Complex PTSD (cPTSD) describes the effects of prolonged and repeated trauma, which often happens during childhood. A common misconception about cPTSD is that the person has to have experienced physical or sexual abuse to have a cPTSD diagnosis, but this is not the case. The trauma can take the form of witnessing physical or sexual abuse, emotional abuse and neglect, or physical neglect.
Attachment trauma & attachment difficulties
The term attachment trauma can apply to someone who has experienced emotional abuse or emotional deprivation, usually at the hand of a parent or carer. According to schema therapy, someone with emotional deprivation has come to expect that their need for a typical degree of emotional support won’t be met by others. People with attachment difficulties have often experienced the following in relation to a key attachment figure in their life:
Deprivation of Nurturance
This involves an ongoing absence of attention, affection, warmth, or companionship.
Deprivation of Empathy
This involves an ongoing absence of understanding, listening, self-disclosure, or mutual sharing of feelings.
Deprivation of Protection
This involves an ongoing absence of strength, direction, or guidance from others. This can include not protecting a child from the other parent or an abusive family member. Attachment trauma is not necessarily the fault of the parent, or of any one person. For example, attachment trauma may result from the following situations:
- The parent/carer has a physical or mental health condition, an intellectual disability, or a neurodivergent profile that makes it hard for them to meet the child’s needs (note: many parents in these situations meet their child’s needs more than adequately)
- The parent/carer finds it hard to identify and regulate their own or others’ emotions
- The parent/carer has a significantly different personality/set of needs that leads to repeated disruption/misunderstandings in the relationship
- The parent/carer is forcibly distracted by urgent needs such as financial distress, another child with complex needs, divorce/loss of partner etc.
While some people may not identify with attachment trauma, they may relate to having experienced significant ongoing attachment difficulties with their parent/carer. People who have experienced emotional deprivation or attachment difficulties often see their emotions as:
- Not real
- Not important or significant
- Not making sense (illogical or an overreaction)
In adulthood, attachment trauma can show up as relationship difficulties such as co-dependency, fear of rejection and intimacy, staying in relationships that hurt you, difficulty maintaining relationships and difficulty with boundaries. Other ways it can show up include:
- Feeling constantly on edge (hyperarousal)
- Difficulty regulating emotions
- Impulsive behaviours
- Low self-worth
- Alcohol or drug use
Parentification
Parentification is a form of attachment trauma that can contribute to cPTSD. It occurs when a child has to take on the role of the carer (either physically or emotionally), and the carer takes on the role of the child. This can occur when a parent/carer is mentally, emotionally or physically unable to parent (sometimes through no fault of their own).
While not meeting the typical definition of parentification, people may have a similar experience to parentification through the following scenarios:
- Having to worry about finances early on
- Having a parent/carer open up to them about adult topics or stressors before they were old enough
- A parent/carer periodically using the child as an emotional support. This can include the carer divulging their own trauma
Is cPTSD in the DSM?
The Diagnostic and Statistical Manual (DSM) does not recognise cPTSD as significantly different from PTSD, and therefore cPTSD was not included in the latest DSM. That said, many people find the term cPTSD or attachment trauma therapeutically meaningful and validating.
What are the support options for cPTSD?
There are a number of therapies that can help with cPTSD. These include:
Acceptance Commitment Therapy (ACT), Compassion Focused Therapy (CFT), and Dialectical Behaviour Therapy (DBT) can also be useful for cPTSD, depending on what you would like to work on. It is important that you work with your therapist to find the therapy, or combination of therapies, that is the right fit for you.
Does trauma therapy involve going over the memories?
While some aspects of trauma therapy can involve desensitising painful memories or triggers, that is only one trauma therapy strategy out of many, and some people do trauma therapy without focusing on the details of the trauma at all.
