Note: This is a page on my blog, written last year, that a lot of folks have found helpful because it summarizes a lot of aspects of Complex PTSD. It gets more traffic than any of my posts, so I thought I’d re-up it. Pieces of it have appeared in various posts, so if you see something you saw before, you can just skip that part and maybe find some information that’s new to you.
PTSD — or Post Traumatic Stress Disorder is a real diagnosis usually used for cases where people had a traumatic event happen in adulthood (like taking part in a violent battle, or having a car accident). The symptoms include flashbacks, anxiety, depression, insomnia, social withdrawal and explosive emotions, among other things.
Another, second of PTSD is Complex PTSD (or C-PTSD) which is caused by chronic exposure to emotional or physical trauma, such as living through a war, being in an abusive relationship, or growing up in traumatic conditions, which is what this blog is about. The diagnosis is not 100% clear, so for now let’s call this kind “Childhood PTSD.” There is a LOT of research going on right now in this area. The biggest and most impactful is probably The ACE Study, which has kind of become the standard measurement of childhood crappiness.
The ACE Study
the Ace Study began in the mid-1990s, when physician researchers Vincent Felitti of Kaiser Permanente and the Robert Anda of U.S. Centers for Disease Control interviewed hundreds of study participants about their history of adverse childhood experiences” known as the “ACE” Study.
Felitti and Anda created a survey (you can see it and take the survey here) that asks about each of these experiences; respondents gave themselves one point for each experience on the list they checked as a yes. So a person’s ACE score is somewhere between zero and ten.
The ten adverse childhood experiences, or ACEs include:
- Physical abuse
- Sexual abuse
- Emotional abuse
- Physical neglect
- Emotional neglect
- Mother treated violently
- Household substance abuse
- Household mental illness
- Parental separation or divorce
- Incarcerated household member
(There are probably many other experiences that ought to be included, like the death of a parent, or being bullied in school, or being desperately poor, or a refugee — you can take this into consideration when you take the test.)
The “T” Word
Another, shorter word for adverse experiences is “trauma,” “childhood trauma” or “developmental trauma.” I almost hate to say all these words, because they make me feel so damaged and doomed, but it may help you get a more realistic sense of the causes and possible solutions for the problems you have today.
Trauma is what we experienced as kids when the Adverse Childhood Experiences were happening. When you’re a baby or small child, trauma is particularly toxic for your brain, and causes developmental changes. Believe it or not, being neglected can be even worse for your brain than being abused. For healthy brain development, a child needs the parent to be connected with them, to make eye contact and talk to them, to respond to their feelings and their accomplishments. If parents are dead, gone, drunk, high, obsessed with a boyfriend, depressed or otherwise not paying attention to the child, the child may learn to dissociate (it kind of means “to check out”), and may grow up with a limited capacity to connect with people, pay attention or learn.
These brain changes also have consequences for physical health. A traumatized child may have headaches and stomach troubles, but as she grows to adulthood, even more serious problems can show up — depression, addictions, eating disorders, migraines, gastrointestinal disorders, autoimmune diseases, diabetes, heart disease, lung disease and even cancer.
It’s not well understood yet how exactly trauma leads to to these chronic health problems, but there is no doubt that, the more adverse experiences a person had as a kid, the higher their risk of these health problems.
Trauma also at play in Post Traumatic Stress Disorder, or PTSD. In the case of combat veterans, for example, they come back from terrible war experiences, and they may be anxious, depressed, and have trouble sleeping, connecting with people or dealing with the bad memories. They get “flashbacks,” where they remember something or dream about it, and forget for a moment that this is now, and the old trauma is not actually happening. Their body is reacting as if it IS happening, with heart pounding, adrenaline pumping, and other stress hormones pushing their bodies into a stressful overdrive. If the reaction keeps happening, it can wear them down. Combat vets with PTSD have a high rate of drinking, doing drugs and even suicide.
Those of us who had traumatic childhoods may develop Complex PTSD, or C-PTSD, which may not be the same as adult-onset PTSD. There are two specific symptoms that mark C-PTSD:
Emotional Flashbacks: Unlike specific memories of events, emotional flashbacks involve strong negative emotions. A person will be flooded, for small reasons or no reasons, with an overwhelming sense of sadness, rage, terror or frustration. It can happen when you wake up, for example, or when someone criticizes you, or gives you a present. You are not reliving some childhood experience consciously — you know that you are here in present time. But the emotions don’t know it and are reacting like you did during the original trauma.
Dissociation: There is a kind of full-on dissociation that people get, like where they can’t remember who they are, or they feel like they’re not in their body. But more common is a subtler version where you just space out. You might feel numbness in your hands or mouth, get lost while driving, or find yourself unable to finish a sentence. If it happens with an emotional flashback and you’re upset or angry, your emotions might first flare (flashback) and then go very flat and emotionless (dissociation).
