complex ptsd

i've seen a few people here mention complex ptsd and i happened to look it up and i'm thinking this describes pretty comprehensively what i may be dealing with. i've had major depression, am quite avoidant, and am realizing i dissociate in some fashion. i'm going to mention it to my t and see what she thinks.

complex ptsd isn't an official diagnosis yet but here are some proposed criteria. i know some here don't like labels or diagnoses but i actually find them helpful to get a sense of what it is i'm dealing with. there is a lot that can be said about it but i thought i'd just start with this. what do you think of this? do you relate to this? i'm not sure how many categories one has to identify with. one of the key features is that it refers to people who have suffered prolonged abuse or trauma.

i found the above on this blog

Reflection- Thanks for posting that. I never knew what complex ptsd was. But what is the difference between that and regulat ptsd?
I was diagnosed with borderline pd. What you posted sounds like bpd too. Very similar.

I first heard of complex ptsd from T who mentioned it in session. It sort of felt validating when I heard the "complex" word because it helped me to believe what I felt was true but other than that I don't really require a dx, because it doesn't or won't change my therapy.

A yep
B yep
C yep
D no
E yep
F yep

blue, i did read on one site that it can be quite similar to boderline pd and they mentioned insecure attachment. i'm finding some variations in the proposed diagnosis as another mentioned health problems like i have (i have something similar to chronic fatigue syndrome but i'm more avoidant rather than boderline). i'll see what i can find about the differences between ptsd and complex ptsd as i know i did read some about that. the link in my first post may have said.

blue, here's what the blog author i linked to previously said:

Thanks Reflection- I wonder what makes them "quite different"? From the description, they sound very similar. What would be the major differences?

I found this online:

Note: there has recently been a trend amongst some psychiatric professionals to label people suffering Complex PTSD as a exhibiting a personality disorder, especially Borderline Personality Disorder. This is not the case - PTSD, Complex or otherwise, is a psychiatric injury and nothing to do with personality disorders. If there is an overlap, then Borderline Personality Disorder should be regarded as a psychiatric injury, not a personality disorder. If you encounter a psychiatrist, psychologist or other mental health professional who wants to label your Complex PTSD as a personality disorder, change to another, more competent professional.

About a year ago, I asked my T if he thought I had BPD, and he said definitely not, that I had Complex PTSD. I think the way he explained it was that my "symptoms" (I'm tired, can't think of a better word) were caused by prolonged and repeated exposure to trauma, and are a direct result of that.

blue, also on the wiki for complex ptsd they say that not all (25%) who have bdp were abused but researchers think there might be more of a genetic component to it whereas of course with complex ptsd there would have to be trauma of some sort. but then the woman who is mentioned as the one who developed complex ptsd wants to see that term replace the bdp diagnosis. if that were to happen then i wonder how much one would have to have the insecure attachment to have the diagnosis. it probably wouldn't fit for me then. i know there is quite a stigma to bpd so i can understand wanting that diagnosis to have a new name. i just hope they are able to specify the various differences still.

I read all this stuff about the stigma of bpd. What do you understand the stigma to be?

There is an article on the PC site about research on BPD. A study showed there was a difference in parts of the brain, which means it's something you're born with, and not caused by trauma. I don't know how PTSD and BPD can be the same. But I also thought that environment caused BPD. I suppose it's a combination, or maybe they need to do more research first.

It seems like the 2 disorders may present similar symptoms, but the causes are quite different.

There was an interesting conversation that took place in the PTSD Forum about C-PTSD.

http://forums.psychcentral.com/showthread.php?t=98490

Really? Hmmmm.......I do feel as if I was born this way...but I have abuse in my history...so who knows. So the difference is the causes of similar looking disorders?

i've heard some ts don't want to treat clients with bpd because they are "difficult". blue, i don't know a lot about it just that i hear folks with bpd get slammed a lot which is really not helpful. personally, i would guess bpd is probably caused both by nature and nurture. i tend to think most things are both but hey i'm no doctor so take that for what it's worth. also, i've heard abuse can actually change the brain so it may be more of a chicken or egg question than people sometimes think. i'm all for destigmatizing mental illnesses. if they decide to include bpd in complex ptsd it wouldn't bother me (if it is accurate) as long as it's not a requisite because then i wouldn't fit the description of complex ptsd, and right now i'm feeling like it explains what i'm experiencing quite well. but i'll leave those questions up to the experts though since hopefully they know what they are talking about.

