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Complex Trauma: CPTSD Vs. BPD Vs. Insecure Attachment

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What is complex PTSD, and how does it differ from the more commonly known post-traumatic stress disorder (PTSD)? Complex PTSD, also known as CPTSD, is a psychological condition that arises when an individual has experienced prolonged exposure to repeated interpersonal trauma such as childhood abuse, neglect, or captivity.

In this article, we delve into understanding and treating complex PTSD. We’ll explore its unique symptoms, the root causes behind it, and the most effective treatment methods for complex and chronic trauma. We will look at how people might start their path to recovery from CPTSD, giving insight into the actions required for healing and resilience.

What Is Complex PTSD?

what is complex trauma

Complex PTSD, also known as complex post-traumatic stress disorder, is a mental health condition that arises when an individual experiences prolonged and severe trauma, especially in important relationships.

These experiences can encompass enduring ongoing physical or emotional abuse, neglect, or being confined in captivity. People contending with complex PTSD frequently endure a succession of traumatic events spanning an extended period of time.

The condition is characterized as an expanded version of the existing PTSD definition, encompassing the clinical features of PTSD along with three additional symptom clusters: emotional dysregulation, negative self-perceptions, and interpersonal difficulties. These additional features resemble the clinical characteristics frequently seen in borderline personality disorder (BPD).

These experiences can leave lasting and profound imprints on people’s mental and emotional well-being. Individuals frequently contend with challenges like diminished self-esteem, difficulties in forming healthy relationships, and broader mental health issues that trace their roots back to these catastrophic experiences.

Complex PTSD the Evolution of Trauma Diagnosis

complex PTSD trauma diagnosis Complex posttraumatic stress disorder is not an official DSM-recognized term, yet its use is becoming increasingly prevalent among therapists. Although CPTSD is not recognized as an official psychiatric disorder, the term was borne out of necessity.

A need to describe a type of trauma that extends beyond a singular traumatic event, those that were recurring and impacted the individual’s life in profound ways. We currently don’t have a psychiatric disorder that can appropriately diagnose the result of long term traumatic events that are not considered a risk to a person’s life, but to their psyche.

While not officially recognized in the DSM, the term Complex PTSD is frequently referenced by therapists. This term has been embraced to describe prolonged trauma, illuminating a collective belief that the DSM may not fully encapsulate the intricate dimensions of trauma in its entirety.

When we talk about Complex posttraumatic stress disorder, we refer to traumatic situations that span a longer duration. These can include years of child abuse, prolonged domestic violence, or long-term captivity, among others. The symptoms can often overlap with traditional PTSD but also introduce elements such as emotional regulation issues, changes in consciousness, negative self-perception, difficulties with relationships, and more.

The current trauma-related diagnostic criteria in the DSM seem somewhat inadequate, particularly when trying to encompass the depth and breadth of ongoing relational trauma or attachment injuries. The present trauma diagnoses are:

Current trauma-related diagnoses include:

  • Acute Stress Disorder: This disorder includes symptoms that arise in the immediate aftermath of a traumatic event, with symptoms lasting no longer than a month. It can be seen as an acute response, with symptoms ranging from flashbacks to feelings of unreality or even amnesia.
  • Adjustment Disorders: This diagnosis speaks to our struggles when confronting significant life changes or stressors. The symptoms can be varied, with anxious feelings, depressive mood, and even behavioral symptoms.
  • Post-Traumatic Stress Disorder (PTSD): Probably the most recognized, PTSD in the DSM focuses on a traumatic event that exposed an individual to death or significant threats to their physical well-being. But it fails to encapsulate childhood trauma or those which might not involve direct harm but still leave a profound psychological impact.
  • Other Specified Trauma and Stressor-Related Disorder: This is a more encompassing diagnosis for trauma-induced disorders that don’t fit neatly within the categories previously mentioned.

The current trauma-related diagnostic criteria in the DSM appear somewhat incomplete, especially when trying to grasp the nuances of ongoing relational trauma. None of the current diagnoses describe a type of trauma that delves deeper into extended and repeated traumas, like those tied to developmental, relational, or attachment issues.

