A Preview of The  Newest Research on Complex Post-Traumatic Stress Disorder

Posted On July 6, 2019

There have been some truly remarkable research papers written about complex post-traumatic stress disorder (CPTSD) in the past few decades. Some of the research focuses exclusively on CPTSD while others can apply to any mental health disorder.

In this article, I’m going to break the ice in the series about complex post-traumatic stress disorder and new research findings.

A Definition of CPTSD

I realize that many reading this article are familiar with the definition of CPTSD. However, for the sake of those who are not we shall examine a description of complex post-traumatic stress disorder and some older research outcomes.

CPTSD is a psychological disorder formed in response to prolonged exposure to interpersonal trauma. CPTSD forms in the minds of those who have little hope or no chance of escaping the trauma perpetrated against their person.

Used to explain complex post-traumatic stress disorder, the trauma model of mental disorders is associated with repeated sexual, psychological, physical abuse or neglect, and chronic intimate partner violence. CPTSD can form in childhood or adulthood depending on when the traumatic experiences began.

Symptoms of complex post-traumatic stress disorder vary from person to person, but a comprehensive list is below:

• Reliving the trauma through flashbacks and nightmares
• Avoiding situations that remind them of the trauma
• Dizziness or nausea when remembering the trauma
• Hyperarousal, which means being in a continual state of high alert
• The belief that the world is a dangerous place
• A loss of trust in the self or others
• Difficulty sleeping or concentrating
• Startling easy by loud noises
• A negative self-view
• Changes in beliefs and worldview
• Emotional regulation difficulties
• Problems with relationships
• Thoughts or actions of suicide
• Fixating on the abuser or seeking revenge

Neuroimaging of PTSD and It’s relevance to CPTSD

 While complex post-traumatic stress disorder has many differences from post-traumatic stress disorder (PTSD), the two are closely related. So, let us examine the outcomes of neuroimaging done on the brains of those living with PTSD to better understand brain changes from trauma.

A study conducted in 2013 concluded that not only were CPTSD and PTSD closely related, but there are also close similarities to borderline personality disorder (BPD) as well (Stevens,  Jovanovic, et. al. (2013)¹. The similarities allowed researchers to conduct fMRI studies on those with PTSD and use the same data to project that the same damages were in the brains of people who live with CPTSD.

CPTSD and PTSD are not just for those who have experienced severe trauma such as rape or accidents. These two life-altering disorders affect fifty to seventy percent of the citizens of the United States and cost America over forty billion dollars per year. The suffering and impact on families and communities are profound, leaving many adults unable to cope with their lives and losing the ability to work well (Brenner, (2018)².

Interestingly, some people traumatized individuals may not show symptoms for many years after the traumatic event. In fact, a paper published in the Neuroscience and Biobehavioral Review found that trauma-exposed people who presented without PTSD showed significantly smaller hippocampal volume, smaller amygdalae, and smaller cortical regions than healthy control subjects.

Not only were those brain regions affected, but regions that control intellect, such as the corpus callosum (the wiring of the brain) and smaller than average frontal lobe volume (the seat of intelligence) (Karl, Schaefer, et. al. (2006).³      

The Findings from Neuroimaging Post-Traumatic Stress Disorder

Researchers have conducted many research projects using different modes of neuroimaging, including fMRI, PET, and newer forms of visualizing the brain come into existence every year (Bremner, Randall et. al. (1995).

What researchers looked at the brains of those who have experienced severe traumatic events, such as those returning from war, they found damage to the amygdalae and hippocampi.

A study examined, with the then new neuroimaging tool functional magnetic resonance imaging (fMRI) in 1980 revealed smaller than normal volumes in both the hippocampi and amygdalae of people living with the diagnosis of PTSD.

What this study shows is how two vital regions of the brain associated with emotional regulation and memory consolidation are damaged when exposed repeatedly to traumatic stress.^{4, 5}

Placing Complex Post-Traumatic Stress Disorder into a Spectrum

Mental health professionals are currently trying to decide if CPTSD is its own disorder, or if it belongs to a spectrum of trauma disorders. The Diagnostic and Statistical Manual of Mental Disorders Fifth Edition (DSM-5) the diagnostic bible of the psychological world, did not add CPTSD as a separate diagnosis. Now many mental professionals wish to list it under a spectrum of mental health disorders caused by trauma in both childhood and adulthood.

By placing complex post-traumatic stress disorder into a spectrum means linking it to a range of conditions by similar symptoms and traits. This spectrum may represent a range of severity from “severe” to “mild nonclinical deficits.”

While classifying trauma-based disorders into a spectrum may seem to lessen the impact of complex post-traumatic stress disorder, it does not. By putting CPTSD into a spectrum, it will finally receive recognition in the next Diagnostic and Statistical Manual of Mental Disorders.

What Neuroimaging is Teaching Us

Neuroimaging has become a powerful tool in recognizing and treating complex post-traumatic stress disorder. However, studies on CPTSD directly are nearly non-existent. By using neuroimaging techniques and tools such as fMRI, scientists are getting closer to understating how badly trauma impacts both children and adults.

Children who grow up under stress from living in a dysfunctional family where they experienced some type of abuse or neglect, grow up with significant changes in their brains. Since they have damage to their hippocampi and amygdalae, they have problems regulating their emotions and overreacting to triggers in their adult environment that cause conflict in forming adult relationships.

Since the hippocampus and amygdala are vital for memory formation, survivors of childhood neglect and abuse have problems remembering events or even suffer from dissociative amnesia. Dissociative amnesia includes forgetting having said or done something or losing time for short periods without having alters like with dissociative identity disorder.

Clearly, complex post-traumatic stress disorder is highly disruptive to the lives of those living under its influence. However, new and exciting research about not just CPTSD but other mental health disorders as well shine a new light of hope for future treatments.

A Hint of Things to Come  

This piece has been a review of the basic knowledge many of my readers already have about CPTSD. In the next article, I am going to share some very important discoveries that could mean not just treatments, but possibly a cure.

Be sure to watch for the next installment in this two-part series because the next article will not only blow your mind but also give you hope and encouragement.

References

 Stevens, J. S., Jovanovic, T., Fani, N., Ely, T. D., Glover, E. M., Bradley, B., & Ressler, K. J. (2013). Disrupted amygdala-prefrontal functional connectivity in civilian women with posttraumatic stress disorder. Journal of psychiatric research, 47(10), 1469-1478.

2. Brenner, G.H, (2018). New Study Shows Brain Change After Psychological Trauma. Psychology Today. Retrieved from: https://www.psychologytoday.com/us/blog/experimentations/201812/new-study-shows-brain-change-after-psychological-trauma

3. Karl, A., Schaefer, M., Malta, L. S., Dörfel, D., Rohleder, N., & Werner, A. (2006). A meta-analysis of structural brain abnormalities in PTSD. Neuroscience & Biobehavioral Reviews, 30(7), 1004-1031. Retrieved from: https://www.ncbi.nlm.nih.gov/pubmed/16730374/

4. Bremner, J. D., Randall, P., Scott, T. M., Bronen, R. A., Seibyl, J. P., Southwick, S. M., … & Innis, R. B. (1995). MRI-based measurement of hippocampal volume in patients with combat-related posttraumatic stress disorder. The American journal of psychiatry, 152(7), 973.

5. Pitman, R. K., Rasmusson, A. M., Koenen, K. C., Shin, L. M., Orr, S. P., Gilbertson, M. W., … & Liberzon, I. (2012). Biological studies of post-traumatic stress disorder. Nature Reviews Neuroscience, 13(11), 769.