7 Things Writers Should Know About Complex Post-Traumatic Stress Disorder
Author Noreen Masud shares seven things writers should know about complex post-traumatic stress disorder (or CPTSD) when writing characters, including how CPTSD can manifest in different ways than “single event” PTSD.
You’ve probably heard of post-traumatic stress disorder (PTSD). But awareness of another condition—complex PTSD, or CPTSD—has also been growing in recent years, among both health professionals and the public. My memoir-travelogue, A Flat Place, describes how the flat landscapes of Britain and Pakistan gave me an image to help me think about my difficult early life, and my experience of complex post-traumatic stress disorder that followed.
But what exactly is complex PTSD? And how do we write about it in a way that’s realistic and ethical? If you’re writing about CPTSD, or portraying characters who have CPTSD, here are seven things to consider.
1) The main difference between PTSD and CPTSD relates to duration.
PTSD is caused, usually, by a single shocking event: an experience of a bombing, for instance, or a one-off sexual assault. CPTSD, meanwhile, is caused by traumatic events which happened over a long period of time, and usually in a context where the person has no hope of escape or relief.
These include childhood abuse or neglect, but also situations like slavery, trafficking, or being a prisoner of war. You’re more likely to experience CPTSD if you were very young when the trauma(s) took place, or when the perpetrator was also your caregiver.
2) Its symptoms are different from ‘normal’ PTSD.
Complex PTSD includes some of the symptoms of PTSD, plus additional ones. Both PTSD and complex PTSD may involve (for instance) flashbacks, intrusive thoughts, difficulty sleeping, and ‘hypervigilance’ (an over-alertness to the world around you). But people with CPTSD are likely also to have problems with self-worth, relationships, and regulating feelings.
You may have a sense of yourself as fundamentally worthless or different, and the world as totally untrustworthy. You may experience ‘dissociative’ symptoms (these may include feeling like you are not real, or the world around you isn’t real), struggle to sustain intimate relationships (more about this in point 5), and have regular suicidal feelings.
Your flashbacks may also take the form of ‘emotional flashbacks’—suddenly feeling overwhelmed by the same feelings which you experienced during past traumas, without the sense that you are ‘literally’ back there. This can be very confusing and destabilizing.
These differences mean that CPTSD is often diagnosed as other conditions—Borderline Personality Disorder, for instance. And they also result in debate over whether CPTSD should be categorized separately from PTSD, as a subtype of PTSD, or indeed categorized entirely outside any schema of ‘post-traumatic stress disorder.’
3) Complex PTSD looks different in different people.
People with CPTSD may be very angry, or very withdrawn. Or they may hide their feelings very well. Different people may experience different symptoms. There’s no one personality type for people with CPTSD, and it’s a mistake to try to universalize experiences of the condition (especially given points 6 and 7, below).
4) The causes of CPTSD in a person may be harder to see or explain than with ‘normal’ PTSD.
With non-complex PTSD, there’s usually a definite event to focus on. And there’s usually a clearer sense of a ‘before,’ which felt okay, and an ‘after,’ which did not. In contrast, complex PTSD is trickier to pinpoint in terms of a single cause.
The events involved might well be as shocking or violent as any which might trigger PTSD as a one-off—but they might also, individually, seem comparatively small: just built up over long, long periods of time. Or the traumas might stretch far into the past, before one’s memory even begins: There might be no memory of any ‘before’ that felt okay. Or the trauma might relate to, for instance, a pervasive sense of threat, which might or might not ever have materialized.
As a result, in some situations, it can be easy to feel as though one is over-reacting with CPTSD: as though nothing ‘real’ happened, and the fault is with oneself for making a fuss about nothing. And it can equally be difficult to explain what happened to other people, because they might be primed to expect a more ‘dramatic’ narrative.
One of the things which makes complex PTSD worse is the sense of not being believed or understood. This really compounds the sense of alienation from other people, which is such a key part of the condition—as the next point explains…
5) Complex PTSD makes relationships very difficult—and yet they’re the only way out.
When people have hurt you over a prolonged period of time, especially people who should have cared for you, and you have no belief that the suffering will ever end, it becomes very difficult to trust other people. It can feel safest to cut yourself off from others. And this is one of the most challenging things about CPTSD: Other people are the source of fear and pain, but also—ultimately—the only cure for them.
The only way to feel safer in the world is to learn to trust other people and feel safe around them. This can be incredibly tough, because everyone is human, and fallible, and coping with their own problems and difficult experiences. And because we receive tangible proof, every day, that the world really isn’t safe, and is getting less safe for marginalized people!
Order Noreen Masud's A Flat Place today.
6) The diagnosis ‘complex post-traumatic stress disorder’ comes from a specific place in culture and in time.
It’s important to remember that different cultures think about pain, and trauma, and repair, in different ways. CPTSD is just one way of thinking about pain, among many. And it can be really damaging to ‘impose’ a diagnosis on someone if it makes no sense within their model of the world.
7) But equally, people from any culture may find the diagnosis meaningful.
Indeed, structural racism is a major cause of complex PTSD. Grinding poverty, endless microaggressions, life in a warzone: People of color are more likely to experience all of these. Yet, in a cruel irony, people of color affected by complex trauma may well be criminalized or incarcerated rather than listened to, or supported.
Racism affects who is diagnosed with the disorder, and who is dismissed. And it's vitally important that we deal with complex trauma on a society-wide basis—no individual can ‘fix themselves’ in a world set up to hurt and damage them every day. We have to repair the system, not just the individual!
Noreen Masud is a Lecturer in Twentieth Century Literature at the University of Bristol, and an AHRC/BBC New Generation Thinker 2020. Her work focuses on the 20th century, writing about things which, in one way or another, present variously as absurd, unrevealing, embarrassing, or useless. These include aphorisms, flatness, puppets, nonsense, leftovers, earworms, footnotes, rhymes, hymns, surprises, folk songs, colors, and superstition.
