So What is CPTSD?

[Kizzie]

By Dr. C. Courtois - http://giftfromwithin.org/html/cptsd-understanding-treatment.html

Complex traumatic events and experiences can be defined as stressors that are:

(1) repetitive, prolonged, or cumulative

(2 ) most often interpersonal, involving direct harm, exploitation, and maltreatment including neglect/abandonment/antipathy by primary caregivers or other ostensibly responsible adults, and

(3) often occur at developmentally vulnerable times in the victim's life, especially in early childhood or adolescence, but can also occur later in life and in conditions of vulnerability associated with disability/ disempowerment/dependency/age /infirmity, and so on.

Child abuse of all types (physical, sexual, emotional, and neglect) within the family is the most common form of chronic interpersonal victimization. Such abuse is often founded on problematic and insecure attachment relationships (between parent and child or others who have primary caretaking responsibilities). Parents and other caregivers who abuse exploit a child's physical and emotional immaturity and dependent status to meet their own needs or do so in response to their own inadequacies or distress, quite often their own history of unresolved trauma and/or loss.

Rather than creating conditions of protection and security within the relationship, abuse by primary attachment figures instead becomes the cause of great distress and creates conditions of gross insecurity and instability for the child including misgivings about the trustworthiness of others.... 

Rather than having a secure and relatively carefree childhood, abused children are worried and hypervigilant. The psychological energy that would normally go to learning and development instead goes to coping and survival.....

Child abuse, occurring in the context of essential relationships, involves significant betrayal of the responsibilities of those relationships ....


The seven categories of additional aftereffects [to PTSD] include the following:

1. Alterations in the regulation of affective impulses, including difficulty with modulation of anger and of tendencies towards self-destructivenesss. This category has come to include all methods used for emotional regulation and self-soothing, even those that are paradoxical such as addictions and self-harming behaviors;

2. Alterations in attention and consciousness leading to amnesias and dissociative episodes and depersonalization. This category includes emphasis on dissociative responses different than those found in the DSM criteria for PTSD. Its inclusion in the CPTSD conceptualization incorporates findings that dissociation tends to be related to prolonged and severe interpersonal abuse occurring during childhood and, secondarily, that children are more prone to dissociation than are adults;

3. Alterations in self perception, predominantly negative and involving a chronic sense of guilt and responsibility, and ongoing feelings of intense shame. Chronically abused individuals (especially children) incorporate abuse messages and posttraumatic responses into their developing sense of self and self-worth;

4. Alterations in perception of the perpetrator, including incorporation of his or her belief system. This criterion addresses the complex relational attachment systems that ensue following repetitive and premeditated abuse and lack of appropriate response at the hands of primary caretakers or others in positions of responsibility;

5. Alterations in relationship to others, such as not being able to trust the motives of others and not being able to feel intimate with them. Another "lesson of abuse" internalized by victim/ survivors is that other people are venal and self-serving, out to get what they can by whatever means including using/abusing others. Abuse survivors may be unaware that other people can be benign, caregiving, and not dangerous;

6. Somatization and/or medical problems. These somatic reactions and medical conditions may relate directly to the type of abuse suffered and any physical damage that was caused or they may be more diffuse. They have been found to involve all major body systems and to include many pain syndromes, medical illnesses and somatic conditions;

7. Alterations in systems of meaning. Chronically abused and traumatized individuals often feel hopeless about finding anyone to understand them or their suffering. They despair of being able to recover from their psychic anguish.

[Brackets mine]


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OTHER DEFINITION/DESCRIPTIONS


A] Description from Out of the FOG-http://c-ptsd.org/ - This is easy to read and understand, and gives some insight as to why personality disordered behaviour can result in the development of CPTSD


B]  Pete Walker's Description of CPTSD - From the book "CPTSD: From Surviving to Thriving" (2013) 

"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 "...are sudden and often prolonged regressions to the overwhelming feelings states of being an abused/abandoned child" and involve "shame, alienation, rage, grief and depression."  These are unlike flashbacks experienced with PTSD in that EFs do not typically have a visual component. (p. 3)

-  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 .... toxic shame also inhibits us from seeking emotional comfort  and support.  In a reenactment of the childhood abandonment we are flashing back to, we often isolate ourselves and helplessly surrender to an overwhelming feeling of humiliation" (pp. 5-6)

-  Self-abandonment - "As the quest for perfectionism fails over and over, and as parental acceptance and nurturing remain elusive, imperfectionism becomes synonymous with shame and fear. Perceived imperfection triggers fear of abandonment, which triggers self-hate for imperfection which expands abandonment into self-abandonment" (p. 177).

