is true. If you go home and google your diagnosis and it doesn't fit, you're going to be on the hunt again and get nowhere. I can honestly say that the presentation of symptoms among people like me are synonymous and highly relatable.

      There are however other dual PTSD diagnosises in CPTSD. The breakdown is as follows

      PTSD with DID

      PISD with DDNOS (Dissociative disorder not other specified)

      -Conversion Disorder

      -Dissociative Fugue


      But the dichotomy of whichever two are presented creates the same generalized symptoms.

      Don't go on a crusade to change something you are not fully knowledgeable about.

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      brownroo22 6 years ago

      When I first came across the diagnosis of complex ptsd it was literally like stepping out of the wilderness and into the light. Everything suddenly made sense. It felt like,Judith Herman, who first theorised it had been living in my head for the last 30 years and had come up with a diagnosis specifically for me.

      I was not a victim of big T trauma such as abuse but due to certain untalked-about disfigurements that I was born with i spent the first 13 years of my life believing that I was going to grow up to be a monster/freak the likes of which had never been seen before. The problem was not so much that I had the disfigurements, as they were fixable at a later age, but that they were NEVER mentioned so right from day one I lived with this secret shame and fear of what I might become.

      I now understand that at an early age I subconsiously 'structurally dissociated'as a means of coping. Structural dissociation is when your personality splits into subsections; your ANP (Actual normal personality) and one or more EP'S (Emotional personality). Your ANP is the personality you basically exhibit in everyday life and develops at an age appropriate rate. Your EP is basically all the emotional states connected to your trauma ie, fear, fight, freeze, attachment etc... In most traumaless people these 2 subtypes are integrated pretty sufficiently and therefore you have a definitive sense of self but in those who have suffered trauma the dichotomy between the two means that you often end up with a fragmented sense of self to the point when you don't really know who you are, what you are or what you think. Often this structural dissociation doesn't just come about because of the trauma or traumas but is dependant on the support or attachment you had with a caregiver.

      Why PTSD is called simple is because generally it involves a simple structural dissociation of just one ANP and one EP. Complex PTSD involves one ANP but more than one EP. Incidentally, if when you structurally dissociated you develop more than one ANP that is indicative of Dissociative Identity Disorder otherwise known as multiple personality disorder.

      Treatment for all types involves the reintegration of your fractured selves. In PTSD due to the often terrifying nature of the trauma and the fact that it is more in your recent history therapy such as EMDR is proven to be very affective as it allows you to reprocess your thoughts and feelings over a relatively short course of treatment so that you can reintegrate and hopefully move on.

      For complex PTSD it is usually far more indepth and involves several processes in order to reintegrate; You have to recognise and own the things that made up your trauma, no matter how big or how objectively small, and you have to educate yourselves about the effects this had on your enduring peronality. This may be tricky if like me you have always felt relatively normal(ANP)and have lead a life time not acknowledging the cries from your EP. You then have to begin the task of mourning the things you have inevitably lost as a result of enduring problems and this may be many. Only when you have done the first 2 parts can you begin to form a cohesive narrative to your life, attempt integration and begin to find a new path with a single sense of self.

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      Jordan 7 years ago

      If is not going to be another diagnosis all together than PTSD should be broaden in its defintion.

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      Laura 7 years ago

      When I first saw a description of C-PTSD, it was the first thing that "talked" to me, after years of looking at individual descriptions of my individual "symptoms". What has always felt fractured, confused, full of "yeah but what about this?", now seemed more whole somehow. More so than PTSD ever did. It was never a case that my problems were "more", just that the PTSD did not answer so many of my own perceived "weirdnesses". C-PTSD is not a perfect moniker for many reasons, but the relief I felt was far from fictional and such relief is in short supply sometimes.

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      ElizabethIsabelle 7 years ago

      If people don't like the term Complex PTSD, go with Compound PTSD. That makes it sound like a compound fracture - a bone broken in more than one place, but a fracture is still a broken bone. Or go with PTSD I and PTSD II.

      CPTSD has more differences from PTSD than Bipolar I has from Bipolar II, and CPTSD calls for different treatments to get results. EMDR works on PTSD because you can go back to the one event and treat for the one event and it relieves the symptoms. Desensitization can also work because you have a particular thing to desensitize from. When there were enough events that contributed to the CPTSD that they all can not be addressed individually, EMDR treatments are less likely to work, and if you desensitize a person to a wide enough variety of stimuli to cover all the areas that a CPTSD person may need covered, you could create a sociopath instead.

