Question 1

Can a person with an extremely severe and complex trauma history be treated to the point of having no symptoms? Or do you find that they simply learn to live with and manage the complex PTSD?

Christine Courtois · Accepted Answer

This is a complicated question. Individuals heal in different ways and to different degrees; however, I do believe that some individuals can resolve their major symptoms but for others the effort may be ongoing. What is important is separating past from present and working to live to the fullest degree possible. I fully believe taking your life back and living well is the best outcome and the best revenge. It is also important for the next generation.

Question 2

How do you help a client reduce hypervigilance when the abuser still lives in the same city as them?

Christine Courtois · Accepted Answer

By taking as many steps as possible to stay safe and away from the abuser if he or she still poses a threat (emotional as well as physical). In the event of ongoing or occasional contact, to develop a strong safety plan and an escape plan. It is also important to have a support system who can help and provide support. It also helps to focus on being a competent and empowered adult (rather than the child who was taken advantage of due to immaturity and small size) who can manage in the case of a chance or other type of encounter. Abusers typically don’t like it when there is an assertive and self-protective response. Anticipating and role playing responses in therapy can be very helpful.

Question 3

When will C-PTSD be accepted as an official condition?

Christine Courtois · Accepted Answer

It has recently been accepted in the World Health Organization, International Classification for Disorders-11 and will start to be used next year. It is a so-called sibling diagnosis of PTSD and criteria for both PTSD and C-PTSD must be met.
It is not a freestanding diagnosis in the DSM-5 but may meet criteria for the Dissociative Sub-type of PTSD. We hope it will be included in the next version of the DSM.

Question 4

What are the differences between PTSD, BPD and C-PTSD?

Christine Courtois · Accepted Answer

There is broad overlap between the three. Many people describe C-PTSD as PTSD plus and we now have research on the C-PTSD diagnosis that supports this distinction. The additional after effects/symptoms of C-PTSD are known as Disorder of Self Organization (DSOs) having to do with identity, emotional-regulation, and relationships. Both BPD and C-PTSD are usually due to traumatic circumstances and adversities (including attachment and relational trauma in primary relationships and frank types of abuse) that begin in early life and that often become repeated and chronic, that impact identity, ability to self-regulate, and interpersonal functioning. Key differences are that those with BPD may have a more approach-avoid tendency in relationships, including emotional and impulse dysregulation. Those with C-PTSD may be more prone to not invest in relationships due to mistrust.

Question 5

How should the treatment of C-PTSD differ from treatments based on a traditional conceptualization of PTSD?

Christine Courtois · Accepted Answer

Generally, it is more extensive than the treatment of PTSD symptoms alone. It is generally conducted in a sequence, starting with education, safety, emotion regulation, skill-building, concurrent treatment of other issues, with formal trauma processing undertaken after the client is stabilized.

Question 6

In my experience, it's often the betrayal trauma that hurts people the most. How do you help patients with this?

Christine Courtois · Accepted Answer

I agree with you. By clearly identifying such betrayal and how much it hurts. Often the relationship was a close one and it was used to justify the abusive behavior and exploitation. This adds insult to injury. Then by allowing a processing and a grieving process to unfold, followed by discussion of possible courses of action, with strong support by the therapist.

Question 7

Are somatic or body-oriented interventions useful in treating people with complex trauma? e.g., trauma-sensitive yoga

Christine Courtois · Accepted Answer

Yes, they are showing good evidence. It is important that these types of techniques are modified for individuals with PTSD/C-PTSD because they can easily overstimulate and so should also be applied progressively.

Question 8

Question 9

What are some common examples of complex traumatic events and experiences?

Christine Courtois · Accepted Answer

Fundamentally, it is interpersonal. In childhood, relational and attachment trauma early in life when parents or other primary caregivers are unable to bond with their child or to provide them adequate response and security, due to a wide variety of circumstances, including the parent’s unresolved history of trauma and loss. This often leads to vulnerability to other forms of trauma (layered trauma) over the course of childhood, including physical, sexual, and emotional abuse, abandonment and neglect, and loss, often repetitive to the point of becoming chronic. It might also involve ongoing exposure to community or domestic violence and poverty.
In adulthood, it may involve domestic and community violence, displacement and relocation, human trafficking, sexual harassment and assault, extended poverty, and so on.

Question 10

What are the neurological changes that occur with complex developmental trauma? In the case of ADD/ADHD, how do you differentiate if symptoms as a result of trauma or pre-existing ADHD?

Christine Courtois · Accepted Answer

There are many neurological changes that have been identified, starting at the neuronal level if a child victim is very young and impacting later development. The brain’s structure and functioning might be changed by ongoing posttraumatic defensive responses (“survival brain”). The good news is that even when that happens, the brain is plastic, meaning it can grow new neuronal pathways when the atmosphere supports change. ADHD is differentiated by assessing whether there is a trauma history or whether the individual has a dissociative condition which can mimic ADD. Also, if ADHD is diagnosed and medication prescribed that doesn’t work, then another assessment is called for. Finally, PTSD/C-PTSD and ADHD can co-occur.

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