September is cPTSD Awareness Month. What is cPTSD, or Complex Post-Traumatic Stress Disorder? How does cPTSD relate to religious trauma? Welcome to Part 1 of a 2-part series answering these very questions.
I’m Michelle F. Moseley, a licensed mental health counselor in NC and a Religious Trauma Specialist. I have spent 1000s of hours learning about complex trauma and working with individuals who have been impacted by this type of harm. I’m also the lead author on several texts on the subject of religious trauma which are scheduled to be published in 2027. In addition to this clinical work, I have lived experience of spiritual abuse and religious trauma, as well as the related cPTSD symptoms.
PTSD vs. cPTSD
You may be familiar with PTSD, Post-Traumatic Stress Disorder. In the US, mental health concerns are diagnosed utilizing the DSM (current edition DSM-5-TR), which includes PTSD but does not currently include cPTSD.
PTSD includes the following symptoms or components:
- Results from exposure (directly or through extreme details) to death, serious injury, or sexual violence
- Intrusive Symptoms – unwanted memories or dreams, flashbacks, physiological distress at reminders of the event
- Avoidance – actively staying away from reminders associated with the event
- Negative Cognitions / Mood – changes in thoughts and mood following the event; for example, believing that you, others, and the world are bad or unsafe
- Arousal and Reactivity – changes in levels of irritability or alertness (hypervigilance) to the environment, sleep disturbances
These symptoms must last for more than one month and cause significant impairment in daily functioning to result in a diagnosis of PTSD. Often, but not always, PTSD is related to a single-event trauma.
cPTSD includes the following symptoms or components:
- Results from prolonged, repeated, or inescapable traumatic events (not limited to the specific events mentioned in the PTSD criteria)
- Typically associated with events that involved harm by a trusted person or authority figure
- Intrusive Symptoms – unwanted memories or dreams, flashbacks, physiological distress are reminders of the events
- Avoidance – actively staying away from reminders associated with the events
- Arousal and Reactivity – changes in level of irritability or alertness (hypervigilance) to the environment, sleep disturbances
- Emotional Dysregulation – difficulty managing intense feelings, emotional numbness, feeling detached from your body (dissociation)
- Negative Self-Concept – persistent feelings of shame, guilt, or worthlessness; believing you are permanently “damaged”
- Interpersonal Difficulties – difficulty trusting others appropriately, withdrawing from important people, being drawn to unstable and intense relationships
While cPTSD cannot currently be officially diagnosed in the US, it is listed in the diagnostic criteria that is used more broadly throughout the world (current version is ICD-11). Complex PTSD is associated with repeated exposure to traumatic events in which the victim is held captive in some way – physically, psychologically, financially, etc.
What Causes cPTSD?
People often talk about cPTSD in the context of childhood abuse or neglect. This is one of the most common contributors to cPTSD symptoms. A child who does not experience care from the adults in their life is in a situation where their needs are not being met and they do not have an option for escape. This can lead to the development of cPTSD symptoms.
There are several other types of experiences that can contribute to cPTSD, including:
Long-term abusive interpersonal relationships. This may include romantic partnerships, family relationships, interactions with colleagues, or any other relationship where you are connected to that person for some reason and there is abuse occurring over time. The abuse may be physical, such as hitting, slapping, or kicking. The abuse may include unwanted sexual activity or coercion to comply with sexual demands. Long-term abuse can also include emotional or psychological abuse – name-calling, making belittling comments about you, gaslighting or causing you to question your experiences. Financial abuse may also occur in these relationships when one person controls access to money or when a person’s ability to meet basic needs depends on complying with an abuser.
Being held in captivity – human trafficking, slavery. Sometimes the inability to escape a situation includes literal captivity. This may include being forced into labor of some sort, having basic needs left unmet if you do not comply with an abuser.
Inescapable systemic oppression. We all live within systems that provide some individuals with care and access while leaving other individuals trapped without the ability to access basic needs such as respect, compassion, shelter, food, or connection. Your geographic location and your intersecting identities will play a role in how these systems impact you and what options you have for escape. Some of the oppressive systems that can hold someone captive and cause repeated harm include racism, patriarchy, homophobia, transphobia, and anti-fat bias.
Physical torture or genocide. Being held physically captive, experiencing torture, or witnessing genocide are other forms of inescapable harm that can result in cPTSD symptoms.
You may notice that many of these types of situations describe things that have been happening throughout history. Even before humans had the current terminology to describe cPTSD, our ancestors recognized that these kinds of inescapable events had an impact on our bodies and personhood. The generational impacts of trauma and the concept of epigenetics are beyond the scope of this blog post, but may be topics you want to check out further.
Religious Trauma and cPTSD
So, what does this have to do with religious trauma? How does religious harm contribute to the development of cPTSD?
Some religious contexts can create dynamics where there are repeated incidents of abuse or harm, and that feel inescapable to leave. This will not always lead to cPTSD, but for some folks these experiences will result in cPTSD symptoms. Stay tuned for part 2 where we’ll take a look at some of the ways religious harm can contribute to cPTSD, how cPTSD can show up in religious trauma, and some options for recovery.
Michelle F. Moseley (she/her) is a Licensed Clinical Mental Health Counselor in NC (#12491). She believes ALL people deserve respect, compassion, and access to mental and physical healthcare. Michelle specializes in working with survivors of religious trauma, and with those who have body image concerns, finding there is frequent overlap in these areas. She also frequently supports late-identified neurodivergent individuals as they navigate the grief and relief of a new understanding of self. You can learn more about Michelle by visiting her website at MichelleFMoseley.com or following her on Instagram – @therapy_with_michelle
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