David Baxter PhD
Late Founder
How I'm Recovering from C-PTSD
By Liz Lazzara, The Fix
November 8, 2017
Persistent neglect in childhood can lead you to believe that you don?t deserve to be loved or cared for. This idea begins to define you: you are a person who ought to be treated badly.
C-PTSD is a result of the accumulation of "small" traumas on the mind as one grows up.
When we think of people with post-traumatic stress disorder (PTSD), a specific list comes to mind: soldiers returning from combat zones and police officers connected to terrible incidents in the line of duty; victims of sexual trauma and women who were beaten by their partners; the families who stood on the roofs of their houses in the aftermath of Katrina and those who managed to walk away from the horrific South Asian tsunami in 2004. We are right to think of these people and to recognize their experiences, but there are many others living with an equally damaging--yet much more invisible--condition: complex post-traumatic stress disorder or C-PTSD.
The psychological community credits Judith Herman as the originator of this diagnosis. She first described C-PTSD in her book 1992 book, Trauma and Recovery, complementing the diagnosis of PTSD that had been added to the Diagnostic and Statistical Manual of Mental Disorders 12 years earlier, noting that trauma-related disorders weren?t only the result of one intense, acute crisis, but also through chronic, subtler experiences of pain.
In 1992, I was four years old and my path toward a C-PTSD diagnosis had already begun. My mother had filed for divorce when I was two after years of enduring my father?s emotional, physical, and sexual abuse. I don?t remember that time in my life, but I?ve since learned that doesn?t matter; according to Lise Eliot, Ph.D., author of What?s Going on in There? How the Brain and Mind Develop in the First Five Years of Life, if a baby is exposed to inconsistent care or abuse, ?he?ll fail to develop the confidence and emotional security that are so essential to a healthy psyche...For even though the child will never remember the specific events at any conscious level, his lower limbic system ? and the amygdala in particular ? does store powerful associations between an emotional state, like fear or pain, and the person or situation that brought it on, associations that may be indelible.? In other words, I can?t remember the specific things that my father did to my mother when I was an infant and toddler, but the part of my brain responsible for emotion, survival instinct, and memory retains those experiences.
By the same token, the more times I experienced fear or pain, especially as a small child, the more my brain came to believe that the world was inherently cruel. As a result, I slowly developed more and more symptoms of C-PTSD. My mother worked odd hours when I was young, so I spent most of my free time with babysitters. I began to believe I was set apart from others, isolated from the world. When I visited my father, I often couldn?t sleep. He made me pace around the room until I tired myself out, and eventually I became afraid of going to bed at all.
Both my parents expected that I would get a full ride to college based on my grades. If I ever received less than an A, I felt intense shame. My mother and I fought bitterly in high school and she sent me to live with my father three times as a result. I began to understand the meaning of ?dysphoria,? and to feel fierce rage.
As I entered adulthood and the world of dating, love, sex, and commitment, I was ignored sexually, used for sex, raped, emotionally abused, and kept a secret or as a trophy. As a result of these painful experiences, I began to self-harm and think of suicide. I searched over and over for a partner who would protect me, but also began to rationalize that I deserved this type of treatment: it was my fault; my partners were good people, but I was contaminated by my past. When these relationships would end, I sought solace in the company of new partners or in alcohol and drugs. Eventually, I came to realize that I live with alcoholism, drug addiction, and indeed a lifestyle addiction: instead of dealing with negative emotions in a healthy manner, I have always filled my emptiness with some destructive diversion.
What?s especially alarming is that I didn?t consciously adjust my behavior to meet my changing circumstances. My brain was permanently altered by these incidents. According to Eliot, ?The brain itself is literally molded by every experience...modifying the way future sights, sounds, and thoughts will be registered.?
So what is the solution for people whose environments have trained their minds to feel anxious, shamed, guilty, helpless, and angry; to always be on guard against danger; to feel incapable of trusting others; and for whom self-injury or seeking similarly painful experiences provides a valid escape from their pain?
The International Society for Traumatic Stress Studies (ISTSS) Complex Trauma Task Force (CTTF) published a set of guidelines
for treating C-PTSD in adults. According to these experts, there are three stages of treatment:
The ultimate goal of treatment is for you to recover a feeling of control and each step toward this aim is broken down into sub-steps. For me, the breakdown is comforting. It makes the entire process seem (more) manageable. However, it does not make any of these steps easier.
For example, Phase One entails learning more about trauma and its effects, reducing the severity of trauma-related symptoms through medication or meditation/mindfulness, learning how to manage stress and other emotions, developing or improving social skills, and engaging in therapy. According to Herman, the goal here is to set up a feeling of ?safety and stability in one?s body, one?s relationships, and the rest of one?s life,? while ?developing one?s own inner strengths.?
