If you have ever seen a small c in front of the letters PTSD, you may have wondered “what is cPTSD?”
cPTSD stands for complex post traumatic stress disorder. It is a more severe form of PTSD and describes a lived experience of surviving repeated and prolonged abuse, neglect, abandonment, and/or engulfment. An individual with PTSD can usually acknowledge a marked difference before and after a traumatic event that they survived. Someone with cPTSD, on the other hand, may not have ever known a time they felt differently. Because of this, treatment of cPTSD usually involves an exploration of childhood and developmental experiences and their current impacts on life as an adult.
What is cPTSD?
PTSD and cPTSD can both originate from abuse: physical, sexual, verbal, or emotional. One way caretakers can emotionally abuse their child is through contempt. This entails verbal and emotional abuse using denigration, rage, and disgust. It often occurs in response to a child signaling they need attention, connection, or help. A caretaker can chronically ignore their child’s attempts to seek help in experiencing an overwhelming emotion. In these cases, the child will feel abandoned in an emotional crisis. If this pattern repeats, the child learns to avoid signaling their needs and feels abandoned, leading to emotional neglect. They learn to instead succumb to inevitable helplessness and hopelessness and this develops into a ruthless inner critic. This cycle commonly leads to cPTSD.
Watch a video about PTSD and trauma
Sometimes a caretaker will express their contempt for the child’s emotional needs through corporal punishment. In these cases, the harmful impact of emotional abandonment can be deeper. Caretakers may use tactics not unlike those of law enforcement officers, religious and cult leaders, and humans who seek to control people through enslavement. In other cases, children experience engulfment. This occurs when the child is not allowed to individuate from the caretaker and experiences development while enmeshed with their caretaker.
While anyone can open up a DSM V and learn about PTSD, cPTSD is not currently an official diagnosis. This is despite decades of established research and development of multiple healing modalities for treating cPTSD. For this reason, it is important to define cPTSD.
Signs and symptoms of cPTSD
According to Judith Herman, a person with cPTSD has experienced prolonged trauma. This can in the form of subjugation to totalitarian control. A survivor with cPTSD may experience alterations in six areas of internal functioning: affect regulation, consciousness, self-perception, perception of perpetrator, relating to others and systems of meaning. Every child needs healthy development of these functions and trauma may block, interrupt or complicate the ability to grow from child to adult. Below we will look at how cPTSD can impact each of these areas.
Affect regulation
When a person experiences alterations in affect regulation, it means they struggle to experience natural ebbs and flows in mood. They may feel persistent dysphoria and experience suicidal thoughts or urges to self-harm. They may also have issues expressing anger or experience sexual desire in a way that is compulsive, inhibited, or alternates between the two.
Consciousness
When consciousness is impacted, it can affect memory, causing us to dissociate. It can lead to becoming stuck in reliving trauma in thoughts or in physical symptoms.
Self-perception
When the development of self-perception is impacted, may feel helpless or paralyzed to change our circumstances well into adulthood. A healthily developed self-perception can protect us from shame, guilt, and blame. It also can protect us from a sense of being unworthy compared to others or a sense that there are fundamental differences between us and everyone else. When our self-perception is compromised, we are vulnerable to a powerful double bind of fear and shame.
Perception of the perpetrator
Someone with cPTSD may feel preoccupied or even obsessed with maintaining a specific perception of the perpetrator. Often this looks like idealizing them. It can also result in fantasizing about or actually seeking revenge. Other ways this perception can be distorted is in believing the connection is special, designed by fate, or even supernatural. Or, they may believe that the perpetrator is more powerful than any one human can be. They may also be indoctrinated into the belief system the perpetrator uses to rationalize the abuse.
Relating to others
Living with cPTSD may impact your development of how you relate to others. This could feel like urges to isolate or withdraw frequently or difficulty trusting others. It could also look like searching for someone to rescue or save you. Or it could be a sense that, because relationships over your life have been consistently unstable, you don’t believe you can protect yourself.
Systems of meaning
cPTSD changes the way we interpret meaning in our lives, from our jobs to our relationships to our goals. If someone’s systems of meaning are impacted by prolonged trauma or abuse, they may feel unable to maintain a sense of faith in self, others, or the world. They may often or always feel a sense of hopelessness and despair.
cPTSD and emotional flashbacks
According to Pete Walker, cPTSD includes emotional flashbacks, toxic shame, self-abandonment, a viscous inner critic, and social anxiety.
