CPTSD vs RT

[Dante]

For decades, I've struggled with self destructive behaviors and been unable to understand why I could not get better.  I was treating symptoms, not the illness.  I came across CPTSD maybe an year ago and read some stories from others who had similar experiences.  I held on to CPTSD like an lifeline and awareness of it and work on it is the first thing that has ever made a difference. 

But I've never been formally diagnosed with CPTSD (despite multiple therapists, because all agreed labels were harmful).  To me, I needed it to validate my experience.  To say this is why I am like I am.

But as I thought about this today, I'm realizing a couple of things.  This reflects my own thinking on this, and does not imply anything about where someone else might be on their journey, and how they choose to identify.   What I now realize is that the CPTSD label is no longer one I identify with. For two reasons.  For one, I have been retraumatizing myself for years.  So hardly "post traumatic".  And second, I may or may not have diagnosed CPTSD, but one thing I know for absolute certainty is that I am a relational trauma survivor.  So I'm going with that now. 

Again, no judgement implied to anyone else and their use of the terms.  This is just what feels right for me right now. 

[Kizzie]

    Couldn't agree more with the problems associated w/the Complex PTSD diagnosis.  This is from the OOTS web site:

CPTSD Diagnosis from the Perspective of Survivors

The current ICD-11 CPTSD diagnosis, while welcomed by survivors and professionals alike, is not without its problems. For example, the events leading to its development are characterized as "extremely threatening or horrific" trauma. Unfortunately, this may lead some to minimize or negate the impact of more covert forms of relational trauma such as emotional abuse, coercive control, or narcissistic abuse.  A more nuanced understanding acknowledges that ongoing/repeated trauma of any kind may threaten one's sense of self and survival and is horrific for this reason.

The language used in the diagnosis itself is somewhat problematic. For example, as Rosenthal and her colleagues (2015) suggest, the word "disorder" is problematic for three reasons:

First, human experiences leave predictable and understandable marks; trauma in particular, and interpersonal trauma more specifically, impacts survivors' minds, bodies, and spirits. Second, these scars do not constitute psychological disorder but instead are the natural and expected consequences of abnormal events, including betrayed trust, violated bonds, and broken boundaries. The effects of trauma are indeed just that—effects of an event—and as such are causally related to the trauma and not to the harmed individual. And third, when psychology and mental health professionals draw that causal path incorrectly, when the field fails to place the dysfunction solidly on the shoulders of individual and societal wrongdoing, survivors of trauma are thus reduced to a single experience that was enacted on them. They end up shouldering the burden. This, in essence, is pathologizing—the assumption that because individuals exhibit certain sets of symptoms, they are themselves disordered. (pp. 131-137)

It is more accurate (and less stigmatizing/pathologizing) to use a word that conveys how and why survivors developed CPTSD symptoms. That is, CPTSD symptoms are responses to the trauma inflicted by others, not due to a character defect, a lack of resilience or personal weakness. These responses can be thought of as protective strategies against the abnormal and threatening situation survivors were trapped in.  As such, here at OOTS the term "Relational Trauma Response" (RTR) is used interchangeably with Complex PTSD.   

The word "post" implies that the trauma is in the past and yet many survivors still experience relational trauma as adults. This may be because they are in contact with those who abused/neglected them beginning in childhood (e.g., trauma that is inflicted by family members), and/or because they are in present day relationships that are relationally traumatic.   

Finally, an important omission from the ICD-11 definition is the negative, lasting and often life-threatening impact of ongoing trauma on physical health, particularly trauma occurring in childhood. Landmark research, the Adverse Child Experience (ACE) study, revealed the serious health consequences of complex trauma. During the years 1995 to 1997 Investigators surveyed 17,000 Americans regarding a history of adverse experiences (e.g., abuse/neglect), and their current health and behaviours. As Herman (2015) writes "The results were stunning":

....higher ACE scores were strongly correlated with great incidence of the ten leading causes of death in the United States, including heart, disease, lung disease, and liver disease...smoking, obesity, alcoholism, risky sexual behaviour....injection drug use....clinical depression and suicidal behavior. (pp. 257-258)

Clearly, relational trauma and Complex PTSD exact a high physical and psychological toll on both individuals and societies. Despite this, governments, medical/mental health care, justice and service systems are slow to acknowledge and address the lasting and costly impact of relational abuse. 