      Also the recreating of the trauma or subconscious seeking out of similar situations is unique to CPTSD. If someone is in a single car accident, they don't tend to go out and get into car accident after car accident. If someone was raised in an abusive situation, they don't even notice that they are going right back into another abusive situation until it is too late. There may be additional thinking problems or physical symptoms that without the CPTSD diagnostic option, the clinician may chalk up to something else. This Wikipedia article may help:

      Finally, although the blame-the-victim stuff goes on with PTSD, not only does it go on with each instance in CPTSD, but the person who suffers from CPTSD is often not believed, sometimes not even by the professional they go to - especially if the person had been through a lot of serious traumas and the one that finally pushed them over was relatively minor. People either don't believe that you really went through the earlier stuff since you fell apart at something comparatively minor, or they think that you are faking your symptoms now since you didn't have them after bigger traumas.

      Not only should CPTSD be listed separately, CPTSD might also need to be subdivided into those who developed this due to child abuse throughout significant developmental stages and those who had a normal childhood, then developed this due to extensive traumas only in adulthood such as war. It appears to me that those who had a normal childhood can at least recognize the difference between what is normal and what is a bad idea better, therefore they can avoid the bad ideas better. You asked where the differentiation should end. I propose it should end where the symptoms or treatment are sufficiently different.

      CPTSD is PTSD and then some. That does not diminish PTSD in the same way that having your arm broken in 2 places or 5 places does not mean that having your arm broken in "only" one place doesn't hurt. Sheila, it looks like you have a good comprehension of the pain PTSD can cause. Yes, PTSD can be fatal. So can depression. I'm not really sure how to put it in such a way that does not invalidate what PTSD sufferers go through while also not scaring "the normals" to a point that they don't want to hire, work with, or socialize with anyone with any of these disorders. Being fair to one group does not require being unfair to another group, and acknowledging what one thing is does not take away from what another thing is. There is plenty of pain to go around for everyone. :)

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      Tristesita 7 years ago

      The DSM-I came out in 1952 - there were 106 diagnoses, including the diagnosis of homosexuality as a psychiatric disorder. The DSM continues to evolve as our understanding of neurobiology and psychology increases. The brains of those with C-PTSD are physically different than those who had normal childhoods, then experienced a traumatic event later. I survived both chronic abuse as a child and several traumatic events as an adult - have been misdiagnosed as BPD, Bipolar, treatment-resistant depression. Now with correct diagnosis and treatment, I am improving: I have hope for the first time in my life. No one is demeaning PTSD, but CPTSD is different, more complex, tougher to treat because of the additional layers of chronic neurologic alterations. And many doctors are ignorant of developments in the field, as are many therapists. Learning new information is time-consuming. It means putting away old thought processes. Learning new uses for medications and new types of therapy. If they someday find that there is a tremendous difference in how people who get PTSD from natural disasters respond to a certain medication that those who get PTSD from war do not - well that's great, that is how medicine refines and personalizes treatment.

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      jj 7 years ago

      I'm sorry to say, but you sound more than mad to me. Complex or not, I am just grateful that I am at last able to identify what has been wrong with me the last 44 years. I think the complex designation is more about how the patient is treated. Although I agree that the symptoms are the same, I was diagnosed as a depressed histrionic, narcissist (SP?) for years, and although it did help me control my behavior, today I feel as if I'm rotting inside. The treatment for complex ptsd seems longer and a little more subtle. Some Dr's are calling it an injury more than a disorder. I think we probably read different things although I do appreciate your post very much. -theunconfirmed

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      anonymous 7 years ago

      This sort of argument makes me angry - when will people stop trying to be politically correct and avoid upsetting people?

      I had someone suggest I was borderline, so I looked into that, but it didn't quite fit.

      Then I found out about complex PTSD, it made perfect sense, and now, I am beginning to make progress. Feelings I had that had been buried for years are finally being dealt with after over 10 years of being buried.

      I have been struggling with everything, with an entire emotional past which was suppressed - it isn't a question of what is worse, but that my symptoms are not immediately recognisable as PTSD, largely because everything was suppressed, totally blank, forgotten, and my flashbacks are emotion-only. My PTSD symptoms were so far repressed that they were almost entirely hidden.

      Without the C-PTSD idea, I would not have been recognisable as having PTSD. Psychiatric professionals missed it over years ago more recently following the trauma. It does not matter so much what the label is, as it is just a way of describing a particular form of PTSD so it can be identified.

      The idea people want to deny people the opportunity to recover over political correctness and categorisation is selfish.

      I don't disagree with reframing BPD though.

