DISCLAIMER: The following article makes references to childhood neglect and abuse as well as other situations that some may find to be upsetting or triggering. I am NOT a licensed mental health professional and cannot diagnose anyone with any type of mental health condition, nor can I provide any type of professional support. There are resources within this article to find a therapist or counselor who is well trained in trauma.
Truthfully, I can’t remember a time where I didn’t feel just a little bit “different.”
Even when things were going seemingly well, I never felt fully grounded. I walked around holding my breath at the slightest sounds, convinced that the worst was right around the corner.
I watched in frustration as I was labeled many different things, knowing that none of them were all that wrong: negative, overdramatic, easily stressed, aggressive, argumentative, confrontational.
And I couldn’t deny that these labels were often accurate. I knew that better than anyone. Who did they think was the one feeling all those feelings?
But it didn’t seem to matter. No matter how hard I tried to change my outlook, to think more positively, to let things go, it was like an instinctual reaction. I couldn’t understand why everyone else didn’t understand that I was being negative because the sky really was falling. Why was I always the only one who noticed?
Pete Walker, a licensed psychotherapist and one of the leading experts on complex trauma, sums up Complex PTSD in his book – Complex PTSD: From Surviving to Thriving by writing:
“Many abandoned children enter adulthood feeling that the world is a dangerous place where they are ill-equipped to defend themselves”
“It is through such neglect the child’s consciousness eventually becomes overwhelmed with the processes of drasticizing and catastrophizing. Drasticizing and catastrophizing are critic processes that lead the child to constantly rehearse fearful scenarios in a vain attempt to prepare himself for the worst. This is the process by which CPTSD with its overdeveloped stress and toxic shame programs sets in and becomes triggerable by a plethora of normally innocuous stimuli.”
Reading these descriptions, for one of the first times in my life I finally realized that maybe I wasn’t the problem, but instead the problems stemmed from what I had been through.
When I hear the term PTSD, the first thing that comes to mind is the episode of Grey’s Anatomy where Owen has a flashback that was triggered by the spinning blades of the ceiling fan and ended up choking Cristina.
However, this isn’t always the most accurate (or at least, inclusive) representation of PTSD.
PTSD can develop after someone experiences any type of traumatic event – a car accident, a sexual assault, even a terrible medical experience.
According to the NIMH, to be diagnosed with PTSD, an adult must meet the following criteria for at least 1 month:
What is Complex PTSD?
Like I said, when I think about PTSD, I think of traumatized war veterans. Not 16, 19, or 23 year olds trying to find their place in a world that seems inherently dangerous.
But that’s the thing….. trauma doesn’t always come from a singular experience.
Sometimes trauma is spread out over a long period of time, and it can be just as damaging.
Consider this…….. here are two possible situations:
- Someone steals $100 from you in a single robbery
- Someone steals $10 a week from you and by the time you realize, $100 is gone forever
The end result is you lost $100, but the manner in which you lost it probably makes a difference in how it impacts you (if we’re talking about serious trauma, that is).
What Kind Of Events Can Cause Complex PTSD
CPTSD often stems from childhood neglect or abuse, domestic abuse, human trafficking, and living in a war-torn region for more than one year.
However, C-PTSD can occur from any traumatic situation that is prolonged.
PTSD vs. Complex PTSD
Complex PTSD varies from regular PTSD in that it is usually caused by repeated exposure to trauma over an extended period of time. One of the biggest risk factors for developing complex PTSD is childhood abuse or neglect.
Complex PTSD is similar to traditional PTSD in that all of the traditional symptoms of PTSD that are listed above can be present, but complex PTSD has a few additional symptoms as well.
The Additional Symptoms That Are Unique To C-PTSD Include:
Difficulty with emotional regulation
It is very common for survivors of complex trauma to experience emotional flashbacks. Emotional flashbacks are intense and confusing episodes of fear, toxic shame, and/or despair, which often are a recurring of the feelings from the original triggering event.
The intense feelings of explosive anger, persistent sadness, depression, and suicidal thoughts may be disproportionate to the present situation, but are equal to the intensity of what was required of them at the time of a trauma.
Altered self perception
People with C-PTSD often have a sense of being completely different from other people and feel helpless, guilty, or ashamed.
Pete Walker writes…. “Perhaps there was no more detrimental consequence of our childhood abandonment than being forced to habitually hide our authentic selves. Many of us come out of childhood believing that what we have to say is as uninteresting to others as it was to our parents.”
This is the feeling that I described in the beginning, and one that is very common to most people living with C-PTSD.
Difficulty with relationships
Survivors often either avoid relationships completely or develop unhealthy relationships because of past experiences. This can lead to further trauma as they repeatedly find themselves in toxic relationships.
No “system of meanings”
A system of meanings is the thing that people look to when facing uncertainty in life. This can include core beliefs, values, religious faith, or hope in the world and other people.
