What do you remember about your childhood? Can you describe what it was like to live with your family, in your home, in your own skin on a daily basis growing up not just because you know the broad outlines of your own story but because you have at ready recall a slew of memories, of events and experiences that you compiled along the way? If so, good for you. Congratulations, even; you probably didn’t grow up as a victim of prolonged, repeated trauma over which you had little control and no escape. I wish I could say the same. For my part, I don’t remember much. Oh, I can tell my own story, but only because I have a well-rehearsed script which has been reinforced by what others have told me about my own childhood. Ask me to remember it, though, and I more or less can’t. Or won’t. Or both. And for damn good reason.
As those who have read the last few posts know, my latest foray into therapy has led me in an unexpected direction, as I’m now diagnosed with PTSD. In fact, the term that was cavalierly mentioned in passing was “Complex PTSD,” or “C-PTSD,” which actually isn’t even a diagnosis yet. It’s a proposed diagnostic category for the next DSM; I think it’s been proposed for a while, but hasn’t been officially recognized yet. My exploration thus far of C-PTSD has been revelatory, however, because boy does it fit. For ease of reading and the overabundance of “wow, that’s me” moments as I read, the following from the self-help website “Out of the Fog” was especially enlightening. It’s a little long, but as I said is easy to read and was super especially helpful. I’ll have a little more to say myself at the end. Here’s the info:
Complex Post Traumatic Stress Disorder (C-PTSD)
Complex Post-Traumatic Stress Disorder (C-PTSD) – Complex Post-Traumatic Stress Disorder is a psychological injury that results from prolonged exposure to social or interpersonal trauma, disempowerment, captivity or entrapment, with lack or loss of a viable escape route for the victim.
- C-PTSD Introduction
- C-PTSD What It Feels Like
- Differences between C-PTSD & PTSD
- C-PTSD Characteristics
- C-PTSD Causes
- C-PTSD Treatment
- C-PTSD Support Groups
Complex Post Traumatic Stress Disorder (C-PTSD) is a condition that results from chronic or long-term exposure to emotional trauma over which a victim has little or no control and from which there is little or no hope of escape, such as in cases of:
- domestic emotional, physical or sexual abuse
- childhood emotional, physical or sexual abuse
- entrapment or kidnapping.
- slavery or enforced labor.
- long term imprisonment and torture
- repeated violations of personal boundaries.
- long-term objectification.
- exposure to gaslighting & false accusations
- long-term exposure to inconsistent, push-pull,splitting or alternating raging & hooveringbehaviors.
- long-term taking care of mentally ill or chronically sick family members.
- long term exposure to crisis conditions.
When people have been trapped in a situation over which they had little or no control at the beginning, middle or end, they can carry an intense sense of dread even after that situation is removed. This is because they know how bad things can possibly be. And they know that it could possibly happen again. And they know that if it ever does happen again, it might be worse than before.
The degree of C-PTSD trauma cannot be defined purely in terms of the trauma that a person has experienced. It is important to understand that each person is different and has a different tolerance level to trauma. Therefore, what one person may be able to shake off, another person may not. Therefore more or less exposure to trauma does not necessarily make the C-PTSD any more or less severe.
C-PTSD sufferers may “stuff” or suppress their emotional reaction to traumatic events without resolution either because they believe each event by itself doesn’t seem like such a big deal or because they see no satisfactory resolution opportunity available to them. This suppression of “emotional baggage” can continue for a long time either until a “last straw” event occurs, or a safer emotional environment emerges and the damn begins to break.
The “Complex” in Complex Post Traumatic Disorder describes how one layer after another of trauma can interact with one another. Sometimes, it is mistakenly assumed that the most recent traumatic event in a person’s life is the one that brought them to their knees. However, just addressing that single most-recent event may possibly be an invalidating experience for the C-PTSD sufferer. Therefore, it is important to recognize that those who suffer from C-PTSD may be experiencing feelings from all their traumatic exposure, even as they try to address the most recent traumatic event.
This is what differentiates C-PTSD from the classic PTSD diagnosis – which typically describes an emotional response to a single or to a discrete number of traumatic events.
Difference between C-PTSD & PTSD
Although similar, Complex Post Traumatic Stress Disorder (C-PTSD) differs slightly from the more commonly understood & diagnosed condition Post Traumatic Stress Disorder (PTSD) in causes and symptoms.
