PTSD Awareness: Recognizing Survivors of Complex Trauma and Abuse

Author: Rebecca Bywaters

As we approach PTSD awareness day on June 27th, it is important to understand the nature and effects of PTSD on those who experience it. This includes those under acute or prolonged abuse, such as is often the case in issues of domestic violence, sexual abuse, and human trafficking. 

A common misconception of PTSD, or Post Traumatic Stress Disorder, is that it only affects those who have experienced war or intense combat, but this understanding is lacking. In reality, PTSD is developed through experiencing or witnessing any traumatic event that causes fear, extreme stress, horror, or helplessness in an individual. Such parameters for the development of PTSD can include anyone, no matter their profession, age, gender, background, familial situation, culture, ethnicity, etc., as trauma is not selective nor bound by such categories. 

PTSD is often characterized by its singular-natured causation, meaning that a single traumatic event is what causes the condition in the person experiencing or witnessing it. Such events can be sexual or physical assault, experiencing violent crime, a natural disaster, military combat, etc. The symptoms of PTSD may not show up immediately after a traumatic event but can begin to develop from weeks, months, to even years after the event. This can make it difficult at times to identify one's symptoms or struggles as stemming from the traumatic event, especially if a great deal of time has passed between the event and its symptoms. Thus, it can also be difficult to seek help for the correct underlying cause of those symptoms, being PTSD. The symptoms of PTSD, according to Mayo Clinic, are usually grouped into four categories: 

• Intrusive memories - such as nightmares, flashbacks, or habitual thinking patterns bringing the individual back to their trauma 

• Avoidance - avoiding thinking about the traumatic event, participating in activities or being near places that remind them of the event 

• Negative changes in thinking or mood - such as negative thoughts of self or others, prolonged negative emotions like helplessness, numbness, detachment, etc.

• Changes in physical or emotional reactions - self-destructive behavior or thoughts of self-harm, heightened reactivity to stimuli, trouble sleeping, etc.    

PTSD can take many forms and looks different for everyone, as not everyone with PTSD experiences all of its typical symptoms or even the same symptoms as someone else with the condition. But what happens if the traumatic event is not a singular instance? What happens when a person experiences the traumatic event, but rather than escaping it, the trauma repeats itself? When an event that would cause PTSD is continual, habitual, or long lasting, a different form of PTSD, called C-PTSD is developed. 

C-PTSD, or Complex Post-Traumatic Stress Disorder, is a condition that shares many similarities and characteristics to PTSD but carries additional effects that are unique to itself.  Because it involves prolonged and continual trauma, C-PTSD often challenges preexisting mechanisms of functioning, such as emotional regulation, healthy relationship habits, and interpersonal relation capabilities. This effect of C-PTSD is due to the duration of the trauma, as it allows the mind to be “rewired,” in a sense, over time, something that is more difficult to achieve the shorter the period of time one experiences trauma.

Due to this characteristic of C-PTSD, this particular form of PTSD is more common to those who have experienced prolonged periods of domestic abuse/violence and human trafficking, as they involve continual subjection to trauma and in a highly intimate context. In fact, the effects of C-PTSD can often be the intentions of the perpetrator in such instances, as they seek to destabilize the one experiencing their abuse in order to control and wield power over them. 

When an individual experiences abuse over an extended period of time, that trauma gradually alters one’s view of, and engagement with, themselves, the world, and people around them. C-PTSD can cause an individual who experienced human trafficking to begin to see the world as more dangerous and untrustworthy in a way that, even once the individual has escaped their situation, the effects are deeply ingrained and take time and help to heal from. One may experience domestic violence and begin to view all men as unsafe and predatory, causing a struggle to form and maintain meaningful relationships after leaving their abuser. C-PTSD can even make it a struggle to maintain interpersonal relations with people deemed trustworthy or safe in survivors’ lives. 

Such are only a few examples of what C-PTSD can bring with it, as its effects are unique to the individual and can look different depending on the context/nature of the person's abuse, the duration, the personalities and people involved, how it was resolved, and much more. According to Cleveland Clinic, other effects of C-PTSD include, but are not limited to, a deficiency in emotional regulation, difficulty sustaining healthy relationships, heightened emotional responses, anxiety, flashbacks or nightmares, and an avoidance of people, places, or activities that remind the individual of their trauma. 

The reality is, both PTSD and C-PTSD are common in DV, SV, and human trafficking survivor stories. In the case of PTSD, one’s symptoms may be trauma-specific and limited in duration, while one’s symptoms with C-PTSD may appear in areas unrelated to their trauma story and chronic. Oftentimes PTSD and C-PTSD can go undiagnosed, however, because they can be experienced internally rather than externally. 

Internalized symptoms are where the effects of PTSD sabotage day-to-day functioning in “invisible ways,” such as disordered thought processes, relationship issues, and mental health struggles. External symptoms, like flashbacks, outbursts of aggression or violence, or even persistent nightmares (all of which present themselves in externally measurable ways) are more likely to receive a PTSD or C-PTSD diagnosis, but they are not always experienced by those suffering from it. 

This is why it is important to bring awareness to PTSD in all its forms and expressions. Oftentimes, just being able to identify a struggle and connecting it to one’s trauma can empower the individual to take action to heal and seek help to do so. Once PTSD is identified, there are many resources available to those suffering from PTSD or C-PTSD, such as the counseling services provided at New Directions Center, for instance.

At NDC, we are aware of the effects of PTSD on those who have experienced trauma through domestic violence, sexual violence, and human trafficking, and it is our mission to limit those effects. Individuals experiencing PTSD or C-PTSD are not stuck in their struggle, as these conditions can be addressed and healed with time, understanding, and care.

To those who have PTSD/C-PTSD or believe they might, several resources are available for you. 

• New Directions Center 24/7 hotline: (540) 886-6800

• Suicide & Crisis Lifeline: 988 (Available in both English and Spanish)

• Crisis text line: Text “CONNECT” to 741741 for text crisis support by trained counselors

• Veteran crisis line: call 988 and press 1, or text 838255 

• The C-PTSD Foundation: A resource for daily recovery support and peer groups, found at https://cptsdfoundation.org/

• The National Center for PTSD: The national webpage for PTSD resources, education, treatment, etc. For PTSD: https://www.ptsd.va.gov/. For C-PTSD: https://www.ptsd.va.gov/professional/treat/essentials/complex_ptsd.asp#one