Complex post-traumatic stress disorder (C-PTSD)

It has been known for a long time that various forms of trauma, abuse, neglect or severe ongoing stress in childhood (such as bullying at school) leads to people developing patterns of emotions, thinking and behaviour which can make their lives very difficult and unhappy. For example:

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• If other people do bad things to you as a child you may learn that you cannot be in control of what happened to you and you stop planning ahead, making decisions for yourself and you do not learn to solve problems you face in life. This makes live very difficult and makes more bad things happen. It can also mean it is hard to focus on and achieve long-term goals.
• When children are trapped in stressful or traumatic situations and cannot get away from them, their brain learns to escape mentally by switching off or "dissociating". Another way of mentally escaping is to go into a fantasy world in various ways, making up a different reality or imagining things that only you can see or hear.
• If you have had bad experiences or been badly treated as a child you may learn not to trust other people. You may build up barriers around yourself and do not let people get too close. This makes it difficult to have good relationships.
• If you learnt as a child that suddenly very bad things can happen to you, it teaches you to be on the lookout for danger, always on edge or anxious and very jumpy.
• This makes you react very strongly to everyday problems. Normal life is full of little problems so these strong reactions can make your emotions, your thinking and what you do very changeable and extreme. It is like having a very thin emotional skin.
• Because this extreme distress is very painful it can lead people to look to for anything that will make the feelings go away, for example taking drugs, drinking alcohol, causing physical pain to drown the mental pain (often by cutting), or by just shutting off mentally (we call this "dissociation"). This means it can be hard to feel good about yourself or have a secure sense of self-identity.

People who have these difficulties and often the people around them, including professionals may think that this is just they way they are and they cannot be changed. This is not true. An important first step is for you to recognise what this problem is because it is often misunderstood and therefore the wrong treatment is given. Recognising the problem is often difficult because people with this are much more vulnerable to other difficulties such as depression and because these symptoms are very like the symptoms of anxiety and depression. This means that people have often had lots of different diagnoses and sometimes have found that the treatments they have had have not helped, or have only helped a bit.

In order to recognise these patterns and to change them, it is useful to give them a name but many different names have been used, which is confusing.

In the past, and still quite commonly now, the term "Borderline Personality Disorder" is used. This name originally developed because people thought this problem was "borderline psychotic" because of the voice that sufferers commonly describe. After this the term "Emotionally Unstable Personality Disorder" started to be used more commonly. This better describes the very unstable emotions but says nothing about where the problem comes from. Most recently, researchers have come to understand how these patterns come from abuse, stress or trauma in childhood and how similar the patterns are to people who suffer trauma in adulthood, for example, soldiers in war situations. The pattern of problems they get, which is very similar, is called Post Traumatic Stress Disorder (PTSD). So we now call these problems "Complex PTSD".

The major difficulties in life and the distress that C-PTSD causes can be reduced by addressing the rapid and extreme changes in thinking and behaviour and replacing these with more regular steady routines, thinking ahead and predicting difficulties and more helpful ways of dealing with thoughts and situations. The first step in learning to change this is getting good at recognising the unhelpful patterns. After that, there are techniques you can learn that will help change these patterns. Some of these techniques are called Emotional Coping Skills . These are best learnt in a group situation with other people who have the same difficulties and are learning the same techniques. This is often very difficult for people with C-PTSD and, to start with, you may need to work with an individual professional to help you get ready for learning in a group. A more intense therapy which teaches the same emotional coping skills is called Dialectic Behaviour Therapy (DBT). This is also done individually and/or in a group. It can be extremely effective in helping people achieve major change and improvement in the quality of their lives. This sort of therapy is usually only available from specialist mental health services.

C-PTSD causes a lot of disability and suffering, not just for people who suffer from it but for other people around them. This makes it very important to recognise this problem and to work hard at trying to overcome to associated difficulties. The sooner this is done, the less likely it is to cause damage to somebody's life and it is probably easier to deal with it, but whenever you start trying to deal with it, it is likely to be difficult. Even so, it is definitely worth it as it can make life so much better.

• Your local Health Visitor in Shropshire, Telford and Wrekin here.
• Your GP
• Shropshire Community Perinatal Mental Health Team (PMHT). The PMHT provides specialist assessment and support for women across Shropshire and Telford & Wrekin, providing both support to those women experiencing mental health difficulties, and those at risk of developing mental health difficulties up until a year after baby's birth. The service supports women experiencing moderate to severe mental health problems
• Click here to find your local talking therapies service
  • Shropshire
  • Telford & Wrekin

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• The Lighthouse Service supports women, birthing persons and support partners in Shropshire and Telford & Wrekin whose mental health has been adversely affected by their birth or maternity experience. They may be experiencing loss, grief or trauma, or have a fear of childbirth.

• Local Specialist Perinatal Mental Health Team.

• Baby Buddy is the multi-award winning free app that guides you through pregnancy, birth, parenting and beyond. You can explore the web version of Baby Buddy or download the full version of the app for free on the App Store and Google Play. There is a lot of information including videos about your physical and mental health.