Why it’s so hard to know you have CPTSD

Most of us are trained in the treatment of single traumatic events and the diagnosis of post-traumatic stress disorder (PTSD). But from my years of experience now, I can see 90% of clients come to therapy with an extensive history of trauma that begins in childhood and continues into adulthood with layers of personal, relational, societal, or cultural losses. This is complex PTSD (C-PTSD), a diagnostic term that accounts for the consequences of repeated or chronic traumatization.

For example, child abuse or childhood trauma — physical abuse, emotional abuse, sexual abuse, and neglect — often develops into C-PTSD. Clients with C-PTSD often feel overwhelmed by their pain and have organized their sense of self around survival.

Their wounds might sound like:

  • “I was physically abused as a kid. I am suffering from several health issues and pain, sometimes I wish I had not been born. Life is too painful.”
  •  “I have never felt safe. I witnessed my dad beat up my mum and saw her bleeding many times. My 1st memory was dad took a knife and chased after my mum, I was only four then.”
  • “I have grown up always feeling angry and guarded. I am very suspicious about my surroundings and people around me all the time. I don’t know what it feels like to be ‘safe'”.
  • “My childhood seemed “okay”, but I was always alone, no one would come and ask me how I was doing. My parents are always busy.”

When a child experiences neglect, anxiety, or danger repeatedly in a close relationship, that child often grows up with a sense that they are not okay. In our practice as trauma-informed therapists, we recognize that many of those seeking our care have a history of trauma throughout their childhood. It is likely they have complex trauma that has resulted in C-PTSD. It’s hard for trauma survivors themselves to recognize this.Many people are so accustomed to living in a state of alertness that they are unaware that trauma is the cause of their feelings of being “not okay.” For this reason, I wish to talk about C-PTSD here and reassure others that they are not broken, even if they feel helpless or overwhelmed. They have wounds, but they can be healed.

It is very common for individuals with C-PTSD to have been in therapy for years. Some might feel cautious about therapy because of historical experiences where they have been misunderstood, misdiagnosed, or blamed for their symptoms. I have had a client who was laughed at by her psychiatrist when she said she suffered from C-PTSD. The psychiatrist said, “What has your past got to do with your future?” This is a very ignorant doctor, who has not updated himself/herself.

Clients like this might come to therapy with well-constructed defenses, reluctantly, and body tension that serve as their protection armor, to protect them from underlying fear, helplessness and shame.

‘Complex PTSD’ was originally conceptualized by Herman (1992), to describe complex behavioural conditions in survivors of prolonged or multiple trauma, where trauma escape is difficult or impossible, and entails changes in affect regulation, consciousness, self-perception, and relationships with others, among other symptoms. Despite supporting empirical evidence, the diagnosis was not included in the DSM-IV but was included in an appendix with research diagnoses under the name ‘disorders of extreme stress not otherwise specified’ (DESNOS) (American Psychiatric Association [APA], 2000).

Most of the clients who suffer from C-PTSD have common sleep issues. They have difficulty sleeping at night or waking up from bad dreams because they are more sensitive to threats and rely on instinctive defense mechanisms. For most, these protective behaviors have been essential for their survival, and they don’t want to give them up easily.

Clients with long-term and chronic trauma are smart, and they’ll notice if we don’t approach therapy with authenticity. It’s our job to win their trust, which can be difficult, especially if they’ve experienced betrayal in past relationships. But if we do our job right, we may be entrusted with a holy mission: to witness their pain and attend compassionately to their wounds.

Clients are not “broken”, they are hurt and in need of empathy and compassion. Our ability to understand their perspective and stand in their shoes and desire to be of service in relieving their suffering.

Schwartz, A. (2021). The Complex PTSD Treatment Manual: An Integrative, mind-body approach to trauma recovery. PESI Publishing.
Nestgaard Rød, Å., & Schmidt, C. (2021, December 9). Complex PTSD: What is the clinical utility of the diagnosis?. European journal of psychotraumatology. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8667899/