C-PTSD results more from chronic repetitive stress from which there is little chance of escape. PTSD can result from single events, or short term exposure to extreme stress or trauma.
Therefore a soldier returning from intense battle may be likely to show PTSD symptoms, but a kidnapped prisoner of war who was held for several years may show additional symptoms of C-PTSD.
Similarly, a child who witnesses a friend’s death in an accident may exhibit some symptoms of PTSD but a child who grows up in an abusive home may exhibit the additional C-PTSD characteristics shown below:
C-PTSD – What it Feels Like:
People who suffer from C-PTSD may feel un-centered and shaky, as if they are likely to have an embarrassing emotional breakdown or burst into tears at any moment. They may feel unloved – or that nothing they can accomplish is ever going to be “good enough” for others.
People who suffer from C-PTSD may feel compelled to get away from others and be by themselves, so that no-one will witness what may come next. They may feel afraid to form close friendships to prevent possible loss should another catastrophe strike.
People who suffer from C-PTSD may feel that everything is just about to go “out the window” and that they will not be able to handle even the simplest task. They may be too distracted by what is going on at home to focus on being successful at school or in the workplace.
How it can manifest in the victim(s) over time:
Rage turned inward: Eating disorders. Depression. Substance Abuse / Alcoholism. Truancy. Dropping out. Promiscuity. Co-dependence. Doormat syndrome (choosing poor partners, trying to please someone who can never be pleased, trying to resolve the primal relationship)
Rage turned outward: Theft. Destruction of property. Violence. Becoming a control freak.
Other: Learned hyper vigilance. Clouded perception or blinders about others (especially romantic partners) Seeks positions of power and / or control: choosing occupations or recreational outlets which may put oneself in physical danger. Or choosing to become a “fixer” – Therapist, Mediator, etc.
Avoidance – Avoidance is the practice of withdrawing from relationships with other people as a defensive measure to reduce the risk of rejection, accountability, criticism or exposure.
Blaming – Blaming is the practice of identifying a person or people responsible for creating a problem, rather than identifying ways of dealing with the problem.
Catastrophizing – Catastrophizing is the habit of automatically assuming a “worst case scenario” and inappropriately characterizing minor or moderate problems or issues as catastrophic events.
“Control-Me” Syndrome – “Control-Me” Syndrome describes a tendency that some abuse victims and some people who suffer from personality disorders have to nurture relationships with people who have a controlling narcissistic, antisocial or “acting-out” nature.
Denial (PD) – Denial is believing or imagining that some factual reality, circumstance, feeling or memory does not exist or did not happen.
Dependency – Dependency is an inappropriate and chronic reliance by one adult individual on another for their health, subsistence, decision making or personal and emotional well- being.
Depression (Non-PD) -Depression is when you feel sadder than your circumstances dictate, for longer than your circumstances last – but still can’t seem to break out of it.
Escape To Fantasy – Escape to Fantasy is sometimes practiced by people who routinely shun transparency with others and present a facade to friends, partners and family members. Their true identity and feelings are commonly expressed privately in an alternate fantasy world.
Fear of Abandonment – Fear of abandonment and irrational jealousy is a phobia, sometimes exhibited by people with personality disorders, that they are in imminent danger of being rejected, discarded or replaced at the whim of a person who is close to them.
Hyper Vigilance – Hyper Vigilance is the practice of maintaining an unhealthy level of interest in the behaviors, comments, thoughts and interests of others.
Identity Disturbance – Identity disturbance is a psychological term used to describe a distorted or inconsistent self-view.
Learned Helplessness– Learned helplessness is when a person begins to believe they have no control over a situation, even when they actually do have the power to change their circumstances, leading them into an unneccessary state of depression, where initiative, action or investment is deemed futile.
Low Self-Esteem – Low Self-Esteem is a common name for a negatively-distorted self-view which is inconsistent with reality. People who have low self-esteem often see themselves as unworthy of being successful in personal and professional settings and in social relationships. They may view their successes and their strenghts in a negative light and believe that others see them in the same way. As a result, they may develop an avoidance strategy to protect themselves from criticism.
Panic Attacks – Panic Attacks are short intense episodes of fear or anxiety, often accompanied by physical symptoms.
