Understanding CPTSD and Addiction

Trauma as a cause of psychopathological stress is a firmly entrenched fact. People develop chronic stress-related psychotrauma during personal exposure to highly disturbing events, such as:

• Exploitation in childhood.
• Dysfunctional parental homes.
• Abuse, violence or crime.
• Death/loss of a loved one.
• Accidents and natural disasters.
• Victimisation, discrimination.
• Serious medical conditions.
• Acts of war or terrorism.

Trauma-related disorders are often exacerbated by self-medication in the form of substance use disorder. Though certainly not confined to it, substance use disorders are especially prevalent in cases where distressing childhood influences played a role.

1. Impersonal: Caused by random events like accidents, earthquakes, fires.
2. Interpersonal: Victimisation, neglect, exploitation of one person by another.
3. Communal: Ongoing discrimination of a group (race, religion, gender etc.)
4. Identity: Self-condemnation and a reduced belief in your own value.
5. Complex: Caused by prolonged, ongoing or repeated traumatic experiences.

These are good examples of Overt Trauma or the “bad things” that happened to us. However there are other equally serious forms of trauma that patients still experience together with or in absence of the above.

Covert Trauma (Concealed Trauma) or the absence of the good things that are supposed to happen to us, such as “good enough” parenting. Covert trauma is a lack of nurturing behaviour, not being heard, abandonment, or simply not being able to talk about the trauma because of shame.

CPTSD is a psychological condition, underpinned by painful memories and maladaptive behaviour caused by repetitive, prolonged traumatisation of a person who has little or no control over the situation, by means of sustained or repeated stressful subjugation. Prolonged exposure to distress and longer duration of symptoms are primary distinctions of CPTSD over PTSD.

CPTSD has a multifaceted emotional impact that influences the affected person in different ways over a long period of time. The symptoms include a variety of intertwined disorders, adaptations and self-harming responses. The dysfunctions are usually interactive and can create additional disorders. It is referred to as Complex Post Traumatic Stress Disorder because of the intricacy of the condition.

• Presence of multiple disorders.
• Maladaptive coping skills.
• Entrenched/fixated dysfunctions.
• Lack of efficient cognitive skills.
• Feeling different from other people.
• Revival of distressing memories.
• Excessive avoidance of exposure.
• Dissociation and depersonalisation.
• Aggression and/or isolation.
• Distrust and fear of betrayal.
• A constant search for a rescuer.
• Inability to manage relationships.
• Problems with intimacy.
• Violent abuse of life partners.
• Diminished capacity for pleasure.
• Anxiety, depression, self-blame.
• Feelings of hopelessness, despair.
• Self-harm and suicidal thoughts.
• Substance use disorders.

Note concerning dissociation and depersonalisation: During a long period of living with constantly occurring unpleasant events, some victims learn to desensitise themselves by avoiding thoughts that they deem unpleasant and to become detached from reality. This becomes an unhealthy personality trait that they apply to all aspects of their lives.

Maladaptive coping skills: Inability to control their circumstances propels trauma victims to adapt to it with unhealthy survival skills that become fixated and accompany them into the future. A prime example is the inability of children of alcoholics to function in normal family environments. As children they learn skills to deflect or evade the attention of society and fragile situations in their dysfunctional homes, whilst healthy values are underdeveloped – as adults they continue to function in the same manner.

Some of the above symptoms are classified as co-morbid conditions, but are included because of their prevalence. A prime example of this is the tendency for the compulsive taking of alcohol and drugs to suppress emotional discomfort.

Additional adaptations include:

“Fight-or-flight” turmoil: Normally people assess a challenge and reasonably assert themselves or withdraw. A CPTSD sufferer may overreact with either an aggressive reaction or by totally avoiding people.

“Freeze” mode: The natural response to a potentially false threat is to “freeze” momentarily, assess the situation, and then resume normal activity, but a CPTSD sufferer may remain in “mental freeze” mode, trapped in a constant state of alarm.

“Fawn” response: The normal solution to an argument is to negotiate a compromise, but a CPTSD sufferer may avoid debate and simply agree, in order to please the adversary or to evade critical scrutiny.

Treatment for CPTSD

When a variety of chronic symptoms and co-morbid disturbances are present, trying to heal the patient by treating each problem separately is ineffective, as is the normal approach of sequential elimination of problems.

Treatment for CPTSD requires an integrative therapeutic plan, tailored to the patient’s individual requirements, that can heal their complex system of overlapping, interactive issues in a broad sweep. The patient must be properly assessed and the treatment program must deliver a coordinated, synchronised solution to address all the mental dysfunctions.

Traditional symptomatic treatment programs and relatively simple solutions such as the AA, NA and 12-steps programs have been found to deliver poor success rates. CPTSD sufferers should turn to rehabilitation facilities with an intense focus on evidence-based trauma therapy treatment techniques.