Complex PTSD: From Surviving to Thriving

by Pete Walker

Recovery from Cptsd typically has important self-help and relational components. The relational piece can come from authors, friends, partners, teachers, therapists, therapeutic groups or any combination of these. I like to call this reparenting by committee.

Cptsd is a more severe form of Post-traumatic stress disorder. It is delineated from this better known trauma syndrome by five of its most common and troublesome features: emotional flashbacks, toxic shame, self-abandonment, a vicious inner critic and social anxiety.

Emotional flashbacks are sudden and often prolonged regressions to the overwhelming feeling-states of being an abused/abandoned child. These feeling states can include overwhelming fear,

shame, alienation, rage, grief and depression. They also include unnecessary triggering of our fight/flight instincts.

Finally, a more clinical and extensive definition of Cptsd can be found on p. 121 of Judith Herman’s seminal book, Trauma and Recovery.

Toxic shame, explored enlighteningly by John Bradshaw in Healing The Shame That Binds, obliterates a Cptsd survivor’s self-esteem with an overwhelming sense that he is loathsome, ugly, stupid, or fatally flawed.

List Of Common Cptsd Symptoms Survivors may not experience all of these. Varying combinations are common. Factors affecting this are your 4F type and your childhood abuse/neglect pattern. Emotional Flashbacks Tyrannical Inner &/or Outer Critic Toxic Shame Self-Abandonment Social anxiety Abject feelings of loneliness and abandonment Fragile Self-esteem Attachment disorder Developmental Arrests Relationship difficulties Radical mood vacillations [e.g., pseudo-cyclothymia: see chapter 12]

Dissociation via distracting activities or mental processes Hair-triggered fight/flight response Oversensitivity to stressful situations Suicidal Ideation

Reducing Cptsd to “panic disorder” is like calling food allergies chronically itchy eyes.

If the child has learned through experience that he can come to at least one of his parents when he is hurting, frightened or needing help, he will tell mom or dad about it. With them, he will grieve the temporary death of his sense of safety in the world by verbally ventilating, crying and angering about it [chapter 11 expands on these processes of grieving].

A fight response is triggered when a person suddenly responds aggressively to something threatening. A flight response is triggered when a person responds to a perceived threat by fleeing, or symbolically, by launching into hyperactivity. A freeze response is triggered when a person, realizing resistance is futile, gives up, numbs out into

dissociation and/or collapses as if accepting the inevitability of being hurt. A fawn response is triggered when a person responds to threat by trying to be pleasing or helpful in order to appease and forestall an attacker. This fourfold response potential will heretofore be referred to as the 4Fs. Traumatized children often over-gravitate to one of these response patterns to survive, and as time passes these four modes become elaborated into entrenched defensive structures that are similar to narcissistic [fight], obsessive/compulsive [flight], dissociative [freeze] or codependent [fawn] defenses.

Wilhelm Reich, in his brilliant book The Psychology of Fascism, explains how scapegoating occurs on a continuum that stretches from the persecution of the targeted child by a bullying parent to the horrific scapegoating of the Jews by the Nazi’s.

Carol remained symbolically enthralled to the family by getting ensnared with narcissistic people who were just as abusive and neglectful as her parents. This well known psychological phenomenon is called repetition compulsion or reenactment, and trauma survivors are extremely susceptible to it.

Key Developmental Arrests In Cptsd What follows is a list of some of the most common developmental arrests that occur in Cptsd. You may find that you experience a diminishment or absence of these key features of healthy human being. Typically, survivors will vary on which and how many of these arrests relate to them. Factors affecting this are your 4F type, your childhood abuse/ neglect pattern, your innate nature and any recovery work that you have already accomplished. Self-acceptance Clear sense of identity Self-Compassion Self-Protection Capacity to draw comfort from relationship Ability to relax Capacity for full self-expression Willpower & Motivation Peace of mind Self-care Belief that life is a gift Self-esteem Self-confidence

My efforts to nurture myself in these arrested areas of development were limited and spoiled in early recovery by a feeling of resentment. “Why do I have to do this?” was a common internal refrain. Resentment that should have been directed toward my parents often boomeranged onto me and spoiled or thwarted my efforts at self-nurturance. Thankfully ongoing recovery work helped remedy this resentment. It taught me to practice self-care in a spirit of giving to a child who needed and really deserved to be helped.

Moreover, even when he manages to identify a goal of his own choosing, he may struggle to follow through with extended and concentrated effort. Remedying this developmental arrest is essential because many new psychological studies now show that persistence – even more than intelligence or innate talent - is the key psychological characteristic necessary for finding fulfillment in life.

