Do You Need a Psychiatrist for Complex PTSD?

Summary: You need a psychiatrist for complex PTSD – called C-PTSD – if you review your treatment options and decide you want to take prescription psychiatric medication during treatment.

Key Points:

• Complex PTSD is a serious mental health condition that requires specialized treatment.
• Providers who treat people with PTSD must be experienced in the principles of trauma-informed care
• Evidence shows trauma-informed cognitive-based therapies are the most effective approach to reducing and managing the symptoms of complex PTSD (C-PTSD).

What is Complex Post-Traumatic Stress Disorder (C-PTSD)?

Complex PTSD is currently not recognized as a separate mental health disorder in the Diagnostic and Statistical Manual of Mental Disorders (DSM-V), which includes it as a subtype of post-traumatic stress disorder (PTSD). However, C-PTSD is recognized as a separate disorder in the International Statistical Classification of Diseases and Related Health Problems, 11^th Revision (ICD-11).

In order to understand how providers diagnose of C-PTSD, we’ll use information from the resource Complex PTSD: Assessment and Treatment published by the U.S Department of Veterans Affairs (VA).

To meet criteria for diagnosis, you must first meet criteria for standard PTSD, which you can read about in detail in the two articles above. To meet criteria for C-PTSD, a person must also experience and report symptoms in the following three categories:

1. Emotional dysregulation, e.g. having a hard time settling down after being upset and/or feeling emotionally disconnected/numb
2. Negative self-concept, e.g. feelings of inadequacy and/or feeling like a failure.
3. Difficulty in relationships, e.g. feeling distant from others and/or inability to establish/form/maintain close bonds with others.

Here’s a summary of the signs and symptoms of C-PTSD.

CPTSD: Signs and Symptoms

Presence of standard PTSD symptoms:

• • Flashbacks to memories of traumatic events/reliving traumatic events
  • Hyperawareness of danger
  • Avoidance of anything physically or emotionally risky

Additional presence of C-PTSD symptoms:

• • Emotion dysregulation, including:
    • Extreme emotional reactivity
    • Persistent anger
    • Chronic irritability
    • Tantrums/outbursts
  • Negative self-concept, including:
    • Feeling/seeing oneself as less-than, damaged, or diminished
    • Feeling of being defeated by life
    • Persistent sense of worthlessness
    • Not feeling worthy of kindness of love from others
  • Interpersonal problems:
    • Rocky/unstable family relationships
    • Difficulty forming and maintaining healthy and fulfilling relationships
    • Avoidance of social interactions

You can receive a diagnosis for C-PTSD from psychiatrists, clinical psychologists, licensed clinical social workers (LCSWs), licensed mental health counselors (LMHCs), and licensed professional counselors (LPCs).

What Causes C-PTSD?

We know why people develop PTSD; they experience a significant traumatic event. The National Institute of Mental Health (NIMH) identifies the following traumatic events associated with PTSD:

• Experiencing/witnessing violence
• Experiencing/ witnessing war/living in a war zone
• Physical, sexual, and/or emotional abuse
• Natural disaster
• Major accidents or illness
• Loss of a loved one

Complex PTSD than is different than PTSD in that it’s associated with the experience of chronic, ongoing trauma. Events that meet criteria for chronic, ongoing trauma include:

• Ongoing, long-term physical and/or sexual abuse during childhood
• Ongoing, long-term domestic abuse/violence
• Rape and any form of sexual assault or exploitation, including trafficking
• Direct experience of combat in war
• Indirect experience of combat, i.e. being stationed near front lines
• Living in a war zone
• Regularly experiencing/witnessing community violence

Research shows C-PTSD most often appears in victims of rape, but may also appear in victims of torture, prisoners of war, victims of kidnapping and any form of slavery.

The causes of C-PTSD reveal why it’s a serious mental health condition. The bullet lists above include some of the worst events that can happen to a person. Some are virtually unthinkable, but unfortunately, they do happen, and real people feel the real consequences of them, in the form of the symptoms of C-PTSD, every day.