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      janie 7 years ago

      Sheila, let me put an example to you, if it's all right? A friend and I both have PTSD diagnosis, his from combat and mine from how I grew up. Same basic symptoms. But I shake, vomit, and black out because my experience was severe abuse and torture that went on for years by people on whom I depended, and not an act of violence from fate or external environment, and therein is Complex PTSD. It is the relationship of the abused and abusers, the length of time, and as one who is living this, I think you need to take a step back and consider that all PTSD is not alike. Trauma will produce the same symptoms, but which symptoms belong to abuse and which to accidental occurance? If the shoe fits, it is not fictional, I'm afraid. Anyone who has lived through all this knows things they never should, and wish they didn't, and one of those things is how to look truth in the eye. C PTSD is not fiction, though we all wish it could be.

      To Safe-at-last, I am glad you brought up justification--I struggle too. Glad to see you are doing well with this!!

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      Lori Colbo 7 years ago from Pacific Northwest

      Interesting hub. I have had PTSD (regular or whatever) for 9 years and had never heard the term Complex PTSD. It seems unneccasary because PTSD is PTSD. But I did read Sara's comment and have found her views gave me another perspective to consider. What you said Sara made sense. Something more for me to look into. Blessings you all.

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      technorican 7 years ago from Houston

      I'm glad to see a discussion about PTSD. I've never heard of "complex" PTSD. Unfortunately, I have over 5 years of experience with PTSD, Medications and therapy don't resolve the root cause. They are important to survive but I've had to find my own way, which has been long, painful, and miserable. And there is a domino effect. I will be writing about this later.

      If anyone has PTSD from the workplace, there is the Workplace Bullying Institute website and 13 State Coordinators organizing efforts for legislation. Look for Healthy Workplace Advocates on Facebook and elsewhere.

      Thank you all!

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      Rosina 7 years ago

      I don not understand how or why the term "simple" PTSD is being all the reading and research that I have done the term simply does not exist. Complex PTSD is just a bit different and is also an attempt to rethink the diagnosis "BPD" as those with a history of chronic victimization have been labeled. Unfortunately, the psychiatric profession has mistreated people with CPTSD and PTSD. Let's try to see this as a nuanced disorder and be supportive of each other. It is still disturbing to me how ignorant most psychiatrists are about trauma treatment. In so many instances, they are treating nothing but a symptom-remember the term "disguised presentation?"Believe me, there is trauma treatment and real trauma treatment. I learned this the hard way by spending 7+ years with incompetent Drs. of all kinds. This type of experience can be traumatizing in itself. Please, inform and educate yourself and interview at length a prospective therapist. There are also tests to determine what is going on physiologically...this can have a tremendous impact on your recovery. I think it is best to respect, understand and support each other; we are all so unique.

    • bill oneill profile image

      bill oneill 7 years ago


      This is the first time I heard of Complex PTSD! I thought PTSD was PTSD!!!? I have struggled with PTSD since May 1970 when I sifted sand to put a brother's head, back together, so we wouldn't send him home in a closed box. It didn't work, I know what color brains are!

    • safe-at-last profile image

      Mel Stewart 7 years ago from Western Australia

      Having experienced both PTSD and Complex PTSD I think it IS important for them to be distinguished between. You are correct that all the symptoms of PTSD are also present in complex PTSD, but the fact is that complex PTSD includes other symptoms on top of the already recognized symptoms of PTSD. One symptom of significance is justification, or the need to justify oneself even when with positive, supporting people.

      I have been acutely aware of my tendency to justify myself to anyone and everyone for years now (even a stranger in the street can be a target occasionally), but no matter how aware I was of it, I was unable to stop doing so. It made things worse as I withdrew from those who could support me because I was continually embarrassed my my inability to self edit.

      When talking about anything other than my ex I come across as completely normal (if occasionally a little hyper due to my AD/HD), and people think I'm intelligent, witty, insightful and completely sane. HOWEVER, as soon as I talk about my ex, I change into a complete basket case and people think I'm a paranoiac and more than a little neurotic!

      When I had PTSD from a horrific motor accident, I was eventually diagnosed and from there I was treated with Rapid Eye Movement Desensitization. It took about 6 sessions over 6 weeks, each of which was emotionally distressing in itself, and therefore "hard work", but the result was fantastic - no more nightmares, flashbacks, blackouts, exaggerated startle reflex, etc... that I had endured for 2 years since the accident. My depression lifted and my physical pain reduced substantially too.

      You can understand why I was keen to try the same treatment 10 years later when I was again diagnosed with PTSD following a long relationship of domestic violence. Trouble was though that the treatment did not work. Instead of moving from once specifically related memory to another during the desensitization, my mind just kind of skipped along the surface of many different issues, instead of the specific instances of violence. I guess the events that had caused me to have PTSD were more complex!

