Insights

What is trauma?  What are Post-traumatic Stress Disorder (PTSD) or Complex Post-traumatic Stress Disorder (CPTSD)?

After the exposure to traumatic events, such as actual or threatened death, serious injury, or sexual violence, a person may develop acute stress reactions within three days to one month after the trauma.  These reactions include both psychological and physiological responses, such as negative mood, intrusive distressing memories of the event, inability to remember some important aspect of the event, hypervigilance, problems with concentration, sleep disturbance and/ or irritable mood.  These reactions may be normal reactions after experiencing traumatic events in short-term.  However, when a person does not have someone who could provide compassionate understanding and support, he or she may be more likely to develop PTSD.  Furthermore, if a person experienced ongoing abuse from which there is no escape in an extended period of time, and there is no social support, he or she may be more likely to develoop CPTSD.

According to the Diagnostic and Statistical Manual of Mental Disorders Fifth Edition (Text Revision) (DSM-5TR), after the exposure to a traumatic event, the essential features of a person having symptoms of PTSD are re-experiencing the event intrusively, avoidance of stimulus associated with the event, negative alterations in cognitions or mood, and negative alterations in arousal and reactivity.  For instance, the person may have intrusive distressing memories or dreams of the traumatic event.  He or she may also experience flashback in which one feels the event is actually occurring.  In some case, the person may avoid exposing to stimuli associated with the traumatic event, such as people, places, conversations, memories, thoughts or feelings.  The person may also be either hyperaroused or hypoaroused persistently.  Sometimes, the person may have distorted cognitions about the cause of the consequences of the traumatic event that lead the individual to blame oneself or others.  With these symptoms, the person has significant distress or impairment in daily functioning.

Some people experienced repeated traumatic events or were chronically exposed to extremely threatening events.  Usually, escape from these threatening events is impossible.  As a result, according to the International Classification of Diseases 11^th Revision (ICD-11), CPTSD can be developed.  Situations associated with CPTSD may include prolonged domestic abuse, chronic discrimination, bullying, or longstanding developmental trauma.  Developmental trauma may include childhood sexual abuse, physical abuse, neglect, parent with mental illness, or exposure to domestic violence.  Sometimes, the impact of the trauma may exacerbate due to betrayal trauma, that is, when the victim is blamed for the abuse and significant others develop an alliance with the abuser.  It is even more debilitating when no one can support and protect the child.

Symptoms of CPTSD include the abovementioned symptoms of PTSD.  In addition, there are three additional categories of symptoms, affect dysregulation, negative self-concept, and interpersonal disturbances.  Complex trauma is often associated with dysregulated sympathetic and parasympathetic nervous systems.  This results a repeated pattern of emotional fluctuations.  This may include chronic anxiety or persistent depressive mood.  Some individuals may also have alternaration between hyperarousal and hypoarousal states.  People with complex trauma may also have an impaired sense of self-worth.  They may also have difficulty in forming a coherent sense of self.  As a result, they may frequently experience self-doubts, shame and sense of worthlessness.  Furthermore, people experienced complex trauma have difficulty to develop trusting relationships with others.  They may also tend to avoid relationships or develop overdependence in relationships. 

What happened in the brain for those who had experienced trauma and developed PTSD?

Neuroscientist Stephen Porges described that there are three subsystems in the Autonomic Nervous System (ANS). When a person is having a relaxed walk in the street on a Sunday afternoon, the Ventral Vagal Complex (VVC) activated the social engagement system. This allows the person to chat humorously with his friends and all his present moment experiences are in sync.

However, when a car is approaching the sidewalk from the road, the person suddenly perceives danger that activates his Sympathetic Nervous System (SNS). Adrenaline and Cortisol are released for the activation of a fight or flight response. If the person is able to run away from the car to a safe place, he would be able to return to equilibrium after the danger passed. The stress-related hormones would be metabolised and his running will reduce his arousal.

What if he is knocked down? The person is forced to freeze as he cannot run away. This activated the most primitive subsystem, the Dorsal Vagal System (DVS). The person become immobile and endorphins is released to block the pain. As the person is immobile, he may not elicit the fight or flight response, he is trapped in a dysregulated state with the SNS being constantly activated after the trauma. He sweats more often, heart rates frequently increase, and mouth is constantly dry. His physiological urge to flee had not discharged.

Symptoms of post-traumatic stress occur when a person cannot release his or her sympathetic response. That is, the energy that helps us to fight or flee is being bottled up in our body. This is why a person with PTSD frequently re-experiences the trauma with constant release of stress hormones, even though he or she knows there is no danger in the present moment.

What is trauma-informed treatment?

Trauma-informed treatment is an approach recognise the impact of trauma on an individual’s mental and psychological problems.  This approach seeks to tailor-made treatment that is sensitive to the trauma history of the individuals.  As a result, the psychologist creates a safe and supportive space for the individuals that emphasizes trust, collaboration and empowerment.

What are the common treatment modalities for PTSD and CPTSD?

There are many evidence-based treatment modalities being found to be effective in treating PTSD and CPTSD.  These modalities include, Cognitive Behavioral Therapy, Schema Therapy, Emotion-focused therapy, Dialectical Behavioral Thearpy, Eye Movement Desentization and Reprocessing, Somatic Experiencing, Mindfulness-based Therapies, Compassion-based Therapies, etc.