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Complex (Chronic) Post-Traumatic Stress Disorder
(PTSD)

Post-Traumatic Stress Disorder (PTSD), is a form of anxiety disorder that may develop after exposure to a trauma with physical injury or where physical threat was perceived. Trauma can include violent assaults, natural disasters or human-created disaster, and accidents.

Some PTSD patients suffer from Complex or Chronic PTSD. This condition is seen in patients who suffer long-term abuse or exposure to terrifying conditions (e.g. teenage prostitutes, residents or soldiers in war-torn countries, children who are abused in the home.

If symptoms of PTSD persist for more than three months after diagnosis, the diagnosis is changed to chronic post-traumatic stress disorder, which is a sub-form of PTSD. This disorder is sometimes called Extreme Stress Disorder or Disorder of Extreme Stress. Whatever the name, it is a debilitating disorder that causes the patient to avoid activities that may bring on memories or flashbacks related to the repeated trauma they experienced.

Survivors of repeated and long-term trauma actually have chemical and hormonal changes in their brains. It is believed that these changes result from early or prolonged trauma, and may contribute to behavioral and eating disorders, alcohol and drug abuse and self-destructive behavior. Sometimes survivors forget some or all of the events and remember them later when a stimulus triggers a memory, or when the patient is under extreme stress. The physical and emotional symptoms of chronic or complex PTSD are severe, and if the survivor does not seek treatment, they will typically begin to have problems at work, in school, at home and in social settings.

What are the symptoms?

New research and diagnostic tools enable doctors to more quickly diagnose Chronic PTSD and, with time, it is hoped that the public will be educated on this disorder and stop blaming survivors for their symptoms. Because of the chronic victimization endured by the survivor, they are often misdiagnosed as Borderline, Dependent, or Masochistic Personality Disorder. Doctors will typically perform medical and psychiatric examinations to rule out other causes for the patient’s symptoms. Treatment(s) can include:

• Headache, gastrointestinal symptoms, immune system depression, dizziness, chest pain, thyroid abnormality
• Hyper-arousal of nervous system, hyperactive startle reflex
• Interpersonal and social problems
• Feelings of detachment and estrangement, feeling numb
• Feeling strange and out of place
• Agitation when exposed to sense memories reminding patient of trauma (touch, smell, taste or sound)
• Blanks or gaps in memory of traumatic event, amnesia
• Avoiding activities, people, discussions or sensations that remind you of trauma
• Difficulty in experiencing strong feelings of love or attachment, distrust of others
• Heart pounding, difficulty breathing
• Self blame or feelings of guilt about the trauma, shame
• Alcohol and drug abuse
• Eating Disorders, Personality Disorders, Dissociative Disorders
• Reliving traumatic episode, realistic flashbacks (minutes or hours, occasionally for days), nightmares, frightening images and thoughts
• Insomnia or interrupted sleep cycles, trouble falling asleep or staying asleep
• Shaking, trembling, sweating
• Abnormal neuro-hormonal levels (cortisol, epinephrine, norepinephrine, natural opiates)
• Feelings of danger or fear or panic
• Physical numbness or strange physical sensations that can’t be otherwise explained
• Rage, Anger, aggression, need to defend self, inhibited anger, wanting revenge
• Memory and cognitive difficulties, inability to focus or concentrate
• Depression, loss of interest in activities that used to be pleasurable, loss of religious beliefs or hope
• Inability to feel pain or sensation
• Physical health symptoms that do not have any other cause
• Self Esteem and Identity problems
• Self Destructive Behavior, Sexual Dysfunction or Acting Out, Suicidal Thoughts

In our society, a person who has been repeatedly abused is often mistaken as weak. When survivors are blamed for the symptoms, they will often withdraw and, out of shame, refuse to seek treatment.

How is it diagnosed and treated?

New research and diagnostic tools enable doctors to more quickly diagnose Chronic PTSD and, with time, it is hoped that the public will be educated on this disorder and stop blaming survivors for their symptoms. Because of the chronic victimization endured by the survivor, they are often misdiagnosed as Borderline, Dependent, or Masochistic Personality Disorder. Doctors will typically perform medical and psychiatric examinations to rule out other causes for the patient’s symptoms. Treatment(s) can include:

• Psychodynamic Therapy
• Psychotherapy
• Eye Movement Desensitization and Reprocessing (EMDR)
• Cognitive Behavioral Therapy
• Group and Family Therapy
• Medication (Sertraline, psychotropic medications, lorazepam, neuroleptics, haldol, anticholinergic, antiadrenergic agents (clonidine, guanfacine, propranolol) Seratonin Reuptake Inhibitors (SSRIs), Antidepressants
• Coping Skills for Survivor and Family

Treatment usually takes a lot longer than the treatment course for regular PTSD, and it may progress at a slower rate, and require structured treatment by a trauma specialist.

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