      The fact is that PTSD is caused by a specific traumatic event, and the resulting psychiatric injury therefore does not extend through hundreds of memory pathways and neural clusters. On the other hand, complex PTSD is caused by many many separate events, which occur over a long period of time, all of which are however, related to a single significant person, and the psychiatric injuries from each of those events are therefore spread out through thousands of related memory pathways and neural networks - so it is a much more complex injury, and requires different understanding and support.

      Complex PTSD is far from a fake disorder. It is not included in the DSM because it has only recently been discovered, and still being researched.

      New treatments and medications can only be discovered when there is something to research, and I believe that complex PTSD is probably widely under diagnosed and leads to many misdiagnoses such as borderline personality disorder etc... Disorders such as those are internally caused by chemical balances and such, and can never be cured although they can be treated.

      PTSD and Complex PTSD are psychiatric injuries and they can be recovered from. The symptoms, such as anxiety and depression, are not internal chemical imbalances, but reactive or situational disorders, and so people suffering from either disorder can make a FULL recovery in time.

      Lou and Ahab - great comments!

      Shiela, if you want to make a hoo haa about fake disorders try researching parental alienation instead!

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      Ahab 7 years ago

      Just had to post in support of Tiffie and Lou_1978.

      The DSM in my experience was just meant as a starting point. something everybody could agree on, not the least of whom included but weren't limited to: psychological skeptics (As someone already mentioned, PTSD didn't exist 25 years ago, and Ill add that after almost every "new" diagnosis there is always a large crowd of disagreement, google it if you don't believe me), Older medical proffessionals (Before the internet, the Paper Edition of the DSM was sometimes the only way geologically isolated doctors could read up on new ideas/techniques regarding psycology), and certainly not least the Insurance companies.....

      The DSM itself even states inside itself that it probably doesn't cover everything, and that as more is learned it will probably need to be updated. This is also why to be diagnosed by the DSM, it lists "minimum requirements" (IE one episode of self harm, several episodes of public dissociation, etc etc). Using its approved writings as a starting point, it intentionally leaves room for more, and for interpretation on a case by case basis. In my humble opinion, CPTSD would be an example of something that the DSM would try to describe during a time where a lack of understanding was understood, and something that the DSM would hope to have helped explore further.

      /quote (I apologize I can't make this look better, alas, like the DSM, some sites need updating as well in my honest opinion):

      My issue with Complex PTSD is that it does no good. I have only seen it cause division among people with PTSD and confusion among those who are diagnosed with it /endquote.

      To this I would suggest that perhaps your experiences haven't included dealing more closely with people that have Identified so closely with CPTSD? Or perhaps with people who are either misdiagnosed, or perhaps themselves confused as to what exactly it is they have been diagnosed with (Of which happens more frequently then statisticians would have us believe). This is just a suggestion, as your experience with those diagnosed with CPTSD has been vastly different from mine. Perhaps you've never personally been involved with someone when, after having been diagnosed with singular PTSD, they are still unable to feel as though it fits them, because there is more to their symptoms then what PTSD itself has identified for them. I don't know of course, but these thoughts are what my experiences would lead me to believe.


      Why is it necessary?


      In my humble opinion, For the same reason that all Psychological disorders are researched and cataloged in the first place.... Because A(As others have pointed out):Our current understanding of the human brain on a psychological level is imperfect, and constantly evolving;

      and B: in that process, we have learned that old categorizations though perhaps a valid starting point, can in often cases be just that, simply a starting point for things much more complex. Perhaps one day, and I can only hope humanity will reach a point where we understand our psyches to this point, we WILL have categories for each individual trauma with complete understanding of the different possible emotional reactions that any given person might take to the initial trauma, so that those individuals might be able to have an easier time Identifying it, Learning about it, Coping with it, and moving on in life from it. So that our understanding of how our Psyche works could be so complete that after a car accident, or a War, or some other specific event, a victim would but have to ask for all or any knowledge/history on the subject and be able to garner whatever support/help they could possibly need to get over it as quickly as they feel comfortable with (wait, isn't that what were trying to do by creating things like the DSM anyway?). But alas, I can only hope.


      Yes, thats silly, and so is having a diagnosis of Complex PTSD. /End quote.