When you’re dissociated part of your brain is actually shut down (an old response to unbearable stress when your brain was developing. Without your full brain working, you are not fully yourself. So you may seem to have too little emotion, and say things you don’t really mean (they seem true in the moment, but only because you’re operating with half a brain!).
Treating Trauma: The Old Way
Most professionals truly believe that either medication or therapy — or better yet, a combination of both — are the best approach to treating childhood trauma. This approach is based on two old ideas:
Old Idea #1: Most people who are depressed or anxious have a “chemical imbalance” that can be corrected with medication.
Medication has been prescribed to everyone who feels distressed emotionally, so that it can “correct” their brain chemistry and, the thinking goes, allow them to focus on their therapy. Antidepressants and anti-anxiety meds may be good for treating some things, but are way overprescribed and have very limited effectiveness for treating trauma. When medication is discontinued, so are any benefits. And there can be serious side effects to boot (like violent behavior and thoughts of suicide).
Old Idea #2. Adults with childhood trauma gravitate toward experiences that will re-traumatize them because they have an unconscious wish to repeat past trauma. If the problem is just distorted thinking, the solution, or so it is believed, is to talk regularly to a therapist who can “explain” this to you. For example:
- A woman who keeps jumping into relationships with indifferent men might be told she is trying to recreate her childhood, or that she doesn’t love herself.
- A woman who is 100 lb. overweight might be told she is unconsciously trying to avoid sex and intimacy.
- A teenage girl expecting a baby is told she is did this on purpose so she’d have someone to love.
- A woman who smokes might be told she has an unconscious need to rebel, or even even to slowly kill herself.
The truth is, we want to feel better, not worse!!! There is a neurological reason for the repeating trauma pattern: PTSD shuts our brain down (also known as disregulation), so , operating with only part of our brain, we have trouble recognizing trouble, and we grasp at quick solutions (like carbs and emotional intensity) to jumpstart our brains and get back into our bodies. Romance, food, sex and cigarettes all help sooth the intense dark emotions that are common us. They all work about as well as antidepressants, and like antidepressants, they have negative side effects and don’t produce long-lasting change.
Unfortunately these old ideas — fix trauma by taking meds and talking about your feelings — are the bread and butter of professional services for people who are suffering emotionally. They might be helpful for some people and some problems, but for childhood trauma, all this talking about traumatic stuff can actually re-traumatize us and make the problems worse.
When I first learned this, I recognized right away that it was true for me. Therapy always made me feel worse, and I never made progress even when I went often, and even over the long term. (One exception is a certain couples therapist. That was helpful. But we weren’t talking about my old memories so much.)
It is all too common for adults who had a hard childhood to go round and round the merry-go-round of the old system — therapy, medication, new therapist, new medication, and so on — and never really recover. After a while, when hope fades, they blame themselves, or justify themselves. A lot of people focus not on their present day lives but on their parents’ shortcomings, or the world’s failure to make it better for them. They never learn to break old patterns, create loving relationships, nurture their own physical health, clear up mistakes, perform fulfilling work or serve others. In short, they are not free, and the potential of their lives is trapped within them. God knows, healing from childhood trauma is never a straight and easy road. But now that the role of the brain is better understood, there are effective and hopeful new possibilities.
Some New Ways to Treat PTSD and Complex Trauma
EMDR (eye movement desensitization and reprocessing). This is a powerful technique, endorsed by the Veterans Administration, that helps to integrate the haunting, traumatic memories typical of PTSD. In PTSD, the activation of certain memories produces an intense psychological and physiological distress (nightmares, pounding heart, outbursts of rage) as though the event is happening in this very moment. These reactions occur again and again, and don’t tend to diminish over time.
EMDR involves the use of controlled side-to-side eye movements, vibrating paddles, or other tools that alternately stimulate the left and right brain. The practitioner helps you to visit traumatic memories, and then “reprocess” them so they become more like a normal memory — remembered, but not so intensely charged. The effects are long-lasting; occasionally those who have benefitted from it will opt to come back for EMDR sessions months or years later. The technique is astonishingly effective at treating adult-onset PTSD. It is less effective for treating PTSD that originates in childhood.
Depression and anxiety are extremely common in people with complex trauma, and these days it is highly likely that those who seek help for these problems will be prescribed antidepressants and/or anti-anxiety medication. With complex trauma, they can be somewhat helpful to calm intense symptoms, though in many cases it can delay recovery by dulling awareness, or producing a “brain-fog.” There can be serious side effects, including suicidal and homicidal ideation, sexual difficulties and a sense of numbness when trying to make decisions or connect with others — all very important to recovery. Medications do not offer a cure; side effects as well as benefits subside as soon as medication is discontinued.
Let’s say you have a history of making bad choices, or you tend to overreact to things. If you grew up with complex trauma, these are common traits, and probably not just the product of your personality, but of an altered brain response to stress or certain triggers. Triggers might be a loud noise, a critical remark, a feeling of being left-out or abandoned, or something embarrassing. Most people might feel some distress at these triggers, but for us they can launch an emotional explosion (such as a surge of rage or a flood of shame) or “checking out” mentally and emotionally, called dissociation. Flooding is often followed by dissociation.
