Complex Post-Traumatic Stress Disorder (CPTSD) And Addiction

What Is CPTSD?

Complex post-traumatic stress disorder (CPTSD) is a diagnosis similar to post-traumatic stress disorder (PTSD), with additional symptoms. Along with certain PTSD symptoms, a diagnosis of CPTSD requires:

• Affect numbing or over-reactivity
• Persistent negative self-concept
• Difficulties forming and maintaining interpersonal relationships

Whether someone meets the criteria for CPTSD or PTSD, people with trauma histories have an increased risk of developing substance use disorders. A main part of PTSD is avoidance of thoughts and feelings related to traumatic events, and for some, alcohol and drugs become a shortcut to that avoidance.

While nearly 5% of the general population in the U.S. meets the criteria for post-traumatic stress disorder, 25 – 35% of people with substance use disorders meet the criteria for PTSD. For some, alcohol and drug use become ways to cope with the aftermath of trauma and the symptoms of PTSD. The connection between PTSD and addiction is so impactful that self-help and treatment programs specifically address how they interact.

Mental health clinicians used to think it was necessary to treat alcohol and drug disorders before PTSD or other mental health disorders. However, research shows that integrated treatment that addresses them at the same time leads to the best outcomes.

PTSD Vs. CPTSD

In recent years, the terms “trauma” and “traumatized” have been used broadly to reference experiences that are emotionally upsetting. However, there is pushback to the casual use of these terms since it can minimize the struggles of people with PTSD.

For a diagnosis of PTSD, “traumatic events” must meet certain criteria. Specifically, the current edition of the Diagnostic and Statistical Manual for Mental Disorders (DSM-5-TR) defines a qualifying traumatic event as:

• Exposure to actual or threatened death, serious injury, or sexual violence in one (or more) of the following ways:
• Directly experiencing the traumatic event(s).
• Witnessing, in person, the event(s) as it occurred to others.
• Learning that the traumatic event(s) occurred to a close family member or close friend. In cases of actual or threatened death of a family member or friend, the event(s) must have been violent or accidental.
• Experiencing repeated or extreme exposure to aversive details of the traumatic event(s) (e.g., first responders collecting human remains; police officers repeatedly exposed to details of child abuse).

A diagnosis of PTSD requires a traumatic event that meets the specific criteria discussed above. It also requires a specific set of symptoms related to re-experiencing the traumatic event in dreams, memories, or feelings, avoidance of things related to the trauma, negative changes in thoughts and moods, and marked changes in arousal and reactivity associated with the traumatic event.

For a diagnosis of PTSD, the symptoms must have continued for at least one month after the traumatic event, and they must be causing clinically significant distress or impairment in functioning. About half of the adults diagnosed with PTSD recover fully within three months. Still, the other half may continue to struggle with PTSD symptoms for many years or even throughout their lifetime.

Recently, a diagnosis of CPTSD was introduced in the 11th edition of the World Health Organization’s International Classification of Diseases (ICD-11). A diagnosis of CPTSD requires substantial functional impairment caused by six symptom clusters, three of which are the same as a diagnosis of PTSD (re-experiencing, avoidance, and a sense of current threat).

It’s important to note that CPTSD is still a controversial diagnosis, and the DSM-5-TR does not include a separate diagnosis for Complex PTSD. Opponents of CPTSD consider the complexity better explained by PTSD and a range of comorbid psychiatric disorders. From that perspective, someone would be diagnosed with PTSD and other disorders instead of CPTSD.

What If You Think You Have CPTSD?

Complex post-traumatic stress disorder (CPTSD) is a controversial diagnosis not yet accepted by all mental health and medical professionals. If you notice some CPTSD symptoms, consider bringing it up with your counselor, therapist, psychologist, or psychiatrist. It’s also important to know that CPTSD symptoms are not new, and they are probably areas already being addressed in treatment and recovery efforts.

Where To Find Help For PTSD Or CPTSD

Since CPTSD is a newly recognized diagnosis, there are probably very few practitioners that explicitly state they specialize in it. Finding a well-trained and trauma-sensitive provider is your best bet. If you think you may have CPTSD, look for a clinician who specializes in evidence-based therapies and specifically identifies substance use disorders and PTSD in specialty areas. Depending on where you are in your addiction recovery journey, you may want to find a provider who also works from a perspective consistent with your recovery path.

Veterans with access to VA Care can seek state-of-the-art treatment for PTSD and addiction by reaching out to their local VA or the National Center for PTSD. Since more practitioners offer telehealth services, you can consider non-local providers licensed to provide telehealth in your state, such as PSYCPACT certified Psychologists.

When searching for a therapist, either online or in person, select one that has the specialization and training you are looking for. Start your search today and explore your online therapy options.