      Of course, I disagree here. I bring this up though because you, though you want people to see both sides of a disagreement, you seem to have no problems insulting one side. Yes, I do posit that calling the opposing view point "silly" is insulting. Needless, counter-productive, even problem-inducing I can "approve" (Because approving of an oppositions argument can be as much a sign of respect if nothing else). However insulting is a bit much. And if for no other reason then this, you attack your own credibility (Which Rob in his post indirectly pointed out in his post), by insulting the opposing view. It might lead a reader to believe that you are in fact a bit more personally involved then you may or may not be, particularly after citing no other outside source beyond PTSD Forums. I can only hope the insult was mistaken.


      One only has to look at a PTSD Forum to see arguments about the Complex PTSD diagnosis. /end quote

      I mentioned it above, but I brought it up here for another reason. Psychiatrists, Psychologists, Counselors, and all manner of other medical proffessionals probably have more a free hand then you realize.... Any one of these can diagnose anything under the sun if they want, including but not limited to Alien Symbiosis, Heat Fluid Retention, or Paranoid Strawberry Jam Phobia.... However, if they don't back their diagnosis up with proof and by submitting said proof to one of several medical boards (Such as the American Psychiatric Association), their credibility goes down the drain, followed quickly by their medical license if they act on these diagnosis without the consideration and generally the approval of their peers. At the very least, Im thankful they tend to cite, and certainly rely on, more then experience from "PTSD Forums". But the free exchange of ideas is certainly important no matter what form it might take.

      Thanks for reading if you have, my intention was to post what I considered some sorely lacking counter-points and observations for any-one else that, like me, stumbled across this page purely on accident.


      This might be a double post, for which I apologize, however, seeing as my net hiccuped in the time it took me to write this out, and I wanted to make sure it was posted.

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      lou_1978 7 years ago

      Interesting article and comments - 25 years ago PTSD in any form did not exist or was not recognised, yet it has since been discovered.

      Further evolution/experience has recognised complex PTSD - why in another few years time maybe they will discover other 'strains' which have a similar 'group of symptoms" recognised.

      Single cause PTSD has a very clear 'event' trigger, Complex PTSD does not - I enjoyed a balanced and happy childhood and adolescence, no more dysfunctionality through life as any other person of a similar background - yet after an 18 month experience of negative stress in a work situation (which culminated in my initial findings being categorically proved correct by independent experts, after all that time of being labelled as a 'scare mongerer' and having my experience and intelligence questioned, Gas lighting is a very good description of what occurred ) I have found myself for almost 7 months being treated for Complex PTSD. Although I experienced certain symptoms of Single Cause PTSD, I was not raped, witness to murder, war or any other catastrophe or terrible event.

      I appreciate that who we are as people and how we react to situations is based on all our life experiences to date, eg being human - it is careless to assume that all those affected by Complex PSTD are manipulative or are full of shame, or have all had dysfunctional upbringings (appreciate some folk being treated for this may have this) - Perhaps in 10 years time these folk will have a separate PTSD category of their own.

      The most poignant reason for responding to this article was Tiffie's comment about not being alone. Had Complex PTSD not been a recognised state eg; a normal reaction to a series of abnormal/controlling events with no perceivable means of exit strategy, I could easily have spent the rest of my life being wrongly 'diagnosed' as having various mentally unstable conditions, being prescribed drugs I did not need and being in a cycle of trying to find people or events to blame from my upbringing to explain my mental state (nb I am referring to my own experience here) when actually I

      have experienced one of the most natural human reactions to prolonged negative stress.

      The human mind is a very complex thing that we are all still trying to understand, add this to the new theories and findings every day, week, month - if it helps others the way it did me then I hope more categories for this condition are also recognised.

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      Rob 7 years ago

      It sounds to me like your article has more to do with your own feelings regarding someone arguing with you than it does the validity of Complex PTSD as a mental disorder.

      Look, anyone can dwell on the past -- flashbacks. Anyone can be fatalistic -- lose hope in their future. And anyone can give up on life as a result of that negative thinking.

      However PTSD is like the first stage of a burn, whereas Complex PTSD is like being on fire. The core PTSD symptoms only revolve around an individual's reaction to an event. Complex PTSD symptoms are a result of a negative, shame-driven personality which is predisposed to having PTSD symptoms...hence the association of the names.

      A person with Complex PTSD is likely to manipulate others through shame, such as acting hurt in order to get what they want. Take a look at your own words, "If there is a complex PTSD, it is implied that regular PTSD is Simple PTSD." In the comments section, you said it again, "This implication does nothing but belittle people's struggles with simple PTSD."

      It is immoral and foolish to assume the worst of others' intentions, people we have not even met, but perhaps a crazy life has left you predisposed to mistrusting others. I suggest you educate yourself on shame-driven Complex PTSD behaviors starting with Dr. Pete Walker's articles.

