The concept of PTSD is familiar to us. We keep hearing it in series, movies, interviews, psychotherapy sessions, even used jokingly when we refer to something disturbing. We know some keywords: traumatic event, panic attacks, flashbacks. But what if the event is not singular, but repeated over several years? What if some peculiarities with a much deeper impact are added to the classic symptoms? Do we still know how to define such keywords?

Today, the elephant in the room is Complex PTSD – a pathology that occurs mostly in childhood, after chronic exposure to trauma such as physical abuse, domestic violence, sexual abuse, captivity, crisis/war conditions, or human trafficking.

Before I give you details, I remind you of the classic symptoms: panic attacks, flashbacks, nightmares, insomnia, hypervigilance, somatic reactions, irritability, difficulty concentrating, selective amnesia, physical or emotional numbness, the adoption of destructive behaviors (mostly consumption of alcohol and drugs).

The particularities are classified into alterations of emotions, of the sense of one's own person, of consciousness, of relationships, of the perception of the abuser and of the "meaning system".

 The emotions

The survivor suffers a wide range of emotional alterations. He is unable to identify his emotions (alexithymia), but they also live intensely: either in the low register (sadness, numbness), or in the high register (anger, hypervigilance). The chronic release of stress hormones, adrenaline and cortisol, activates the "survival mode", the person being constantly in anticipation of a danger, even if it is not real. Also, the emotions experienced during the trauma are brought into present, either during panic attacks (triggered by images, sounds, smells, touches or people similar to the context of the trauma), or during nightmares, which are the expression of the subconscious' attempt to process the trauma, recalling memories associated with emotions.

Sense of self

The way the survivor perceives himself differs. The impression that he is evil and guilty is explained, in the case of the traumas that happened in the family environment, as follows: because his survival depended exclusively on his father, he could not conceive that the evil was done by the parent responsible for his care, so he internalized it as a belief,, I had to be punished, because I deserved it"). The impression that he is helpless is also explained in his childhood, when, living in the same house with the abuser and, most of the time, with other relatives who did not defend him, he came to believe that he had no escape. The impression that he is "one with trauma" is caused by the fact that his emotional age is not updated to his physiological age, he cannot define himself as an adult except through the identity of a traumatized child.

Conscience

The survivor dissociates – feels detached from his own body (depersonalization), stares blankly and loses connection with the surroundings (derealisation), forget certain parts of the trauma (selective amnesia), forgets long periods of time from appropriating the trauma (localized amnesia), or involuntarily remembers in the form of non-chronological flashbacks.

NB: The survivor can experience all the variants of dissociation, but at different times, according to the degree of emotional overwhelm he feels.

relations

The survivor is suspicious, erecting walls to avoid vulnerability (insecure-avoidant attachment), or he trusts too easily because he is attracted to people who resemble the former abuser. Also, he can think himself defenseless, looking for saviors, or, on the contrary, he wants to be a savior, ensuring by "repairing" the person control over external factors.

Perception of the abuser

The survivor either abandons himself to the power of the abuser, believing that he will always control or "haunt" him; or they idealize their abuser, feeling sad or even guilty if they leave; or they idolize him, longing for his love and appreciation; or he is extremely angry and constantly has thoughts of revenge.

The system of meanings

The survivor has an altered sense of the world around him. Either he believes that there are no good people with pure intentions anymore, or he believes that he was born to be hurt, so nothing good can appear in his future. His childhood trauma creates his belief that nothing is pointless and that everything is unfair, because if there were consequences and justice, the Universe (or a divine being) would not have let him suffer so much.

The good news for you (and the less good news for the perfectionist in me) is that what I've presented to you is just that small part of the ramifications of complex post-traumatic stress syndrome. For every behavior there is an explanation with the origin in childhood, therefore also a chance for healing. And if I were to end with a short and direct exhortation, it would be to search and discover as much about yourself as possible, however difficult it may be to face your pain.

PS: I recommend two books that may help you – The Body Keeps the Score by Bassel van der Kolk and Complex PTSD: From Surviving to Thriving by Pete Walker.

Resources:

www.mind.org.uk

www.beautyafterbruises.org   

www.nctsn.org

www.msdmanuals.com/professional/psychiatric-disorders/dissociative-disorders/depersonalization-derealization-disorder