My T said she doesn't like to treat more than 1 or 2 people with BPD at a time. She told me she had to work harder with me because she was "careful" not to make me dependent on her. It didn't really work, lol, since I got so dependent on her anyway. I don't have the classic BPD pattern: never cut, not promiscuous, was not mistreated by my family, don't act out. I used to think only those with BPD got so attached to their Ts. Guess I was wrong about that.

The stigma is about how difficult "we" are to live with. Relationships don't last, we manipulate people, and make everyone's life miserable. There isn't a cure, some say. My T believes there is no cure, but I can be "recovered." There are many different variations of BPD, so the stereotype is not even true. Most of my friends and acquaintenances would be very surprised to hear that is my diagnosis!

I dont care what is included in what category. I suppose those things matter in order to treat someone a t doesnt know much about. Tho, my t seems to be following some sort of bpd law about closeness. My t has said I am a "high funcioning" borderline. I am assuming that means that borderlines dont function at a high level. I can function at a high level and then be quite....not high functioning. But one thing my t has said is that she doesnt see me as atttention-seeking or manipulative. That doesnt fit me. But the rest of the self-destructive, black/white thinking and acitng out fits me. And I am difficult. But I dont think I deserve the sterotype. Most of my friends also would be surprised to hear that I was diagnosed as borderline. I dont think it shows. A lot is internal and I dont make as much of a mess of my relationships as I did when I was younger. They do say people outgrow many of the symtoms of bpd......Im still waiting to grow up.......

i think it does matter about whether c-ptsd is validated, and whether it is considered different from BPD or not. i know a few ppl from within the BPD field simply want the name "BPD" changed to c-ptsd, like manic-depression was changed to bipolar -- to combat the stigma. but since many ppl with BPD do not have trauma-related histories, i'm not sure if that's a good idea. i do agree that something definitely needs to be done to combat the stigma (both in public perception & professional circles), but i dont think adopting a different disorder (if that is what c-ptsd turns out to be) is the way to go about it.

pdoc reckons i have c-ptsd. now that we have been working on it a bit more, i think my symptoms are clearing up very quickly - some more than others though, of course. so i dont know if maybe BPD - the symptoms of that - might be more chronic and harder to treat? i dont know.

the closeness thing is what i still struggle with the most. i read that a lot of therapists who work with clients who have BPD try to discourage their clients from getting too close/becoming dependent. with pdoc, it's the exact opposite - he wants me to be close, to experience trust and acceptance to the level that i can be dependent etc. i am terrified, hey. but maybe there are different treatments for the different disorders - the symptoms & presentation might be the same (or very similar), but if they have different causes/illness trajectories... i dont know?

i read recently somewhere that i don't think c-ptsd is going to make it into the new DSM when it comes out. but that was a preliminary report, so things may well change from there.

This has been my experience as well...and T has said that I have C-PTSD. Hmm...

That's the way it's been for me, too. Developing this trusting relationship, being able to rely on T, has been a pain in the rear! It has been hard to do. We haven't talked diagnosis too much, but T has said it's definitely PTSD (I assume the 'complex' part).

I think you are right- it does have a stigma that is unfortunate since what is stigmatized may not actually fit all individuals. I have some real reservations about telling any new t that I have been diagnosed. That is something I am still debating what to do about.

This lack of closeness b/c I am assuming bpd patients will get so close and enmeshed that the therapy will be affected. In my experience, the lack of closeness has hurt my therapy. And my very shaky ability to trust. It has been detrimental to my ability to feel safe and I even have felt like something must be terribly wrong with me that causes her to be so distant. She has told me stories of other patients of her where clearly she had not put up the boundries she does with me. So...what am I to think?
'

((((((((moon)))))))), honestly I think this is just abusive. It's almost like she's saying "I do THIS for my 'good' patients, but you can't have that, because you are so 'bad'". WHY is she telling you what she does with other clients? I seriously can not imagine my T doing that in a million years. I ask him questions about how he is with other clients, and he NEVER answers - he is very kind and gentle about it, but he makes me understand that what matters to me is MY therapy, and that when we are together, it's just the two of us, and whatever happens with his other clients is irrelevant.

It seems like your T has made you think that BPD is almost something to be punished. I don't know, maybe that's just me putting my own spin on things. She is just SO focused on the diagnosis. I guess I'm coming from a different perspective, because my T treats me as a person FIRST, and seems mostly concerned with meeting my needs, rather than with my diagnosis. The only time my diagnosis has come up is when I have pushed and wanted to talk about it myself. And even then, he's wanted to talk about why I want to talk about it before he will even go there.