      Finally, let me clarify that CPTSD directly involves the cycle of abuse in dysfunctional families. It could be more accurate to diagnosing and treating PTSD sufferers than the ongoing DSM-IV criteria -- which does not account for shame-driven behaviors or lack of boundaries. I speculate that many PTSD sufferers actually have CPTSD, but it is easier for me -- a treated CPTSD sufferer -- to identify shame-driven behaviors.

      It's not~ easy for me to avoid being bothered by them, though. So I wish you well, and I hope you take me as seriously as an IRS notice.

    • Sheila Wilson profile image

      Sheila Wilson 7 years ago from Pennsylvania

      Of course, many people disagree with my opinion. There are also many people who agree with me. I don't believe in not approving comments that disagree with me, because readers should be able to see both sides of the issue.

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      tiffie 8 years ago

      This article is a load of hogwash.

      1) Just because something isn't in the DSM doesn't make it "fictional." There is a reason the DSM is updated periodically: We are learning.

      2) Having a "complex PTSD" diagnosis (whatever it is called) available does not diminish a completely separate diagnosis of "PTSD." To minimize the hurt feelings for those with the "simple" variety, call it "singular" (as noted above) or something. We need to use all the knowledge we have about these two separate disorders!

      3) There is a HUMONGOUS difference between a person's perceptions when they have been terrorized, abused, tortured, etc. for an extended period from having experienced a one-time trauma. It isn't always better. It isn't always worse.

      For many, many years, I had such a hard time identifying why I was having the specific symptoms I experienced. I have experienced episodes of dissociation, especially when under stress or experiencing strong emotion. When I told my doctor about my continuing dissociation, he said, "That isn't typical of PTSD patients," and dismissed me. I knew that, when I would find myself in front of a computer missing two hours from my day, or "wake up" on a highway in the middle of nowhere with no idea where I was heading, or find out about conversations I didn't know I had had, it wasn't my imagination. I have no alternate personalities.

      I have some symptoms that seemed to be BPD, but my PDoc dismissed the diagnosis. Close, but no cigar.

      I am relieved to know that I am not alone. I feel so much better knowing that other people in this world have experienced the horror of continued dissociation, the immense shame and self-loathing, the alternating periods of intimate attachment, passive-aggressive behavior and feelings of victimization.

      Knowing that I am not alone gives me some hope. If I am alone in this, there can be no recovery, but if others have gotten through similar circumstances and symptoms, perhaps I have a chance as well.

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      Pandora 8 years ago

      I would have to echo Tilly's comments. C-PTSD is widely recognised by the discipline of psychiatry, regardless of the DSM's continuing failure to include it in their tome, which as Tilly states is the US standard, not th world one.

      Granted, it is not included in the ICD either, but it is well recognised by eminent and experienced psychiatrists as being a distinct phenomenon from "standard" PTSD. For example, see about half-way down this article:

      The above is from the British Royal College of Psychiatrists, which is the governing body for the psychiatric profession in the United Kingdom. Their recognition of the diagnosis would strongly contest your assertion that C-PTSD is fictional.

      My own two cents - having been through sustained and systematic abuse, as well as more immediate and open trauma that occurred only a few times, I can safely say that the effects are quite different. One is not worse than the other necessarily, and neither should be given greater or lesser credence. They are merely distinct. There is nothing belittling about that.

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      Tilly T 8 years ago

      Sheila: just because it is not in the DSM does not make a diagnosis fictional. First, the DSM is published in the USA, it only applies to a minority of the world's population. Second, the DSM is simply a set of ideas about diagnoses agreed upon and written down. Putting something in a book and publishing it does not make it any more or less fictional

    • Sheila Wilson profile image

      Sheila Wilson 8 years ago from Pennsylvania

      Rewa, you make some good points, but I just want to point out that many people who have PTSD have experienced more than one trauma that causes the PTSD symptoms. Think of those with combat PTSD. No doubt many have flashbacks of different traumas. Personally, I was the victim of rapes and sexual assaults- three of which cause flashbacks and PTSD symptoms. One of the risk factors for developing PTSD is an accumulative factor of experiencing multiple traumas. Many people with PTSD have effects from the trauma that have severely damaged the person's self-concept and eliminated any sense of safety. I go through periods when I can't even leave my house enough to check my mail for weeks at a time. Treatment for PTSD needs to be individualized, not categorized. (just my opinion of course)

