Have you heard of Complex Post Traumatic Stress Disorder (CPTSD) ?
Disclaimer: The following information is not to be used as a tool to diagnose or as treatment. When reading symptoms/conditions and behaviours it is a common experience to feel that you or someone you know has these categories. Many people can identify with symptoms/conditions and behaviours and they can be a valued part of their rich character. A 'Disorder' or condition is different to 'character' in that it severely corrodes the quality of life for that person and it is not welcome by the person as part of their continuing life experience. Only a qualified mental health professional can diagnose mental health conditions/disorders. More discoveries in mental health and trauma issues are available for public information that are not covered in this blog. New discoveries may make obsolete some information covered here.
Most people know of Post Traumatic Stress Disorder. This is when a person suffers a traumatic
event - for example being in a 'car crash'. It's as though the car crash is haunting them, their lives are disturbed by nightmare type sensations - they can experience -
1: Feelings of danger - in a safe ordinary day
2: 'Flash backs' - re-experiencing the trauma as though it is happening again.
3: Avoidance - not feeling able to see people or be in places or situations that remind them of the trauma.
Incredibly PTSD was only diagnosed as a condition in 1980!😲
(what have we humans been doing all this time? relying on our jars of leeches too much?!🙄 )
As well as the 3 symptoms above - as listed in 'The world Health Organisations International Classification of Diseases' - (ICD -11) a person with Complex Post Traumatic Stress Disorder (CPTSD) can suffer the following-
* Difficulty controlling their emotions
* An impaired sense of self- worth
* Difficulty with relationships.
When we think of trauma what comes to mind is one big horrific event. With CPTSD a person from a seemingly okay childhood could be suffering this condition. Equally (for example) an adult could have a situation where they were undermined - 'bullied' for a period in their life and could as a result develop CPTSD. The common factor is that a person had or feels they had no escape from relentless stress/trauma.
Many cases of CPTSD are caused from ongoing stress in childhood- known as 'toxic stress'. Stress that the child had no escape from. When the child becomes an adult it is part of our culture to say for example "bad things happen - get over it" , "man up!"," that was the past - it's done and gone now". That attitude may work well if the incident was a one off - now a vague memory - just a thought we remember - but - what if as a child we felt anxious most of the time-stressed? Its not just an unpleasant thought. The child's developing nervous system is constantly being flooded with cortisol - adrenaline - the child feels in danger.
The primitive automatic systems that enabled us to run in a split second (without using the slower thought processes) from predatory animals - is triggered repeatedly - but that child does not run from supposed 'care givers'. A child attaches itself to its 'care giver' if the care giver has their own mental health/behaviour problems, a secure attachment may be not achieved- (see blog on attachment styles - to come). The price the child pays for long term stress as an adult could be the cause some of the following symptoms- (there will be more symptoms not listed here - and some symptoms can be caused by other situations and conditions - not just CPTSD)-
Panic attacks, feeling sudden bouts or longer periods of crushing shame/rejection, feeling paranoid - the world/people are not trustworthy, hypervigilance, worrying bad things are about to happen - catastrophizing, fanaticising about dying - life is so emotionally painful at times imagining dying feels like a relief, self harm, risky behaviours, drug and alcohol misuse, feeling incredibly ugly and or stupid, having low self -worth, needing to control situations - double checking, obsessive compulsions, lack of self care, erratic emotions, outbursts of anger -looking aggressive - but really feeling scared ( because things are getting out of their control) , inability to focus, lapses in memory, physical symptoms that suggest illness or injury but when checked by medical experts no injury/illness can be found (somatization).
To manage this pressure - cooker of emotions humans have built in psychological mechanisms that facilitate our day to day functioning - such as denial - "my parents cared too much really. They hit me a lot because I was so bad all the time", or dissociation where we numb feelings in order to function.
Behaviours and our ability to relate well to others can be affected by the above symptoms. An example of types of behaviour that may evolve from CPTSD -
Working too hard- trying to please management/work colleagues. Servile/ fawning mannerisms. Talking about serious issues most of the time - finding it hard to be light hearted. Needing to control situations - micro-manage. Placing all your self - worth in possessions you buy, the house/car you own, or in the work you do, because without external validation you notice your internalized low self -esteem. Being very critical of oneself/others - openly - or internally. Passive aggressive criticism of others. Outbursts of anger that look aggressive but really are because of fear.
This list of behaviours is just to give an idea of how symptoms can affect behaviour - a person with CPTSD may have a different set of behaviours not mentioned above - or manage their CPTSD well. Alternatively a person can have any the above behaviours and its just their character.
Negative behaviours create a vicious circle that forms a self fulfilling prophesy-
Example of how a vicious circle may work-
This is a very simple example of a particular fictional vicious circle. Many other factors would be involved in real life.