“A child, with parents who are unable or unwilling to provide safe enough attachment, has no one to whom she can bring her whole developing self. No one is there for reflection, validation and guidance. No one is safe enough to go to for comfort or help in times of trouble. There is no one to cry to, to protest unfairness to, and to seek compassion from for hurts, mistakes, accidents, and betrayals. No one is safe enough to shine with, to do “show and tell” with, and to be reflected as a subject of pride. There is no one to even practice the all-important intimacy-building skills of conversation. In the paraphrased words of more than one of my clients: “Talking to Mom was like giving ammunition to the enemy. Anything I said could and would be used against me. No wonder, people always tell me that I don’t seem to have much to say for myself.” – Pete Walker
Detachment from the trauma
A person may disconnect from themselves (depersonalization) and the world around them (derealisation). Some people might even forget their trauma completely.
As complex trauma occurs over a longer period of time, it usually leaves survivors completely overwhelmed by its effects. This leads to a constant feeling of being unsafe and helplessness, which can cause frequent issues later in life.
When the trauma is being inflicted by someone that the victim relies on to survive (like a parent), it can create mixed signals about the need to connect vs. the need for safety.
Repeated exposure to these types of confusing messages in childhood can actually cause permanent changes in how our brain structures develop.
Dissociation and Complex PTSD
When most people hear the term dissociation, they might think of the term “multiple personalities.” Personally, I picture the commercial for that horror movie that came out a few years ago where the guy has multiple identities and they are all really creepy. The good news is that disassociation is not really like that.
Beauty After Bruises reports that the yearly prevalence rate for dissociative identity disorder (DID) is approximately 1.5%, meaning that it is actually more common than young women with bulimia and almost as prevalent as well-known conditions such as OCD.
If you want to read some more DID myths debunked, check out this article from Beauty After Bruises.
I think that the easiest way to think about disassociation is when your mind and your body have some sort of disconnect.
This happens to everyone at some point, and it’s not always bad!
Have you ever been driving somewhere familiar and gotten to your destination only to realize you don’t remember the drive at all? That’s an example of disassociation, but in this case your brain is disconnecting because it feels safe, not because it feels unsafe.
In situations that are traumatic, however, your brain may disconnect because of immense feelings of feeling unsafe. This can cause people to be unable to recall their traumatic memories, or to be able to recall traumatic memories vividly but have no strong emotions attached to them.
Disassociation is actually a healthy coping mechanism as long as it is not overused. When disassociation becomes someone’s go-to coping mechanism or is being used in situations that are not appropriate, that is when it becomes concerning.
There are 5 common types of disassociation related to trauma:
- Identity confusion
- Identity alteration
I’m not going to get into the specifics of each of these types of disassociation within this post, but I will be writing a separate post at some point explaining the differences!
How is Complex PTSD Treated
The Diagnostic and Statistical Manual of Mental Disorders (DSM) is the handbook used by health care professionals in the United States and much of the world as the authoritative guide to the diagnosis of mental disorders. However, currently C-PTSD is not recognized in the DSM-5, meaning there are no set standards of treatment.
Side note: Please take a moment to sign this petition for the American Psychological Association to add C-PTSD to the DSM-5
Therapists may use a variety of approaches, including but not limited to cognitive behavioral therapy (CBT), Dialectical Behavioral Therapy (DBT), Internal Family Systems Therapy (IFS), Trauma Release Exercises (TRE), Eye Movement Desensitization and Reprocessing (EMDR), Somatic Experiencing/Sensorimotor Processing, and more!
All of these different types of treatments can sound confusing and overwhelming. How do you know which one is the best?
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Messy. Accurate. People are often surprised to learn that most of #trauma therapy isn't actually talking directly about trauma- it involves getting to know ourselves and our needs without judgment, learning to extend genuine kindness and care inward, and growing skills to advocate for what we need to thrive. The concept behind this doodle is Allostatic Load, which I'll be unpacking a little more in a post later this week. #selfcaresis #ptsdawareness
Believe it or not, it doesn’t really matter. Studies show that the most successful therapy comes when a person feels comfortable with their therapist and trusts their relationship.
The International Society for the Study of Trauma and Dissociation (ISST-D), provides guidelines for complex trauma treatment:
- Maintain a safe environment that helps manage feelings
- Promotes understanding of symptoms and their origins
- Helps grow emotional and relational skills and apply them to real life experiences
- Respect you and your goals in therapy
- Maintain a pace that is manageable and does not feel overwhelming
- Help manage and reduce trauma related symptoms such as disassociation
- Work through traumatic memories (when you are able) in a manner that is safe and manageable for you
You can use the ISST-D database of therapists to find providers near you who are trained in trauma and dissociation. The most important thing to know is that healing IS possible!
Complex PTSD and Chronic Pain
One study found that 37% of participants with a history of child abuse reported a health problem in the past 12 months, as compared to 22% of participants with no abuse history.
Research shows that complex PTSD and trauma are linked to a variety of health problems including:
- Depression and anxiety
- Sleep problems
- Unexplained body aches and pains, including migraines, stomach and digestion troubles and arthritis
- Type 2 Diabetes
- Sexual difficulties
- Low energy and fatigue
- Substance abuse
There are even some studies that have linked childhood trauma to an increased risk in cancer, lung disease, and cardiovascular disease. While there has not been as much research on the intersection between PTSD and chronic pain, there is some evidence that suggests that those who live with regular PTSD are at increased risk for certain health issues.
If you want to learn more about the relationship between trauma and various health conditions, make sure to check out my post Here Are The Powerful Effects Of Trauma On The Brain And Body.