What is CPTSD?

Although CPTSD is not currently an official diagnosis, the following definition has been proposed for inclusion in the eleventh revision of the International Classification of Diseases (ICD), to be released in 2017:

Complex post-traumatic stress disorder (Complex PTSD) is a disorder that may develop following exposure to an event or series of events of an extreme and prolonged or repetitive nature that is experienced as extremely threatening or horrific and from which escape is difficult or impossible (e.g., torture, slavery, genocide campaigns, prolonged domestic violence, repeated childhood sexual or physical abuse). The disorder is characterized by the core symptoms of PTSD; that is, all diagnostic requirements for PTSD have been met at some point during the course of the disorder. In addition, Complex PTSD is characterized by 1) severe and pervasive problems in affect regulation; 2) persistent beliefs about oneself as diminished, defeated or worthless, accompanied by deep and pervasive feelings of shame, guilt or failure related to the traumatic event; and 3) persistent difficulties in sustaining relationships and in feeling close to others. The disturbance causes significant impairment in personal, family, social, educational, occupational or other important areas of functioning.

The diagnostic criteria proposed by Luxenberg, Spinazzola, and van der Kolk in 2001 is similar, but laid out more clearly here:

To be more specific about what this looks like, here are some common symptoms of CPTSD patients:

Thank you, science; you are genuinely helpful. Here's an equally accurate way of putting it:

http://www.complex-trauma.eu

A Complex Diagnosis

I mentioned I was diagnosed with PTSD, but I'm going to focus on CPTSD because I believe that's more accurate for me. The C is for Complex.

I had never heard of CPTSD until I stumbled upon some information about it last summer. I immediately recognized myself in the diagnostic criteria and suddenly my entire adult life made sense. For years before that I knew there must be something wrong with me, but I didn't have a word for it so I figured I was just weird. (As a friend helpfully pointed out, "They're not mutually exclusive!")

So why was I diagnosed with PTSD? According to the official rules, you can't have CPTSD. In the US, the rulebook we use is the Diagnostic and Statistical Manual of Mental Disorders (DSM). The rules change a lot, so I don't mind breaking them.

I recommend the DSM for entertainment purposes only, so I'm including this brief history just for context: PTSD wasn't officially recognized in the DSM until the 1980s. It soon became apparent that this diagnosis was insufficient for survivors of complex trauma, and when the DSM-IV came out in 1994, it included Disorders of Extreme Stress Not Otherwise Specified (DESNOS) under the PTSD label. The term DESNOS didn't really stick (shockingly) but is basically the same thing as what is commonly called CPTSD today. The most recent edition, the DSM-5, tacks on the additional symptom clusters of CPTSD in a single sentence under "Associated Features Supporting Diagnosis." It also allows for a dissociative subtype, which is closer to CPTSD. This edition was published in 2013, but there is still a lot of controversy over whether CPTSD should be classified as a subtype of PTSD or as a separate disorder.

This chart I stole from the internet shows the difference between PTSD and Complex PTSD symptoms. I think this is taken from the ICD-11 (another classification system that I won't get into now), but the three symptom clusters of PTSD seem to reflect the DSM-IV. In the DSM-5, Avoidance has been split into two clusters: Avoidance and Negative Alterations in Cognition/Mood, which absorbs some of the CPTSD symptoms. So the PTSD diagnosis has expanded to become more inclusive of CPTSD than this chart shows.

Fun times.

Dear Everyone

I'm sorry for being such an unreliable friend/family member/citizen the last few weeks/months/years. I have been dealing with health problems that are difficult to talk about for several reasons.

Earlier this year I was diagnosed with Posttraumatic Stress Disorder (PTSD). Not life-threatening in the traditional sense, but it affects my life every day. These days, my worst symptom is chronic fatigue. Within the past year or so, I have had to cut my work hours in half, quit volunteering, and quit dancing. At this point I am struggling to just make it to work four hours a day. I am seeing an excellent doctor, therapist and nutritionist, but progress is two steps forward and one step back. Some weeks I'm functioning at such a low level that I have to cancel all of my plans, and my energy level is so unpredictable that I often avoid making any to begin with.

So, I'm sorry if I missed your birthday/wedding/major life event. I probably didn't forget. Chances are I had it on my calendar for weeks prior, and then some hugely exhausting task like commuting got in the way. I tend to be all-or-nothing, so I probably opted to disappear completely rather than be flaky. I'm working on that mindset.

I am starting this blog to process my experience in the context of community as a part of recovery. Apparently isolation isn't healthful. I appreciate your support.