The Misdiagnosis and Ignorance of Complex PTSD
by LWK | Dec 27, 2023 | CPTSD, Emotional Wellness, Guest Contributor
Misdiagnosis of CPTSD is common. The lack of knowledge and understanding of CPTSD is huge. Worst of all, the unwillingness to help and support, within our Healthcare Systems, is heartbreaking.
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Misdiagnosis
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Complex Post Traumatic Stress Disorder (CPTSD) is frequently misdiagnosed as Emotionally Unstable Personality Disorder (EUPD), previously known as Borderline Personality Disorder (BPD). CPTSD is kind of like a subset of PTSD but it looks quite different. Complex PTSD comes from long-term exposure to trauma and/or neglect; oftentimes it stems from childhood sexual, physical, and emotional abuse, neglect, or long-term trauma whereby escape would be seemingly impossible or too dangerous. We see CPTSD in survivors of long-term childhood abuse, human trafficking, refugees, or people that have experienced long-term domestic violence or intimate partner violence.
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The chronic nature of the trauma and the inescapability of it, for whatever reason, be it age or risk to life, makes CPTSD quite different from PTSD which in contrast is far more episodic. PTSD is usually caused by trauma seen in combat, a car accident, or a natural disaster, it is one event as opposed to long-term, often years, of trauma building up incident by incident with no safe attachments and no escape in sight.
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There’s a tremendous crossover between PTSD and CPTSD; flashbacks, night terrors, dissociation, fugue states, emotional dysregulation, and hypervigilance. There are core differences that mean behavioural patterns, cognitive thinking and rationale, relationship issues, and disturbances in the sense of self, present in a way that lessens the likelihood of CPTSD being ‘misdiagnosed’ as PTSD. Instead, CPTSD is often labeled as EUPD (previously BPD) and a myriad of other diagnoses such as panic disorder, depression, anxiety, etc.
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EUPD (previously BPD) has a large overlap with CPTSD and it’s something the entire field of psychology struggles with. Particularly, here in the UK where CPTSD is basically unheard of, definitely by primary care services and oftentimes by secondary care services. It is simply not a diagnosis many clinicians are given much information about, only psychiatrists and trauma-specialised psychologists are ‘in the know’. This leaves the survivor feeling more alienated, further dissociated, self-blaming, and reinforces the fear of relationships.
EUPD is a fear-based Personality Disorder, it is led almost exclusively by a chronic fear of abandonment. This is something that you don’t see so much of in CPTSD survivors, there is some level of it in all of us, but with CPTSD it is more the fear of the relationship itself as opposed to abandonment. People who have CPTSD feel that relationships and interpersonal spaces are unsafe places to be.
EUPD (BPD) sufferers usually have an unstable sense of identity, almost as if they don’t know who they are. Whereas people with CPTSD have a distorted sense of self, viewing themselves as shameful, to blame, and effectively just a bad person. They know who they are, it’s simply a warped view induced by the trauma. The two views are very different.
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EUPD (BPD) is a mental health condition with the highest rate of suicide, higher than depression, anxiety, PTSD, or any other illness. Suicidal ideation or gestures and self-harming behaviours are more congruent with EUPD. This is a tricky one though, as there is still a high risk in CPTSD clients due to the sheer level of trauma and distorted sense of self. Self-harming behaviours and suicidal intention is dangerous and more of a classic symptom of EUPD, but we can see it in CPTSD if the person has been retriggered or is going through new trauma.
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We know that something EUPD and CPTSD have in common is early trauma. It is often the case that a person with EUPD has suffered childhood abuse or trauma however, not all have. Not every person out there in the world with EUPD has a history of significant, chronic, childhood trauma, EUPD can be hereditary. With Complex PTSD this is far, far more likely to be the case; there has to have been at least one period in their life where they have experienced long-term, chronic, repetitive, and inescapable trauma. Most often, though not exclusively, this trauma is experienced in early childhood and then follows them as a ‘blueprint’ as they go through life; leading CPTSD survivors to unintentionally fall into unsafe relationships, abusive marriages etc.
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Ignorance
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I write a fair bit about Complex PTSD. In part, this is because I do a fair amount go work for the CPTSD Foundation and I am a survivor myself. That being said, I have experienced firsthand that ignorance of the condition within our healthcare system both private and public.
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The UK is not trained to deal with Complex trauma the professionals and clinicians are seemingly terrified to deal with it, likely because they feel they lack the training. We love calling ourselves ‘Trauma-informed’ and ‘Trauma led’, and yet there is such a gap in the understanding of what ‘trauma’ can actually look like.
When domestic abuse charities claim to be ‘Trauma informed’ and run programs, women’s refuges, man entire county hotlines for advice, yet none of the staff have even heard of CPTSD … there is a problem.
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When band 8a Community Mental Health Nurses, decide to book a patient with CPTSD in for a session with two clinicians each week, simply as a deterrent to stop the patient from disclosing any trauma (because THEY feel unqualified to deal with it) … we have a problem.
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When counsellors and psychotherapists have ‘Trauma’ on their bio but haven’t heard of CPTSD let alone completed any training/CPD on the subject, nor have they knowingly treated any patient with CPTSD … we have a problem.
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GPs are not allowed to prescribe the type of medication required nor are they able to diagnose Complex PTSD, this has to be done by a psychiatrist and yet, GPs are not trained to recognise the signs of CPTSD. They haven’t heard of it, nor have the crisis teams or community mental health teams they refer to, so it goes untreated or worse, treated as depression, anxiety, panic attacks I.e the things a GP is allowed to diagnose and treat. Referrals are made for NHS counselling, but the NHS delivers CBT as an (almost) mandatory response and CBT simply is not the therapy to aid CPTSD.
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‘Do no harm’ is what our Nurses and doctors swear to uphold; so it is understandable that when faced with Complex trauma and the symptoms it presents, they shrink away from the patient in fear of causing ‘more harm than good’. Counsellors and therapists preemptively worry themselves sick about transference, attachment issues, and possible complications around flashbacks or dissociation. Before the patient knows what is happening they have been referred to, as the professional cannot tell the difference between the terrifying *cluster B* that is EUPD/BPD and Complex PTSD. Heaven knows finding a therapist willing to try and treat EUPD is hard enough.
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This fear of ‘doing more harm than good’ and effectively passing the buck, (the ‘buck’ being a trauma survivor!), is so incredibly ironic. People with CPTSD are afraid of the relationship space, they blame themselves for their trauma, and they view themselves as too much, too disgusting, too shameful, and quintessentially bad as humans. The way the healthcare field reacts, that ‘passing the buck’, does nothing but retraumatise and consolidate this distorted sense of self. The sad truth is that the system is set up in such a way, due to the lack of training and general understanding, that the ‘do no harm’ actively becomes ‘doing more harm than good’.
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As a professional, clinician, front-line support worker, and educator … if you want to claim being ‘trauma-informed’ and ‘trauma led’ then you need to do the research and get a good grasp of CPTSD because it is all around us, unseen, unheard and untreated.
The links below are excellent for much more in-depth knowledge.
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