I have worked with many survivors stranded in this form of adult helplessness. Those who recover from it typically do so by engaging extensively in the angering work of grieving that is discussed throughout this book.

The ability to invoke willpower seems to be allied to your ability to health...

With sufficient recovering, you can learn to manufact...

COGNITIVE HEALING The first level of recovery usually involves repairing the damage that Cptsd wreaks on our thoughts and beliefs about ourselves. Cognitive recovery work aims to make your brain user friendly. It focuses on recognizing and eliminating the destructive thoughts and thinking processes you were indoctrinated with in childhood. Cognitive healing also depends on learning to choose healthy and more accurate ways of talking to and thinking about yourself. On the broadest level, this involves upgrading the story you tell yourself about your pain.

Shrinking The Critic Early abuse and abandonment forces the child to merge his identity with the superego, the part of the child’s brain that learns the rules of his caretakers in order to get and maintain acceptance. However, because acceptance is impossible in the Cptsd-engendering family, the superego gets stuck working overtime to achieve the impossible. Perseverating on finding a formula to win over her parents, the child eventually embraces perfectionism as a strategy to make her parents less dangerous and more engaging. Her one hope is that if she becomes smart, helpful, pretty, and flawless enough, her parents will finally care for her. Sadly, continued failure at winning their regard forces her to conclude that she is fatally flawed. She is loveless not because of her mistakes, but because she is a mistake.

Self-criticism, then, runs non-stop in a desperate attempt to avoid rejection-inducing mistakes.

Drasticizing becomes obsessive to help the child foresee and avoid punishment and worsening abandonment. At the same time, it continuously fills her psyche with stories and images of catastrophe.

The survivor becomes imprisoned by a jailer who will accept nothing but perfection. He is chauffeured by a hysterical driver who sees nothing but danger in every turn of the road. Chapters 9 and 10 focus e...

They do this by shaming or intimidating you whenever you have a natural impulse to have sympathy for yourself, or stand up for yourself. The instinct to care for yourself and to protect yourself against unfairness is then forced to become dormant.

All too often, your decisions are based on the fear of getting in trouble or getting abandoned, rather than on the principles of having meaningful and equitable interactions with the world.

MINDFULNESS Psychologically speaking, mindfulness is taking undistracted time to become fully aware of your thoughts and feelings so that you can have more choice in how you respond to them. Do I really agree with this thought, or have I been pressured into believing it? How do I want to respond to this feeling – distract myself from it, repress it, express it or just feel it until it changes into something else? Mindfulness is a perspective that weds your capacity for self-observation with your instinct of self-compassion. It is therefore your ability to observe yourself from an objective and self-accepting viewpoint. It is a key function of a healthily developed ego and is sometimes described as the observing ego or the witnessing self. Mindfulness is a perspective of benign curiosity about all of your inner experience.

I cannot overstate the importance of becoming aware of your inner self-commentary. With enough practice, mindfulness eventually awakens your fighting spirit to resist the abusive refrains from your childhood, and to replace them with thoughts that are self-supportive. Mindfulness also helps you to establish a perspective from which you can assess and guide your own efforts of recovering.

John Bradshaw describes the devastation of the child’s emotional nature as “soul murder”. He explains this as involving a process where the child’s emotional expression [his first language of self-expression] is so assaulted with disgust that any emotional experience immediately devolves into toxic shame.

Because of the deadly one-two punch of familial and societal attacks on our emotional selves, we need to recover our innate emotional intelligence. This is also deeply important because, as Carl Jung emphasized, our emotions tell us what is really important to us. When our emotional intelligence is restricted, we often do not know what we really want, and can consequently struggle mightily with even the smallest decisions.

Grieving As Emotional Intelligence Grieving is the key process for reconnecting with our repressed emotional intelligence. Grieving reconnects us with our full complement of feelings. Grieving is necessary to help us release and work through our pain about the terrible losses of our childhoods. These losses are like deaths of parts of our selves, and grieving can often initiate their rebirth.

Grieving And Verbal Ventilation Grieving restores our crucial, developmentally arrested capacity to verbally ventilate. Verbal ventilation is the penultimate grieving practice. It is speaking from your feelings in a way that releases and resolves your emotional distress. I believe the following description of a six panel cartoon visually conveys the powerful transformative power of verbal ventilation. In the first panel of the wordless cartoon, a woman with a dark cloud over her head is talking to a friend who has a shining sun over hers. In panel two, as the first woman gestures in a way that indicates complaining, the cloud covers her friend’s sun. In panel three, the cloud emits a bolt of lightning, as she angrily purges, and her friend glowers along with her. In panel four, the cloud rains on them as they embrace, commiserating in the rain of their shared tears. In panel 5, relief spreads over their faces as the cloud moves away from the sun. In panel 6 the sun shines over both of them, as they smile and slip into pleasant conversation.

