Beth M. Broom, LPC-S, CCTP-II
As experts observe survivors of trauma over the span of time and culture, we are realizing that traumatization has some nuance. We notice a spectrum of how people experience the lasting effects of a traumatic event. Some people exhibit all or most of the symptoms of Posttraumatic Stress Disorder (PTSD), and some do not. Some people have additional symptoms that are even more severe than those defined under the diagnosis of PTSD. You may not like the idea of using psychological diagnostic terms – for some people, carrying a mental health diagnosis can diminish their capacity toward hope and growth. But even if we are not trying to diagnose a person’s struggles, understanding their symptoms can help us better understand how to care well for them with biblical wisdom and truth.
In this post I’d like to unpack the definition of complex trauma as defined by the International Classification of Diseases (ICD). The ICD-11 is a diagnostic manual similar to the Diagnostic and Statistical Manual (DSM). But unlike the DSM which is utilized mostly within the United States, the ICD has been created by the World Health Organization and is the standard of classification across the world. The ICD also includes diagnostic explanations of all types of health diagnoses, while the DSM only addresses psychological diagnoses.
The American Psychiatric Association’s website explains four categories of symptoms included in the definition of PTSD: 1) intrusions; 2) avoidance; 3) changes in mood and cognition; and 4) changes in arousal and reactivity. The ICD has included an additional definition and list of symptoms for complex trauma, or CPTSD, recognizing that some traumatization includes additional negative effects beyond the scope of PTSD. These additional features of CPTSD include: 1) problems in affect regulation; 2) negative beliefs about oneself that include shame, guilt, or failure; and 3) difficulties in sustaining relationships and in feeling close to others.
Why is it important to notice whether a person is experiencing symptoms that may indicate complex traumatization? With PTSD, a person may experience varying degrees of struggle with emotional regulation, relational struggles, and feelings of shame. But if these issues are persistent and are impacting a person’s daily functioning, we as helpers want to include elements of care that are specific to these struggles. So whether or not you want to use diagnostic language, noting your counselee’s specific symptoms will help you create wise plans for how to help them move forward. For example, if a person struggles with thoughts of self-loathing and shame such as “I am completely unforgivable” or “I am worthless,” we want to work hard to share gospel truth about their identity in Christ while simultaneously exhorting them to refute the lies that keep them locked in shame. We do this with gentleness and wisdom (Galatians 6:1-2).
Here are some questions you can ask your counselee to open the door for discussion about the three areas of symptoms related to complex trauma:
Emotional Regulation:
- When you experience distress, how long does it last? On a scale of 1-10, how severe is it?
- How often do you experience panic? How often do you feel shut down or numb?
- What types of things cause distress that leads to panic or numbness?
- What helps you to return to a state of calm after you’re feeling distressed?
- How long does it take for you to feel calm and alert again?
- What types of emotions are included in your typical moments of distress? (i.e., fear, panic, rage, numbness, sadness, etc.)
Negative Beliefs:
- When something difficult happens, do you typically blame yourself?
- What messages do you hear in your head about the reasons bad things happen?
- What negative things do you believe about yourself? How often do you think about these things?
- Do negative beliefs affect your ability to do your work? to be in relationships?
- Do you ever feel hatred toward yourself when you think about the trauma you have experienced?
Difficulties in Sustaining Relationships:
- Do you have trouble keeping friendships?
- Do other people tell you that they don’t know where they stand with you?
- Do you find yourself clinging closely to one person?
- Do you find yourself avoiding closeness and intimacy?
- Do you tend to blame a failed relationship completely on yourself or someone else?
When we ask good questions, we are more likely to understand the person in front of us. This can lead to wisdom and a path toward healing and thriving. Remember Proverbs 20:5: “The purpose in a man’s heart is like deep water, but a man of understanding will draw it out.”
If your counselee is a Christian, you will want to talk with them about how these struggles impact their walk with God and their inclusion in the Body of Christ. You’ll want to understand the obstacles that hinder their trust in God and ability to allow others to bear their burdens. These emotional and relational struggles are likely to negatively impact their Christian community and communion with Christ, so we must work to gently lead them toward gospel truth.
To help you gauge your counselees’ struggles and needs, I have created the “Daily Functioning and Relational Questionnaire (DFRQ),” a questionnaire that includes a list of symptoms related to daily functioning, relational struggles, and spiritual health. It is not a diagnostic tool but rather is meant to help the counselor discern potential struggles in various areas of mental, relational, and spiritual health. This questionnaire is available for all CTHN members in the “Tools and Handouts” section of our website. To learn how to become a CTHN member, click HERE.
RESOURCES:
“Complex post traumatic stress disorder.” ICD-11 for Mortality and Morbidity Statistics. https://icd.who.int/browse/2024-01/mms/en#585833559
“Posttraumatic stress disorder.” American Psychiatric Association. https://www.psychiatry.org/patients-families/ptsd
