Do you have PTSD or Complex-PTSD?

A segmented diagnosis is used for those who experience symptoms of complex traumatic events

By Rachel Engel

Veterans and first responders are familiar with post-traumatic stress symptoms and the PTSD diagnosis. However, most are unfamiliar with a related condition: Complex-PTSD

C-PTSD, also known as Disorders of Extreme Stress Not Otherwise Specified (DESNOS), is used to diagnose those who suffer from chronic trauma that goes on for months or years, such as POWs or first responders who are repeatedly exposed to death and carnage on emergency calls.  

Victims of C-PTSD are often held in emotional or physical captivity, rendering them unable to escape the fear or violence. 

Who is at risk for C-PTSD?

Anyone can be diagnosed with C-PTSD, but those who work in certain career fields are more prone to developing it, such as law enforcement, firefighters, EMS, military troops. Even people who work in a field where they must repeatedly deliver traumatic news to others, such as Casualty Assistance Officers in the military who inform families when a loved one has been killed, can experience C-PTSD symptoms. 

Those who are diagnosed as having C-PTSD often have the symptoms of traditional PTSD, such as: 

  • Event flashbacks
  • Avoidance of the situation that caused the PTSD
  • Persistent negative thoughts
  • Hyperarousal: Constantly preparing for danger

But, C-PTSD sufferers also experience additional symptoms from their trauma, including: 

  • Becoming preoccupied with revenge of their perpetrator
  • Difficulty regulating their emotions
  • Experiencing emotional distrust
  • Constantly looking for a rescuer
  • Loss of faith in humanity and general hopelessness

How does treatment for PTSD and C-PTSD vary? 

Initial treatment for C-PTSD begins with similar treatments for traditional PTSD: talk therapy and medication. There are several types of talk therapy that can help relieve or temporarily scale back symptoms. 

Cognitive Processing Therapy
During CPT, victims learn how to recognize the effect of the trauma on their lives, and this recognization gives them a better perspective on how to deal with it going forward. 

Prolonged Exposure Therapy
In PE, victims are asked to talk about their experience that led to their PTSD diagnosis until it no longer affects them in a significant way. 

For C-PTSD, a defining characteristic of the diagnosis is forced captivity by the victim's perpetrator, leaving the victim feeling powerless and out of control. Restoration of the power over their own lives is crucial to healing, as well as forming strong relationships with family and friends to heal the emotional vulnerability caused by the experience. 

Phase-based treatment
New studies have shown the best way to combat C-PTSD symptoms is in a three-phase process, through improving self-management skills, reviewing traumatic memories and events and then reintegrating back into social activities. 

How hard is it to diagnose C-PTSD? 

Because so many of the symptoms of C-PTSD mirror those of traditional PTSD, victims are often misdiagnosed, leading to treatments that don't effectively help their symptoms. Due to the trauma of their experience, victims may place the blame of not being able to heal on themselves, causing more damage, instead of questioning the diagnosis itself. 

Resources for those suffering from PTSD and C-PTSD

There are thousands of books and studies on traditional PTSD and how it affects first responders. And, though being a relatively new differentiation from traditional PTSD, there are a few clinical psychologists who have written about C-PTSD that can explain the healing process. 

In "It's Not you, It's What Happened to You," Dr. Christine Courtois takes the reader through the process of how the trauma affects the brain, how that trauma manifests into symptoms and how to effectively heal. 

"Bulletproof Spirit: The First Responder's Essential Resource for Protecting and Healing Mind and Heart" is one of the most highly reviewed books discussing PTSD and those who protect the public. Dan Willis, a law-enforcement veteran, talks about the challenges facing those who work with carnage and terror on a daily basis, notably recommending regular mental health "checks" as preventative maintenance. 

"PTSD WILL NOT OWN ME" is a first-person narrative from a former sailor and a 17-year veteran of the California Highway Patrol whose law enforcement career was ended during a shooting on the job. In his book, Shane Schilperoort gives an unfiltered view of PTSD from someone who has been through it and climbed out. 

If you think you are experiencing symptoms of PTSD or C-PTSD, talk to your doctor about your concerns. If you're a veteran and are having suicidal thoughts or tendencies, contact the Veterans Crisis Line at 1-800-273-8255. 

This article, originally published April 3, 2017, has been updated.

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