The inner critic is sometimes so hostile to grieving that shrinking the critic may need to be your first recovery priority. Until the critic is sufficiently tamed, grieving can actually make flashbacks worse, rather than perform the restorative processes it alone can initiate.

I have worked with numerous clients who were so traumatized around grieving that we needed to spend many months working on the cognitive level before grieving was released from the spoiling effects of the toxic critic. Chapter 11 provides a great deal of practical guidance for restoring your ability to grieve.

“The gratitude feeling is deep and profound when it occurs. It feels like a moment of connection to life itself on the deepest level and all life circumstances and what I deem as problems pale to insignificance in those moments and there is only love in its purest form. It truly feels like a blessing albeit fleeting but gives enough sustenance and hope to continue the journey.”

Nowadays, many therapists attach the phrase “good enough” to concepts like friend, partner, therapist or person. This is usually done to deconstruct perfectionistic expectations of relationships - expectations that are so unrealistic that they are destructive to essentially worthwhile relationships. When I apply the concept of “good enough” to people, I generally mean that a person is essentially good hearted, tries to be fair, and meets his or her commitments a large portion of the time. I also like to apply “good enough” to other concepts such as a good enough job, a good enough try, a good enough outing, a good enough day or a good enough life. I apply this concept liberally to contradict the black-and-white, all-or none thinking of the critic which reflexively judges people and things as defective unless they are perfect.

Cptsd wreaks on our bodies to motivate us to adopt practices that help us to heal on this level. Most of the physiological damage of extended trauma occurs because we are forced to spend so much time in hyper-arousal – stuck in fight, flight, freeze or fawn mode. When we are chronically stressed out [stuck in sympathetic nervous system activation], detrimental somatic changes become ingrained in our bodies. Here are some of the most common examples of body-harming reactions to Cptsd stress: Hypervigilance Shallow and Incomplete Breathing Constant Adrenalization Armoring, i.e., Chronic muscle tightness Wear and tear from rushing and armoring Inability to be fully present, relaxed and grounded in our bodies Sleep problems from being over-activated Digestive disorders from a tightened digestive tract

Somatic Self-Help The good news is that some somatic repair happens automatically when we reduce our physiological stress by more efficient flashback management. Particularly potent help also comes from the grieving work of reclaiming the ability to cry self-compassionately and to express anger self-protectively. Both processes can release armoring, promote embodiment, improve sleep, decrease hyperarousal and encourage deeper and more rhythmic breathing.

Another especially helpful somatic practice is stretching. Regular systematic stretching of the body’s major muscle groups can help you to reduce the armoring that occurs when your 4F response is chronically triggered. This results from the fact that 4F activation tightens and contracts your body in anticipation of the need to fight back, flee, get small to escape notice, or rev up to launch into people-pleasing activity.

Finally, freeze types and freeze subtypes also typically benefit from various types of movement therapy and aerobic exercise regimes.

In this vein, it is my opinion that techniques like EMDR [Eye Movement Desensitization Reprocessing] and Somatic Experiencing are very powerful tools for stress-reduction. They are especially helpful in resolving simple ptsd. However, they are not complete Cptsd therapies, unless the practitioner is eclectic enough to be incorporating inner critic and grieving-the-losses-of-childhood work. Other helpful somatic techniques include Rosen Work, Rolfing, Rebirthing and Reichian work.

A startle response is the sudden full body-flinching that survivors experience at loud noises or unanticipated physical contact. This is usually a somatic flashback to previous abuses.

It is also important to emphasize here that somatic therapies can be especially helpful in healing

the anxiety reaction to touch and physical closeness that many survivors of physical or sexual abuse experience. Exceptions to this are the survivors that I have met who have experienced remediation of this symptom through the help of an especially kind and safe partner.

One caveat here is that unless you do extensive critic shrinking work, the critic will be as strong as ever when the medications wear off.

Changing your eating habits is extremely difficult. A client left this quote on my waiting room

bulletin board: “Alcohol and other drug recovery is like dealing with a tiger in a cage. Recovery from eating disorders is like taking that tiger out of the cage three times a day and then taking it for a walk.”

Instead, I prefer to recommend Mate’s harm reduction approach. Additionally, Geneen Roth’s book, Breaking Free from Compulsive Eating, also offers a moderate and sensible approach to dietary improvement.

As they say in the Twelve Step Movement: “Take the best and leave the rest.”