I have taken, or started to take, all of these steps to complete the first phase of my recovery. I read everything I can about complex/cumulative trauma both to understand my condition and to help educate others. I take an SNRI antidepressant to boost my mood and reduce my chances of entering a state of ?fight-or-flight,? a mood stabilizer to help keep me ?level,? a benzodiazepine to calm sudden fits of anxiety, and an atypical antipsychotic to reduce night terrors so I can sleep through the night. I have studied mindfulness so that I can better identify the facts of my emotional life and I meditate when I feel overwhelmed. I?ve quit drinking, drugs, and (for the moment) engaging in romantic relationships ? my previous methods of self-medicating through stress ? and I?ve started to attend AA/NA meetings to develop a healthy sense of community and to work on myself. I?ve also moved in with my mother in order to reduce the stress of financial instability.
Ideally, we would all complete each phase before moving on to the next. However, in my experience, real life is more complex and often necessitates working on more than one phase concurrently. When you live with constant reminders of your traumas, it?s difficult not to talk about them in an attempt to lessen their impact and integrate them into your life in the healthiest way possible.
This is the bulk of the work done in Phase Two. In safe spaces such as therapy or with other people they trust, trauma victims talk about what happened to them. Other methods, such as art therapy and Eye Movement Desensitization and Reprocessing (EMDR), may be implemented. This is also the time to let yourself grieve your traumas, as well the healthy experiences you did not have as a result of them. The point is to transform traumatic memories into ?normal,? if negative, memories and to redefine how they affect your sense of identity. For instance, persistent neglect in childhood can lead you to believe that you don?t deserve to be loved or cared for. This idea wheedles its way so deep into your brain that you become defined by it: you are a person who ought to be treated badly. This phase of recovery overwrites that definition with a new one: you were neglected and are allowed to mourn that, but that neglect is something that was done to you; it is not something that represents your entirety as a person.
As I mentioned before, these phases often run together, or at least they have for me. I am willing and even happy to talk about my traumas, not only with my therapist, but with almost anyone I meet. As a mental health activist and author of a manuscript about C-PTSD, it?s necessary to my work, but also to my recovery. With every piece I write or person I speak to, it feels like the load lightens somewhat. It?s also empowering to take my past and turn it into work that benefits others, and I move further away from self-victimization every day.
The third stage of treatment ? reintegrating into society ? is one of the hardest. You must create a new self, new relationships, and new faith in the world ? one that isn?t tainted by the awful experiences of the past. You have to create a new future based not on what you were taught as a child, but what you?ve learned as an adult. That future can be difficult to imagine. It is for me, though I do have some dreams and goals.
I?m still held back by trauma-related agoraphobia, so going out with friends is tricky. However, I have begun to contact people from my past who are living healthy lives and whose conversation makes me happy. I?ve also joined a website that uses a lot of the principles of online dating, but applies them to making friends. I?m talking to a couple women in my area and maybe one day we?ll meet. I?ve also been flirting with the idea of entering an online Masters program for psychology to strengthen my career in the mental health field, and have applied to a few schools. While I haven?t made up my mind about whether or not I?ll enroll in any of them, filling out the applications is encouraging in and of itself. AA and NA meetings are helpful, but I?m also gathering the courage to go to a writer?s group meeting near me.
Of course, there are many things I lack. As a rape and abuse survivor, I don?t feel comfortable around most men. As someone who has been hurt by women I trusted deeply, I find it hard to develop new friendships. When I attend meetings to focus on my recovery, I enjoy them, but when I?m struggling emotionally, I find it difficult to reach out to the women who have given me their phone numbers. It?s even difficult to contact my sponsor, the woman I trust most with my recovery, because I feel burdensome. I?ve pushed away negative emotions for so long that grieving can be difficult ? sometimes impossible. My therapist knows that I can?t yet begin to engage in EMDR because my foundation of safety and security is too shaky, and my reintegration into society is more of a goal than a reality. But I remember the oft-quoted saying from my Big Book (?progress, not perfection?) and move forward bits and pieces at a time.
This third phase marks the end of recovery for Herman and the ISTSS, but I propose a fourth: using your knowledge of recovery to help others who are still suffering. You may balk at this suggestion, especially if you?re still in the midst of personal pains. Why would you possibly want to revisit the realm of trauma after you?ve made peace with it? Herman provides an answer:
?It is very tempting to take the side of the perpetrator. All the perpetrator asks is that the bystander do nothing. He appeals to the universal desire to see, hear, and speak no evil. The victim asks the bystander to share the burden of the pain. The victim demands action, engagement, and remembering.?
In order for trauma victims to become true trauma survivors, they must re-enter a community that welcomes them with open arms. So many of us have been hurt deeply by others that trust does not come easy, or at all. How much easier would recovery be if we knew that there were others like us out there, willing to lend a hand?
