Warning! Some of the material about trauma has the potential to trigger an individual’s pain. Please seeksupport if you find yourself being triggered.

Complex PTSD is a diagnosis that has been used to describe prolonged exposure to trauma by the mental health community. However, it is only more recently that diagnostic criteria have come out for complex PTSD. DSM V, which is the most influential diagnostic framework being used in the US, still does not recognize it as a category. A diagnostic category does not predict the existence of a diagnosis but it certainly helps research to happen on the diagnosis. Only then do insurances start helping with treating patients with it. Only then do institutions start recognizing and giving accommodations to people who are struggling with the problem. ICD 11, which is the major diagnostic framework being used in the world, has come up with diagnostic criteria for complex PTSD. For your information, if you would like to be aware of what they have recognized, please read on the criteria someone has to “meet” before they are “diagnosed” with CPTSD.

  • Exposure to an event or series of events of an extremely threatening or horrific nature, most commonly prolonged or repetitive events from which escape is difficult or impossible. Such events include, but are not limited to, torture, concentration camps, slavery, genocide campaigns and other forms of organized violence, prolonged domestic violence, and repeated childhood sexual or physical abuse.
  • Following the traumatic event, the development of all three core elements of Post-Traumatic Stress Disorder, lasting for at least several weeks:
  • Re-experiencing the traumatic event after the traumatic event has occurred, in which the event(s) is not just remembered but is experienced as occurring again in the here and now. This typically occurs in the form of vivid intrusive memories or images; flashbacks, which can vary from mild (there is a transient sense of the event occurring again in the present) to severe (there is a complete loss of awareness of present surroundings), or repetitive dreams or nightmares that are thematically related to the traumatic event(s). Re-experiencing is typically accompanied by strong or overwhelming emotions, such as fear or horror, and strong physical sensations. Re-experiencing in the present can also involve feelings of being overwhelmed or immersed in the same intense emotions that were experienced during the traumatic event, without a prominent cognitive aspect, and may occur in response to reminders of the event. Reflecting on or ruminating about the event(s) and remembering the feelings that one experienced at that time are not sufficient to meet the re-experiencing requirement.

  • Deliberate avoidance of reminders likely to produce re-experiencing of the traumatic event(s). This may take the form either of active internal avoidance of thoughts and memories related to the event(s), or external avoidance of people, conversations, activities, or situations reminiscent of the event(s). In extreme cases the person may change their environment (e.g., move house or change jobs) to avoid reminders.
  • Persistent perceptions of heightened current threat, for example as indicated by hypervigilance or an enhanced startle reaction to stimuli such as unexpected noises. Hypervigilant persons constantly guard themselves against danger and feel themselves or others close to them to be under immediate threat either in specific situations or more generally. They may adopt new behaviors designed to ensure safety (not sitting with one’s’ back to the door, repeatedly checking vehicles’ rear-view mirror). In Complex Post-Traumatic Stress Disorder, unlike in Post-Traumatic Stress Disorder, the startle reaction may in some cases be diminished rather than enhanced.
  • Severe and pervasive problems in affect regulation. Examples include heightened emotional reactivity to minor stressors, violent outbursts, reckless or self-destructive behavior, dissociative symptoms when under stress, and emotional numbing, particularly the inability to experience pleasure or positive emotions.
  • Persistent beliefs about oneself as diminished, defeated or worthless, accompanied by deep and pervasive feelings of shame, guilt or failure related to the stressor. For example, the individual may feel guilty about not having escaped from or succumbing to the adverse circumstance, or not having been able to prevent the suffering of others.
  • Persistent difficulties in sustaining relationships and in feeling close to others. The person may consistently avoid, deride or have little interest in relationships and social engagement more generally. Alternatively, there may be occasional intense relationships, but the person has difficulty sustaining them.
  • The disturbance results in significant impairment in personal, family, social, educational, occupational or other important areas of functioning. If functioning is maintained, it is only through significant additional effort.

The criteria given above can be overwhelming and they are meant to be used by clinicians. However, we believe that this information empowers everyone to participate in the culture of how health is viewed. And we believe that healing ourselves is contributing to that culture of chance. Please reach out to us, at Blossom, if we can help start you on that journey.

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