If you live in a part of the world that has endured a painful natural disaster, no one has to explain how challenging this can be. You wouldn’t have to justify why you feel traumatized or got diagnosed with post-traumatic stress disorder (PTSD). People who experience long-term trauma like neglect or abuse, however, can be disbelieved. Such invalidation can develop into self-doubt.
Complex trauma remains dangerously misunderstood. Living in a triggered state of high alert might get you labeled for your “drama” or “overreactions.” You’re just seeking attention, they say. As a result, diagnosing complex post-traumatic stress disorder (C-PTSD) is a more nuanced journey.
C-PTSD Most Often Starts in Childhood
The experience of complex trauma is hard to identify and explain when you’re still developing. On top of that, if the perpetrator is someone you trust, a child can question their own awareness. Unable to defend themselves or set boundaries, they might cultivate unhealthy coping mechanisms like denial, dissociation, and self-blame — all of which can hamper the diagnostic process. Chronic trauma can get intertwined with a person’s sense of identity.
There is no specific test or tool that can differentiate between PTSD and C-PTSD. If trauma is known or suspected to be present, that must first be confirmed. From there, a trauma-informed practitioner must use practices like observation and assessment to parse out the particulars.
Why Is C-PTSD So Hard to Diagnose?
It can be different for everyone but here are a few possible factors:
Invisibility
The chronic nature of this scenario can bury the related memories and emotions. Even for the survivor, it seems invisible. Someone who has gone through complex trauma can find ways to “normalize” it in their everyday life. For example, they’ll downplay the experiences and/or frame the whole thing as “not that bad.” If the survivor has trouble seeing complex trauma, you can imagine it’s also difficult for a therapist to be sure.
No Base of Comparison
What point of reference does a young person have to truly comprehend that their experiences are not typical? Therefore, in the name of survival, they often seek a feeling of security in the dysfunction. In addition, when they feel negative emotions, they choose to aim their anger inward. Rather than “impose” on others for support, they berate themselves for being “weak.”
Fear
Complex trauma survivors may worry about being punished again. On a parallel track, their desire to be loved and feel healthy can prevent them from “stirring up trouble” by talking about their experiences.
Distrust
An inability to trust others is a hallmark of C-PTSD. This can carry over to therapy time. If a survivor doesn’t believe they can trust their counselor, they may not share pertinent information about themselves.
Dissociation
Let’s face it, a young person may do whatever is necessary to acknowledge what is being done to them. The ability to temporarily dissociate from reality is helpful in the midst of a crisis. In a healing scenario, dissociation can feel like an impenetrable wall.
Misdiagnosis
Frequently, a survivor of complex trauma will be given a diagnosis of borderline personality disorder (BPD). The symptoms of BPD and C-PTSD can overlap but the distinction must be made for an effective treatment protocol to be designed.
Who Can Diagnose C-PTSD?
A clinician with experience and training in the realm of trauma is best positioned to discern the presence of C-PTSD. They can, of course, recognize the existence of a negative self-image, an inability to regulate emotions, and difficulties when interacting with others. However, the deeper work involves identifying what has provoked these patterns. I invite you to reach out so we can talk more about trauma treatment and the party to recovery.