What Is the Difference Between PTSD and Complex PTSD

is complex trauma a diagnosis difference between ptsd

While similarities exist, it’s important to note that CPTSD encompasses a wider range of symptoms and emotional responses. Here are the key differences:

Nature of Trauma

PTSD typically results from exposure to a single traumatic event, such as a car accident, natural disaster, or combat. It can also develop from witnessing such an event. On the other hand, CPTSD is characterized by complex trauma experiences, often stemming from prolonged exposure to traumatic events, particularly those involving interpersonal relationships, such as childhood abuse, ongoing domestic emotional or physical abuse, neglect, narcissistic abuse, gaslighting, sexual assault, or captivity.

Range of Symptoms

PTSD is characterized by symptoms such as flashbacks, nightmares, hypervigilance, and emotional numbness, whereas CPTSD often involves an array of additional symptoms, including difficulties with nervous system regulation, persistent sadness, disturbances in self-identity and self-esteem, difficulties with relationships, and a pervasive sense of hopelessness.

Causes of Complex PTSD

The causes of CPTSD can be complex and multifaceted, but they generally involve one or more of the following factors:

Childhood Neglect and/or Abuse

Childhood experiences of physical, emotional, or sexual abuse, along with caregiver neglect, can significantly intensify the effects of CPTSD. These early traumatic incidents have the potential to deeply affect a person’s mental and emotional health, leaving enduring and profound imprints.

Recurrent Trauma

People who experience trauma on a regular basis—such as ongoing domestic violence, narcissistic abuse, cults, captivity, or human trafficking—are more likely to acquire CPTSD. Multiple traumatic incidents might have a compounding effect that is too great for a person’s coping skills to handle.

Early Attachment Issues

Early childhood attachment disruptions, such as inconsistent caregiving or the death of a key caregiver, might create subsequent struggles in establishing healthy connections. The effects of later stressful events may also be amplified by these attachment problems.

Complex Interpersonal Relationships

CPTSD may develop as a result of violent or unhealthy relationships, particularly those characterized by power disparities or exploitation. These relationships could entail coercion, emotional manipulation, or control.

Loss of a Supportive Environment

Lack of a stable, caring environment or social support during or after traumatic experiences can raise the likelihood of CPTSD. Processing and recovering from trauma require a robust support network.

Cultural and Societal Factors

Societal issues, such as discrimination, systematic oppression, and cultural norms, might contribute to the development of CPTSD, particularly among marginalized or minority communities. Social injustice and discriminatory experiences can be distressing and cause ongoing emotional trauma.

Symptoms of Complex PTSD

Complex post-traumatic stress disorder is characterized by a wide range of symptoms that can significantly affect a person’s emotional, psychological, and social well-being. Some core symptoms of CPTSD include:

Emotional dysregulation: Individuals with CPTSD often find it difficult to manage their emotions effectively. They often undergo unpredictable mood swings and can feel inundated by intense negative emotions such as sadness, anger, or anxiety. These emotional difficulties can manifest as either emotional outbursts or a sense of emotional numbness and detachment.

Depersonalization and derealization: are psychological symptoms characterized by feeling detached from oneself, as if observing one’s own body and thoughts from a distance. It can create a sense of unreality and is often described as feeling like a stranger to oneself. Derealization can be both unsettling and distressing, making individuals feel disconnected from their surroundings and their own emotions.

Nervous system imbalance: refers to a disruption in the equilibrium between the sympathetic (fight or flight) and parasympathetic (rest and digest) branches of the autonomic nervous system. An imbalance can lead to a range of symptoms including anxiety, fatigue, sleep disturbances, and difficulty in concentration.

Dissociation: This coping mechanism can make individuals feel detached from their own thoughts, emotions, or the world around them. It can create a sense of unreality or disconnection from their physical selves.

Flashbacks and intrusive memories: Similar to PTSD, individuals with CPTSD may experience intrusive and traumatic memories or flashbacks of a catastrophic experience.

Disruptions in self-identity: Disruptions in self-identity are a common consequence of CPTSD. Trauma can lead to distorted self-perceptions, a diminished sense of self-worth, and enduring feelings of shame and guilt.

Difficulty in forming relationships: Building and maintaining healthy relationships can be challenging for people with CPTSD. Trust issues, a fear of abandonment, and challenges with maintaining boundaries can present significant hurdles in this regard.

