By Tamara McClintock Greenberg, PsyD, author of The Complex PTSD Coping Skills Workbook
Complex post-traumatic stress disorder, or C-PTSD, occurs when you have experienced traumas not caused by one or two discrete events but by multiple injuries, usually beginning in childhood, that have profound impacts on your self-concept and your ways of relating to others. C-PTSD happens based on the aggregate of a life filled with difficulties. As such, the symptoms of C-PTSD can be more severe, long-lasting, and woven into your personality, which is different than what happens with primary post-traumatic stress disorder (PTSD).
C-PTSD involves multiple betrayals, including abuse, neglect, and having to experience frightening and confusing circumstances way before you should have to. Because early trauma is a predictor of later trauma, C-PTSD also involves damages experienced as an adult.
Symptoms of Complex Trauma
Some of the symptoms of complex trauma are like what’s experienced in PTSD—flashbacks, nightmares, feeling numb, hypervigilance, and avoiding reminders of bad things that have happened. Complex PTSD involves more symptoms that can cause disruption, such as difficulties finding people who treat us well, struggles coping with strong emotions, as well as a tendency to detach from ourselves in stressful situations.
At the heart of C-PTSD is the loss of identity. Trauma takes away the ability to have a relationship with one’s mind. By this I mean that we can spend so much time focusing on the outside, that when we need to look inward toward our own thoughts and feelings, we can miss valuable cues or not even know how we feel. This can impact our ability to learn from experience, especially when it comes to relationships.
Complex Trauma and Identity Theft
When we are young, we need a safe environment. This sounds obvious; it’s not good if we don’t feel cared for. But the result of trauma and other difficult experiences is that we become too distracted by the external environment to develop a relationship with our own minds.
Adults who have not been repeatedly traumatized experience the world very differently. Typically, someone without C-PTSD knows what they want and can make decisions about what their adult lives should look like. It may be easier for them to get along well with a variety of different people. They don’t worry as much about what’s on others’ minds; they can enter relationships without much fear or suspicion. They don’t feel pressured to take care of others or figure out what others want from them. They know when relationships are not helpful. They can sense when something is not right and even when it’s hard, they can leave, as painful as it may be.
Trauma takes away the ability to trust your own instincts, needs, and desires.
Other ways trauma can impact identity are that people can feel the choices they make in life are not owned by them. One way I think about this is that hypervigilance becomes something that is woven into personality. We often think of hypervigilance as an exaggerated startle response, for example, like when someone comes up behind you and you jump. But here I’m talking more about a cognitive strategy that takes over, the need to focus on all things outside of us. It starts as an attempt to monitor the world so we can remain safe, but over time becomes a system of missing valuable data. For example, you might be so worried about what potential friends think of you that you forget to stop and think about whom you’re interacting with and how you feel with them.
Learning to Take Yourself and Your C-PTSD Seriously
One of the hallmarks of trauma is that is that it’s hard to take yourself seriously. You may doubt your reactions, especially in relationships. This can be a good thing—we all should think before we act when something is upsetting; complex trauma can make us prone to outsized reactions. Though people with C-PTSD can sometimes have the problem of overreacting, they can also underreact. We may not listen to our inner voice if someone in our life is not treating us well, or we may just go along with what we imagine others want us to do.
Healing from C-PTSD
The good news is that it’s possible to recover from the adversities you have experienced. Some people in my field have assumed that getting better must always involve going back and wading through memories—things like exposure therapy—or even just talking about traumas in detail. I’m not so sure about this. People with C-PTSD may simply have too many memories to wade through. Also, the identity theft that occurs with C-PTSD means that many people many not even be able to access some memories. Developing a narrative means understanding that there may be jagged edges and missing pieces to one’s story. That understanding can be key in recovery as it takes pressure off survivors to deal with memories before they are ready.
Whether you work with a therapist or explore healing on your own, I suggest focusing on the present. What are your current relationships like? How do you manage strong emotions? Are you feeling like you are detached from the life you want to be living? The mental health field has a variety of options to help—everything from cognitive behavioral therapy (CBT) to acceptance and commitment therapy (ACT) to dialectical behavior therapy (DBT)—therapies that focus on skills to change behavior and thought patterns. Other options involve new insights from mentalization approaches, which some have described as a form of metacognition. These methods help us learn how to be more authentic in our lives and emphasize developing a relationship with your own mind. Also, modern relational approaches (often from psychodynamic theories) can help people understand patterns in relationships that stem from the past to find people more effectively with whom you feel safe.
Whatever you decide to do with this information, know that you are not alone. There is help and you get to choose how and when you’d like to receive it. Reclaiming identity is all about choice and feeling in control.
Tamara McClintock Greenberg, PsyD, is a clinical psychologist and renowned expert in the treatment of depression, anxiety, trauma, and more. Her work has been published in HuffPost, Psych Central, Psychology Today, the San Francisco Chronicle, and she has been featured in Forbes, USA Today, Newsweek, Next Avenue (PBS), and The Washington Post. She has also been interviewed by major radio stations, including KQED’s Forum.