Complex PTSD is the term used for the symptoms people sometimes experience who have suffered from multiple, repetitive, chronic stressors and trauma over a period of years. The trauma often involves harm (such as incest) from the people in their lives who were meant to provide care and nurture at developmentally crucial times.
The stressors are therefore interpersonal and premeditated, always caused by other humans (as opposed to natural disasters/accidents), profound deception and betrayal. Potentially, a child could be submerged in physical, sexual and emotional trauma from birth.
‘Layers of trauma’ is a type of complex trauma that is cumulative. For example, being physically abused by a father as well as being brought up in an area of gun crime on the streets , and as an adult joining the forces, going to war and being further traumatised.
These childhood victims most likely have insecure and disorganised attachment- how do you bond with parents who cause damage and deeply betray you? Because the child lives in constant distress and anxiety responses, there are profound effects on the adrenal gland and their nervous systems. There was no exit for the young child, so he/she experienced gross insecurity, instability, on-going pain and never got the chance to regain emotional equilibrium. There was no place to rest their head- these children experienced terrifying lives, rather than a terrifying event. The child becomes extremely vigilant, is chronically anxious and afraid and much psychological energy is spent ‘coping’, rather than learning, experimenting or growing as a person.
The impact of on- going trauma
Because the child is submerged in isolation, abandonment, deception, blame and humiliation where they are betrayed by the very people who were meant to provide protection, the child’s sense of self is eroded away. Children are, for a period of time, egocentric, so they will naturally blame themselves; especially if the parent reinforces this belief with blaming, harmful and shaming words (“ I wouldn’t do this if you weren’t so seductive”). The child believes that who he/she IS, is bad, (not just that they do ‘bad behaviours’). So not only does the child believe that their very self, their very core is disordered and bad, but he/she develops a deep and abiding sense of shame.
Here are some of the ways the person was altered as a child;
- Did not learn helpful ways of regulating emotions and impulses. Prolonged trauma, results in an overreaction to stress, easily overwhelmed, intense anger/rage. Does not know how to self soothe, may cut, drink or take drugs instead. Does not know how to manage impulses to take risks/suicide. They may try to modulate their behaviour by self harm- physical harm may create relief from emotional distress.
- Trauma can overcome all the natural coping mechanisms. When there is no way to get away at all, the child learnt to ‘dissociate’ so their minds were elsewhere. It helped them remove themselves, they hid in their minds while they were abused which got habituated over time.
This makes people who are constantly terrified, incapable of protecting themselves- fear causes the mind to leave as an automatic reaction. As useful as that was to help the child cope, as an adult, retreating to a mental hiding place and blocking out what you seeing and hearing means you are more likely to get hurt (and re-traumatised).
Dissociative identity disorder is particularly likely to develop if the abuse was carried out in the very early years of the child’s life. To absorb the unadulterated sensations, feelings and pain would be too detrimental to the mind and emotions of the child.
Information and experiences are not neatly stored in memory, they may be highly fragmented or completely missing. So the person never made a narrative out of it because they were not mentally ‘present’, so they cannot necessarily put their experience into words nor make sense of it.
Lawrence Langer studied the memory of holocaust survivors. “Since memory cannot be silenced in the mind, it might as well be heard. The story needs to be told”. Memories speak through symptoms,( even when someone does not consciously remember the cause of the symptoms) and continue to impact people’s lives. Langer wrote of “anguished memory”; memory that assaults and finally divides the self. He noticed survivor’s inability to take the times in death camp, link it into their current lives or create a narrative. They reported; “It just wasn’t me there” , “it was someone else”, “I have two visions of life” “ It is as if it were not me at all”.
- Destruction of the way we perceive ourselves. Develop as a sense of self; I am incompetent, I am marked (everyone can tell), I am damaged, I am unlovable, I am helpless, I am full of shame, I am undesirable. Shame, not just because of what was done, but because of what was done to them because of who they are.
- There may be a pre-occupation with the abuser, or fantasise about revenge. Intense fear he will appear or feeling controlled by him even if he is dead. The survivor may take the perpetrators view, that he has full control over them. The client may have a more accurate perception of how powerful and controlling he is than does the therapist and so the fear may very well be justified- fear is a measure of the instability within an environment. The child may significantly bond with the perpetrator, he may be the kinder of the parents when he is not abusing. The bonding is necessary for the child to grow up, but creates a very confusing dilemma.
- There may be re-occurring victimisation. How do you have a healthy relationship if you have never had/seen one? How do you recognise warning signs if danger was always enmeshed with affection? Once re-victimised, people tend to resort very quickly to the familiar feeling of helplessness; feeling “there’s nothing I can do”.
- There is an intense inability to trust others because of the primary betrayal. Why would survivors believe you if you tell them that they are safe?
- Somatisation; chronic trauma impacts the brain and the body, compromising the stress response system, capacity to evaluate stimuli to encode verbal memory and hindering information processing. An over reactive nervous system results in an exaggerated startle response. Over production of certain chemicals causes intense anxiety and there can be immune system dysfunction.
- Changes in meaning; prolonged trauma results in despair, hopelessness and a loss of former beliefs. It becomes very difficult to create meaning out of life; to process any history of trauma impacts on previous beliefs. There must be a heart-breaking adjustment to a world of loss. Trauma can take away choice, result in overwhelming fear, feeling alone, hopeless and humiliated.
As a result a portion of the person can turn inwards which takes up a lot of psychological energy; they may not be able to handle what is happening and they may ‘abandon’ life, which is a (possibly safer, but) very lonely place.
Helping people to move beyond, to return to life and good relationships.
Recovery involves a reversal of the experience of trauma within the therapeutic relationship. Trauma silences human beings, it brings emotional darkness, isolation, time can stand still and survivors may not be able to see ahead.
- Talking- expression of their experiences and their impact
- Tears- a period of grief. Most people are afraid of touching into this.
- Time- trust and healing will take time. We can use time to help nurture you so that the process of talking does not overwhelm. Little by little…
Talking is about telling your truth, it connects the survivor to another person, restores dignity by being heard, felt and affirmed. Talking can provide choice, a commodity that was not afforded to the child- it allows a client to decide when to tell, what to say and when to stop. Crucially, talking to a professional counsellor can provide you with caring connection.
Where you were silenced; you will be heard
Where you were isolated; you will be connected with
Where you did not matter; you & your feelings most certainly DO matter.
Things to consider before therapy, memory/relationship work
Safety and stabilisation
- Physical safety; is it safe in your home? Are you safe from yourself; Suicidal, cutting, eating enough/too much, drug use. Can you engage with therapy give the above or do you need to seek help with these first?
- What do you do when you feel extreme rage, suicidal?
- Exercise; helps with depression by releasing endorphins.
- Look for 10 beautiful things when you are overly focused on not being hurt.
Langberg, D. Complex Trauma; Going deeper. FOCL Online https://www.youtube.com/watch?v=4n8ydiaWmNc
Langer, L (1991) Holocaust Testimonies: The Ruins of Memory. Yale University
Deep breathing- Dr wheil. A breathing technique that quietens to body. https://www.youtube.com/watch?v=gz4G31LGyog