Complex PTSD & Dissociation

Instructor: Karin Gonzalez

Karin has taught middle and high school Health and has a master's degree in social work.

In this lesson, you will learn the definition of complex PTSD and how it compares to regular PTSD. You will learn the definition of dissociation, how it presents in complex PTSD, and how it can develop into Dissociative Identity Disorder. Following the lesson will be a brief quiz.

What Is Complex PTSD?

Jack, an American journalist, was held as a prisoner of war for six years and endured neglect and physical abuse.

Valerie, now 18, just started seeing a therapist at her college for enduring years of sexual abuse by her foster parent.

What is the common denominator in these two cases? Prolonged and chronic trauma. An accumulation of evidence in the field of mental health therapy suggests that solely having traditional disorder of PTSD falls short, in that it does not decipher between individuals who have just experienced one large trauma, with individuals who have endured years of repeated trauma. Further, it does not fully encompass the severe, sometimes psychotic, effects that prolonged trauma can have on an individual.

Complex PTSD (C PTSD), or complex post-traumatic stress disorder, is a severe mental condition that results from sustained exposure to trauma where one was vulnerable, defenseless, disempowered and/or imprisoned, without the possibility of escaping the abusive or neglectful long-term situation. In addition to symptoms of regular PTSD, complex PTSD incorporates the following six symptom groups:

  • Changes in ability to regulate emotions
  • Deterioration in relationships with others
  • Somatic symptoms
  • Negative alterations in opinion of self
  • Difficulty with attention and lapses of consciousness (dissociation)
  • Changes in perception of life meaning, feelings of hopelessness

Characteristics of complex PTSD.
What is complex PTSD?

Regular PTSD involves exposure to a traumatic event that causes nightmares, negative memories of the event, avoidance of things that remind one of the trauma, heightened arousal response, feelings of fear, depression or hopelessness, and social isolation. Regular PTSD can sometimes even cause feelings of dissociation, but dissociation is more complicated and severe in complex PTSD. In fact, some individuals with complex PTSD develop Dissociative Identity Disorder (DID). We will discuss this relationship further in this lesson.

Severe impairments in interpersonal disturbances, negative self concept, and affect dysregulation, are what set complex PTSD apart from regular PTSD.
PTSD and complex PTSD

What Is Dissociation?

Individuals with complex PTSD can experience dissociation, which means 'to disconnect.' When speaking of dissociation and its relationship with PTSD, we are specifically talking about a disconnection with reality, not feeling like oneself, having lapses of consciousness, or feeling like the mind is separate from the body. Let's look at some ways that Jack, the American journalist who was held as a prisoner of war for six years, experiences symptoms of dissociation with his complex PTSD:

  • Flashbacks- Flashbacks usually occur after a person is exposed to a trigger that reminds them of the traumatic event. They can be mild, to where the person has a a brief episode of bad memories of the event, or more severe to where a person feels like they are reliving the trauma.

When Jack was held as a prisoner of war, he constantly heard helicopters above his prison. Now, every time he hears a helicopter, he is brought back to the horrors of imprisonment. Sometimes these flashbacks last an hour, to where he cannot escape the painful and livid memories.

  • Selective amnesia- This is typically a defense mechanism of someone who has experienced intense or prolonged trauma. The person will subconsciously place memory of the traumatic event(s) out of consciousness as a way to cope.

When Jack's therapist asks him about details of the time he was a prisoner of war, he cannot recall many details, especially the details that were more traumatizing and ridiculing.

  • Time Loss- This involves episodes of amnesia or an inability to remember a certain period of time, thus 'losing time.'

Jack mowed his family's lawn for half an hour one day. At dinner, his wife commented on how great the lawn looked. Jack was confused, and absolutely could not recall that he was the one who did it.

  • Trances- Some people meditate to enter a state of trance, or half-consiousness, in order to quiet the busyness of the mind and relax. But trance-like states in dissociation are involuntary. A person may appear spacey or 'out of it.'

Jack often enters trance-like states where he dissociates while playing with his children. They will try to engage him but it is like talking to a brick wall- Jack will not respond. He also has these episodes in conversations with his wife sometimes. She will be talking for ten minutes and she will look at him for a response, but he will just give her a blank stare.

  • Out-of-body experiences- This is when a person feels like they are not a part of their body. It could also mean that they feel like they are not in control of their body. This can be dangerous. Some people with dissociation will do something dangerous or commit a crime and say that they had no control of their body while in an out-of-body state.

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