Understanding emotional flashbacks is integral to recovery from trauma. Without an awareness of what an emotional flashback is, we can interpret our experiences as evidence of our wrongness or our dysfunction. This can further reinforce the shame we are already suffering from. We can define an emotional flashbacks as a sudden and overwhelming change in emotion. This can include feeling small, young, fragile, powerless, helpless, afraid, ashamed, alienated, enraged, in grief, and/or depressed. When we experience an emotional flashback, we travel back in time. We often feel how we felt when abused, neglected, abandoned, or engulfed as children. An emotional flashback can last moments to weeks. It can feel like a bump in the road or be as intense as a complete crisis.
During an emotional flashback, the sympathetic nervous system lights up. This response is there to help us survive what we experience as an overwhelming threat. If the flashback is about fear, the nervous system will spiral up and respond with anxiety, panic, and/or suicidal ideation. If the flashback is about feeling despair, the nervous system will spiral down into numbness, paralysis, or desperation to hide.
Read more about trauma triggers
cPTSD and suicidal ideation
Many abuse survivors experience suicidal ideation in a specific way. Suicidal thoughts, urges, and other cognitions exist on a spectrum of passive to active. Active suicidal ideation involves making a plan, gathering necessary materials, and taking concrete actions to act on suicidal urges. Passive suicidal ideation may sound more like a fantasy of relief from pain and suffering, or like wanting to disappear.
What differentiates passive from active suicidal ideation is that a passive fantasy ends before taking any action steps. This can commonly look like experiencing a wish to die, fantasies about ways life could end, or experiencing an act of fate that ends life. We can view these thoughts as almost like time-traveling. They take us to moments of profound abandonment so incredibly painful it is natural to look for an escape hatch. That said, unless the thoughts become more concrete, specific, or involve action, the presence of passive suicidal ideations does not necessarily mean someone wants to end their life.
cPTSD and toxic shame
Another common experience tied to cPTSD is toxic shame. This is an internalized set of beliefs that feel like evidence that you are wrong, broken, worthless, or deserving of contempt, alienation, or abandonment. Messages received from caretakers’ actions and words teach children to have disdain for themselves. Toxic shame creates a vicious cycle reinforced by the inner critic. This often holds us back and prevents us from seeking the comfort and support we desperately need. Social anxiety may also be present in cPTSD. This is due to the impact of the trauma on our development as children and our ability to form secure attachment to others.
cPTSD and Me
“Was I really traumatized?” This question can be so pervasive among those with experiences of complex trauma. Often, these experiences are difficult to define or explain in a short, simple way. That said, there are other questions that might be worth asking yourself:
Does my current suffering match the description of an adult that experienced trauma?
Do I experience emotional flashbacks, toxic shame, self-abandonment, attacks from my inner critic, and/or social anxiety?
Do those experiences significantly impact my life at home, at work, at school, in relationships?
Even if you can’t recall and explain traumatic memories, your trauma is still valid. The very nature of cPTSD can compromise our ability to store and retain memories of our experiences. Additionally, we may be suffering from contempt, emotional neglect, physical or sexual abuse, abandonment, or other overwhelming experiences. Often, these experiences occurred before we developed verbal skills. This means we may never be able to remember the trauma we experienced.
Working with a trauma-informed therapist is one of the best ways you can support your recovery. At myTherapyNYC, our therapists are trained to provide trauma-informed psychotherapy and EMDR (Eye Movement Desensitization and Reprocessing). While traditional talk therapy engages mostly the analytic thinking part of our brains, trauma-informed practices target the parts most affected by trauma, including the nervous system. Mental health professionals often refer to trauma recovery as bottom-up processing, instead of top-down. This means that models of recovery integrate physical and somatic awareness.
Does your experience reflect the signs that you may be suffering from cPTSD or another trauma-related disorder? Reach out to myTherapyNYC today and you can get on the path to healing.
How has your perception on trauma shifted after reading about symptoms and signs of cPTSD? Join the conversation in the comments below!
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