It is the diagnosis we have at the moment though which is a far cry from where we were pre-2018 as professional orgs, the APA in particular, debated endlessly over whether or not it was a credible/distinct diagnosis.

[Dante]

Thanks, Kizzie!  That was super helpful reading!

[rainydiary]

Thanks for bringing up this topic - it gives me information and vocabulary that helps me understand my own uncertainty with the label CPTSD. 

[Armee]

I'm torn. There's so much wrong with the term cPTSD. And yet there's something that's not quite traditional PTSD and not quite relational trauma that it does capture...Those traumas that are ongoing instead of one and done and may have a relational component but are more defined by the more traditional definitions of trauma. Referring to this stuff as relational trauma would cause some stuff to fall through the cracks.

Like the trauma of the suicide threats and self harm from my mom growing up. It was more about life threat and feeling powerless and trapped, except it wasn't a one time thing, it was ongoing for 5 years and then another 20 years. That's different from a one time event. But it also is different from the relational traumas even though there is a relational component. All three forms need treatment and maybe CPTSD isn't the best umbrella term. But I'd hate to lose what it captures, too. Maybe Complex Traumatic Stress Disorder...CTSD...and a relational trauma subtype...CTSD-rt.

[Papa Coco]

Wow,

Kizzie.  This is all new information for me. But the parts that you copy/pasted into your post made a lot of sense.

I really like the idea of removing "Disorder" out of my diagnosis. "Response" makes a lot more sense. After all, if a person has a broken leg, are they now suffering from Painful Leg Disorder? NO! They're having a natural pain Response to a trauma that happened to them. Right? Response makes way more sense.

Naturally, lines will blur for some of us, who did fear for our lives on occassion during a time when we were also being covertly abused and neglected by our families. But like some of you have eluded to, a lot of the treatments will work in either case.

Well...You've launched me onto yet another study to see what I can learn about how and why yesterday's trauma continues to impact our lives today.

[Kizzie]

Ongoing relational trauma is why we develop Complex PTSD; that is, the first is the cause and the latter is the result if that makes sense. RT is one type of Complex Trauma, one of a number of different types of CT all involving ongoing traumatic stress including:

• relational trauma: one-to-one interpersonal neglect & physical/sexual/emotional abuse;
• community or group trauma: abuse of grps by grps based on race, gender, sexual orientation, religion, etc;
• lasting natural disasters like COVID, famine, drought, etc

A bit confusing I know    Hope this helps.

[Dante]

I guess if nothing else, I'm glad to see I'm not the only one struggling with terminology!  Thank you all for your perspectives.   

[BeeKeeper]

Kizzie,

Thanks for this:

relational trauma: one-to-one interpersonal neglect & physical/sexual/emotional abuse;
community or group trauma: abuse of grps by grps based on race, gender, sexual orientation, religion, etc;
lasting natural disasters like COVID, famine, drought, etc

[Kizzie]

Surprisingly, having been Co-Chair of the ISSTS Special Interest Group for Complex Trauma for 2 years, I can say there's a fair amount of confusion as to what exactly is Complex Trauma, its sub-categories (relational, collective, etc), and the Complex PTSD diagnosis even by professionals. I found the same thing in my field (Adult Education); that is, newer terms were often misunderstood and/or misused which is why I've tried to clarify them on the OOTS web site. 

[BeeKeeper]

Kizzie,

You brought up a point which I never thought about, confusion, misunderstanding and probably discussion (let's hope so!) within the field by professionals. I've recognized that mainstream Western Medicine has been slow to adopt anything but PTSD, but I have taken comfort in the fact that trauma experts knew the score. This is not the first incorrect assumption I've made either!

In your 2 year involvement, would you say, it's been "worth it" in terms of allowing your voice to be heard? Gauging the overall emotional intelligence of your peers, (that is perhaps harsh, but don't know how to say it better) and hope for the future? When any bureaucratic change is necessary, it's probably safe to think in terms of years or decades. Where do you stand, or does it change periodically?

Lastly, do you think the cost of the journals or membership is balanced or would you just say it's the cost of participation and access?

