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When you hear “PTSD,” chances are, for example, you think about the military who have served in war, or people who have witnessed a crime or been victims of a house fire or natural disaster. Yet living with complex trauma, also known as complex post-traumatic stress disorder (C-PTSD), a condition caused by a wide range of traumas that have occurred over a long period of time, is something that has become more widely recognized in the medical community in recent years.
In the LGBTQIA+ community, in particular, mental health conditions are already prevalent, but because of stigma, bias, discrimination, marginalization, abuse, and assault that many individuals have experienced throughout their lives, there’s a higher chance that C-PTSD will develop.
Although we know a lot about the causes and symptoms of C-PTSD, and have effective treatments available, it remains largely undiagnosed or misdiagnosed, has barriers to care access, and is most certainly something not addressed by healthcare providers.
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What Is Complex PTSD?
C-PTSD, which was first introduced by Judith Herman, MD, thirty years ago, refers to trauma that occurs over weeks, months, and years.
“It leads to a shamed and damaged sense of self, disrupted interpersonal relationships, and shattered systems of meaning,” Herman said in this article.
Research shows complex trauma affects about 3% of the population.
Traumatic events can include physical, psychological and sexual abuse, neglect, and witnessing domestic violence, among others.
While C-PTSD is not included in the DSM-5, the handbook used by health care professionals to diagnose mental disorders and, therefore, not recognized by the American Psychiatric Association (APA), it is included in the eleventh edition of the World Health Organization’s International Classification of Diseases (ICD-11 ).
While anyone can be at risk for C-PTSD, people in the LGBTQIA+ community have a higher risk for experiences that can increase their propensity for developing it, including:
- Homophobia, biphobia, transphobia
- Discrimination
- Bullying
- Microaggressions
- Physical, verbal, and emotional abuse
- Intimate partner violence
- Hate crimes
- Traumatic loss
Among LGBTQIA+ youth, coming out can also lead to trauma. According to the 2019 GSLEN National School Climate Survey, 86% of LGBTQIA+ students experienced harassment or assault as a result of sexual orientation, gender expression, and gender.
Plus, nearly one-third of LGBTQIA+ youth have been homeless, kicked out of their homes, or run away, a 2020 survey found.
of the population is affected by complex PTSD
People with complex PTSD have a threefold risk for suicidality
psychiatric hospitals in the U.S. that offer specialized treatment for C-PTSD.
$10,000 and $50,000 in out-of-pocket costs for C-PTSD treatment
What Are Complex PTSD Symptoms
C-PTSD is similar to PTSD and includes many of the same symptoms, such as:
- Anxiety
- Intrusive memories, flashbacks, and nightmares
- Hyper-vigilance or an enhanced startle response
- Avoidance of thoughts, memories, or situations that can lead to re-experiencing the traumatic events
C-PTSD, however, can also include:
- A distorted sense of self and low self-esteem
- Changes in previously held beliefs or a negative view of the world
- Difficulty regulating emotions
- Problems with relationships
- Dissociation from the trauma, or lapses in memory
- Impairment in functioning
- Problems with sleep, memory, and mood
C-PTSD can lead to physical or somatic symptoms, such as:
- Chronic headaches and migraines
- Neck and back pain
- Gastrointestinal problems, such as irritable bowel syndrome (IBS)
- Allergies
- Chronic fatigue syndrome
- Fibromyalgia
- Thyroid problems
Other comorbid conditions can occur with C-PTSD including:
- Dissociative Identity Disorder (DID)
- Other Specified Dissociative Disorder (OSDD)
- Borderline Personality Disorder (BPD)
- Anxiety disorders
- Depression and Major Depressive Disorder (MDD)
- Bipolar disorders
- Obsessive-Compulsive Disorder (OCD)
- Eating disorders
- Substance Use Disorder (SUD)
Those with complex PTSD also have a threefold risk for suicidality, a 2019 study in the journal Depression & Anxiety found.
Life stressors, such as job-related pressures, a lack of work-life balance, financial stress, and relationships—including those with parents or family members who played a role in the risk of C-PTSD—can exacerbate the condition.
Caring for Complex PTSD in the LGBTQIA+ Community
Mental health, irrespective of complex trauma, is a concern in the LGBTQIA+ community.
People who identify as lesbian, gay, or bisexual are more than twice as likely to experience a mental health condition and have a higher risk for suicide.
Plus, according to a 2019 study in the journal Transgender Health, approximately 58% of transgender patients had at least one mental health diagnosis compared with 13.6% of cisgender patients.
When we look at C-PTSD, not only is its prevalence likely underestimated, but the condition is also often not properly addressed by providers. Even when care is available, it’s extremely costly.
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According to Beauty After Bruises, a project of The Foundation for Enhancing Communities:
- There are less than 10 psychiatric hospitals in the U.S. that offer specialized treatment for C-PTSD.
- Insurance providers prefer to work with their networks and will often deny treatment for out-of-state care.
