For those of us who have sought treatment for the symptoms of complex post-traumatic stress disorder, here at CPTSD Foundation, know how difficult it is to find a therapist trained to treat us. In fact, in the United States, finding a therapist specifically for CPTSD is exceedingly arduous.
This set of articles will explore the mental health disparities displayed in finding help for one of the nation’s most significant and fastest-growing mental health disorders.
Attempting to Find Treatment
We have already discussed the futility of searching Google to find a specialist in CPSD, what about the other resources out there to find a therapist.
There are dozens of websites, including the site for the Substance Abuse and Mental Health Service Administration (SAMHSA). However, most, if not all, of these sites do not search for complex post-traumatic stress disorder. Instead, they may search for therapists who are trauma-informed or treat post-traumatic stress disorder instead.
Finding a therapist who is trauma-informed or treats PTSD is enormously easier than searching for someone who treats CPTSD specifically. Psychology Today has its own search program to help one find a therapist that treats PTSD and is trauma-informed.
Trauma-informed care (TIFC) done by a trained therapist offers an approach to understanding the entire person who is seeking treatment. Since trauma affects one’s sense of self and their beliefs about the world, TIFC serves to directly challenge the assumptions that a trauma victim may have about themselves and others.
The therapist who is trained in trauma-informed care will strive to aid their client in recognizing how the events changed how they see themselves but also fights not to retraumatize the person seeking treatment.
The Differences in Treatment
So far, the treatment for complex post-traumatic stress disorder and post-traumatic stress disorder are strikingly the same.
The treatment options commonly adopted for the care of post-traumatic stress disorder include trauma-focused psychotherapies, including cognitive processing therapy (CPT) and prolonged exposure (PE).
Cognitive processing therapy teaches trauma victims to reframe their negative thoughts about what happened during the traumatic event. CPT involves victims talking with a therapist about their negative thoughts and doing short writing assignments to change the story of what happened to them.
Prolonged exposure therapy (PE) teaches victims of trauma living with PTSD to gain control by talking about the trauma in treatment. During therapy, the client will be encouraged to go ahead and do the things they have avoided. This intentional exposure to triggers will desensitize the brain of victims, calming the fight/flight/freeze response.
To treat complex post-traumatic stress disorder, therapists often take a drastically different approach. They may use cognitive behavioral therapy (CBT) or eye movement desensitization and reprocessing therapy (EMDR).
Cognitive-behavioral therapy involves talking to a therapist who will help steer one away from the traumatic events in the past. They will then replace those memories with new methods of thinking to help the client navigate their way through the trauma to health.
EMDR is a treatment option that is available for both CPTSD and PTSD. Eye movement desensitization and reprocessing therapy help people who live with the diagnosis of CPTSD by using the movements of their eyes to process and deal with the emotions and flashbacks that occur during treatment.
Using EMDR involves remembering the trauma while paying close attention to a back and forth movement of fingers or a repetitive sound. This combination of remembering and movement somehow has been found to desensitize the brain to the trauma of the past.
Doing a Google Search
Like many of us who live with the effects of CPTSD on our lives, you have probably conducted a search on Google to try and find a therapist. When you do carry out a search for a CPTSD trained therapist, one is met with a long list of ads for therapists with treatment options for post-traumatic stress disorder.
There are distinct differences between complex post-traumatic stress disorder and post-traumatic stress disorder, such as the following.
Post-traumatic stress disorder is caused by a single event such as a natural disaster, a terrorist attack, or a rape.
Unlike PTSD, Complex post-traumatic stress disorder is caused by a series of brutal, traumatic events that may last decades. These traumatic events may include:
- Emotional abuse
- Neglect
- Sexual abuse
- Mental abuse
- Human trafficking
- Physical abuse
- Domestic violence
- Being a prisoner of war
- Surviving a concentration or internment camp
- Living in a war zone
The symptomology of each of these chronic mental health disorders is also different. While some do overlap, the difference between the two disorders is striking.
A few of the host of symptoms of PTSD:
- Intrusive and distressing memories of the traumatic event
- Intense distress when triggered by a similar event to the traumatic event
- Persistent and exaggerated negative expectations about oneself or the world
- Have distorted blame of self or others for the consequences or cause of a traumatic event
- Persistent anger, shame, horror, and guilt
A few of the host of symptoms of CPTSD:
- Difficulty regulating emotions especially rage
- Losing memories of the trauma
- Depression
- Suicidal thoughts or actions
- Feeling ashamed
- Having difficulty forming or maintaining relationships
The list above contains only a few of the myriad of symptoms of both post-traumatic stress disorder and complex post-traumatic stress disorder.
