CPTSD – What is it?

In the world of trauma therapy people have begun to use the phrase Complex Post Traumatic Stress Disorder to describe something that seems unique from the kind of trauma that results from a single event.  If it occurs to children and it impacts normal development, there is a related concept called Developmental Trauma.  Complex PTSD describes the kind of trauma that happens when people suffer from long term abuse or neglect.  Unlike the trauma that can result from a car accident or a cancer diagnosis it is relational.  A relationship that should have been safe and life giving experienced repeated violations.  It is trauma after trauma and the sufferer has no way to escape it.

Causes of CPTSD:

• Childhood neglect / abandonment
• Childhood abuse
• A disruption in the emotional bond between parent/caregiver and child
• Violence in the home
• Being held captive
• Bullying or other continuous stress at school or in the community
• Living in military conflict, becoming a refugee, or living in a continuously unsafe state

CPTSD is difficult because those who suffer from it have a very difficult time trusting people or feeling safe.  This makes it difficult form relationships that provide a life giving emotional bond.  This often means romantic, family and work relationships are harder to maintain.

This can look like

• Blaming
• Pushing friends and family away
• Becoming critical
• Withdrawal
• Finding it hard to accept genuine affection / compliments

Often people feel disconnected from their body.  They might have a hard time noticing what they are feeling physically or emotionally.  Some encounter learn helplessness becoming convinced nothing will ever change.

It isn’t uncommon for sufferers to have extreme reactions to situations that would otherwise seem safe or routine.  Emotions can go back and forth very quickly.  The lengths people go to get relief from their anxiety and pain can be extensive.

Responses to CPTSD

In his book Transcending Trauma, Frank Anderson shares the way we respond to CPTSD

• Dissociation
• Suicidal ideation
• Numbing
• Shame
• Addiction
• Passivity
• Perpetrating
• Substance use
• Excess sex
• Avoid sex
• Depression
• Panic
• Anxiety
• Critical (of others and self)
• Vigilant
• Story telling
• Worry
• Controlling
• Shyness
• Rigidity
• Anger
• Intellectualizing
• Obsessive behavior
• Conflict-avoidant

All these behaviors have a purpose.  They are to either:

• Avoid future pain
• Soften the blow of anticipated traumatic experiences
• Numb out existing pain
• Find some kind of connection

Sufferers often get caught finding themselves getting pulled to two different directions.  One is a desperate need for closeness and the other a fear of intimacy and vulnerability.  Which can lead people seem confused and irrational.  One moment they warm and inviting, but as soon as they are triggered, they can turn in an instant and push people away.

Fear and anxiety are consistent companion for many with CPTSD.  The part of their brain that design to detect threats is on alert most of the time.  Many live-in constant fear of the worst case scenario because they have experienced the worst case scenario.

CPTSD is linked to chronic illness and pain

• Chronic fatigue
• Fibromyaligia
• Stomach problems (IBS, GERD)
• Migraines and Seizures
• Autoimmune disorders
• Symptoms that doctors find difficulty understanding

In Gabor Mate’s book “The myth of normal” he outlines several connections between trauma and physical illness.

CPTSD can be missed

Often people who meet the criteria for CPTSD might be diagnosed with depression, generalized anxiety, or even Borderline Personality Disorder.  Often therapists can look only at the symptoms and neglect to do a proper trauma history.  This can lead to people getting stuck doing therapy geared more for depression or anxiety than something that helps heal the trauma.

Frank Anderson outlines two distinct cycles of shame related to trauma

Critical Shame Cycle

Here the sufferer grows up in an environment where they are constantly criticized or abused.  They can’t help but feel terrible about themselves  as they can’t stop thinking unfair things about themselves.  A part of them takes on the role of an inner critic parroting the things their abusers told them.  The goal of this self criticism is usually to motivate themselves to live better and avoid future criticism.  Unfortunately the self-criticism can be worse than the potential pain they seek avoid by being good enough.  Often the expectations are unreasonable or even impossible.  So, the CPTSD sufferer is trapped and starts turning to anything to help ease the pain.  This might include items on the list above like substance abuse or casual sex. Risky or unhealthy behavior in turn triggers that critical part all over again.  Which motivates people try harder, eventually fail, feel shame, try to cope and end up with more self-criticism.  Underneath all of these is generous amounts of shame.

Neglect Shame Cycle

When kids are neglected and abandoned, they feel tremendous shame.  The child does his or her best to make sense of this.  They often conclude that there is something deeply wrong with them. Why else would their parent or caregiver abandon them.  So many who suffer in this way have tried intellectualizing the situation.  The neglect can come from parents or caregivers that are physically present but offer no nurture or support to the child.  The child may aspire to perfection to make themselves good enough to be accepted, and some others just give up hope.

For these people feelings can be difficult to access and hard to express.  But at the bottom of it all is shame.  Shame that we try to explain away, run away from or outperform.

Healing in relationship

Ultimately relational wounds are healed in relationship.  Which is very difficult when you have been wounded so badly by the people you should have been able to trust.  It takes time, gentleness, empathy and compassion to heal.  The very defenses that get triggered often make it hard to maintain relationships.  People tend to pursue relationships with those they feel they deserve, and if they feel terrible about themselves they don’t think they deserve very much.  It can be hard to maintain healthy boundaries either being too open or too closed.  The partners of people with CPTSD need to have lots of grace, patience and compassion.  It can be easy to misunderstand triggers and take things personally.

A good therapeutic relationship is essential in the healing process.

Sources

Anderson, Frank. Transcending Trauma: Healing Complex PTSD with Internal Family Systems . PESI Publishing, Inc.. Kindle Edition.