An unfortunate aspect of CPTSD is that on an unconscious level adults who had abusive childhoods can seek relationships that feel familiar and end up in another abusive relationship. Awareness through therapy can enable clients to break these vicious circles and make better choices in careers, relationships and life partners.
A message for people who suffer CPTSD-
STOP! Lets stop these cycles - and get joy back!
Firstly its not your fault - you have been deeply hurt by a person or people who should have cared/respected your human rights. Look after yourself - be self - compassionate (if you have a critical voice in your head challenge it every time it speaks.)
Imagine what a kind nurturing parent might say to you.
"I love you - I will protect you" , "I see how much potential you have" "Let me help you find better ways of relating with others - so they can see how nice you are." "Lets find ways to calm your anxiety" "Lets make better choices - you deserve the best".
For a person with CPTSD its important to find a therapist who understands CPTSD is not something that can easily be 'snapped out of'. Its not just a thought process that can cause unfortunate behaviours. Its the way the person feels how the world is to them - its imprinted on their nervous system. A therapist who understands the psychodynamic aspect of the therapeutic relationship is required. Recommended treatments for CPTSD will fall short of what is needed if the client -therapist relationship is not attuned to this deep level of understanding and connection.
I would like to share with those who do not have CPTSD what an intense 'flashback' can feel like-
A 'flashback' can vary in intensity - I can describe it in parallel to physical illness. Have you ever experienced food poisoning/stomach virus?
If you have its like suddenly being aware of a violent intense feeling of nausea. The type of nausea where you realise you no longer have control over your body - you need to be alone - you are about to go through an awful ordeal. At this point your automatic response systems take over. Your whole body feels an intense surge and you just want to vomit the bacterial poison in your stomach out. As CPTSD is not something just physical it cannot be purged out - there is not that sense of relief - there is no physical substance to vomit out - they can only ride out the intensity of emotional feeling. This emotional intensity a 'flashback' triggers a whole body into flight, fight freeze response.
'Flashbacks' can vary in intensity - on a sliding scale - on the other end of the scale a person with CPTSD can live in a half life that is so full of anxiety that every day is emotionally draining - an effort. A person with CPTSD notices the nastier side of people - the world is predictably hostile. When a victim of this trauma gets back to their safe place that's when they really need to relax as they can experience their day as excessively stressful - but their body is still on edge- full of adrenaline/cortisol. This is when a victim of trauma often can rely too readily on alcohol to induce relaxation - and or sometimes drugs.
Repetitive stress from an abusive situation can come from a wider environment. A worrying trend appears to be growing where some children have their developing years in the control of other children. For example where school systems fail to protect children from bullying by their peers. A child may come from a loving home only to be unprotected within their own peer group in school - and/or through social media abuse. Over years /months a child may have high levels of stress from bullying that there was no escape from. With social media bullying that can follow the child home and invade their safe place. The body's automatic nervous system senses danger - and is in a state of preparation - to flight/fight/freeze- from the looming predator. With new technology a child can be in a loving home environment but feel in mortal danger each time the text message bleeps. The child could then go on to develop CPTSD.
CPTSD was first described in 1992 by American psychiatrist Judith Herman in her book 'Trauma and recovery'. This disorder is listed in the World Health Organisations eleventh edition (ICD 11) diagnostic book which is used by the National Health Service (NHS). CPTSD is is mentioned in the NHS website with treatments available. In America the psychiatrists book for diagnosing mental illness is the 'Diagnostic and Statistical Manual of Mental Disorders Fifth Edition' (DSM-5) does not list CPTSD yet - much to the dismay of experts in trauma.
CPTSD as a newly recognised condition has not always been well understood by mental health professionals. This has caused people (especially people with more that one condition) to be misdiagnosed. Conditions that could be misdiagnosed instead of the correct CPTSD diagnosis-
Bipolar disorder, Attention Deficit Hyperactivity Disorder (ADHD), Learning Disabilities, Anxiety Disorders (such as panic attacks/ obsessive compulsive disorder), Major Depressive Disorder, Borderline Personality Disorder, Addictions, Somatization Disorder (this list is not conclusive).
For more information on CPTSD -
Books - 'A PRACTICAL GUIDE TO COMPLEX PTSD' by Arielle Schwartz PhD
'The COMPLEX PTSD WORKBOOK' by Arielle Schwartz PhD
NHS website-
Once in the NHS website type in to the search -
Complex PTSD
If this blog has brought uncomfortable issues to the fore - and you need to talk to someone - see 'Helplines' page on this site with useful contacts.
In depth books on trauma in general-
'The Body Keeps The Score' by Bessel Van Der Kolk, MD.
'In an Unspoken Voice' by Peter A. Levine, PhD.
'Trauma and Memory' By Peter A. Levine, PhD.