As one can see, many of the symptoms of post-traumatic stress disorder are more outwardly focused while the symptoms of complex post-traumatic stress disorder are focused inward.
Follow the Money
The reason behind this difficulty in even finding a listing for a therapist in the United States who treat complex post-traumatic stress disorder is that it is not yet recognized in the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5).
The DSM-5 is the bible, published by the American Psychological Association, that all therapists follow to diagnose and treat mental health disorders. It is also, unfortunately, where therapists get their diagnosis codes for payment from insurance companies, Medicare, and Medicaid.
This lack of listing in this crucial reference for therapists means that therapists will not get paid by insurances if they treat CPTSD. All the more reason to lobby the American Psychological Association to include complex post-traumatic stress disorder under its own heading.
A Call To Action
Are you a survivor or someone who loves a survivor and cannot find a therapist who treats complex post-traumatic stress disorder? Please, contact CPTSD Foundation. We have a staff of volunteers who have been compiling a list of providers who treat CPTSD.
Are you a therapist who treats CPTSD? Please, consider dropping us a line to add you to our growing list of providers. You would not only get aid in finding clients but also you would be helping someone find the peace they deserve.
If you or a loved one are living in the despair and isolation that comes with complex post-traumatic stress disorder, please, come to us for help. CPTSD Foundation offers a wide range of services including:
All our services are reasonably priced, and some are even free. So, to gain more insight into how complex post-traumatic stress disorder is altering your life and how you can overcome it, sign-up, we will be glad to help you. If you cannot afford to pay go to www.cptsdfoundation.org/scholarship to apply for aid. We only wish to serve you.
References:
Harris, M. & Fallot, R. D. (Eds.) (2001). Using Trauma Theory to Design Service Systems. New Directions for Mental Health Services. San Francisco: Jossey-Bass.
Substance Abuse and Mental Health Services Administration (2014). A Treatment Improvement Protocol: Trauma-Informed Care in Behavioral Health Services, Tip 57. U.S. Department of Health and Human Services, 14-4816.
My name is Shirley Davis and I am a freelance writer with over 40-years- experience writing short stories and poetry. Living as I do among the corn and bean fields of Illinois (USA), working from home using the Internet has become the best way to communicate with the world. My interests are wide and varied. I love any kind of science and read several research papers per week to satisfy my curiosity. I have earned an Associate Degree in Psychology and enjoy writing books on the subjects that most interest me.
Related
Complex post-traumatic stress disorder (CPTSD) is closely related to post-traumatic stress disorder (PTSD). However, it usually develops due to repeated trauma over months or years rather than a single event.
Most people are familiar with PTSD, an anxiety disorder that results from a traumatic event, such as a natural disaster or car accident.
However, a similar condition called CPTSD is becoming more widely recognized by doctors in recent years. Read on to earn more about the symptoms, causes, differences from PTSD, diagnosis, treatment, and more.
What are the symptoms?
The symptoms of CPTSD usually include those of PTSD, plus an additional set of symptoms.
Symptoms of PTSD
Reliving the traumatic experience
This can include having nightmares or flashbacks.
Avoiding certain situations
You might avoid situations or activities, such as large crowds or driving, that remind you of the traumatic event. This also includes keeping yourself preoccupied to avoid thinking about the event.
Changes in beliefs and feelings about yourself and others
This can include avoiding relationships with other people, not being able to trust others, or believing the world is very dangerous.
Hyperarousal
Hyperarousal refers to constantly being on-alert or jittery. For example, you might have a hard time sleeping or concentrating. You might also be unusually startled by loud or unexpected noises.
Somatic symptoms
These refer to physical symptoms that don’t have any underlying medical cause. For example, when something reminds you of the traumatic event, you might feel dizzy or nauseated.
Symptoms of CPTSD
People with CPTSD typically have the above PTSD symptoms along with additional symptoms, including:
Lack of emotional regulation
This refers to having uncontrollable feelings, such as explosive anger or ongoing sadness.
Changes in consciousness
This can include forgetting the traumatic event or feeling detached from your emotions or body, which is also called dissociation.
Negative self-perception
You may feel guilt or shame, to the point that you feel completely different from other people.
Difficulty with relationships
You might find yourself avoiding relationships with other people out of mistrust or a feeling of not knowing how to interact with others. On the other hand, some might seek relationships with people who harm them because it feels familiar.
Distorted perception of abuser
This includes becoming preoccupied with the relationship between you and your abuser. It can also include preoccupation with revenge or giving your abuser complete power over your life.
