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Allan Schwartz, Ph.D.Allan Schwartz, Ph.D.
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Trauma: Complex PTSD

Allan Schwartz, LCSW, Ph.D. Updated: Feb 26th 2013

Trauma: Complex PTSDOne of the factors of PTSD is that some people seem to have severe cases while others do not. In fact, whether in Iraq or Afghanistan, some soldiers were more vulnerable to extreme trauma and stress than others. As an explanation for some of these complications it has been suggested and researched that there is a form of PTSD that is called DESNOS. DESNOS stands for Disorders of Extreme Stress Not Otherwise Specified. Another and similar term is C-PTSD or Complex-PTSD.

There is a wide difference between PTSD and DESNOS. PTSD results from and extreme trauma such as what happens in a hurricane, earthquake, trauma experienced in war. PTSD is bad enough but DESNOS is even worse than that. DESNOS results from repeated and long term trauma. In other words, the  negative experiences are prolonged and repeated. The victim is at the mercy of a perpetrator and cannot get away from the situation. The perpetrator can be a parent or parents, criminal or any variety of other people.

Some of the types of trauma that contribute to DESNOS are:

1. Concentration Camps

2. Prisoner of War Camps

3. Prostitution and Living in Brothels

4. Long Term Domestic Violence

5. Long Term Child Physical Abuse

6. Long Term Sexual Abuse

7. Organized Exploitation of Children

It's important to understand that the effects of Complex PTSD fall into the three main categories of the Bio-Psycho-Social sphere. In other words the impact is so complete the it affects every aspect of life. Some of the symptoms of this disorder are:

*Substance abuse

*Enduring change in Personality

*Difficulty regulating and controlling emotions: depression, sadness, suicidal thoughts, explosive anger.

*Social isolation, distrust of others, repeated search for a rescuer and more.

*Being preoccupied with thoughts about the perpetrator, fantasies of revenge and other distortions.

*Feelings of shame, guilt helplessness and a sense of being different from other people.

*Feeling detached or dissociated from life and from other people. Also, reliving traumatic events.

*Self mutilation and other forms of self harm.

*Multiple physical symptoms including vulnerability to all types of illnesses.

There are treatments for DESNOS and they are similar as those for PTSD. However, symptoms are more persistent and difficult to treat. One of the goals of treatment is to help the patient to gain a sense of control over their lives and over their emotions.

There is debate over whether DESNOS is a separate category of diagnosis or comes under that for PTSD. Therefore, it is not as yet listed in the DSM IV, the manual used by psychiatrists and other mental health professionals to diagnose patients.

Do you know someone with DESNOS or with PTSD? Your comments, questions and observations are welcome.

Allan N. Schwartz, PhD

Allan Schwartz, LCSW, Ph.D.

Readers who live in the Boulder, Colorado metro area, or in Southwest Florida may contact Dr. Schwartz for face-to-face consultation. He is also available for psychotherapy through Skype video for those who are not in Florida or Colorado. He can be reached via email at for details.

Reader Comments
Discuss this issue below or in our forums.

cptsd - cindilu - Feb 3rd 2015

I had a car accident 2 years ago and of course I had nightmares about it and was afraid to drive etc. I was diagnosed with PTSD. But there was more than that. My personality changed, I was so angry and anxious and depressed. I had to go on medications for it. My nightmares got worse and they weren't always about the accident. They were/are about my childhood and about my first husband, horrible things that I hadn't thought about in years. I lost my job of 14 years beccause I couldn't concentrate or stay focused anymore and my ability to remember things is just gone. I've been on a  search to figure out what the heck is happening to me and this is the first article I have read that made sense to me. 

I want to help myself, so I really appreciate hearing what others are doing that works.

So Much Hope - May - Dec 22nd 2014

Having CPTSD isn't the end of the world, it's almost a badge of honor. We survived.

If I can give you one bit of experientially learned knowledge, it's this: cut the source of your trauma out of your life as much as possible. Forgive them, but don't force yourself to endure their presence. Your abusers' need to have you around is less than your need to be free. They have no claim on you. You have a right to freedom and happiness.

I was diagnosed unofficially with CPTSD about eight years ago. I had so much success with counseling, I decided I was cured. I've derived a lot of strength from my faith, and also from my logic. If doing a certain thing would help, then I was going to do it. Period. Screw my abusers, fear was not going to rule my future like it did my past. This attitude has taken me really far, and will continue to do so, but in the midst of it I also experience recurring periods of exhaustion and hopelessness. I just ride it out, ride the wave, then keep going.

I can tell you with absolute certainty that CPTSD can be managed and you can gradually recover. It helps to have a \\

Not all of us - waki - Nov 1st 2014

Hello, I doubt that many people went through what you have been. Although probably more women than men. I also have C-PSTD and with additional late traumas, it went worse, now I have to focus most of my very low energy on healing because I wan to have a life.