-  Vicious inner critic - "The inner critic blames you incessantly for shortcomings that it imagines to be the cause of your parents' rejection. It is incapable of understanding that the real cause lies in your parents' shortcomings" (p. 168).   ".... most survivors spend tremendous amounts of time barely conscious of how incessantly self-critical they are" (p. 172).

-  Social anxiety - "Many therapists see CPTSD as an attachment disorder. This means that as a child the survivor grew up without a safe adult to healthily bond with.....  When the developmental need to practice healthy relating with a caretaker is unmet, survivors typically struggle to find and maintain healthy relationships.  ........childhood abuse installs a powerful people-are-dangerous program (pp. 50-51)

See various CPTSD related articles by Walker here - http://www.pete-walker.com/


C]  Clinical Description

CPTSD was first proposed as a diagnosis by Judith Herman is her 1992 book "Trauma and Recovery" to describe a cluster of symptoms which results from ongoing or repeated trauma over which the victim has little or no control, and from which there is no real or perceived hope of escape (e.g., children who are subjected to abuse and/or neglect by their parents). It is in this respect that CPTSD differs from the more well-known diagnosis Post Traumatic Stress Disorder (PTSD) which typically involves a single instance of acute trauma such as witnessing a tragedy or being the victim of an act of violence.  That is, CPTSD is a layering of repeated trauma which results in additional symptoms to those of PTSD. In addition to the recurring flashbacks, avoidance or numbing of memories of the traumatic event, and hypervigilance experienced in PTSD, CPTSD involves five additional symptoms which include alterations in:

•   regulation of emotions (e.g., anger, hair trigger flight/flight responses, suicide ideation);
•   consciousness (e.g., dissociation);
•   self-perception (e.g., fragile sense of self; pervasive sense of shame, guilt, self-blame, of being completely different from other human beings)
•   perception of the perpetrator(s) (e.g., preoccupation with relationship with perpetrator);
•   relations with others (e.g., isolation and withdrawal, distrust of others, relationship difficulties, loneliness and feelings of abandonment/rejection);
•   systems of meaning (e.g., sense of hopelessness and despair, depression). 

For further information see "Judith Herman and the Formulation of C-PTSD" at http://traumainform.wordpress.com/2012/07/07/judith-herman-and-the-formulation-of-c-ptsd/.  (Includes a video of an interview with Judith Herman)

It should be noted that the term CPTSD has yet to be recognized as an official diagnosis, but has been and continues to be used extensively by both professionals (i.e., traumatologists, researchers, therapists) and the public.  The disorder is also known as Complex Trauma, Developmental Trauma Disorder (when the sufferer is a child), and a Disorder of Extreme Stress Not Otherwise Specified (DESNOS). However, given that CPTSD is widely used, it has been adopted so that those of us who are dealing with it -- by whatever name -- can begin our journey out of the storm that is CPTSD, to share our knowledge of and experiences, and to support and encourage one another on our journey.

Note: For a discussion of the various terms/diagnoses used for CPTSD see
Developmental trauma, complex PTSD, and the current proposal of DSM-5 by Vedat Sar Mar 2011 at http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3402152/

[Badmemories]

•   regulation of emotions (e.g., anger, hair trigger flight/flight responses, suicide ideation);
•   consciousness (e.g., dissociation);
•   self-perception (e.g., fragile sense of self; pervasive sense of shame, guilt, self-blame, of being completely different from other human beings)
•   perception of the perpetrator(s) (e.g., preoccupation with relationship with perpetrator);
•   relations with others (e.g., isolation and withdrawal, distrust of others, relationship difficulties, loneliness and feelings of abandonment/rejection);
•   systems of meaning (e.g., sense of hopelessness and despair, depression). 


I do not know how many of these criteria that it takes to be diagnoised with CPTSD but I have these.

• hair trigger flight/flight responses, suicide ideation);
  consciousness (e.g., dissociation);
  
• fragile sense of self; pervasive sense of shame, guilt, self-blame, of being completely different from other human beings)
• preoccupation with relationship with perpetrator
  
• isolation and withdrawal, distrust of others, relationship difficulties, loneliness and feelings of abandonment/rejection);
  
  •   sense of hopelessness and despair, depression
    
  
  I fail to realize what disassociation is. I go into dream worlds when I am stressed. also sometimes when I am stressed out I just am not there.. I mean I could be like a spirit standing over myself looking down. I am not thinking or I am thinking to much, I at least can't remember what I am thinking..
  
