What People Don’t Understand About PTSD

The popular understanding of PTSD describes a real and debilitating condition, but it’s not the most common form of PTSD.

January 10, 2021

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PTSD Isn’t Always Like The Movies

The most widely held understanding of Post Traumatic Stress Disorder is one which has been popularised by film and television. It’s a version characterised by flashbacks and panic attacks, almost exclusively following acutely violent or threatening events. 

This is a very real condition which can have a significant and debilitating impact on individuals, especially those whose work routinely exposes them to such trauma. While such responses to trauma in the short term are normal, it’s categorised as a ‘disorder’  when symptoms persist, recur or intensify for months, or begin to interfere with our ability to function normally in our daily lives.

But there’s another and far more common form of PTSD which is less well understood, and it’s called Complex Post Traumatic Stress Disorder, or ‘C-PTSD’. 

C-PTSD describes the impact of ongoing, longer-term forms of trauma which occur during developmentally important periods of life, such as childhood or young adulthood, or at other times of extreme vulnerability. Rather than a singular threatening event, this form of trauma is often inflicted by individuals intentionally and often involves a power imbalance such as older-younger, parent-child, teacher-child or boss-employee.

Examples of such trauma may include parental neglect, a parent’s drinking or substance addiction, witnessing or experiencing domestic violence, the death, imprisonment or separation of a loved one, or instances of physical abuse, sexual abuse or emotional abuse. “Trauma from our childhoods, especially early childhood, has an especially deep impact because it’s inflicted while our social, emotional and physical responses and identities are still developing,” says Tori McCarthy, a senior therapist at Sydney’s South Pacific Private, an addiction and mental health tretment centre with a special focus on trauma.

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Understanding Complex PTSD

“Trauma that an individual perceives as intentionally inflicted, and when it occurs in an intimate, interpersonal relationship, can have a long-lasting negative impacts,” McCarthy says. Sexual or physical abuse from a caregiver or authority figure can have especially deep impacts, even if memories of the events have faded, been blocked out or become jumbled. “That kind of trauma wreaks havoc with our notions of trust, our sense of self and ability to maintain healthy relationships.”

Several symptoms of C-PTSD and PTSD are quite similar, they may include:

  • Hyperarousal, which describes being easily startled, on high alert or feeling an ongoing sense of threat
  • Intrusions, which describe past traumatic experiences recurring in our thoughts, and are sometimes described as flashbacks.
  • Avoidance, which describes a defence mechanism which may include withdrawing from others, avoiding emotional triggers, or numbing feelings with substances, behaviours, addictions or self-harm.

Symptoms which are more unique to C-PTSD include:

  • Emotional dysregulation, which describes struggling to control our mood and emotions.
  • Negative self-concept, which describes a persistent feeling of worthlessness and defeat as well as extreme feelings of shame and guilt.
  • Disturbance in relationships, which describes ongoing difficulties in forming and sustaining relationships, including within friendships, partnerships, families and the workplace.

Trauma’s Long-Lasting Impact

McCarthy says that because C-PTSD symptoms can persist for years after the trauma and last deep into adulthood, they can be mistaken for inherent personality characteristics or other mental health issues. Such symptoms may include an unhealthy relationship with shame, enduring sadness and loneliness, issues with body image and self-worth and/or an ongoing search for, or reliance upon a ‘saviour’.

“Close friends and family members, including the individuals themselves, may not realise that the challenges they’re experiencing in adulthood actually stem from trauma experienced in childhood or early adulthood,” McCarthy says. “In our rehab programs at South Pacific, we pay special attention to it because C-PTSD can often lead to addictions or other mental health conditions including depression and anxiety. If you don’t treat it directly and just focus on medication or detox, then the driving cause will remain unresolved.”

Just like PTSD, C-PTSD is treatable, and there is hope for survivors of ongoing trauma.

“Treatment includes equipping patients with healthier coping strategies and mindfulness techniques to lessen the impact of symptoms, as well as raising their own awareness of how their responses to situations in adulthood may stem from the impact of trauma,” McCarthy says. 

“Compassionate, delicate therapy by a therapist or psychiatrist can also aid in addressing unresolved aspects of trauma,” she says. The aim is to help individuals develop healthier relationships, a more balanced approach to their self-worth and increased resilience.

“It can be a challenging but rewarding process for both therapists and patients – it can be a real journey,” McCarthy says. “There’s a reason it’s known as ‘complex’ PTSD.”


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