Complex PTSD: From Surviving to Thriving

by Pete Walker

I also hope this map will guide you to heal in a way that helps you become an unflinching source of kindness and self-compassion for yourself, and that out of that journey you will find at least one other human being who will reciprocally love you well enough in that way.

First, the good news about Cptsd. It is a learned set of responses, and a failure to complete numerous important developmental tasks. This means that it is environmentally, not genetically, caused. In other words, unlike most of the diagnoses it is confused with, it is neither inborn nor characterological. As such, it is learned. It is not inscribed in your DNA. It is a disorder caused by nurture [or rather the lack of it] not nature. This is especially good news because what is learned can be unlearned and vice versa. What was not provided by your parents can now be provided by yourself and others.

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.

When fear is the dominant emotion in a flashback the person feels extremely anxious, panicky or even suicidal.

Toxic shame can obliterate your self-esteem in the blink of an eye. In an emotional flashback you can regress instantly into feeling and thinking that you are as worthless and contemptible as your family perceived you. When you are stranded in a flashback, toxic shame devolves into the intensely painful alienation of the abandonment mélange - a roiling morass of shame, fear and depression.

If you are stuck viewing yourself as worthless, defective, or despicable, you are probably in an emotional flashback. This is typically also true when you are lost in self-hate and virulent self-criticism.

Suicidal ideation is a common phenomenon in Cptsd, particularly during intense or prolonged flashbacks. Suicidal ideation is depressed thinking or fantasizing about wanting to die. It can range from active suicidality to passive suicidality. Passive suicidality is far more common with the Cptsd survivors who I have known, and it ranges from wishing you were dead to fantasizing about ways to end your life. When lost in suicidal ideation, the survivor may even pray to be delivered from this life, or fantasize about being taken by some calamitous act of fate. He may even think or obsess - without being serious - of stepping in front of a car or jumping off a building.

have witnessed many clients with Cptsd misdiagnosed with various anxiety and depressive disorders. Moreover, many are also unfairly and inaccurately labeled with bipolar, narcissistic, codependent, autistic spectrum and borderline disorders.

“Simple”, one incident traumas can often be resolved relatively easily if Cptsd is not already present.

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.

Abusive and abandoning parents can injure and abandon us on many levels: cognitive, emotional, spiritual, physical and relational. To recover, you need to learn how to support yourself – to meet your unmet developmental needs on each level that is relevant to your experience of childhood trauma.

An especially tragic developmental arrest that afflicts many survivors is the loss of their will power and self-motivation. Many dysfunctional parents react destructively to their child’s budding sense of initiative. If this occurs throughout his childhood, the survivor may feel lost and purposeless in his life. He may drift through his whole life rudderless and without a motor. 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.

Some survivors have confidence but not self-esteem. In childhood, my own flight response got channeled into acquiring academic skills for which the outside world rewarded me. But the benefit of these rewards never penetrated my toxic shame enough to allow me to feel that I was a worthwhile person.

Like many other survivors that I have worked with, I developed the imposter’s syndrome. This syndrome contradicted the outside positive feedback that I was receiving. It insisted that if people really knew me, they would see what a loser I was. Eventually, however, I became confident in my intelligence even though my self-esteem was still abysmal.

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.

Cognitive work is fundamental to helping you disidentify from the self-hating critic with which your parents inculcated you.

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. She can only see what is wrong with or missing in her.

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.

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.

You are free now as an adult to develop peace of mind and a supportive relationship with yourself. A self-championing stance can transform your existence from struggling survival to a fulfilling sense of thriving. You can begin right now by inviting your instincts of self-compassion and self-protection to awaken and bloom in your life.

Cognitive tools are irreplaceable in healing cognitive issues, but they do not address all the levels of our wounding.

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 of benign curiosity about all of your inner experience. Recovery is enhanced immeasurably by developing this helpful process of introspection. As it becomes more developed, mindfulness can be used to recognize and dis-identify from beliefs and viewpoints that you acquired from your traumatizing family.

The survivor, who is seeking a healthy relationship with his emotional being, will strive to accept the existential fact that the human feeling nature is often contradictory and frequently vacillates between opposite polarities of feeling experiences. It is quite normal for feelings to change unpredictably along continuums that stretch between a variety of emotional polarities. As such, it is especially human and healthy to have shifts of mood between such extremes as happy and sad, enthused and depressed, loving and angry, trusting and suspicious, brave and afraid, and forgiving and blaming.

For just as without night there is no day, without work there is no play, without hunger there is no satiation, without fear there is no courage, without tears there is no joy, and without anger, there is no real love.