No urgency, when and if you feel like it. Thanks.
`

[Kizzie]

It was definitely worth it and the only reason I stepped away was that my H had a stroke and I just couldn't do the work on top of all that.

I guess what I encountered was both confusion about terms (my own included), and resistance to the idea of Complex PTSD. Apparently there were a lot of political reasons I couldn't know as an outsider but was told about by several well-known trauma insiders like Christine Courtois, Marylene Cloitre, Julian Ford and Judith Herman. They are members of a larger group of researchers and clinicians pushing to have Complex PTSD accepted as a distinct diagnosis. Bessel van der Kolk talks about the politics here - https://www.psychotherapynetworker.org/magazine/article/2368/the-politics-of-mental-health. 

Fortunately, the reality of Complex PTSD showing up in clinician's offices is pushing understanding and acceptance everywhere even in North America despite the APA's reluctance to acknowledge and validate it. Sites like this are popping up and that's brilliant considering I couldn't find any back in 2014 when I was diagnosed.

Re journals - it's somewhat of a barrier, especially in poorer countries, but most academics, clinicians and researchers have access through their institutions or have a budget for journals. For those who don't, many are becoming aware of the Sci-Hub https://sci-hub.se/ which gives free access to articles, even very recent ones.

So, bottom line for me is that the understanding and acceptance is coming (the APA still resists, the WHO did accept Complex PTSD in 2018), it's the action part that's lagging.  We need better, more effective treatments specifically focusing on Complex PTSD and way more services and support.  The latter requires the former though so it may take some time yet, how much though I don't know.  What I do know is the more of us who push the better are our chances 

[Papa Coco]

Kizzie,

I agree that it's a shame the APA always has to be so slow at accepting the next level of PTSD.  I also agree that in many places, the lack of acceptance of Complex PTSD is a barrier between the victims and the treatments.

And I agree completely with your final statement that we need to keep pushing for our practitioners to accept and learn and treat the subsets of Complex-PTSD that make it more suitable to us than PTSD.

To bring home the part of your post that refers to how the evolution is happening, albeit slowly, I want to take a few minutes to share my positive outlook on PTSD diagnosis:

I'm a resident of the US, and luckily for me I tend to avidly seek answers, and if one seeks, one finds. So even if the APA hasn't given Complex-PTSD a place in the DSM-V, at least I found there to be a lot of therapists hidden around the US who understand it. Pete Walker, a Californian, has shown that the treatment is available if we find a therapist who has an understanding of it.

Look at the history of the evolution of PTSD itself. It's always been a human condition. Always. But treatment for it has only begun to be understood. It got it's current name to deal with the trauma stress of the soldiers of Desert Storm. For centuries before that it was called all sorts of things, like Battle Fatigue, A Soldier's Heart, Shell Shock and Mustard Gas Poisoning. In centuries past, the French called Melancholy Disorder. In the 1800s, in the US, it was called Railway Spine, because most of the obvious cases were haunting train crash victims. It's not new at all. World famous author and humanitarian, Charles Dickens died with "Railway Spine" in the 1800s. At the age of 53, in the 1865 Staplehurst train crash, his was the only railcar that didn't fall into the river, but it hung precariously by its hitch. For a time, he thought he was going to die. But he crawled out, and then, true to his nature, he comforted injured and dying people for over three hours before help arrived. But he was never the same afterward. He stopped traveling the world. Stopped riding trains. Kept begging carriage drivers to slow down. He called his condition "The Shakes" and died of heart failure on very day of the fifth anniversary of the crash itself.

When I was diagnosed with PTSD in the year 2000 it didn't make sense to me. I had never been in a war or a train crash. Still, the treatments were working so I accepted the diagnosis with a hearty joy. During that time I tried to find a support network like this one, but couldn't. My friends who had PTSD from war told me they couldn't respect the audacity in me that I tried to claim I had it too, even though I hadn't seen what they'd seen. I was once thrown out of a PTSD survivors presentation because the speaker found out I'd never been in the military. It was something I needed to be careful who I shared it with. There was a lot of shame in being a traumatized civilian male. All the websites and all the resources for PTSD that I could find since 2000 up until only recently were only open to soldiers and women who had been abused in childhood or abusive marriages. One recovery center in Arizona U.S. even posted on their website that it was physically impossible for any man to get PTSD unless he was in war. That only women could even be traumatized at all. I wrote some blog articles back then where I laid out the frustration of how a man who'd been horribly abused as a child wasn't allowed to get help. I called them The Men Without Scars. There were no cigarette burns on my arms, nor scars on my back to prove I'd been abused, so therefore I wasn't? And the only novels and fiction stories being written until recently about abused men with residual trauma, showed that those men had grown up to be abusers themselves in the novels. Screw that! I'm one of the kindest, gentlest, helpful souls I know. And society has painted me as an evil whiner??? Really??? Talk about setting me up for failure.