Thankfully, in recent years, since the identification of C-PTSD as a separate form of PTSD, mental health experts have identified several effective treatment modalities for reducing and managing the symptoms of C-PTSD.

Treatment for C-PTSD: What Works?

You can receive treatment for C-PTSD from psychiatrists, clinical psychologists, licensed clinical social workers (LCSWs), licensed mental health counselors (LMHCs), and licensed professional counselors (LPCs).

In two peer-reviewed journal articles – PTSD And Complex PTSD, Current Treatments and Debates: A Review Of Reviews and Systematic Review: Effectiveness Of Psychosocial Interventions On Wellbeing Outcomes For Adolescent Or Adult Victim/Survivors Of Recent Rape Or Sexual Assault – researchers examined and identified available data on treatment for C-PSTD.

Information from these articles helps us answer the question we pose in the title of this article: Do You Need a Psychiatrist for Complex PTSD?. Data indicates that psychiatric medication – i.e. anxiolytics, antidepressants, antipsychotics – are not first-line treatments for C-PTSD.

Therefore, you don’t need a psychiatrist for complex PTSD, since clinical psychologists, licensed clinical social workers (LCSWs), licensed mental health counselors (LMHCs), and licensed professional counselors (LPCs) can all offer treatment if they have appropriate training.

However, a psychiatrist who also offers psychotherapy – and has experience in the modalities we list below – may be an ideal choice.

Why?

Because in an emergency, they can prescribe medication that can, in the short-term, manage the most severe symptoms of C-PTSD, and in combination with intensive emergency psychotherapy, can mitigate, reduce, or eliminate the need for an extreme crisis response, such as inpatient psychiatric hospitalization.

Let’s take a look at the modalities considered effective for C-PTSD, according to the two studies we cite above.

Evidence-Based Treatments for C-PTSD

• Cognitive behavioral therapy (CBT)
• Eye movement desensitization and reprocessing (EMDR)
• Cognitive processing therapy (CPT)
• Prolonged exposure therapy (PE)
• Systematic Desensitization (SD)
• Brief psychoeducation (PEI)
• Psychological support (PS)

All of these approaches function under the umbrella of trauma-informed CBT. To learn more about the principles and practices of trauma-informed care, please read this article on our blog:

PTSD Treatment: How Do I Find It and What Does It Involve?

How Do These Approaches Help C-PTSD?

The evidence indicates that the approaches above, when delivered in the overall context of trauma-informed CBT, can help patients reduce and manage the following symptoms.

• General PTSD symptoms, including:
  • Hyperarousal
  • Avoidance of traumatic memories
  • Avoidance of triggers associated with traumatic memories.
  • Constant sense of threat
• Depression
• Fear of subsequent traumatic experiences

Among the therapies assessed, those that show the most consistent positive outcome included

• B-CPT: Brief cognitive processing therapy
• Prolonged exposure therapy (PE)
• Brief psychoeducation (PEI)

What these studies show, overall, is that treatment for PTSD is effective for C-PTSD as well, and that programs designed to target C-PTSD specifically, such as phase-based treatment called Skills Training in Affective and Interpersonal Regulation (STAIR), show no clear advantage over standard trauma-informed CBT.

Here’s how the experts on PTSD at the Veterans Administration (VA) characterize the current state of the evidence:

“Early studies—with DSM-5 PTSD populations and interventions–have not found an advantage so far for phase-based treatments for people who have CPTSD or have found that people with CPTSD benefit as much as those with PTSD from standard PTSD treatments.”

Further research is required to determine whether phase-based treatment is effective, with studies directly comparing phase-based C-PTSD treatment to trauma-informed, cognitive-based treatment for PTSD. The VA summarizes the evidence on C-PTSD treatments as follows:

“At present, there is encouraging evidence that people with CPTSD can benefit from existing PTSD treatments.”

That’s good news. And in answer to whether you need a psychiatrist for complex PTSD, we’ll reiterate that it’s not absolutely necessary – unless you prefer to receive a prescription for psychiatric medication – but seeking support from a psychiatrist includes advantages and options not available during treatment with psychologists, therapists, or counselors.