Perfectionism – Perfectionism is the practice of holding oneself or others to an unrealistic, unsustainable or unattainable standard of organization, order or accomplishment in one particular area of living, while sometimes neglecting common standards of organization, order or accomplishment in others.
Selective Memory and Selective Amnesia – Selective Memory and Selective Amnesia is the use of memory, or a lack of memory, which is selective to the point of reinforcing a bias, belief or desired outcome.
Self-Loathing – Self Loathing is an extreme self-hatred of one’s own self, actions or one’s ethnic or demographic background.
Tunnel Vision – Tunnel Vision is the habit or tendency to only see or focus on a single priority while neglecting or ignoring other important priorities.
C-PTSD is caused by a prolonged or sustained exposure to emotional trauma or abuse from which no short-term means of escape is available or apparent to the victim.
The precise neurological damage that exists in C-PTSD victims is not well understood.
Little has been done in clinical studies of treatment of C-PTSD. However, in general the following is recommended:
- Removal of and protection from the source of the trauma and/or abuse.
- Acknowledgement of the trauma as real, important and undeserved.
- Acknowledge that the trauma came from something that was stronger than the victim and therefore could not be avoided.
- Acknowledgement of the “complex” nature of C-PTSD – that responses to earlier traumas may have led to decisions that brought on additional, undeserved trauma.
- Acknowledgement that recovery from the trauma is not trivial and will require significant time and effort.
- Separation of residual problems into those that the victim can resolve (such as personal improvement goals) and those that the victim cannot resolve (such as the behavior of a disordered family member)
- Mourning for what has been lost and cannot be recovered.
- Identification of what has been lost and can be recovered.
- Program of recovery with focus on what can be improved in an individuals life that is under their own control.
- Placement in a supportive environment where the victim can discover they are not alone and can receive validation for their successes and support through their struggles.
- As necessary, personal therapy to promote self discovery.
- As required, prescription of antidepressant medications.
What to do about C-PTSD if you’ve got it:
Remove yourself from the primary or situation or secondary situations stemming from the primary abuse. Seek therapy. Talk about it. Write about it. Meditation. Medication if needed. Physical Exercise. Rewrite the script of your life.
What not to do about it:
Stay. Hold it in. Bottle it up. Act out. Isolate. Self-abuse. Perpetuate the cycle.
What to do about it if you know somebody else who has C-PTSD:
Offer sympathy, support, a shoulder to cry on, lend an ear. Speak from experience. Assist with practical resolution when appropriate (guidance towards escape, therapy, etc.) Be patient.
What not to do about it if you know somebody else who has it:
Do not push your own agenda: proselytize, moralize, speak in absolutes, tell them to “get over it”, or try to force reconciliation with the perpetrator or offer “sure fire” cures.
This makes so much sense to me because I certainly was exposed to long term emotional trauma in a situation in which I had little or no control and little or no hope of escape as a victim of childhood emotional abuse. The description of the layering of trauma and the interaction of one trauma with another was important too, as the roller coaster of my life certainly didn’t stop when I finally fled my family of origin at 18. I’ve often talked about being something of a “crisis junkie,” about how crisis seems to follow me and I seem to live best in that state. I talk about being conditioned to accept crisis as “normal” and expecting- if not creating- it when things seem calm. These statements too are “spot on” in describing me:
- (C-PTSD sufferers) “…may feel unloved – or that nothing they can accomplish is ever going to be “good enough” for others.”
- (C-PTSD sufferers) “…may feel afraid to form close friendships to prevent possible loss should another catastrophe strike.”
Some of the language about how C-PTSD can manifest in the victim over time was apt-
“Rage turned inward: Eating disorders. Depression…Co-dependence.
Rage turned outward: Becoming a control freak.
Other: Learned hyper vigilance. Clouded perception or blinders about others (especially romantic partners) Seeks positions of power and / or control: choosing to become a “fixer” – Therapist, Mediator, etc.”
Finally, when it starts listing 18 characteristics of C-PTSD starting with Avoidance, then Blaming, etc., I could readily identify with no less than 16 (SIXTEEN!) of them, especially Catastrophizing, Depression, Fear of Abandonment, Hypervigilance, Low Self-Esteem, Perfectionism, Selective Amnesia, and Self-Loathing.
Yea, me. So…..now what?