Loss of systems of meanings
Systems of meaning refer to your religion or beliefs about the world. For example, you might lose faith in some long-held beliefs you had or develop a strong sense of despair or hopelessness about the world.
It’s important to note that symptoms of both PTSD and CPTSD can vary widely between people, and even within one person over time. For example, you might find yourself avoiding social situations for a period of time, only to start seeking potentially dangerous situations months or years later.
If you’re close to someone with CPTSD, it’s also important to remember that their thoughts and beliefs might not always match up with their emotions. They might know that, logically, they should avoid their abuser. However, they might also hold onto a sense of affection toward them.
What causes CPTSD?
Researchers are still trying to figure out exactly how traumatic stress affects the brain and leads to conditions like CPTSD. However, studies on animals suggest that trauma can have lasting effects on the amygdala, hippocampus, and prefrontal cortex. These areas play a big role in both our memory function and how we respond to stressful situations.
Any type of long-term trauma, over several months or years, can lead to CPTSD. However, it seems to appear frequently in people who’ve been abused by someone who was supposed to be their caregiver or protector. Examples include survivors of human trafficking or ongoing childhood sexual abuse by a relative.
Other examples of long-term trauma include:
- ongoing physical, emotional, or sexual abuse
- being a prisoner of war
- living in an area of war for long periods of time
- ongoing childhood neglect
Are there any risk factors?
While anyone can develop CPTSD, some people may be more likely to develop it than others. Aside from having past traumatic experiences, risk factors include:
- underlying mental illness, such as anxiety or depression, or a family history of it
- inherited personality traits, which is often referred to as temperament
- how your brain regulates hormones and neurochemicals, especially in response to stress
- lifestyle factors, such as not having a strong support system or having a dangerous job
How is it diagnosed?
CPTSD is still a relatively new condition, so some doctors aren’t aware of it. This can make it hard to get an official diagnosis, and you might be diagnosed with PTSD instead of CPTSD. There’s no specific test for determining whether you have CPTSD, but keeping a detailed log of your symptoms can help your doctor make a more accurate diagnosis. Try to keep track of when your symptoms started as well as any changes in them over time.
Once you find a doctor, they’ll start by asking about your symptoms, as well as any traumatic events in your past. For the initial diagnosis, you likely won’t need to go into too much detail if it makes you uncomfortable.
Next, they may ask about any family history of mental illness or other risk factors. Make sure to tell them about any medications or supplements you take, as well as any recreational drugs you use. Try to be as honest as you can with them so they can make the best recommendations for you.
If you’ve had symptoms of post-traumatic stress for at least a month and they interfere with your daily life, your doctor will likely start with a diagnosis of PTSD. Depending on the traumatic event and whether you have additional symptoms, such as ongoing relationship problems or trouble controlling your emotions, they may diagnose you with CPTSD.
Keep in mind that you may need to see a few doctors before you find someone you feel comfortable with. This is very normal, especially for people dealing with post-traumatic stress.
How is it treated?
There are several treatment options for CPTSD that can both reduce your symptoms and help you better manage them.
Psychotherapy
Psychotherapy involves talking with a therapist either alone or in a group. It also includes the use of cognitive behavioral therapy (CBT). This type of treatment helps you identify negative thought patterns and gives you tools to replace them with more healthy, positive thoughts.
Your doctor might also recommend dialectical behavioral therapy, a type of CBT that helps you better respond to stress and build stronger relationships with others.
Eye movement desensitization and reprocessing (EMDR)
EMDR is commonly used to treat PTSD, and it can be helpful for CPTSD as well. You’ll be asked to briefly think about a traumatic moment while moving your eyes from side to side. Other techniques include having someone tap on your hands instead of moving your eyes. Over time, this process may help to desensitize you to traumatic memories and thoughts.
While there’s some debate within the medical community over its use, the American Psychological Association conditionally recommends it for PTSD. This means that they recommend it but additional information is still needed due to insufficient evidence.
Medication
Medications traditionally used to treat depression can also help with symptoms of CPTSD. They tend to work best when combined with another form of treatment, such as CBT. Common antidepressants used for CPTSD may include:
- sertraline (Zoloft)
- paroxetine (Paxil)
- fluoxetine (Prozac)
While some people benefit from using these medications long term, you may only need to take them for a short period of time while you learn new coping strategies.
Living with CPTSD
CPTSD is a serious mental health condition that can take some time to treat, and for many people, it’s a lifelong condition. However, a combination of therapy and medication can help you manage your symptoms and significantly improve your quality of life.
If starting treatment sounds overwhelming, consider joining a support group — either in person or online, first. Sharing your experience with people in similar situations is often the first step toward recovery.
