Complex Post Traumatic Stress Disorder in Children and Adults

Childhood abuse or long-term mistreatment in a romantic relationship can lead to complex post-traumatic stress disorder.

Reviewed and approved by the psychologist Valeria Sabater.

Written by Valeria Sabater

Last update: 20 October, 2022

Complex post-traumatic stress disorder (CPTSD) is also known as a disorder of extreme stress not otherwise specified (DESNOS). It almost always originates in childhood. It appears when an individual suffers various psychological traumas for a long time. These are situations of high and continued suffering, such as those caused by constant sexual abuse and negligence by parents.

Most of us have already heard of PTSD. However, in some cases, it’s necessary to add the “complex” label at the beginning when there are more factors at play. In fact, while the first defines a specific adverse experience, such as an assault or a car accident, the second has more peculiarities.

Complex PTSD involves negative experiences that are repeated and fed back on a daily basis. The victim is defenseless because, when they finally leave behind the harmful experience, in reality, the abysmal wound of trauma opens up. This condition was first described in the 1980s. However, today it receives much more attention from experts. Let’s take a look at it.

Complex post-traumatic stress disorder (CPTSD) or DESNOS

CPTSD is also known as DESNOS (Disorder of Extreme Stress Not Otherwise Specified). It should be noted that today this psychological reality is not yet included in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5).

It’s assumed that there are different degrees of post-traumatic stress and that one of them is particularly extreme. This is complex post-traumatic stress disorder, which has already been included in the WHO International Classification of Diseases (ICD-11).

In 2013, New York University conducted research that stressed that CPTSD or DESNOS is very different from any other kind of post-traumatic stress. Indeed, after analyzing hundreds of cases from the child and adolescent psychiatry unit of the Langone Medical Center (New York), clear evidence of this particularity could be seen. In fact, the researchers found that there are many children who, in addition to being neglected, have suffered abuse for years. In them, the psychological impact is different from the one who suffers a specific traumatic episode in their life.

What are the symptoms?

It’s important to note that complex PTSD manifests itself differently in children than in adults. Therefore, a distinction must be made.

Symptoms of childhood and adolescent C-PTSD

The early experience of an adverse situation maintained over time disrupts the normal development of the child. In fact, they usually assume that there’s something wrong with them. Indeed, in their minds, they harbor the conviction that there’s something defective in them that justifies their parents or figures in their environment for not loving them and abusing them instead. These kinds of children:

• Show slower physical and psychological development. Furthermore, they tend to suffer greater somatization and medical problems.
• Develop insecure attachments that make it difficult in the future for them to establish social and emotional relationships.
• Have a lack of emotional regulation. Consequently, they’re unable to understand and control their emotions.
• Don’t know how to express their needs.
• May suffer selective amnesia.
• Show a lack of impulse control that often leads to bouts of aggression.
• Manifest insomnia problems, night terrors, and eating behavior problems.
• Often self-harm.
• Have cognitive impairments. Among the most common is lack of attention and also problems in executive functions (planning, analysis, reflection, memory…).
• Show immaturity in language and communication skills.
• Have serious alterations in self-concept and personal image. For example, low self-esteem, feelings of shame.

Symptoms of CPTSD in adults

Complex post-traumatic stress in adults arises from various experiences. For example, traumatic dating relationships, such as those based on abuse and mistreatment. Having experienced conditions of war, or being kidnapped are other possible triggers. These are the symptoms:

• Dissociation is one of the most common. It’s a phenomenon that ranges from disconnection to depersonalization or derealization. They’re actually defense mechanisms that the mind experiences to separate itself from the focus of pain. They consist of emotionally and cognitively detaching oneself from the environment or feeling that one is not part of one’s own body.
• Amnesia or memory loss about some fragments of the past is fairly common.
• Feelings of guilt and worthlessness.
• Problems connecting, relating, and trusting others.
• Somatizations (muscle pain, digestive disorders, headaches, etc).
• Crisis in the value system.
• Dysphoric states, going from effusiveness to irritability, suffering frequent anger, outbursts of rage…
• Self-harm.
• Suicidal ideas.

How is complex post-traumatic stress treated?

In 2018, a study was conducted in collaboration with the University of Oxford, the University of Sydney in Australia, and the University of Beijing in China. This study found that one of the most effective therapeutic approaches for treating CPTSD was eye movement desensitization and reprocessing (EMDR) therapy.

The objective of this approach is for the person to integrate these lived events (often fragmented or forgotten) so that remembering them doesn’t generate so much pain and suffering. An attempt is made to restructure these experiences in the present so that they don’t disturb the well-being and balance of the person.

On the other hand, it’s also common to resort to pharmacological therapies, antidepressants being especially useful. However, as we well know, each case is unique and exceptional. The most important thing is to obtain specialized support as soon as possible so that these realities don’t worsen or reach extreme levels.