What is Complex PTSD ( cPTSD)?

It’s likely you may already be familiar with PTSD. You may know it as the condition that affects war veterans and survivors of car accidents, natural disasters, and isolated acts of violence. Complex PTSD, however, is specific to severe, repetitive trauma that typically happens in childhood – most often abuse.

     On the surface, it may seem like PTSD and Complex PTSD are none too dissimilar — they both come as the result of something deeply traumatic, they cause flashbacks, nightmares and insomnia, and they can make people live in fear even when they are safe. But at the very heart of C-PTSD – what causes it, how it manifests internally, the lifelong effects (including medically), and its ability to reshape a person’s entire outlook on life – is what makes it considerably different.

WHY DOES C-PTSD EXIST?

Complex PTSD comes in response to chronic traumatization over the course of months or, more often, years. This can include emotional, physical, and/or sexual abuses, domestic violence, living in a war zone, being held captive, human trafficking and other organized rings of abuse, and more. While there are exceptional circumstances where adults develop C-PTSD, it is most often seen in those whose trauma occurred in childhood. For those who are older, being at the complete control of another person (often unable to meet their most basic needs without them), coupled with no foreseeable end in sight, can break down the psyche, the survivor’s sense of self, and affect them on this deeper level. For those who go through this as children, because the brain is still developing and they’re just beginning to learn who they are as an individual, understand the world around them, and build their first relationships – severe trauma interrupts the entire course of their psychologic and neurologic development.

When an adult experiences a traumatic event, they have more tools to understand what is happening to them, their place as a victim of that trauma, and know they should seek support even if they don’t want to. Children don’t possess most of these skills, or even the ability to separate themselves from another’s unconscionable actions. The psychological and developmental implications of that become complexly woven and spun into who that child believes themselves to be — creating a messy web of core beliefs much harder to untangle than the flashbacks, nightmares and other posttraumatic symptoms that come later.

Another important thing to know is that the trauma to children resulting in C-PTSD (as well as dissociative disorders) is usually deeply interpersonal within that child’s caregiving system. Separate from both the traumatic events and the perpetrator, there is often an added component of neglect, hot-and-cold affections from a primary caregiver, or outright invalidation of the trauma if a child does try to speak up. These disorganized attachments and mixed messages from those who are supposed to provide love, comfort and safety – all in the periphery of extreme trauma – can create even more unique struggles that PTSD-sufferers alone don’t always face.

WHAT DOES C-PTSD LOOK LIKE?

To delineate some these hallmark challenges – as outlined in the proposed Complex PTSD criteria – we’ll begin with the one that shows up most frequently in day-to-day life: emotion regulation. Survivors with Complex PTSD have a very difficult time with emotions — experiencing them, controlling them, and for many, just being able to comprehend or label them accurately. Many have unmanaged or persistent sadness, either explosive or inaccessible anger, and/or suicidal thoughts. They may be chronically numb, lack the appropriate affect in certain situations, be unable to triage sudden changes in emotional content, or struggle to level out after a great high/low. It’s also very common for these survivors to re-experience emotions from trauma intrusively – particularly when triggered. These feelings are often disproportionate to the present situation, but are equalto the intensity of what was required of them at the time of a trauma — also known as an emotional flashback.

    Difficulty with self-perception is another fundamental struggle for complex trauma survivors — particularly because their identity development was either fiercely interrupted or manipulated by someone with ulterior motives. In its simplest form, how they see themselves versus how the rest of the world does can be brutally different. Some may feel they carry or actually embody nothing but shame and shameful acts – that they are “bad”.  Others believe themselves to be fundamentally helpless; they were let down by so many who could’ve stopped their abuse but didn’t, so it “must just be them”. Many see themselves as responsible for what happened to them and thus unworthy of kindness or love because “they did this to themselves”. And, countless others may feel defined by stigma, believe they are nothing more than their trauma, worry they’re always in the way or a burden, or they may sense they’re just completely and utterly different from anyone or anything around them – they are alien. Startling as it is, all of these feelings and more can live inside someone whom, to you, seems like the most brilliant, competent, strong, and compassionate human being you know.