  I have always fought depression. My first depression was at 16. as I have gotton older my depression is more severe.
  Mostly I have the flight or fight responses. Altough sometimes I wish I was dead I am Not suicidal.
  
  I have always felt like I did not belong where ever I am and whoever I am with. I isolate and withdraw myself a lot. I don't trust to many people.
  I am lonely and I can't seem to Make New friends.
  I can not say any of My relationships (marriages) were healthy
  

[Kizzie]

Hi BadMemories:

I found this description of five core symptoms of dissociation (http://www.karenbelfontaine.ca/consultation-therapy.php#steinberg, and http://www.isst-d.org/default.asp?contentID=76#idcon).  It's a bit clinical still, but it seems like what you describe when you say you feel almost like a spirit looking down on yourself is depersonalization.   

Depersonalization: a feeling of detachment from yourself or your body or your emotions; feeling like a robot. This is perhaps the most recognizable form of dissociation, often described as "zoning out", "checking out" or "being foggy". Some people describe feeling as if they are not in their bodies, but are observing things from a distance.

Derealization – a feeling of detachment from your environment, feeling like what used to be familiar is now foreign (including people).

Derealization is the sense of the world not being real. Some people say the world looks phony, foggy, far away, or as if seen through a veil. Some people describe seeing the world as if they are detached, or as if they were watching a movie.

Amnesia: the inability to account by memory for a specific and significant block of time.

... often an important event that is forgotten, such as abuse, a troubling incident, or a block of time, from minutes to years. More typically, there are micro-amnesias where the discussion engaged in is not remembered, or the content of a conversation is forgotten from one moment to the next. Some people report that these kinds of experiences often leave them scrambling to figure out what was being discussed. Meanwhile, they try not to let the person with whom they are talking realize they haven't a clue as to what was just said.

Identity confusion – a feeling of uncertainty or conflict about who you are and how you define yourself.

Identity alteration – a shift in role or identity, accompanied by changes in your behaviours that are observable to others.

I don't know about the last two, but I do experience the first three.  For me dissociation is a sort of emotional numbing, a zoning out or getting away from feelings that are too strong or when I am stressed.  I also have a lot of amnesia about time - I don't have a clear sense of individual years unless a major event happened (e.g., the year I got married or my son was born, that kind of thing). When I have an emotional flashback I often feel like the world kind of tipped on its side or something - hard to describe in words, but things don't feel the same so that sounds like derealization. 

[Annegirl]

I thought all these things were normal what everybody experiences.
I can relate to all of these.

[Badmemories]

boy this is some pretty heavy stuff. I don't know I am going to have to read it a few time to understand it all.

My last experience of this problem happened in church. MY NPD sis, granddaughter and I were in church. I always sit in the front of the church. My Sis was sitting in the middle the church behind me. My grandaughter was sittin one pew ahead of My Sister with the Sunday school teacher.She was coloring and the SS teacher told My grandaughter to be quite. Grandaughter started crying in church (because she was not getting Her way.) the SS teacher say she could go sit with either me or MY NPSis  She came and sat by me.  She was crying uncontrolably. I was hugging her and trying to sooth her. I got her to the point where she would cry a little bit and then stop. She was looking around.
MY NPSis was saying that My grandaughter was looking back and making faces at her I did not see it. Finally quietly got GD settled down and she wanted to go and sit with her friends and collore again. So I walked her back to sit with the SS class so she could collor. I walked her back to the per ss teacher was sitting in, and I got he in the Pew.
NPD SIS started telling me HOW GD was making faces at her. How rude it was and acted like I was promotting her NOT liking NPDSis. letting her make faces like that. I did not even see GD making faces.To me it seemed like NPDSis was talking very loud. (later on SS teacher said she did not hear it) It was more of her jelousy (NPDSis) She is so displinanarian to the kids.( (think Mean IMO)

I was upset. I felt like everyone heard it and she was talking loud. I felt embarrassed,angry, hurt. I went and sat down again in my pew. i know I was doing all the things in church like praying, singing, but I felt trapped. i wanted to get out of there. I sat there feeling numb. I felt like I was looking down at myself. Physically I felt small... I was going through the motions.

Another thing a little different for me mentally is a day My husband was going through rages. this was a bad one. He was mad because lightning struck all our electronics and we lost 2 flat screens and out phone system. he was starting to rage and so I went into the bedroom. I was sitting on my side of the bed. a tenant came to the door. I hear him tell the tenant Not now B. the tenant tried to push his way and tell him he had lost circuits in him trailer. NPDH started raging and throwing stuff. He threw something at our stand alone cupboard in the kitchen. He came into the bedroom and was looking for his wallet he couldn't find it, so he threw a ditto bag at the window and broke the window out.