Somatic symptoms: CPTSD can manifest physically with symptoms like gastrointestinal problems, headaches, and chronic pain. These physical issues often have a psychological component linked to long-term trauma.

Feelings of guilt and shame: Feelings of guilt and shame are common struggles for many survivors of trauma. These emotions often run deep, arising from a perceived sense of personal responsibility for the traumatic event or a feeling of powerlessness to prevent it.

Hypervigilance: Hypervigilance, rooted in past trauma, involves a heightened state of constant alertness. Individuals experiencing this symptom may react intensely to sudden stimuli and constantly feel on edge, as if anticipating imminent danger.

Difficulty with self-care: People with CPTSD may struggle to practice self-care, which includes maintaining a healthy lifestyle, attending medical appointments, and handling daily responsibilities.

Social isolation: Many individuals with CPTSD tend to avoid social situations due to fears of retraumatization or the belief that others cannot comprehend their experiences.

Reenactment of trauma: Some CPTSD sufferers unknowingly recreate harmful patterns by reliving certain aspects of their traumatic experiences in their current relationships or behaviors.

Feelings of emptiness and hopelessness: Patients with CPTSD often battle feelings of emptiness and hopelessness about the future, making it challenging to envision a happy and fulfilling life.

Dorsal vagal shutdown: refers to a state of immobilization or “freeze” response, governed by the dorsal branch of the vagus nerve. It’s a primitive survival mechanism that can be triggered by extreme threat or trauma. In severe cases of complex PTSD, individuals may frequently experience this shutdown, manifesting as emotional numbness, dissociation, or feeling “stuck” in their body.

How to Treat Complex PTSD

Treating complex post-traumatic stress disorder is indeed a complex and multifaceted process that often necessitates a comprehensive and personalized approach. Here are some key treatment options for CPTSD:

  • Psychotherapy. Psychotherapy is often the cornerstone of CPTSD treatment. Individual sessions, especially when utilizing approaches like CBT and eye movement desensitization and reprocessing, can be incredibly helpful. These therapies are tailor-made to target symptoms stemming from trauma, assisting individuals in working through and reevaluating troubling memories.
  • Medication. Typically, medication isn’t the initial choice for addressing CPTSD, but it can be considered when dealing with specific issues like depression, anxiety disorder, or sleep disturbances. A psychiatrist or another mental health expert can carefully assess an individual’s situation and determine whether medication may be beneficial. If deemed appropriate, they will prescribe the appropriate medications as part of a comprehensive treatment plan aimed at helping manage these specific symptoms.
  • Mindfulness and relaxation techniques. Anxiety and hypervigilance can be controlled with the help of relaxation techniques, deep breathing exercises, and mindfulness meditation.
  • Skill building. Empowering patients with the skills to manage their emotions, build healthier relationships, and enhance their self-esteem is a key element of CPTSD treatment. This often includes teaching emotional regulation, boundary setting, effective communication, and self-care strategies.
  • Self-compassion and self-care. Learning to be kind and compassionate toward oneself is essential to CPTSD recovery. Self-care, healthy boundaries, and putting one’s health first are essential components of healing.
  • Holistic approaches. Yoga, acupuncture, art therapy, and animal-assisted therapy are a few examples of complementary therapies that can be used in conjunction with conventional therapies to promote healing.

Treatment Approach

PTSD treatment commonly combines psychotherapy and medication. Therapies like cognitive behavioral therapy (CBT) and exposure therapy are often utilized to help individuals manage and recover from post-traumatic stress disorder.

Treating complex PTSD (CPTSD) is more intricate than regular PTSD because it involves addressing not only the trauma but also its profound impact on an individual’s core beliefs (schemas) and relationships. The trauma from CPTSD can distort one’s ability to trust others and oneself, which differs from standard PTSD where trauma might not always be interpersonal.

Therefore, therapy for CPTSD often requires extended periods and incorporates a blend of trauma-focused therapies such as DBT, EMDR, and somatic experiencing, all tailored to address the profound and multifaceted nature of the relational trauma.

