July 5, 2023

Chronic Trauma: Recognising and Treating its Symptoms

What is CPTSD?
Complex post-traumatic stress disorder (CPTSD) has recently been recognised as a psychological problem that can arise from long-term exposure to trauma experiences. Symptoms can include:

• Anxiety (often there is an anxiety diagnosis as well)
• Avoidance of situations, places and experiences related to the trauma experience
• Heightened emotional responses including impulsivity or aggression. In children there may be a wide range of child behaviour problems including those that seem like attention deficit disorder
• Frequent difficulties in sustaining relationships
• Flashbacks or nightmares.

Examples of persistent, long-term trauma resulting in CPTSD include:

• Long-term emotional, physical or sexual abuse
• Long-term domestic violence
• Being the victim of human or sex trafficking

Although CPTSD is often associated with chronic trauma occurring during childhood, adults who experience chronic trauma can also develop this condition.

Is CPTSD a diagnosis?

There are various opinions about whether CPTSD or chronic trauma is a distinct condition and diagnosis.

For example, two organizations that publish diagnostic manuals have different opinions about chronic trauma and CPTSD. The World Health Organization (WHO) listed CPTSD in its 11th revision of the International Classification of Diseases (ICD-11). However, the American Psychological Association (APA), which publishes the Diagnostic and Statistical Manual of Mental Disorders (DMS-5), does not recognize CPTSD as a distinct condition.

What is the difference between CPTSD and PTSD?

The main differences between CPTSD and PTSD are the duration trauma and the symptoms.

In the past, experts thought PTSD generally developed from short-term trauma, such as a vehicle accident or a natural disaster. With further research, they realised that people who experience long-term and repeated trauma tend to have other symptoms in addition to the symptoms of PTSD.

Both CPTSD and PTSD involve symptoms of psychological and behavioural stress responses that can include flashbacks, hypervigilance and efforts to avoid distressing reminders of the traumatic event(s).

People with CPTSD usually have additional symptoms, including chronic and significant issues with:

• Emotion regulation
• Identity and sense of self
• Relationships
• For children, they have often been labelled as a depressed child, a child with ADHD or having a child behaviour problem.

Psychological therapy, provided by a psychologist or other mental health therapist (or a child therapist for children), focused on treating trauma, as well as psychiatric medication, are the main treatment approaches to addressing the effects of CPTSD and trauma more generally. Dr. Adler is a psychologist Hong Kong, child psychologist and counsellor HK who is highly experienced in treating trauma.