- Treatment can cost patients between $10,000 and $50,000 in out-of-pocket costs, leaving most untreated. For those who do seek treatment, the financial burden alone can trigger additional stress and anxiety.
- The average length of stay for inpatient and intensive outpatient programs (IOP) is 3 to 6 weeks.
- Therapy sessions cost $100 per session, on average, or $5,000-$20,000 annually.
- Payers often place limits on the number of visits.
While people with complex PTSD often have chronic conditions that are unmanaged, oftentimes, what’s driving high utilization of the emergency department and urgent care is C-PTSD itself.
Treatment Options for Complex PTSD
For people in the LGBTQIA+ community with C-PTSD, there are a wide range of treatment modalities available, but effectively treating the condition requires personalized, appropriate, holistic care that employs a combination of therapies. Some include:
- Psychotherapy:
- Talk therapy can help individuals process the traumatic events and find ways to cope with the symptoms. Many practitioners specialize in LGBTQIA+ issues and trauma and telehealth can reduce stigma.
- EMDR:
- Eye movement desensitization and reprocessing, which involves directing eye movements while talking about the traumatic events, is designed to relieve distress, reformulate negative beliefs, and reduce physiological arousal.
- Exposure therapy:
- A type of treatment in which psychologists create a safe environment to “expose” people to feared objects, activities, or situations. Exposure therapy is meant to reduce fears and decrease avoidance.
- Virtual reality:
- Studies suggest virtual reality, a way to create exposure-based therapy (EBT) by immersing an individual in the environment that triggers memories of the trauma, may have some benefit.
- Cognitive Behavioral Therapy (CBT):
- Is a form of treatment that provides various strategies to help people change their thinking patterns, such as recognizing distortions and reframing them.
- Dialectical Behavior Therapy:
- A treatment that combines the principles of behavior therapy, cognitive behavior therapy, and mindfulness, DBT helps people to regulate and tolerate their emotions.
- Internal Family Systems:
- A type of psychotherapy that focuses on healing wounded “parts” of the mind that have experienced trauma and restoring balance and harmony.
- Somatic Psychotherapy:
- A type of therapy that focuses on body awareness on inner physical sensations and uses various techniques, such as mindfulness, relaxation techniques, and movement to identify the reactions linked to the trauma and regulate arousal, thus decreasing symptoms and distress.
- Medication:
- Antidepressants and medications that help with anxiety may help those with C-PTSD.
- Support groups:
- Individuals can find support through community groups such as CPTSD Community Safe Group
Effectively treating C-PTSD requires personalized, appropriate, holistic care that employs a combination of therapies.
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How Alight Supports Employers and LGBTQIA+ Employees
In the last two decades, many employers have increasingly prioritized the needs of LGBTQIA+ individuals through their recruitment and retention strategies and have offered sensitivity training through HR compliance platforms.
At Alight, we have the capability to provide healthcare guidance to transgender, transsexual, and gender nonconforming people.
Our Health Pros help employees navigate their benefits and understand their coverages and what to expect, as they assist with finding safe and effective pathways.
In addition to identifying providers that are LGBTQIA+ allies, we have a cohort of expert physicians who can provide gender-affirming expert medical opinions across primary care and several specialty care areas.
Our transgender allies undergo many hours of training and approach all participants through the lenses of inclusivity, empathy, and cultural humility.
Alight is also proud to be partnered with Fenway Health, a global leader in LGBTQIA+ health.
The organization advocates for and delivers innovative, equitable, accessible healthcare, supportive services, as well as transformative research and education to LGBTQIA+ and BIPOC individuals.
Through our partnership, Alight gains access to Fenway Health’s leadership and experience in LGBTQIA+ health, their library of educational and training materials which are utilized by our teams, and the ability to co-create expert resources for use in the channels we serve.
Employers can look to infuse this kind of competency and education throughout their benefits programs by selecting vendors that line up in meaningful ways to support inclusivity, and proactively inquire about how their current suite of vendors are meeting the needs of those in the LGBTQIA+ community.
Additionally, the Alight Partner Network provides employers with a trusted source of curated, high-value solutions that promote holistic wellbeing. Mental and behavioral health programming from organizations like Vida and meQuilibrium, for instance, can be accessed through our partner network.
Vida provides evidence-based therapy and coaching to help people not only overcome behavioral health challenges, but also chronic physical conditions, which we understand can be closely linked.
meQuilibrium uses science-based trainings to build resilience, manage stress, and reduce burnout in employees, which, given the nonstop pace of change in today’s world, is running unchecked in many populations.
Both partners’ experiences are complemented by our Medical Ally team, which can help participants and caregivers navigate the full spectrum of mental health needs, from lower acuity episodes of stress and anxiety to more complex, longer-running issues like substance abuse and addiction.
During the tremendous social and political division and discord in the U.S., it’s important that we recognize that others are suffering, even if it’s not apparent, and show kindness, love, and caring for one another.