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      Rewa rewa 8 years ago

      I also see value in seperating the 2 diagnoses. Maybe singular is a better concept than Simple. Many people who grew up in terror, lived in trauma the whole of their lives. That is a huge difference. My home environment was abusive, controlling unsafe. My father kept us in a state of uncertainty by imposing ever changing rules. I was the one he beat. Anything could warrant a sudden escalation into violence and me being subjected to prolonged beatings. he also played controlling games, making me do things that scared me, while he watched + at the first sign of fear, or if I closed my eyes invlountarliy, more violence. I understand how that could be different than for people who have good enough parenting, a supportive homelife, then experience trauma. I simply never had a safe place inside or out. And dissociation is a huge problem for me. Therapy must find safety that never existed before beginning to attend to trauma. With an incomplete self, PTSd treatments are dangerous. That's why we need the CPTSD, to maintain safety + to treat the prolonged terror of captivity, and finally for therapist to notice dissociation and acknowledge it. i say this because I did several years of therapy without people noticing, + I hid it because I had no word for it.

      I say, lets stop fighting over the difference between 'a broken arm, + a broken leg' both are bad, both need help to heal. If we accurately note what we're treating, we have a better chance of being helped + of therpay doing no further harm.

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      Omar 8 years ago

      Having worked with many traumatized individuals, I believe there is some benefit in the concept of complex PTSD. One of the problems we face is that PTSD is categorized as an anxiety disorder including re-experiencing, avoidance/numbing, and arousal symptoms. There are effective Cognitive Behavioral Treatments for PTSD. It does not make sense to argue that because one is referred to as complex PTSD the other must be simple PTSD. The difference is in how you understand the development and the treatment of the problems. PTSD is extremely distressing and no one should doubt that. However, when treating PTSD it is often possible to identify one external event that lead to the disorder. We can then work with a person to resolve their symptoms – as complex as those symptoms may be for any given individual. For example, those diagnosed with PTSD often have diagnoses of depression as well or suicidal/self injurious behaviors. The difference is that these are not required for a diagnosis of PTSD. One solution is to give a person a diagnosis of PTSD and then add multiple other diagnoses to capture the other problems. This is what you would do for billing purposes, but I think it misses the point. The benefit of the concept of complex PTSD is that it attempts to explain how prolonged or chronic exposure to traumatic events, neglect, or other stressors changes a person’s ability to regulate emotions, relate to others, etc. Where processing a horrific rape or car accident is extremely difficult for patients, it is possible to help patients gradually reduce their anxiety and PTSD symptoms through repeated exposure to that traumatic event. Once the anxiety symptoms have improved, it is then possible to work with all of the shame, guilt, and other emotions that can be brought about by a traumatic event. In the case of complex PTSD, it is often difficult to pinpoint one traumatic event and the work is less about reducing anxiety (although this can be one important part of the treatment). There are specific treatments for complex PTSD that have been researched and seem to be effective. These are treatments that tend to have more components than the treatment of PTSD. I am not sure that claiming one disorder is more complex, troubling, or severe than any other is useful. I have seen people devastated by many disorders. The other thing to keep in mind is that having a DSM code or a diagnosis that is accepted by your insurance does not make it a more legitimate diagnosis. Having research to support to utility of a separate diagnosis and the effectiveness of treatments is what is needed.

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      Sheila Wilson 8 years ago from Pennsylvania

      My label of complex PTSD as fictional is merely an objective fact, not meant to belittle anyone's experience with PTSD. If it is not in the DSM, it is not an official diagnosis. If person is in the United States, has been diagnosed with "complex PTSD," and pays for mental health services with insurance, I can pretty much guarantee that person's diagnosis listed on their medical forms is PTSD or simply 309.81, the diagnostic code for PTSD. Otherwise, insurance wouldn't pay the claim.

      You make a good point about mental health professionals lacking in knowledge of how different causes of PTSD may manifest themselves. I just don't think that dividing the group and causing conflict and confusion is the answer. Many different traumas that lead PTSD cause different symptoms. Educating mental health professionals about these different symptoms without making numerous divisions of the diagnosis would be ideal.

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      Sara 8 years ago

      I understand your point about "simple" vs. "complex." But we can choose more sensitive names for them while still recognizing that they're distinct.

      The main reason I think the latter type needs it's own category is for facilitating diagnosis in people who may not realize that their symptoms are related to PTSD. The former type of PTSD is discussed in the mainstream press everywhere. If you were raped or in a horrific car accident or witnessed a murder or survived 9/11 and you're having nightmares or phobias or depression or thoughts about self-harm, it likely occurs to you (and to any therapist you may see) "These symptoms may be a result of that trauma. This may be PTSD." If you spent years in the midst of a long, slow-burning trauma that contained elements of joy and pride and belonging mixed in with the trauma and you're now having nightmares or phobias or depression or thoughts about self-harm, it may not occur to you that the symptoms are even connected to each other, much less to your past.

