Do I Really Have C-PTSD?

Reader’s Question

I’m a university student who has been tentatively diagnosed with C-PTSD for some time now. The therapist I originally went to had said that she’d just call it that because it’s nice to have a name for something and, frankly, she couldn’t find anything better — a working diagnosis. I switched therapists some time later due to illness (on her part), and the diagnosis followed. What had been a ‘working diagnosis’, stuck.

I hadn’t actually given it much thought until lately, when I was helping a friend do some research for a project. I stumbled upon the definition of C-PTSD (it was for a psych course), and was quite disturbed. Not only do I not fit criteria, but the sorts of behavior listed therein are the sorts of things that irritate me the most! I’ve never felt suicidal nor degraded, victimised, guilty for things done to me, constantly depressed or vengeful, self-pitying or self-destructive, and I certainly have never ‘sought out a rescuer’. I feel strange even asking a professional anonymously and online! I don’t have very close relationships with people, but neither do I have very distant ones, etc. etc. and so forth. Bad things have and do happen, but I’ve never seemed to mind. If anything, I’m mildly upset and exhausted, but in a good-humored way. Something like: “Okay, sure, why not! Everything else has happened, so, c’mon randomly improbable and unfortunate thing! Join in on the fun — you’ll fit right in. Whoopie!”

Thus, I’m at a bit of a loss. The things that I do have in common are that I had an extremely long period of rather intense trauma from a young age, have a great deal of memory loss, horrid hypervigilance, and a constant feeling of disconnect. For orderliness’ sake, I’ll separate the descriptions of these symptoms into separate categories — I’m rather amazing at being tangential and hard to understand. Hopefully this will help:

Trauma/Memory loss:

I recall almost nothing about anything. I know that when I was younger, there was a three-year period after a time of stress during which I was continually in and out of prolonged states of catatonia, and that I have a rather extensive abuse/trauma history. I don’t know what happened, and I go to great lengths to keep it that way as I sort of check out and freak when any piece of a memory comes near. Not only am I NOT in control, but I don’t even remember what I did when I snap out of it. When things become stressful (not as in exams, but as in I’m stuck taking care of someone who won’t stop sobbing and is continually comparing themselves to a car), it’s almost as if I have to hop states of mind in order to do anything at all. Everything becomes very partitioned and my presentation becomes very inconsistent. At its most extreme, I act almost like some form of a threatened feral cat. There’s not much in the way of actual cognition, but lots of… uh… weird. It seems like my memories are wiping themselves as the day goes along, sometimes with me noticing after dark that it’s dark outside, as opposed to being the morning where my brain left off. I’m said to have said or done things that I would never say or do and recall nothing even upon prompting. If, however, things are less rocky, it seems that I have more mental room to work with (weird term, but it’s the best way to describe it). There’s still that weird feral/survivalist undercurrent, and I still feel somewhat disconnected, but I’m mostly normal. There’s a great deal of information that I’ve learned, facts, books and histories of all sorts, but don’t know when I learned and/or read them. In day-to-day life, I’m said to seem entirely normal, if not a touch too cheery.

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Hypervigilance:

Most of the time, I don’t really notice this. I just identify people by how they cough, walk or breathe. I’ll be at the Library, and someone will walk into the room next to the one that I’m in and cough, and I’ll address them by name and ask them to come see the neat new book I found. They think it’s weird, but I don’t register that I’ve done it unless someone points it out. Other times, however, it goes all crazy and extreme, to the point of dominating what I do (see the above comment about feeling like a feral cat). I actually avoid going into town because of this: I just get all loopy and strange and start making mental notes and acting as if I’m on enemy territory in a war-zone. If I’m waiting for something, I’ll actually feel the need to hide (i.e., sitting next to the corner chair up against a wall in a waiting room — not ON the chair).

Disconnect:

I’ve mentioned it quite a bit above, simply because it works in so closely with the memory loss and hypervigilance. There are times during which I just check out and know nothing of what I’m doing, either before or after. Sometimes I can feel myself slipping into this loopy feral animal-ish state, and other times it’ll just SNAP. Often, everything’s so jumbled up and jumpy that it’s impossible to tell because I just forget the whole period of time surrounding. I feel horrid being close to people because it seems to me that I’m being dishonest in some way. Not because I ever lie, but because everyone assumes (or, at least I assume that they do) that I’m in the moment and experiencing like they are. Since I’m not, it feels like a lie.

These behaviours have all been attributed to responses to extreme trauma, but, without any of the other symptoms associated with C-PTSD, I’m not certain that it can be classed as such. All treatments, as of yet, have been completely unhelpful (the hypervigilance and ‘flipping’ make it very hard…). I’m reluctant to re-enter therapy for fear of ‘flipping’ and becoming volatile. The most useful thing I’ve done was to be removed from the most intense of strain. Living in a typically stressful place calms the weirdness down — to the point at which I’m of no danger to anyone short of a mugger, but I’m still incredibly uncomfortable. I could, of course, shut myself down and just get on and do things, but seeing as that’s the problem to begin with, I don’t find that at all comforting.

Does any of this seem to fit another condition? Or is it actually a case of C-PTSD? Any help/advice that you could provide would be greatly appreciated.

Thanks, and sorry about the length…

Psychologist’s Reply

C-PTSD or Complex Post-Traumatic Stress Disorder is a proposed diagnosis. PTSD is associated with exposure to a significant trauma. Over the years, however, mental health professionals noted a difference between classic PTSD based on brief events such as an assault, fire, life-threatening experience, near-death, etc — and PTSD symptoms found in individuals who have experience prolonged exposure to abuse, captivity, exploitation, or fears of death. From a clinical standpoint, there is a debate over using C-PTSD to describe this symptom pattern or using PTSD and an accompanying other diagnosis to describe the same symptoms. Due to behaviors such as self-injury, many have felt C-PTSD is actually a combination of PTSD and Borderline Personality. Others have felt it may be PTSD and a form of Stockholm Syndrome.

As described by a therapist, C-PTSD is being used as a “working diagnosis”, a diagnosis provided to summarize the patient self-report, observations, mental status, and current patterns noted by the clinician. As a working diagnosis, not all specific symptoms of the diagnosis need to be present. It’s the therapist’s impression of the general category of the problem, in this case (C-PTSD) suggesting your situation is related to previous prolonged trauma, has significant amounts of anxiety reactions, and is likely to be very intrusive in your daily life. The C-PTSD also tells us what the situation isn’t — it’s not a psychosis, you’re not a paranoid (yet hypervigilant!), and it’s not a short-term or acute problem.

I’d focus on treatment rather than the diagnosis at this time.

The fact that your symptoms are still intrusive in your daily routine suggests that you should continue to seek treatment. Some symptoms of PTSD respond to psychiatric medications for example. Other forms of therapy are recommended for PTSD features. As the “complex” of C-PTSD would suggest, these situations are complicated and typically require a multidisciplinary treatment approach.

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