PTSD is a complex disorder which is often associated with soldiers returning from combat, but it is something which is very common with people who have suffered traumatic events in their lives.  It can occur at any time after the event or series of events with the person affected often having flashbacks or nightmares.  Symptoms may surface at the time, months or even years later.  PTSD is treatable with the correct help and support.

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Symptoms of PTSD vary from person to person and may severely impact on the ability to lead a normal life.  Some of the most common symptoms are listed below…
Reliving the original trauma or event as if it is happening now


Disturbed sleep, nightmares

Intrusive thoughts


Inability to concentrate

Feelings of distress and anxiety

Panic attacks

Nervousness and feeling on edge

Physical symptoms – such as pain, nausea, sweating or trembling

Some people have difficulty quelling the constant stream of negative thoughts resulting in a continuum of questioning oneself, thus negating an ability to come to terms with the past.

It is estimated that one in three people who have suffered trauma will develop some form of PTSD.

Complex PTSD 

The US Department of Veterans Affairs has stated that Dr Judith Herman of Harvard University suggested that a new diagnosis, Complex PTSD, is needed to describe the symptoms of long-term trauma.  It may not develop for years and can cause similar symptoms to PTSD.

Cases that involve prolonged, repeated trauma may indicate a need for special treatment considerations.

What types of trauma are associated with Complex PTSD? 

During long-term traumas, the victim is generally held in a state of captivity, physically or emotionally, according to Dr. Herman.  In these situations the victim is under the control of the perpetrator and unable to get away from the danger.

What additional symptoms are seen in Complex PTSD?

An individual who experienced a prolonged period (months to years) of chronic victimization and total control by another may also experience the following difficulties:

  • Emotional Regulation: may include persistent sadness, suicidal thoughts, explosive anger or inhibited anger.
  • Consciousness:  Includes forgetting traumatic events, reliving traumatic events, or having episodes in which one feels detached from one’s mental processes or body (dissociation). Distorted Perceptions of the Perpetrator. Examples include attributing total power to the perpetrator, becoming preoccupied with the relationship to the perpetrator, or preoccupied with revenge.
  • Self Perception: May include helplessness, shame, guilt, stigma and a sense of being completely different from other human beings.
  • Distorted Perceptions of the Perpetrator: Examples include attributing total power to the perpetrator, becoming preoccupied with the relationship to the perpetrator or preoccupied with revenge.
  • Relations with Others: Examples include isolation, distrust, or a repeated search for a rescuer.
  • One’s System of Meanings: May include a loss of sustaining faith or a sense of hopelessness and despair.

What other difficulties are faced by those who experienced chronic trauma?

Because people who experience chronic trauma often have additional symptoms not included in the PTSD diagnosis, clinicians may misdiagnose PTSD or only diagnose a personality disorder consistent with some symptoms, such as Borderline, Dependent, or Masochistic Personality Disorder.

Care should be taken during assessment to understand whether symptoms are characteristic of PTSD or if the survivor has co-occurring PTSD and personality disorder.  Clinicians should assess for PTSD specifically, keeping in mind that chronic trauma survivors may experience any of the following difficulties:

  • Survivors may avoid thinking and talking about trauma related topics because the feelings associated with the trauma are often overwhelming.
  • Survivors may use alcohol or other substances as a way to avoid and numb feelings and thoughts related to the trauma.
  • Survivors may engage in self-harm.
  • Survivors who have been abused repeatedly are sometimes mistaken as having ‘weak character’ or are unjustly blamed for the symptoms they experience and result in victimization.

It is perfectly normal to experience intrusive thoughts after trauma though these should improve naturally after a relatively short period of time, however treatment should be sought if symptoms persist.

Written by Anne McCrea


  1. Herman, J. (1997). Trauma and recovery: The aftermath of violence from domestic abuse to political terror. New York: Basic Books
  2. US Department of Veterans Affairs, 17 August 2015, PTSD: National Center For PTSD, [Online] accessed 15 February 2016.

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