Beyond fear and survival: Complex post-traumatic stress disorder, emotion regulation, and post-traumatic growth in substance use disorders

Abstract

ABSTRACT Background: The reconceptualization of complex post-traumatic stress disorder (cPTSD) has changed how we view substance use disorders (SUDs), highlighting trauma and maladaptive emotion regulation over vulnerability or environment. Trauma-related disorders are common in those with SUDs, but research in India is limited, especially since cPTSD was added to ICD-11. Aim: This study examined the links between cPTSD symptoms, emotion regulation, and post-traumatic growth (PTG) in SUD patients. Methods: This cross-sectional study was conducted at a tertiary addiction treatment center in India. Forty patients with SUD and traumatic history were assessed after detoxification. Trauma symptoms were evaluated using the International Trauma Questionnaire (ITQ) for ICD-11 PTSD and cPTSD. Cognitive emotion regulation was measured with the Cognitive Emotion Regulation Questionnaire (CERQ), and PTG was assessed using the PTG Inventory. Anxiety and depression were evaluated with the Hamilton Anxiety and Hamilton Depression Rating Scale. Descriptive analysis revealed the occurrence of PTSD and cPTSD in the sample, correlation analyses explored relevant associations, and a regression model identified predictors of PTG. Results: cPTSD and PTSD were found to affect 75% and 82.5% of the study sample, respectively. cPTSD symptoms—especially affective dysregulation and negative self-concept—were linked to higher anxiety and depression. Greater cPTSD severity correlated with lower PTG, especially in interpersonal domains. Adaptive emotion regulation strategies were associated with higher PTG and explained 44.8% of PTG variance in regression. Conclusion: The findings affirm the hypothesized associations underscoring the necessity of trauma-informed, individualized treatment approaches integrating emotion regulation and trauma processing within addiction recovery.