🧠 Episode Outline – Complex PTSD Title: When Nothing Makes Sense (and the Kitchen Sink)
Podcast: The Supervised Mind
Host: Dr. Faisal Rafiq 🎯 Learning Objectives * Understand the core features of complex PTSD * Identify how cPTSD is often misdiagnosed and misunderstood * Explore medication options for symptom clusters and emerging treatment strategies * Recognize the importance of stabilization before trauma therapy * Integrate supervision practices into complex case management 🧩 Segment 1: What Is Complex PTSD? * Caused by chronic, repeated trauma (e.g., childhood abuse, captivity, neglect) * Not in DSM-5, but defined in ICD-11 * Characterized by: * Emotional dysregulation * Negative self-image * Dissociation * Interpersonal dysfunction * Somatic symptoms and fragmented identity ❗ Segment 2: How It Presents * Commonly misdiagnosed as: * BPD * Bipolar II * TRD * ADHD, OCD, or psychosis (especially with dissociation) * Timeline and trauma history often clarify the diagnosis 🧠 Supervision Prompt: “Did the symptoms follow trauma—or precede it?” 💊 Segment 3: Medication Strategy – Support, Not Cure * Treat symptom clusters (not the diagnosis itself) * Options include: * Lamotrigine, atypicals – mood instability * Prazosin – nightmares * Clonidine/propranolol/gabapentin – hyperarousal * SSRIs/SNRIs – intrusive thoughts * Hydroxyzine/trazodone/melatonin – sleep * Avoid benzodiazepines due to risk of worsened dissociation 💊 Segment 3B: Newer Treatments * Rexulti (brexpiprazole) – emotional reactivity, co-occurring depression * Auvelity – rapid-onset treatment for anhedonia and numbness
Avoid in bipolar-spectrum or seizure-prone patients
 🧠 Supervision Prompt: “Is this true treatment resistance—or unresolved trauma?” 💊 Segment 3C: Stabilization Before Therapy * Emphasize sequencing: meds first → therapy second * Supports sleep, emotion regulation, and therapy engagement * Prevents re-traumatization from premature processing 💬 Patient analogy: “We don’t do surgery while someone’s still bleeding.” 💊 Segment 3D: Reconsidering Elavil (Amitriptyline) * Benefits: * Chronic pain, fibromyalgia, IBS * Sleep and appetite * Use with caution in elderly or suicidal patients * Often overlooked due to its age—but still effective in trauma presentations 🧘 Segment 4: Therapy Is the Treatment * Best-fit modalities include: * EMDR * Internal Family Systems (IFS) * Trauma-informed CBT * Narrative therapy * Sensorimotor psychotherapy * Group trauma processing Frame therapy as tool-building, not retelling trauma. 🧠 Segment 5: Supervision Talking Points * “Is this mood, personality, or trauma?” * “What parts of the case are evoking emotional reactions in me?” * “Is medication clarifying—or clouding—the picture?” ⚠️ Segment 6: Common Trainee Pitfalls * Overdiagnosing BPD * Polypharmacy out of desperation * Avoiding trauma content due to clinician discomfort * Over-identifying or losing therapeutic distance 📋 Segment 7: Documentation & Patient Language Chart: “Patient presents with symptoms suggestive of complex PTSD. Medication used to support affective regulation and stabilization. Trauma-informed referral initiated.” Say to patients: “You’re not too complicated—what happened to you was.”
“We’ll go at your pace. Skills first. Safety always.” 🧭 Final Thoughts * Complex PTSD is a functional adaptation—not a pathology * Healing requires structure, patience, and supervision * The goal is not to fix the story—but to help the patient live beyond it