What is Complex PTSD? 

Do I suffer from Complex PTSD? And can EMDR help me?

Complex PTSD is also called a disorder of extreme stress in adults or developmental trauma in children and adolescents (van der Kolk, 2005). However, complex PTSD is ubiquitous and seen in clients with a background of extensive abuse and neglect in childhood. 

Surprisingly, there is no specific diagnosis for complex PTSD in the diagnostic and statistical manual. 

The current criteria for PTSD include the following symptoms: 

  1. Exposure to actual or threatened death, serious injury or sexual violence
  2. Intrusive symptoms such as flashbacks, nightmares, and emotional triggering by reminders of the trauma
  3. Avoidance of thoughts and behaviours
  4. Symptoms of hyperarousal and emotional reactivity associated with the traumatic event
  5. Negative alterations in cognition and mood
  6. Memory difficulties
  7. Negative, irrational, self-blaming thoughts about self
  8. Persistent negative emotions
  9. Social withdrawal
  10. Inability to experience positive emotions

The PTSD definition also includes reference to dissociative subtypes: 

  1. Symptoms of depersonalization: perceiving one’s self as not real or whole or connected) 
  2. Derealization: perceiving the world or the immediate environment as unreal.

However, the phenomenon of traumatization for PTSD extends beyond the criteria listed in the DSM. Highly impactful but not necessarily life-threatening events are often the origin of severe emotional problems in children and adults. It is also referred to as “small-t”. Small-t does not mean that the occurrence was minor or small in its impact, but it is more referred to as ” invisible trauma”. For example, a study in 2006 by Teicher et al. found that parental verbal aggression during childhood contributed more to adult psychiatric symptoms than physical abuse within the family. 

So, emotional disturbances and behaviour problems in the present often have their origins in previous events that were not life-threatening but were very damaging. This is true for children with ongoing exposure to adverse events (traumas of commissions) and children who had traumas of omission, failure to receive adequate nurturing, mirroring, engagement or guidance during childhood (Lyons-Ruth, 2006). 

Often, trauma survivors are unaware of how that small trauma or trauma of omission is connected to their day-to-day struggles, such as having trouble breaking risky or unhealthy habits, addictions, eating disorders, repeated relationship struggles, long-standing sleeping issues, etc. Or they might not even classify it as trauma themselves. 

There is much evidence that PTSD and small-t traumas show similar symptoms structure and follow the same course of resolution through EMDR treatment. However, treating complex trauma, with onset in childhood, requires a more individualized approach, considering each client’s unique personality structure, attachment patterns, defensive processes and dissociative separation of parts of the self. 

Don’t hesitate to get in touch with me if you suspect complex trauma or wonder how your ongoing struggles might be connected to small-t trauma. 

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