Psychotherapy Approaches for Treating Complex Trauma

complex PTSD and Borderline personality Disorder

Dialectical behavior therapy (DBT)

DBT is another valuable approach that treats mental health conditions and psychiatric disorders associated with emotional dysregulation. DBT teaches clients how to tolerate distressing emotions, enhance interpersonal effectiveness, and develop mindfulness. These therapeutic methods offer practical tools for individuals dealing with complex PTSD. It can be particularly beneficial in treating the emotional dysregulation that is a common symptom of CPTSD.

Acceptance and Commitment Therapy (ACT)

ACT is an approach used by mental health professionals to help individuals accept their thoughts and feelings. This therapy, especially when tailored to treat PTSD, emphasizes mindfulness and values. By committing to values-driven actions, those with complex trauma histories can move beyond their traumatic past.

Cognitive Behavioral Therapy (CBT)

One of the most recognized psychological interventions, CBT, is employed by mental health professionals to treat a range of psychiatric disorders, including PTSD. By identifying negative thought patterns, CBT assists individuals in re-framing and confronting these harmful cognitions. For those with a complex trauma history, this therapy can provide essential skills to cope with distressing memories.

Prolonged Exposure Therapy

Prolonged exposure therapy, a subset of CBT, is often employed to treat PTSD. It aids individuals in confronting and reducing the distress associated with traumatic memories. Over time, this therapy can help patients see PTSD symptoms diminish as they become more accustomed to the traumatic memory. Additionally, cognitive processing therapy, an offshoot of prolonged exposure therapy, aids those who experience chronic trauma by helping them process the trauma and alter the distressing thoughts associated with it.

Somatic Psychotherapy

This trauma-focused therapy emphasizes the connection between the body and the mind. Mental health professionals utilize somatic psychotherapy to help individuals recognize and release physical tension associated with traumatic memories. For those who have experienced long-term traumatic experiences, this approach provides a unique way to heal.

A body-centered intervention used in Somatic Psychotherapy, somatic experiencing, aids in the release of tension and stress associated with trauma that has been held in the body. It can be beneficial for addressing physical symptoms associated with CPTSD.

Sensorimotor Psychotherapy

Sensorimotor psychotherapy, another trauma-focused therapy, combines somatic therapies with cognitive interventions. Mental health professionals adopt this approach to assist individuals in processing traumatic memories by integrating body and mind interventions. Those with CPTSD symptoms often find this method beneficial due to its holistic approach.

Schema Therapy

Schema therapy, utilized by mental health professional, addresses deep-rooted patterns or “schemas” formed in childhood. For individuals diagnosing complex PTSD, often stemming from childhood trauma, this therapy proves instrumental. By identifying and addressing these patterns, those with PTSD symptoms diminish and find healthier ways to relate to the world. Take the schemas quiz to find out your interpersonal schemas.

Insecure Attachment Styles and Complex PTSD

insecure attachment styles and complex PTSDComplex PTSD, often stemming from interpersonal trauma experienced over prolonged periods, significantly influences an individual’s attachment style. This type of trauma can arise from consistent exposure to abusive situations, parental misattunement, attachment wounds, or relationships, where repeated trauma combines with extreme stress, leading the individual to develop complex PTSD.

The experience of such trauma, especially when it occurs in one’s formative years, can cause individuals to develop unhealthy relationships later in life. Diagnosing PTSD, especially the complex variant, requires a comprehensive understanding of the person’s history and the nature of their traumas. One of the significant indicators, aside from other symptoms like flashbacks and avoidance behaviors, is evident relationship difficulties.

These difficulties often manifest as fears of abandonment, an inability to trust others, or a perpetual sense of danger, even in benign situations. This is closely linked to the attachment styles the individual adopts, with many displaying patterns of anxious, avoidant, or disorganized attachment. Adult survivors of prolonged interpersonal trauma might find themselves caught in a cycle where their internalized negative beliefs about themselves and the world around them sabotage their relationships.

The challenges they face aren’t just about recalling traumatic events but also about navigating relationships in their lives. While other symptoms of complex PTSD, like dissociation or emotional dysregulation, are often discussed and addressed, the profound impact on attachment and relational patterns needs equal attention.

Interpersonal Schemas in Complex PTSD

complex trauma and interpersonal schemas

CPTSD symptoms, which emerge as a result of sustained interpersonal trauma, notably alter an individual’s foundational beliefs about themselves, others, and the world. It’s as if the enduring impact of chronic trauma has handed them a pair of sunglasses tinted with maladaptive schemas, changing the color and tone of everything they see and experience.