      My first diagnosis was ADHD and depression. My physiology had been slowly worn down (over 10 years) and eventually even the strategies I'd been using to compensate (channeling my negative emotions into working hard in school) gave out, and my concentration was so shot I couldn't read fast enough to finish exams on time. I went from Valedictorian of my high school to flunking out of college. The shrinks all looked for what had *changed*, what was *different*, what the *catalyst* was. My long-standing hyperarousal, my gradually increasing impairments in concentration, and my new difficulties with depression (all of a sudden, my crying became uncontrollable--if I started I couldn't stop) were treated as separate, unrelated sets of symptoms.

      When I later read Trauma & Recovery, I identified strongly with the chapter entitled "Captivity." I realized (duh!)that my various symptoms were connected, and rather than having a specific catalyst, they were caused by overall burnout. Because I had adjusted so *well* to my captivity (in the sense of accepting the hand I was dealt and learning and adapting to the rules, not in the sense of stockholm syndrome) and because I earned my way out with a scholarship, I didn't perceive my past to be a traumatic influence powerful enough to affect my present, and there were apparently no flags to motivate the shrinks to investigate further. I had to figure out on my own that my symptoms were a form of PTSD.

      Figuring it out helped me seek out and find much more effective treatment.

      So... Obviously I support efforts to get psychologists to recognize that people can get PTSD from long-term moderate stressors. I personally have no problem with the simple vs. complex distinction, but if people find the term "simple" insulting, I think the problem could be solved by naming them differently or by broadening the definition of PTSD to include sub-types.

      All I'm saying is that I think it's useful and important to recognize that there are different types of PTSD. Just as you find it insulting when a struggle that affects every minute of your day is called "simple," I find it insulting when a diagnosis that saved my life is called "fictional." I don't think this has to be an either-or conflict. I think there's room for both of us.

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      Sheila Wilson 8 years ago from Pennsylvania

      I don't believe that people who suffer from "simple" PTSD have more inner conflict than someone with "complex PTSD." Someone who was raped by a stranger may be diagnosed with PTSD and have no desire to remember the parts of the trauma that they cannot. However, someone with "complex PTSD" who was repeatedly sexually abused by their father may have a tremendous amount of internal conflict due to the love for their father.

      One of the main issues I have with this fictional diagnosis is well illustrated in your comment. If one is "complex," the other is "simple." This implication does nothing but belittle people's struggles with "simple" PTSD.

      Several different causes of PTSD can have slightly different symptoms. A person with PTSD from a horrific car accident can develop a phobia of driving. Rape-trauma PTSD can cause severe damage to the person's self-esteem and sense of safety and security. Should we separate all of these types of PTSD and others?

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      Sara 8 years ago

      Complex PTSD is a legitimately different disorder than regular PTSD. Just because symptoms of the two disorders *can* overlap doesn't mean that the labels are synonomous.

      Like pulling a tablecloth out from under a table full of dishes, speed matters. Quick, acute traumas shock the physiology and make it go haywire. Slow, moderate traumas habituate the physiology to new baselines, slowly eroding its resilience.

      Simple PTSD is a third degree burn.

      Complex PTSD is heatstroke.

      Simple PTSD is an internal conflict. Half of you is trying to remember and half of you is trying to forget.

      Complex PTSD is an internal defeat. All of you is trying to forget.

      Neither disorder is worse or more severe than the other. They're just different. And the more specifically we classify them, the more effectively we can treat them.

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      bittybrasize 8 years ago

      Interesting argument. I really like Judith Herman's book Trauma and Recovery, in which she argues in favor of the complex PTSD diagnosis as a replacement for borderline personality disorder and other diagnostic labels with similar symptoms that can be stigmatizing to women. I don't think she anticipated that people diagnosed with "simple PTSD" might feel belittled as a consequence, but that's a good point. All trauma is complex, and I agree with you that all of us with PTSD have a great deal in common with each other no matter what the type, duration or source of our individual traumas.

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      OpPTSD_Jason 8 years ago

      I agree with you on the division of PTSD diagnosis. This problem has enough complexity. I would like to see a more focused effort made toward research of successful treatments for the "original PTSD." I am quite tired of the old school therapists insisting that meds and talk therapy are the answer while downing NLP as psuedo science. I am of the belief that whatever works is the right answer for each individual. I also think that the patient has a tremendous impact on his/her own outcome based upon belief of its effectiveness.