By Liz Lazzara, The Fix
November 8, 2017
Persistent neglect in childhood can lead you to believe that you don?t deserve to be loved or cared for. This idea begins to define you: you are a person who ought to be treated badly.
C-PTSD is a result of the accumulation of "small" traumas on the mind as one grows up.
When we think of people with post-traumatic stress disorder (PTSD), a specific list comes to mind: soldiers returning from combat zones and police officers connected to terrible incidents in the line of duty; victims of sexual trauma and women who were beaten by their partners; the families who stood on the roofs of their houses in the aftermath of Katrina and those who managed to walk away from the horrific South Asian tsunami in 2004. We are right to think of these people and to recognize their experiences, but there are many others living with an equally damaging--yet much more invisible--condition: complex post-traumatic stress disorder or C-PTSD.
The psychological community credits Judith Herman as the originator of this diagnosis. She first described C-PTSD in her book 1992 book, Trauma and Recovery, complementing the diagnosis of PTSD that had been added to the Diagnostic and Statistical Manual of Mental Disorders 12 years earlier, noting that trauma-related disorders weren?t only the result of one intense, acute crisis, but also through chronic, subtler experiences of pain.
In 1992, I was four years old and my path toward a C-PTSD diagnosis had already begun. My mother had filed for divorce when I was two after years of enduring my father?s emotional, physical, and sexual abuse. I don?t remember that time in my life, but I?ve since learned that doesn?t matter; according to Lise Eliot, Ph.D., author of What?s Going on in There? How the Brain and Mind Develop in the First Five Years of Life, if a baby is exposed to inconsistent care or abuse, ?he?ll fail to develop the confidence and emotional security that are so essential to a healthy psyche...For even though the child will never remember the specific events at any conscious level, his lower limbic system ? and the amygdala in particular ? does store powerful associations between an emotional state, like fear or pain, and the person or situation that brought it on, associations that may be indelible.? In other words, I can?t remember the specific things that my father did to my mother when I was an infant and toddler, but the part of my brain responsible for emotion, survival instinct, and memory retains those experiences.
By the same token, the more times I experienced fear or pain, especially as a small child, the more my brain came to believe that the world was inherently cruel. As a result, I slowly developed more and more symptoms of C-PTSD. My mother worked odd hours when I was young, so I spent most of my free time with babysitters. I began to believe I was set apart from others, isolated from the world. When I visited my father, I often couldn?t sleep. He made me pace around the room until I tired myself out, and eventually I became afraid of going to bed at all.
Both my parents expected that I would get a full ride to college based on my grades. If I ever received less than an A, I felt intense shame. My mother and I fought bitterly in high school and she sent me to live with my father three times as a result. I began to understand the meaning of ?dysphoria,? and to feel fierce rage.
As I entered adulthood and the world of dating, love, sex, and commitment, I was ignored sexually, used for sex, raped, emotionally abused, and kept a secret or as a trophy. As a result of these painful experiences, I began to self-harm and think of suicide. I searched over and over for a partner who would protect me, but also began to rationalize that I deserved this type of treatment: it was my fault; my partners were good people, but I was contaminated by my past. When these relationships would end, I sought solace in the company of new partners or in alcohol and drugs. Eventually, I came to realize that I live with alcoholism, drug addiction, and indeed a lifestyle addiction: instead of dealing with negative emotions in a healthy manner, I have always filled my emptiness with some destructive diversion.
What?s especially alarming is that I didn?t consciously adjust my behavior to meet my changing circumstances. My brain was permanently altered by these incidents. According to Eliot, ?The brain itself is literally molded by every experience...modifying the way future sights, sounds, and thoughts will be registered.?
So what is the solution for people whose environments have trained their minds to feel anxious, shamed, guilty, helpless, and angry; to always be on guard against danger; to feel incapable of trusting others; and for whom self-injury or seeking similarly painful experiences provides a valid escape from their pain?
The International Society for Traumatic Stress Studies (ISTSS) Complex Trauma Task Force (CTTF) published a set of guidelines
for treating C-PTSD in adults. According to these experts, there are three stages of treatment: - Letting you know you?re safe and reducing your symptoms;
- Helping you to process your traumatic memories; and
- Reconnecting with your job, community, and loved ones again.
The ultimate goal of treatment is for you to recover a feeling of control and each step toward this aim is broken down into sub-steps. For me, the breakdown is comforting. It makes the entire process seem (more) manageable. However, it does not make any of these steps easier.
For example, Phase One entails learning more about trauma and its effects, reducing the severity of trauma-related symptoms through medication or meditation/mindfulness, learning how to manage stress and other emotions, developing or improving social skills, and engaging in therapy. According to Herman, the goal here is to set up a feeling of ?safety and stability in one?s body, one?s relationships, and the rest of one?s life,? while ?developing one?s own inner strengths.?