In fact, much of the plethora of loneliness, alienation, and addictive distraction that plagues modern industrial societies is a result of people being taught and forced to reject, pathologize or punish so many of their own and others’ normal feeling states.

Nowhere, not in the deepest recesses of the self, or in the presence of his closest friends, is the average person allowed to have and explore any number of normal emotional states. Anger, depression, envy, sadness, fear, distrust, etc., are all as normal a part of life as bread and flowers and streets. Yet, they have become ubiquitously avoided and shameful human experiences.

Daniel Goleman defines emotional intelligence as our ability to successfully recognize and manage our own feelings and to healthily respond to the feelings of others. As implied above, I believe the quality of our emotional intelligence is reflected in the degree to which we accept all of our feelings without automatically dissociating from them or expressing them in a way that hurts ourselves or others. When we are emotionally intelligent we also extend this acceptance to our intimates. One of my clients calls this the hallmark of “relationships.”

Another way of saying this is that I have self-esteem to the degree that I keep my heart open to myself in all my emotional states. And, I have intimacy when my friend and I offer this type of emotional acceptance to each other. Once again, this does not condone destructive expressions of anger which are, of course, counterproductive to trust and intimacy.

Emotional abuse is also almost always also accompanied by emotional abandonment, which can most simply be described as a relentless lack of parental warmth and love.

As emotional recovery progresses, the mindfulness described above begins to extend toward our emotional experience. This helps us to stop automatically dissociating from our feelings. We then learn to identify our feelings and choose healthy ways to respond to them and from them. Such emotional development illuminates our own natural preferences, and, in turn aids us in making easier and better choices.

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.

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.

A numinous experience is a powerful moving feeling of well being accompanied by a sense that there is a positive, benign force behind the universe, as well as within yourself. This in turn sometimes brings enough grace with it, that you have a profound feeling that you are essentially worthwhile, that you belong in this life, and that life is a gift.

When developing children receive “good enough parenting”, they feel that life is a gift even though it typically comes with difficult and painful experiences.

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.

Growing up in a safe and loving enough family naturally enhances the child’s capacity to notice and enjoy the many gifts that life also brings. He learns that there is enough good in life to significantly outweigh its necessary losses and travails.

The cultivation of gratitude requires a balanced perspective. You can learn to see and appreciate the good in life without giving up your ability to discern what is truly negative and unacceptable in the present.

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.

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.

Nonetheless, some somatic therapists can ease the physiological traumas that are locked in our bodies, as long as the practitioner is not actively dismissing or impeding the client’s cognitive and emotional work. 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. These techniques can also be very helpful in aiding the recovery of the ability to therapeutically emote both tears and anger.

As a psychotherapist, I am not authorized to give pharmaceutical advice, but I have frequently noticed that survivors who need pharmaceutical help seem to benefit most from SSRI anti-depressants. Taken at the right dosage SSRI’s do not usually blunt your affect in a way that makes grieving impossible. Moreover, if your critic does not budge with extended critic-shrinking work, SSRI’s can usually reduce its volume and vitriol enough so that you can effectively shrink it. Once it is diminished enough, you can dispense with medication. 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.

When the developmental need to practice healthy relating with a caretaker is unmet, survivors typically struggle to find and maintain healthy supportive relationships in their adult lives.

When I was at my least recovered, I couldn’t take out the garbage when I was in flashback. I feared that my neighbor – my sweet, always affirming neighbor – would look out the window and see how wretched and pitiful I was. Even worse, I dreaded the prospect that she might come out and want to interact with me.

All my relationships had been developed under the guise of my people-pleasing, funny guy persona, and in my current state there was not a joke anywhere to be found.

binds.” I believe toxic shame cannot be healed without some relational help. Several therapists and groups aided me greatly to unbind from the shame that made me hide whenever I could not invoke my perfect persona. Concurrently, I learned that real intimacy correlated with the amount I shared my vulnerabilities. As I increasingly practiced emotional authenticity, the glacier of my lifelong loneliness began to melt.

Therapeutic relational experiences enhanced my self-compassion considerably further than what I was able to accomplish on my own. Moreover, I believe that insufficient self-compassion is the worst developmental arrest of all, and restored self-compassion is the keystone of all effective recovery.

Finally, attachment theorists have developed the concept of earned secure attachment to describe the recovered enough state where the attachment disorder of Cptsd becomes sufficiently healed. This is typically evidenced by the survivor forming at least one supportive and reliable enough relationship. Many of the successful therapies I have guided come to an end when the client gains an earned secure relationship outside of our therapy. This is typically a partner or best friend with whom the person can truly be themselves.

Sometimes the control was enforced by as little as one phone call a week.