My goal in publishing TCPR is to help you think differently about your clinical practice, hopefully to enhance your effectiveness as a healer. After editing this month’s issue on posttraumatic stress disorder (PTSD), I think I’ve achieved that goal in my own practice.

I’ve often noticed that PTSD seems to present in two forms: clear and fuzzy. Patients with “clear” PTSD have had a defined traumatic experience and are suffering from it, with flashbacks, nightmares, and other typical DSM-5 symptoms. But patients with a “fuzzy” profile present with long-standing depression and anxiety, and then during the social history relate a horrific tale of childhood abuse—not a single event, but mistreatment or neglect spanning many years. After having interviewed this month’s expert, Dr. Arielle Schwartz, I’m understanding that many of these patients have “complex PTSD.”

They are deeply afflicted by their past, and bring a sense of personal failure and hopelessness into relationships, jobs, and other life situations. This insight helps me to better understand their symptoms, and this empathic connection is good for treatment. As always, I’d love to hear your thoughts about this month’s issue, so feel free to email me at dcarlat@thecarlatreport.com.