In that instance i was sitting there but I felt more like a small mouse in the corner. he left after I had heard the glass break. I don't know really how long I sat there and I finally laid down and feel asleep. (I sleep a lot when I get stressed out!). I did not even notice until hours later that the glass was all over the bedding, and yet I was sleeping next to it. It surprised me. I had not looked at where the glass had broke and thought it was a glass cologne bottle or something like that. anyway..

I know I have been under a lot of stess lately. I am sure that I have not felt those ways at least recently, or maybe I have just become aware of it and I am just now recognized it?

[Kizzie]

HI BadMemories - I mentioned this in another post but it's worth posting it here too I think.  I think what the above more clinical descriptors add up to is an emotional flashback which Pete Walker describes on his site http://www.pete-walker.com/index.htm:

I have come to call these reactions, typical of David and of many other clients over the years, emotional flashbacks—sudden and often prolonged regressions ("amygdala hijackings") to the frightening and abandoned feeling-states of childhood. They are accompanied by inappropriate and intense arousal of the fight/flight instinct and the sympathetic nervous system. Typically, they manifest as intense and confusing episodes of fear, toxic shame, and/or despair, which often beget angry reactions against the self or others. When fear is the dominant emotion in an emotional flashback, the individual feels overwhelmed, panicky or even suicidal. When despair predominates, it creates a sense of profound numbness, paralysis and an urgent need to hide. Feeling small, young, fragile, powerless and helpless is also common in emotional flashbacks.

I see a lot of this in your post, especially the part about feeling small and numb. It is as though the present stress/trauma ignites the trauma from when we were small children, the fear, anger, shame we never were able to express or work through and it becomes overlaid on the present.  Is it any wonder we feel overwhelmed?!   

But now the good news, we can help ourselves:

When clients get that their emotional storms are messages from an inner child who is still pining for a healthy inner attachment figure, they gradually become more self-accepting and less ashamed of their flashbacks, their imperfections and their overall affective experience. They understand that the lion's share of the energy of their intense emotional reactions in the present are actually appropriate but delayed reactions to various themes of their childhood abuse and neglect. As they learn to effectively assign this emotional energy to those events and perpetrators, they metabolize and work through these feelings in a trauma-resolving way. This in turn leads to a reduction of the emotional energy that fuels their flashbacks, and flashbacks in turn, become less frequent, less intense and less enduring. Eventually flashbacks can even begin to automatically invoke a sense of self-protection as soon as the individual realizes she is triggered.

See Walker's 13 Steps to Managing EFs here - http://www.pete-walker.com/flashbackManagement.htm. 

[Annegirl]

That lady should have left you grand daughter alone, she was fine to colour, talk in church. Children cry for a reason, they are right.
Having said that Kizzie saw the real picture in what you were writing.
It also helped me because I have memories all the time and I get intense feeling with those memories and sometimes wish I could somehow block them all out and never think of them again.

[Badmemories]

I think I have blocked a lot of my life out. I don't remember many things about My childhood, and actually many things about my years in My Marriage with NPDH.
One thing I I don't cry much.. I mean I can watch a sad movie and cry, but I don't cry for myself. a few times I have cried at posts on out of the fog.

Hoping that all of this is opening my mind to change patterns and grow.

[Annegirl]

Yes it will, crying is healing.

[Badmemories]

i have been going through the link you gave me right now the one that is can process is this one.
http://www.pete-walker.com/fourFs_TraumaTypologyComplexPTSD.htm

I have read it twice and I still need to process it more...I am thinking about some of the responses I have. i will write more when I get more processed. 

[Annegirl]

I ordered his book

[Kizzie]

That's great that you've order the book AnneGirl.  It's so comprehensive and compassionate, and really it's the only one available right now that's written for us, the rest are for therapists and researchers. 

I added Walker's description of the symptoms of CPTSD in my first post in this thread so that we will have less clinical terms to use when we talk about our experiences.   

For anyone that missed it here is Walker's web site:http://www.pete-walker.com/

[Annegirl]

  that's good I'm looking forward to receiving it.

[emotion overload]

I've read Pete's book.  I just ordered Herman's Trauma and Recovery. 

[KAF]

I have a question and wonder if anyone else experiences this...as I read some of the resources, espcially Mr. Walker's site postings, I get overwhelmed by how much I can identify with what is described.  I have to stop reading....  Does this happen to others?