My case is not as bad as my mum using knives or weapons, but she would beat me with whatever was under her hand, for whatever reason, and she had been almost killed by her own mum when she was 14  --with a broom that broke on her skull. So these things pass from generation to generation.

My case is not as bad as yours though, but somehow even more complex, it is so much deeply embedded, because of birth trauma (delivery lasted 40 hours, the womb was contracting but remained closed), followed by 2 abandonments, the first at the age of 10 days (mum got admitted at hospital and rested there for a week. They did not find what she was suffering from but she was in pain --probalby depression post delivery) and again at the age of 3 months (she had to resume work 1000 km away but for some major strike across the country --France May 1968-- she could not come back for nearly 2 months). So, when my mom later was crazy and violent, I would not ressent, I guess i just had this subconscious, animal survival fear that she would abandon me again, so she could beat me, that was no problem, that was even welcome. That creates so many layers of trauma... So now, I work on myself with meditation and quiet lifestyle, --I have no children--, I practice gentle body work (yoga and taichi), and I do various short therapies with qualified and compassionate psychotherapists. I did hypnotherapy and recently have started EMDR, which is very helpful at least to understand the complete terror and darkness deep inside, of which I have never ever been aware of. It is said that EMDR helps reprogramming or healing trauma, it's not just about going into the things burried inside. I don't know, it's too early to say, but a few hours after each session, i do feel lighter.
I find also self-reparenting and Inner Child techniques all very helpful, and one can do that oneself, as there are a few good videos on youtube and many websites here and there to explain how to do it.

The thing is to decide to love oneself. Decide again. It's a path, it's not immediate but it's a commitment. One cannot respect or love anything on earth (or in heaven) if deep inside, one hates oneself or feel ashamed of being not good enough, or whatever.
Oh, I did the Tapping World Summit, a webinar on EFT, you can do that for free, next TWS will be in spring, don't miss it on the web --it's audio guided sessions for emotional release. Very good. And it's a useful tool one can use as self-help. 

Take care, there is a little one inside of us who is terrified and so desperate and sad, she/he needs our gentleness, patience, love, she/he needs to feel safe and secure at last, so we have to commit to give ourselves that safety and steady sense of caring now. We are grown up now. We can be the champion of the inner wounded self, the hopeless tiny one so scared and wounded within our psyche --within the structure of our emotional brain. We are capable, we are no more helpless children who have nowhere to run to. We have legs and freedom to go where we want to go. Freedom to run away.

Take care. With all my love. Waki. 

understudied - Angela - Sep 6th 2014

This phenomenon is spread amongst us all indeed.   I just learned today, that I have this.  I knew that I suffered multiple and varied traumas repetitively and searched multiple trauma and viola, there I was written out in words.  Validated.  However, this description understates the magnitude of my state.  My husband is a porn addict and I've had multiple surgical catastrophes.  Medically, the words are too horrific to write presently.  Relationally, I am a victim of abuse.  Both of these are compounded onto growing up and always being overweight.  Anyone who has walked that path knows that it's not pretty.   And being molested as a little girl and again as an adolescent over and over again.  

Not enough is known about this, think I'll go get my masters degree.

Makes sense - Vashti Merz Samuel - Aug 6th 2014

I started talking to a therapist a few mths ago but they haven't labelled anything, which I won't ask for. But to my way of thinking, most people in the world must have cptsd. I was physically abused by my mother as many are, all my life I lived at home ( including she stabbing me in the arm with a knife and running after me with an axe and saying she'll kill me) every day I had to cook and clean for her and the family I raised my youngest brother too as she wasn't there much for the first 8-10 years of his life. If I didn't she would beat me. many times I planned to run away but sometimes she would be nice so I thought she would change. A few months ago my father had a heart attack and after 7 years of not being back home I was booking a flight to come but was stopped by my mother raging on viber on the other side of the world telling me "don't come he needs rest it's better if he doesn't see you." After that I tried to still come but I had no more energy and didn't feel welcome ( he hasn't met two of our children) also we lost a boy at 4 mths gestation and I heamorraged and my mother rang the hospital and told them she would come to help me as I needed 3 mths bed rest so the hospital thought I had home help, then she rang me and told me sorry she's not coming anymore. I have got a tic spasm thing now on my face since the Dad having heart attack thing, And am hoping it will go away soon. My therapist is really helpful, but I'm wondering if I was labelled something would it be cptsd?  Yes I have panic attacks etc but I am not addicted to alcohol or drugs. I was thinking, most people in the world must have this thing, so many unstable people around. 

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