These schemas are deeply held beliefs that shape every thought, emotion, and action. Children exposed to such traumas, like sexual and physical abuse, may face alterations in their prefrontal cortex, affecting their cognitive processes and self-regulation. While some beliefs may initially serve as protective measures, over time, they often lead to relationship difficulties and other negative feelings.

One such maladaptive schema is mistrust/abuse, rooted in the fear that others will exploit or hurt them. Many who have experienced chronic trauma see PTSD symptoms as a tip of the iceberg, often not accounting for the deeper, complex trauma history’s influence on these maladaptive beliefs.

Borderline Personality Disorder and Complex PTSD

Borderline Personality Disorder (BPD) can be a result of Complex PTSD. Borderline personality disorder (BPD) is a pervasive personality disorder marked by intense emotions and unstable relationships. While there are similarities in how they manifest, it’s essential to note that not everyone with Complex PTSD develops BPD. Most people with BPD also have CPTSD, but not everyone with complex trauma develops a personality disorder. This distinction underscores the need for a deeper understanding and clear differentiation between the two.

Individuals with complex PTSD (CPTSD) may not necessarily have tumultuous relationships, and unlike BPD, CPTSD is often ego-dystonic, making it feel inconsistent with one’s self-image. This distinction can make CPTSD more recognizable and, in some cases, easier to treat compared to ego-syntonic personality disorders like BPD.

Borderline Personality Disorder (BPD) has overlapping features with Complex PTSD. Both can exhibit issues of emotional dysregulation, feelings of emptiness, fears of abandonment, and unstable self-image. Yet, it’s crucial to emphasize that while BPD might emerge from a foundation of complex trauma, not every individual with Complex PTSD will go on to develop BPD. The overlap has led some to speculate if BPD might be better understood or even reclassified within a trauma spectrum. However, more research and clinical consensus are needed before such a change could occur.

Distinguishing Between Core Beliefs, Attachment Styles, and Personality Disorders

personality disorders, complex trauma, and insecure attachment styles

Attachment styles include a set core beliefs and coping behaviors formed from early-life interactions with caregivers, directing how we relate to others, especially in intimate contexts. For example, a child exposed to inconsistent caregiving might develop an anxious attachment style, characterized by a potent fear of abandonment.

When discussing personality disorders, one observes a more intricate relationship with CPTSD. It’s not merely an attachment style or a set of beliefs. It’s a blend of these with a rigid personality structure. Personality disorders are pervasive, affecting multiple facets of an individual’s life, including work, social interactions, and self-perception.

On the other hand, attachment styles primarily influence romantic relationships, shaping how one connects and relates to their partners. Most people who are diagnosed with a personality disorder also have an insecure attachment style, but not everyone who has an insecure attachment has a personality disorder.

While personality disorders are deeply ingrained and can be challenging to treat, attachment styles are more malleable, offering greater flexibility and potential for change throughout one’s life. Some professionals call for a separate diagnosis for CPTSD from other mental disorders because it’s evident that the consequences of complex trauma reach deep, influencing maladaptive schemas, attachment styles, and even personality disorders in profound ways.

Expanding Our Understanding of Trauma Beyond the DSM

It’s clear that we need a richer, more encompassing classification system for trauma in mental health. Current definitions, while effective for many, might leave out a considerable portion of individuals whose experiences don’t align neatly with DSM criteria. This potential misalignment could lead to misdiagnosis, inappropriate treatments, or missed treatments altogether.

With the increasing acceptance and understanding of Complex PTSD, it’s evident that there’s room for growth within our diagnostic manuals. We must take into account not just a traumatic event itself but the vast array of responses and long-term impacts they can have on an individual.

As our understanding of trauma and its varied presentations deepens, the need to enhance our diagnostic tools and criteria becomes evident. The ultimate goal remains to provide accurate diagnoses, leading to effective and tailored treatments for those in need.

Towards a Brighter Future for Trauma Understanding

The field of psychology is ever-evolving, with new research, understanding, and perspectives emerging continually. As such, our tools, including the DSM, must evolve too. By expanding our understanding and definitions of trauma, we can better serve those who seek our help, offering more tailored, effective treatments and ensuring that no one is left behind due to definitional oversights.

