Complex PTSD, is distinguished from PTSD in terms of the psychological trauma that results from years of abuse, in which a lack of control and entrapment are characteristics. C-PTSD is far more likely in people who were chronically and repeatedly abused during childhood, either through family abuse, or some forms of armed conflict or captivity. People with C-PTSD often have difficulties in regulating their emotions. They frequently experience interpersonal problems and have difficulty in work situations.
According to the National Center for PTSD, examples of captivity include:
Prisoner of war camps
Long-term domestic violence
Long-term, severe physical abuse
Child sexual abuse
Organized child exploitation rings
They go on to say that people suffering with C-PTSD avoid talking about their traumatic experiences because the feelings overwhelm them. They may use alcohol or drugs to numb their feelings and survivors may self-mutilate or engage in other forms of self-harm. There is also some concern that because of their chronic victimization, the symptoms shown are prone to misdiagnosis as Borderline, Dependent, or Masochistic Personality Disorder.
The treatment of complex post-traumatic stress disorder (C-PTSD) with psychotherapy is a fairly slow process. It may be punctuated by periods of crisis that can require a period of hospitalization. Various therapeutic approaches may be used as part of the overall treatment regime.
Trauma therapy is often characterized by a more active and intervening style with maladaptive behavior than is commonly seen in traditional psychoanalysis. The therapeutic environment however remains a safe, nonjudgmental place that allows the client to speak freely. A skilled therapist will remain calm and compassionate throughout. The view is that by sharing traumatic memories in such an environment, the dissociation experienced by the client will be reduced considerably.
One of the issues frequently leveled at psychoanalysis is the lack of controlled research available to support its effectiveness. If anecdotal information is accepted it would appear that the approach is effective, but whether it is any more effective than other forms of therapy is less clear. In one of the few large-scale studies to have been conducted, 112 trauma survivors were randomly allocated to hypnotherapy, psychodynamic treatment, or systematic desensitization. The results found no differences in the effectiveness of one technique over another.