Interruptions in consciousness are also a prevalent – and at times very scary – reality in Complex PTSD. Some may forget traumatic events (even if they knew of them once before), relive them intrusively, recall traumatic material in a different chronological order, or other distressing experiences of what is called dissociation. Dissociation is a symptom that exists on a spectrum, ranging anywhere from harmless daydreaming or temporarily “spacing out”; to more disruptive episodes of feeling disconnected from one’s body or mental processes, not feeling real, or losing time; all the way to the most severe, which includes switching between self-states (or alters), as is seen in Dissociative Identity Disorder. Episodes of missing time can range anywhere from a few minutes, a couple days, or even large chunks of one’s childhood. The larger gaps in time are typically only seen in DID, but those with C-PTSD alone can still endure ‘interruptions in consciousness’ that result in memory gaps, poor recall, traumatic material that is completely inaccessible, or, conversely, re-experiencing trauma against their will (e.g. flashbacks, intrusive images, body memories, etc.)

    Difficulty with relationships may seem like a natural progression since each area mentioned thus far can affect how fruitful your relationships are. But, these challenges go beyond a lack in quality or richness. This refers more to a survivor’s potential to feel completely isolated from peers and not even knowing how to engage, to harboring an outright refusal to trust anyone (or just not knowing why they ever should), trusting people way too easily (including those who are dangerous, due to a dulled sense of alarm), perpetually searching for a rescuer or to do the rescuing, seeking out friends and partners who are hurtful or abusive because it’s the only thing that feels familiar, or even abruptly abandoning relationships that are going well for any number of reasons.

With this in mind, and knowing more about the depths to which C-PTSD sufferers battle with their self-perception and interpersonal relationships, it may make it easier to empathize with them on the next category, which is:

    The perception of one’s perpetrators. This can be one of the most insidious battles for some survivors with Complex PTSD — even if it seems crystal clear to those on the outside. Victims of such prolonged trauma may eventually surrender, assuming their abuser(s) total power over them, possibly even maintaining this belief once they’re ‘free’. “I’ll always be under their thumb, they call all the shots, they may even know what’s best for me more than I ever will.” Others may feel deep sadness or profound guilt at just the thought of leaving them – including long after they’ve successfully left, if they were able. Some may remain transfixed by their abuser’s charming side or the warm public persona that everyone loves; it may feel truly impossible to think ill of them. Many hold a constant longing for their abusers to just love them – craving their praise well into adulthood, slaving away in their personal lives just to make them proud. Alternatively, there are others who may obsess about them angrily, holding only hatred and disdain for them to the point of persistent bitterness and/or vengefulness. Some can even stir desires to seek that revenge. (Though, it should be clearly noted that it’s not at all common for them to actually do so. It’s more about the thoughts than the actions.)

Many survivors can have a primary, more surface-layer set of thoughts and feelings about their perpetrator(s), particularly when asked. They may know what they’re “supposed to say” or “supposed to feel”, and then follow suit. But it’s helpful to know that a collection of all these responses can, and often does, coexist within one person, vacillating between extremes underneath what’s shown to the world or even to themselves. Day to day, and year to year, their feelings may shift – and – what the survivor knows to be true intellectually versus what they feel emotionally may remain incongruent for a very long time.

One’s ‘System of Meanings’.  Of the many, many well-observed developmental disruptions those with C-PTSD face, one that many find to be the toughest to conquer, even with therapy, is one with which we hope to offer the most help and support. That area is what’s referred to as one’s ‘system of meanings’ ; an area that, after being subjected to such tumultuous trauma, can feel almost irreparable. What this criterion is referring to is the struggle to hold on to any kind of sustaining faith or belief that justice will ever be served to indiscretions of ethics and morality. These survivors’ outlook on life and the world at large can be unfairly contorted, and understandably so.

They may doubt there is any goodness or kindness in the world that isn’t selfish-hearted. They may worry they’ll never find forgiveness. Others may even believe they only came to this world to be hurt, so there can be no good coming for them. This level of hopelessness and despair, as well as these greater meanings assigned to their suffering, can fluctuate greatly over time. There may even come several years where things no longer feel so bleak or as though they were conned of a meaningful life. But, as more layers of trauma are processed in therapy, or new memories bubble to the surface, they may wrestle with it once more as new feelings strike a devastating chord inside their chest. This is a common experience for so many survivors, and can have lasting ramifications with each plunge. We want to be here to help bring pause to those deep swings into the darkness – doing what we can to keep survivors in the light a little longer. Or, better yet, support them in adding some of that light inside of themselves. That way, even if they need to hide in the darkness for a bit, the light never leaves them for good.  We’re still here.