I have taken, or started to take, all of these steps to complete the first phase of my recovery. I read everything I can about complex/cumulative trauma both to understand my condition and to help educate others. I take an SNRI antidepressant to boost my mood and reduce my chances of entering a state of ?fight-or-flight,? a mood stabilizer to help keep me ?level,? a benzodiazepine to calm sudden fits of anxiety, and an atypical antipsychotic to reduce night terrors so I can sleep through the night. I have studied mindfulness so that I can better identify the facts of my emotional life and I meditate when I feel overwhelmed. I?ve quit drinking, drugs, and (for the moment) engaging in romantic relationships ? my previous methods of self-medicating through stress ? and I?ve started to attend AA/NA meetings to develop a healthy sense of community and to work on myself. I?ve also moved in with my mother in order to reduce the stress of financial instability.
Ideally, we would all complete each phase before moving on to the next. However, in my experience, real life is more complex and often necessitates working on more than one phase concurrently. When you live with constant reminders of your traumas, it?s difficult not to talk about them in an attempt to lessen their impact and integrate them into your life in the healthiest way possible.
This is the bulk of the work done in Phase Two. In safe spaces such as therapy or with other people they trust, trauma victims talk about what happened to them. Other methods, such as art therapy and Eye Movement Desensitization and Reprocessing (EMDR), may be implemented. This is also the time to let yourself grieve your traumas, as well the healthy experiences you did not have as a result of them. The point is to transform traumatic memories into ?normal,? if negative, memories and to redefine how they affect your sense of identity. For instance, persistent neglect in childhood can lead you to believe that you don?t deserve to be loved or cared for. This idea wheedles its way so deep into your brain that you become defined by it: you are a person who ought to be treated badly. This phase of recovery overwrites that definition with a new one: you were neglected and are allowed to mourn that, but that neglect is something that was done to you; it is not something that represents your entirety as a person.
As I mentioned before, these phases often run together, or at least they have for me. I am willing and even happy to talk about my traumas, not only with my therapist, but with almost anyone I meet. As a mental health activist and author of a manuscript about C-PTSD, it?s necessary to my work, but also to my recovery. With every piece I write or person I speak to, it feels like the load lightens somewhat. It?s also empowering to take my past and turn it into work that benefits others, and I move further away from self-victimization every day.
The third stage of treatment ? reintegrating into society ? is one of the hardest. You must create a new self, new relationships, and new faith in the world ? one that isn?t tainted by the awful experiences of the past. You have to create a new future based not on what you were taught as a child, but what you?ve learned as an adult. That future can be difficult to imagine. It is for me, though I do have some dreams and goals.
I?m still held back by trauma-related agoraphobia, so going out with friends is tricky. However, I have begun to contact people from my past who are living healthy lives and whose conversation makes me happy. I?ve also joined a website that uses a lot of the principles of online dating, but applies them to making friends. I?m talking to a couple women in my area and maybe one day we?ll meet. I?ve also been flirting with the idea of entering an online Masters program for psychology to strengthen my career in the mental health field, and have applied to a few schools. While I haven?t made up my mind about whether or not I?ll enroll in any of them, filling out the applications is encouraging in and of itself. AA and NA meetings are helpful, but I?m also gathering the courage to go to a writer?s group meeting near me.
Of course, there are many things I lack. As a rape and abuse survivor, I don?t feel comfortable around most men. As someone who has been hurt by women I trusted deeply, I find it hard to develop new friendships. When I attend meetings to focus on my recovery, I enjoy them, but when I?m struggling emotionally, I find it difficult to reach out to the women who have given me their phone numbers. It?s even difficult to contact my sponsor, the woman I trust most with my recovery, because I feel burdensome. I?ve pushed away negative emotions for so long that grieving can be difficult ? sometimes impossible. My therapist knows that I can?t yet begin to engage in EMDR because my foundation of safety and security is too shaky, and my reintegration into society is more of a goal than a reality. But I remember the oft-quoted saying from my Big Book (?progress, not perfection?) and move forward bits and pieces at a time.
This third phase marks the end of recovery for Herman and the ISTSS, but I propose a fourth: using your knowledge of recovery to help others who are still suffering. You may balk at this suggestion, especially if you?re still in the midst of personal pains. Why would you possibly want to revisit the realm of trauma after you?ve made peace with it? Herman provides an answer:
?It is very tempting to take the side of the perpetrator. All the perpetrator asks is that the bystander do nothing. He appeals to the universal desire to see, hear, and speak no evil. The victim asks the bystander to share the burden of the pain. The victim demands action, engagement, and remembering.?
In order for trauma victims to become true trauma survivors, they must re-enter a community that welcomes them with open arms. So many of us have been hurt deeply by others that trust does not come easy, or at all. How much easier would recovery be if we knew that there were others like us out there, willing to lend a hand?