I don't know whether you should tell a new T about your diagnosis. I wonder if a different T would diagnose you with C-PTSD instead of BPD?? I guess part of me thinks you should let a new T draw her own conclusions, and part of me wonders if you should tell her so you can be sure that you find someone who doesn't have the same feelings about BPD that your current T seems to have.

I went down the list and had all yep's.
Judith Herman seems to have introduced complex ptsd, the difference that ptsd can stem from a single traumatic occurrence & the "complex" variety comes from multiple traumas. T has shown me, through my history and current symptoms, that I have c-ptsd.

She recently told me, "you are not sick; you are wounded." frankly I struggle with her comment - from where I sit, the two are the same. Both hurt like hell and both are in great need of healing.

Maybe getting sick is due to germs or something like that, while being wounded is due mostly to other people's actions...

I have also been diagnosed with Complex PTSD though it doesn't exist in the manual yet.
My T mentioned that that Dx was chosen because all the criteria fits, as well as me having endured many years of abuse.
Honestly, I was ticked with the diagnoses. I didn't want things on my record but she told me that I didn't have to tell anyone.

I am new to posting but not to c-PTSD. I have been in treatment for it now for several years. One thing that I noticed hasn't been discussed a lot is that c-PTSD can be viewed, in many cases, as a developmental disorder as well as an anxiety disorder. When ongoing trauma occurs in childhood, when the personality is developing, its development can be very negatively affected at the stage when trauma occurs and likely beyond. The personality is thus shaped by the effects of the trauma, which can give rise to symptoms such as personality fragmentation, reliance on dissociative defenses, lack of skills for self-soothing and emotional regulation, and severe, pervasive trust, identity and self issues, etc. Because "non-complex" PTSD is unlikely to have this serious developmental aspect to it (assuming that the PTSD person's personality formed more or less normally apart from the trauma), c-PTSD treatment usually takes longer because it additionally has to address these issues in addition to the anxiety and other PTSD symptoms. New growth of the self takes time, and trust within the therapeutic relationship may take considerably longer to grow in someone who has never known a trusting relationship, for example. And new skills, such as self-soothing and self-regulation, take time to implement in the brain circuitry. When you come down to the level of an individual patient, of course, these distinctions are not written in stone, but that's the general idea.

I'm not a T but from everything I have read, it is considered important to make the distinction between PTSD and c-PTSD when making up treatment plans. Among trauma therapists, it is widely accepted that certain therapeutic strategies that are tried-and-true with PTSD can backfire and actually be quite harmful for c-PTSD. For example, the desensitization approaches that are widely used to treat PTSD are not recommended for c-PTSD. This may be because until the long-term self work is far enough along, and the self-skills of soothing and emotional regulation are in place, the c-PTSD person does not yet have the internal resources to deal front-on with the memories and gets flooded and disorganized. The results can set therapy back considerably and actually make the person worse.

Until I was accurately diagnosed with c-PTSD by my current T, I had previously had had a potpourri of diagnoses and treatments, including a hospitalization and a lot of meds. But many didn't work or gains were always temporary. New symptoms, which seemed to be inexplicable, would suddenly appear during treatment, as well as a host of physical symptoms that were being treated by medical doctors. But viewed within the c-PTSD framework, all of these symptoms came together logically, and a sensible treatment plan for me could finally be made up.

I've been in therapy for several years now and have had a lot of successes (and setbacks), e.g. new skills, better relationships, self-understanding, decreased symptoms, increased sense of control and mastery, and greater ability to trust. On the way, we have dealt slowly with my history, dissociated memories and feelings, backing off as needed to avoid my becoming overwhelmed. The exploring part of things is always entertwined with the strengthening part. It is the slower you go, the faster you will get there approach. I now have internal structure that I lacked before, which of course makes the work of therapy easier and more effective. And has fostered healing and increased well-being. I am not through yet - significant therapeutic tasks still remain to be worked through.I am still lousy at self-soothing But I am very much better than I was at the start.

BTW, my T says that I share some characteristics of BPD but not all. Some overlap, like difficulties with emotional regulation and fear of abandonment, but not others. He says BPD and c-PTSD have some overelapping symptoms but they are not the same, and treatment plans should be individualized anyway for the individual depending upon their own combination of symptoms and issues.

Tapestry - Welcome to PC!!!!

thank you SO MUCH for your clear and helpful post. This is my world all right; I feel you've described it well and I was so interested to hear that some of the things I've suspected are really true - for example, the developmental deficit aspect of c-ptsd (do you have a book or author you could point me to on this?)

Maybe I'm not doing as poorly in therapy as I've thought. It is turning out to be a long road.