Fortunately, that same world is finally accepting that trauma, in all its forms, deserves to be respected, diagnosed, and treated. Kizzie, to your point, this is a great time for us to help push and push and push for greater public awareness and acceptance of Complex-PTSD and RTR and any other nuances we might find. A victim of trauma is a victim of trauma. Period!

My point is that there is an obvious evolution happening in our favor. We went from being told Trauma disorder was only for soldiers, to then accepting that abused women might have them. And now, finally even abused men like me are allowed to be treated for it...but only if we know where to look. I know the evolution is still happening, as there remain more categories that require some more customized empathy for various different situations. And I see a light shining brightly up ahead for us all. The overarching permission to tie our unique individual personality struggles to trauma has opened up a whole new world for us as a huge population of civilian people for treatment. We want to regain our personal control over the original wiring each of us was born with, prior to having been artificially altered by traumatic events that changed our personalities, and that we had no control over.

I can never make my past go away. I can never stop remembering the abuse, the pain, the names and faces of those who took me down, but through the treatments that I've been able find so far are helping. I'm using those findings to balance myself between who I was born to be, and who I was raised to be. My hope is to find the self-love that was taken from me, so I can begin to feel okay being who I am, even if I'm slightly broken. As a Fawn Type, I have done a lot of good for a lot of people. We likely all have. Being a Fawn Type means we're kind and giving souls. I just need to respect that and use it to feel like I deserve to be loved by me also.

[Armee]

I just need to respect that and use it to feel like I deserve to be loved by me also.

[BeeKeeper]

Papa Coco,

Thanks for sharing your experiences and history lesson.

Look at the history of the evolution of PTSD itself. It's always been a human condition. Always. But treatment for it has only begun to be understood. It got it's current name to deal with the trauma stress of the soldiers of Desert Storm. For centuries before that it was called all sorts of things, like Battle Fatigue, A Soldier's Heart, Shell Shock and Mustard Gas Poisoning. In centuries past, the French called Melancholy Disorder. In the 1800s, in the US, it was called Railway Spine, because most of the obvious cases were haunting train crash victims. It's not new at all. World famous author and humanitarian, Charles Dickens died with "Railway Spine" in the 1800s. At the age of 53, in the 1865 Staplehurst train crash, his was the only railcar that didn't fall into the river, but it hung precariously by its hitch. For a time, he thought he was going to die. But he crawled out, and then, true to his nature, he comforted injured and dying people for over three hours before help arrived. But he was never the same afterward. He stopped traveling the world. Stopped riding trains. Kept begging carriage drivers to slow down. He called his condition "The Shakes" and died of heart failure on very day of the fifth anniversary of the crash itself.

In spring I took Modern Western Civilization at college and learned about shell shock, mustard gas poisoning, etc. etc. I vaguely knew about it before but this brought it home.

This is so sad to me, but ultimately shows the misunderstanding "gap."

I was once thrown out of a PTSD survivors presentation because the speaker found out I'd never been in the military.

May you discover more and more every day!

Kizzie,

Thank you for taking the time to answer the questions and share your experience. I knew your H had a stroke, but didn't think about what that shift at home meant exactly. When loved ones need us, everything else gets second place or further down.

Thanks for the Sci-Hub link. I'm trying to rein myself in from uncontrolled research, a tough one. I started to watch Bessel's video but didn't have room for his message. I'll give it another try when I'm rested. Right now I'm torn between continuing my current therapy, which is not even close to any trauma methods, but more a cup of tea at the kitchen table. That's been valuable, but I've been dissatisfied for the last couple years. The other option is nothing. Every trauma therapist I've contacted in the area is not taking new patients, or some other unavailability. I'm willing to pay, but that doesn't change it.