What is complex Trauma and complex Post Traumatic Stress Disorder (CPTSD)? 

There is increasing recognition that the origins of our previous definitions of Post Traumatic stress disorder focused on single events and did not account for the experiences of many individuals such a children or adults living through long-term trauma / traumatic conditions that may not have included a specific, single “life-threatening event”.  

In fact, since the most recent revision of the ICD (11th) was endorsed in 2019 and implemented in 2022, many people and services have begun to use the term Complex Trauma / Complex PTSD to better understand and seek help.  

Complex Trauma It is recognised by national organisations for PTSD such as the those in the USA as well as Australia, both organisations have published summaries regarding the history and research that has led to these changes.
 

Briefly speaking, Complex Trauma includes symptoms related to the earlier definitions of PTSD:

• Re-experiencing such as intrusive memories, flashbacks and nightmares

• Avoidance of thoughts, feelings, conversations and situation/locations associations

• Increased startle or sense of threat that can include hypervigilance

PLUS “disturbances in Self Organisation”, which is characterised by additional symptoms:

• Emotional dysregulation, including numbness or outburst as well as chronic difficulty controlling emotions

• Negative self-concept or beliefs about the self, such as being worthless or damaged/defective

• Interpersonal Difficulties in forming or maintaining relationships or the experience of being distant or disconnected within them
  

This latter section is crucial, because for many decades now, some of those symptoms were included in criteria for personality disorders such as DSM’s Borderline Personality Disorder (BPD).   It is also important to note that symptoms such as anger, headaches and other somatic symptoms that occur in different frequency in different cultural groups are also considered to be part of a trauma response in the ICD-11.

It may not come as a surprise then, that there increasing numbers of individuals previously had a diagnosis such as BPD are now considering trauma treatment and diagnoses, as they have begun to be curious about or have come to understand the significant the impact of earlier life events and dynamics that may have contributed to their symptoms or current experiences. 

In fact, the overlap is between BPD and Complex Trauma is significant, that you can find detailed articles about “BPD and Complex Trauma” on the website of highly regarded Australian organisations such as BPD Foundation Australia and Spectrum Victoria. Some clinicians may use the terms interchangeably or conjointly “BPD/Complex Trauma” to indicate the overlap and co-occurrence of these diagnostic labels especially when both might apply. 

There are also many leading researchers (such as Prof Kulkarni at Monash University’s HER research Centre) and clinicians who would have discussed and recognised the gender-based biases around diagnoses and medical systems.  Some would even argue that what we have been describing as BPD is in fact the presentation of Complex Trauma in women.   See a detailed discussion of various perspectives here.

How does Complex Trauma Therapy differ from that of PTSD?

In direct relationship with what we have already discussed, it stands to reason that Complex Trauma therapy address not only the traditionally acknowledged PTSD symptoms, but also the pervasive around self-identity, relationships and emotional dysregulation. 

It should be mentioned that almost all treatment should include the basic elements of:

• Learning about how trauma affects your mind and body

• Learning how to manage symptoms (perhaps beginning with identifying symptoms)

• Psychoeducation, rapport building, validation and reasonable and clear boundaries around the goals and limits of therapy
  

The main modalities of Complex Trauma therapy include:

• Trauma-focused Cognitive approaches include manualised approaches with strong evidence, e.g., Cognitive Processing Therapy (CPT) and more traditional/accessible Trauma informed Cognitive Behavioural Therapy (CBT) that seeks to identify and reframe unhelpful thinking patterns

• Structured skills-based therapy, such as Dialectical Behaviour Therapy (DBT), may be incredibly important for individuals in establishing and maintaining safety and wellbeing regularly, before and during more other intensive therapy

• Exposure therapies, which can include various intensity and approaches, depending on a person’s needs

• Processing Therapies, such as Eye Movement Desensitisation and Reprocessing (EMDR)

• Therapies focused upon the way a person relates to themselves and others such as Interpersonal Therapy and Mentalisation Based Therapy.
  

For some individuals, psychological treatment works best in conjunction with a comprehensive approach to care that includes medical assessment and treatments such as medications.  Please talk to your medical doctors, such as your General Practitioner (GP) or Psychiatrist, about medical treatments for Complex Trauma and inform your psychologist of any changes that might affect your body/mind. 

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