As mental health professionals, it’s our duty to continuously learn, advocate for our patients, and push for improvements in our field. With collective effort, the future of trauma understanding and treatment looks promising.

The Bottom Line

In our exploration of complex PTSD, we’ve unveiled the multifaceted nature CPTSD, delving into its challenging symptoms and intricate causes. While terms like Complex PTSD may not be DSM-official just yet, their increasing use in the therapy world signifies a shift towards a more nuanced understanding of trauma.

For individuals struggling with complex PTSD in the San Francisco area, finding the right therapeutic support is crucial. At the Bay Area CBT Center, a leading provider of therapy in San Francisco and recognized as one of the top Bay Area therapists, we specialize in treating complex PTSD. Our services include individual therapy, group therapy, workshops, and california online therapy, ensuring accessible and comprehensive care.

If you’re seeking a skilled psychologist in San Francisco, CA, our approach is tailored to meet the unique challenges of complex PTSD. We also offer specialized PTSD counseling in San Francisco, CA, including support for couples with a marriage therapist in San Francisco. Additionally, our online courses provide valuable resources for ongoing learning and management of complex PTSD symptoms.

Our commitment is to provide effective, empathetic support to those navigating the complexities of PTSD, helping you towards a path of healing and resilience.

Frequently Asked Questions

Evidence-based therapy involves interventions that are scientifically proven to be effective for particular issues. In this approach, a strong partnership based on trust and collaboration is formed between you and your therapist. Within this supportive and unbiased environment, you can freely express yourself without fear of judgment. Over a series of sessions, you and your therapist will work together to address obstacles and set goals aimed at personal growth and fulfillment. This method ensures that the techniques and strategies used are not only supportive but also empirically validated to help you achieve your therapeutic goals.

The Bay Area CBT Center provides therapy services for everyone, from children to adults, and welcomes individuals, couples, and groups. We help with various concerns like anxiety, depression, trauma, relationship issues, and behavior challenges. We value diversity and cultural differences, offering personalized and culturally sensitive care to each client.

Studies show that the bond between you and your therapist, known as the therapeutic alliance, is a key factor in treatment success. This alliance is characterized by the strength of your relationship and how well you both agree on treatment goals. Research indicates that individuals with a solid therapeutic alliance experience better treatment outcomes including greater productivity at work, more satisfying relationships, improved stress management, and decreased engagement in risky behaviors.

You can expect a 15-30 minute phone call with our care coordinator, who is extensively trained in ensuring the perfect match for you. During this conversation, our matching expert will collaborate with you to understand your therapy needs, preferences, and scheduling availability. This discussion builds upon the information you provided during sign-up and offers an opportunity for you to address any personal questions or concerns you may have about therapy or our services at The Bay Area CBT Center. Following your conversation, we’ll pair you with the therapist who best aligns with your needs, goals, and preferences.

At your matching appointment, we will match you with a therapist specifically chosen for you and schedule your first session. Depending on your availability, you can expect to meet your therapist anywhere from one day to a week after this appointment.

Our approach to therapy includes a flexible hybrid model, blending both online and face-to-face sessions. This option is perfect for clients situated close to our clinics in the Bay Area who prefer the flexibility of choosing between virtual consultations or meeting their therapist in person. Our aim with hybrid care is to ensure every client is matched with the ideal therapist and therapy environment, be it from the convenience of your own home or in one of our clinics.

At the Bay Area CBT Center, we accept PPO insurance plans that allow you to use out-of-network providers. This means if your insurance plan is a PPO and it includes mental health benefits, you could get back some or all of the money you pay for our services, depending on what your insurance company allows. When you see one of our therapists, they’ll give you a superbill. You can send this superbill to your insurance company to ask for reimbursement. If you’re not sure if your insurance covers services from providers not in their network, it’s a good idea to give them a call and check.

You may be eligible to have 60-80% of your costs covered by out-of-network benefits.

Also, if you have an FSA (Flexible Spending Account), you can usually use it to pay for individual counseling sessions. It’s wise to double-check with your FSA provider or talk to your accountant to make sure that counseling sessions are considered an allowed expense.


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