Disregulation and Re-Regulation
One of the things going on during these responses is disregulation of our brains. When we’re calm, brain activity is even and it’s driving body responses and emotions in an even and predictable way. With disregulation, our thinking and behavior can become erratic. We might feel panic or depression out of nowhere, or our emotions can suddenly explode and flood us with adrenaline (the fight/flight response). Or we might feel physically numb clumsy, forgetful or scattered. It can be hard in these states to read reality correctly, seeing danger where we are actually safe, or safety where there is danger. We might drive off from the gas pump without detaching the nozzle, or believe a sexual hookup is true love, or say cruel things to a loved one, things that (in the moment) we think we mean. Just when we need good judgment most, it can fail us. And so we may find ourselves making the same mistakes over and over.
Once we are disregulated, it can take hours or even days for our brains to become re-regulated. We may have picked up semi-effective strategies to speed it along, such as overeating on carbs, smoking cigarettes, drinking or doing drugs, or jolting ourselves with adrenaline through risky acts like reckless driving or sex or spending. These disregulated periods are not always overtly self-destructive, but they always impair our ability to be present, productive, responsible and connected with people. They also leave us exceptionally vulnerable to retraumatization.
“Inside Traumas” –– Trauma-generated behaviors (that make more trauma). They all tend to be a form of flight from pain. They are each a continuum.
- Neglect of body — shabby clothes, poor hygiene, neglect of physical exercise — avoidance of medical and dental care, self harm
- Addictive use of food — carb binging — obesity, eating disorders
- Addictive use of media/entertainment, TV internet and games enough to interfere with sleep, meals, daily routine — causes problem for family responsibilities, work, school, finances
- Dishonesty, exaggerating, hiding important personal truths or preferences — lying, stealing, infidelity, tax evasion, iillegal activity,
- Work problems, unfulfilling work, under-earning, periods of unemployment — chronic adversarial relationships with employers & coworkers, suing or getting sued, chronic unemployment
- Blame — Difficulty seeing own role, victim thinking, bitterness, slandering others, belief that all problems the result of racism, sexism, foreigners, political party, certain foods,etc., conspiracy theories
- Numbing with substances, relieving stress with alcohol, drugs
- Irritability, sometimes no reason, arguments, conflicts, ranting, rage, mistreating others, violence
- Attraction to troubled partners/friends —- abused, controlled drawn into legal, social, financial trouble — when to get out
- Unfulfilling romantic life — no dating relationships, staying in bad relationship, or sexless or loveless marriage
- Abuse of Sexuality — overly sexualized appearance & conduct, promiscuity, unwanted pregnancy, use of pornography, masturbation for numbing — prostitution, exploiting others
- Fantasy (romantic, financial) not present, not in touch with reality, failure to take reasonable action — obsession, stalking
- Avoidance of people, responsibility, participation — shut-in, social anorectic, hermit
- Black & white thinking, drawn to extreme views, groups, authority figures, often outraged at the news — loss of freedom to disagree or get away, dominating others, slandering others, cutting off contact with outsiders
- Debting, no savings, living beyond means to pay for home, car, therapy — growth of debt, gambling, foreclosure, bankruptcy, homelessness
- Repeating traumatic patterns, seeming inability to detect trouble or step back when trouble appears — relapse into traumatized state, triggering deepening of depression, rage, collapse, reversion to old behaviors
Four Things to Remember
- Recent research has shown that abuse, neglect and other traumas cause brain changes in children. This damage, in turn, can cause cognitive impairment, emotional problems and chronic disease. Though much of the damage can be reversed, it’s important to be aware of how these events can have such a broad impact on every part of our lives.
- Focusing on your childhood traumas will not, by itself, produce recovery. While taking stock of what happened is a useful first step, putting attention on bad things can actually retraumatize you, and in the retraumatized state, it can be impossible to reason, remember or integrate information. This is one of the main reasons that talk therapy doesn’t work very well for trauma, and why other methods of recovery are necessary. Focusing on childhood can also emphasize blame, which ultimately keeps you trapped
- Learning to regulate your emotions makes change possible. The problem is not so much the memories, but the unregulated emotions they trigger. In these hyper-emotional states we are prone to (and even crave) destructive behaviors. The sooner we can recognize that this “flooding” is happening, the sooner we can interrupt the flood. We can do this with quick interventions, like stepping away, refraining from speaking, breathing deeply, writing our fears and resentments on paper, or counting to ten — or ongoing practices like daily writing, meditation, exercise and connecting with like-minded others.
- Instead of talking about it, taking action and making strong decisions about your life is the most powerful way to change your health, your thinking, and your behavior. Granted, past trauma can have a big impact on your functioning today, and messed-up families can pass on some dysfunctional beliefs and habits. But your past can’t change and your family is unlikely to change. It is you and only you who can change your life, and everything now depends on your willingness to take action.