Complex PTSD: Does It Exist?

Please Note:  I first published this post in 2012, a time when the DSM-IV was being revised prior to publication of the DSM-V.  Unfortunately, C-PTSD/DESNOS was not accepted into the DSM-V as a distinct diagnosis.  As a result, the existence of this disorder has been denied by some professionals, and people who may be suffering from the disorder are having a tough time getting the treatment they need in order to heal.  Today, December 8th, 2014, I wrote a followup to this article and described what I have discovered as I have become aware of the prevailing attitude held by professionals here where I am living now, a small town in a rural area in Washington state.  As I see it, the only thing that will bring about a more general acceptance of C-PTSD/DESNOS and will possibly lead to more effective treatment of people who have abuse-caused C-PTSD is inclusion in the next edition of the DSM, DSM-VI.  If you can do anything to insure the inclusion of C-PTSD/DESNOS in the manual, please do it!  As you will read in the post I wrote today, I am going to try my best to help the cause.  Please join me in any way you can!  Thank you .  .  . Jean

April, 2012

The other day I read an article by Bessel A. van der Kolk M.D. titled “The Assessment and Treatment of Complex PTSD.” * The article was long and somewhat difficult for me to read because I am not a trained mental health professional and am not used to reading articles written in APA style by high-powered researchers and doctors, but I did my best to get through it with some understanding of its main points. Since Bessel A. van der Kolk is a pioneer in the field of PTSD research and treatment, I read his articles with interest whenever I come across them. *(To find this article, type the title into Google.)

Bessel van der Kolk's article interested me for several reasons, among them 1. the fact that the people who put together and publish the DSM have not listed Complex PTSD as a diagnosis in itself but are presently considering including “Complex PTSD” as a separate diagnostic category in the DSM V and 2. the fact that many people with symptoms and histories that indicate the presence of Complex PTSD must presently be given a diagnosis of PTSD or “prolonged PTSD” when the Complex PTSD diagnosis might more accurately describe their condition. Here is the Wickipedia definition of C-PTSD: “Complex post-traumatic stress disorder (C-PTSD) is a psychological injury that results from protracted exposure to prolonged social and/or interpersonal trauma with lack or loss of control, disempowerment, and in the context of either captivity or entrapment, . . .” (To find the complete Wickipedia definition and other definitions, type “complex ptsd definition” into Google.)

After I finished reading the van der Kolk article and had some time to reflect upon the reading, I experienced sadness, a sadness of the sort that happens when one might see himself or herself described so clinically in writing. Bessel van der Kolk had described certain aspects of my psychological makeup better than I could describe them—the low self-esteem, the tendency to overreact internally to certain interpersonal interactions that don’t seem to bother other people, my past tendency toward self harm during times of high stress due to interpersonal interactions, all the common PTSD symptoms, and so forth. I wrestled with the sadness for a few days, and then it lifted. I was left wondering if maybe reading journal articles on PTSD should be written into my list of “things NOT to do.” However, I know that the next time I see an interesting-looking article on PTSD, I’ll probably read it, especially if it is written by Bessel A. van der Kolk. My desire to know always trumps potential discomfort.

Another person whose articles I usually read is Judith Lewis Herman, M.D. A few days before I read the van der Kolk article, I had read Herman’s article titled “Complex PTSD: A Syndrome in Survivors of Prolonged and Repeated Trauma.”* Judith Herman and Bessel van der Kolk state many of the same points in their articles, but they state them differently. I found Judith Herman’s article easier to read because it is written using somewhat less clinical terminology and a more narrative style than that of Bessel van der Kolk. However, both authors make a point of emphasizing the fact that the presence of Complex PTSD, in the past often associated mainly with people returning home from battle, is also frequently found in people who have never seen a military battlefield but who have experienced prolonged neglect and abuse on the “family battlefield” as children and then possibly later as battered spouses, members of a cult, or prisoners. According to both van der Kolk and Herman, a few of the factors that appear to lay the foundation for Complex PTSD on this non-military “battlefield” are the prolonged nature of the abuse; the ongoing and overwhelming sense of powerlessness and hopelessness experienced by the victim; a prolonged state of being held captive, whether the captivity be in a concentration camp, a cult, or a family setting; and chronic repeated traumatization. *(Judith Herman’s article is also available if you type the title into Google.)

As one might imagine, treating a person suffering from Complex PTSD (C-PTSD) is, according to both authors, more complicated than treating PTSD brought on by a single traumatic occurrence. Van der Kolk, in his article, presents a list of steps used in treating PTSD and then presents a revised list that includes similar steps with modifications for treating C-PTSD. The complex nature of C-PTSD, of course, was no news to me! I’ve been chewing away at the treatment process now for decades, much of the time trying to do the job on my own—for the most part, futility in action, I discovered. Now that I have found a therapist with the skills and experience necessary to help me, I realize the impossibility of trying to “fix” myself without knowing how and without help. A person with C-PTSD or PTSD must have skilled help; the job is not a do-it-yourself project nor is it a project that should be left to therapists who do not have the skill or knowledge base necessary to effectively treat C-PTSD/PTSD victims!

After reading the two articles and recognizing my own history and symptoms in both, I have a clearer understanding of where I am and where I need to go. Frankly, I’m not sure that I will “get there” before I die, a disconcerting reality to face! Can I repair the damages of the first forty years of my life in just, say, five years? Probably not. However, any progress I make in the process of trying to repair the damages is to the
good and will make my life better in some way. I believe that. I must believe that! I do have evidence for the truth of this belief because since I’ve been in therapy, I can stay in the moment, usually, when somebody acts out on public transportation. A year ago that was not the case. Since I have no car and must, therefore, use public transportation to get from one place to the other, I am really happy that this part of my life has improved!

To return to the original question as posed in the title to this article—Complex PTSD: Does It Exist?—my short answer is “Certainly it does, and I have the marks to prove it!” Obviously, Bessel A. van der Kolk, Judith Lewis Herman, and a host of other experts also believe that Complex PTSD not only exists but exists as a diagnosis in itself, a condition that has many of the same characteristics as PTSD but yet is not exactly like PTSD in certain important respects. Perhaps establishing a diagnostic category called C-PTSD isn’t important to everyone with PTSD, but it is important to me. If I am going to be diagnosed and labeled, I want my diagnosis and label to describe my condition as accurately as possible. Thus, I hope to see Complex PTSD listed as a diagnostic category in the DSM V when it is published in 2013.