April 2025: cPTSD
This month I have decided to write about cPTSD (complex Post Traumatic Stress Disorder) which differs from PTSD in subtle ways. In broad terms, PTSD may result from a life-threatening experience or witnessing trauma resulting in death or life threatening in some way. It is generally a one-time event or of short duration – like a vehicle accident, plane crash, or natural disaster. War can fall into either category depending on duration and/or if there is a repeated threat to life.
War veterans (starting with WWI) have been the catalyst for studying and recognizing what was originally labelled shell shock. Soldiers were expected to recover from battle wounds and return to service unless permanently injured (e.g. loss of limb). Shell shock was not a visible, treatable wound; and therefore, soldiers were often shamed for what is now understood to be disabling PTSD.
Complex PTSD refers to repeated exposure to life-threatening situations over a period of time such as domestic violence (witnessing or experiencing partner abuse, child abuse/neglect), childhood trauma that impacts development (witnessing abuse or tragic event, loss of parent, bullying), or war crimes (genocide, Holocaust, prisoners of war, torture) to name a few. Both forms of PTSD deal with intrusive thoughts, flashbacks, nightmares/terrors, insomnia, cognitive impairments, depression, anxiety, self-isolation, and the like.
One webinar I watched differentiated between the variations of PTSD in terms of safety. In PTSD, there was a sense of safety that was destroyed and needs to be re-established. It’s disorienting because what was taken for granted as foundational to living is no longer reliable. For cPTSD, a sense of safety was never established and needs to be built from scratch – the foundation needs to be created, not rebuilt.
As one’s sense of safety was never properly developed, there is no starting point for re-establishing safety and security, and is often a foreign concept to grasp. The sense-of-self is constantly threatened and often negative or shame-based. Emotional flashbacks are also common and interfere with assessment of perceived or actual danger. In PTSD, the amygdala (danger detector of the brain) had a very real sense of danger that it can’t shake off and gets overlapped with the present. In cPTSD, the amygdala is always “on” – hyper-vigilant and highly sensitive without apparent reason – the triggering event is harder to ascertain and danger is perceived in harmless situations (no actual threat to life, but the amygdala is sending warnings as if there is reason to be ready to fight, flee, or freeze). In essence, we have significant trust issues because we never know when danger will strike.
In both cases, the amygdala needs to be reset to accurately assess for danger requiring fight, flight, or freeze responses. In an oversimplified nutshell, traumatic memories are improperly stored and need to be filed away appropriately to restore or establish stable functioning. Baseline functioning can be interrupted or impaired by triggers: sights, sounds, smells, words, images, etc. that elicit emotional and/or cognitive memories that feel like what is remembered is happening in real time. Our ability to differentiate past from present is impaired. Our recovery mantra becomes remembering, not reliving.
The reason I’ve chosen to write about cPTSD this month is that I had a ‘new’ symptom that took a couple days to figure out. Mid-month, I was experiencing excruciating pain in my lower back and left hip. One morning I could barely walk, and stairs were akin to climbing Mt Everest. I kept reviewing recent activity and couldn’t think of anything that would have pulled a muscle or strained a joint. By the second day and after no relief could be found via the usual treatments (baths, heat, ice, pain medications), I started journalling – revisiting prompts in Your Body Speaks Your Mind by Deb Shapiro.
The lightbulb moment occurred when I reread the connection between my particular area of physical pain and PTSD. So, I worked backwards looking for the trigger – the sensation that twigged my amygdala to sense danger where there was none and prompted my body to remember an unprocessed memory. Using the prompts in the book, I was able to identify the trigger: preparing for company for Sunday lunch – the cooking and cleaning – none of which was an imposition. And the visit was lovely and long overdue with members of my tribe – like-minded people who are trustworthy and true friends. Kinfolk in the figurative sense; or to use a phrase of Anne Shirley of Green Gables fame: kindred spirits.
The trigger puzzled me as it wasn’t the people or the visit – it was the preparations. My body/brain was remembering what it was like to cook & clean for and serve guests when I was a teenager. It was never by choice but required for survival. Always verbal, sometimes physical, abuse was part of the preparations for and execution of having guests over. And while often complimented on my abilities and service by guests, it landed skewed due to the circumstances. Pleasing people became necessary for survival (attempt to appease abusers) and for an externalized sense of self (what others thought of me over what I thought of myself). Remember that shame-based sense of self? External validation helps to appease its constant demands for ‘better.’ It becomes a vicious cycle.
My triggered body was informing me of unfinished business: I needed to complete the trauma loop to reprogram my amygdala. So, I set to work to do just that. I never again have to cook or clean or serve to gain anyone’s approval or appeasement. I cook and clean for my own purposes: genuine love & concern for myself and others, nourishment, hygiene, etc. I never have to be reminded of those former conditions to keep myself safe. I am free to cook and clean as I like – not for survival or for a sense of self via external validation.
I have been working hard on my healing journey to establish a sense of safety and security at my core. I know certain things about myself to be true regardless of external approval or lack thereof. I also have replaced the negative sense-of-self with a healthier, balanced one: recognizing my light and shadow sides – what I am capable of, both good and bad. But my core remains pure, untainted. It is my choice how I express myself and my values from that core – which always remains intact even when assaulted by tragedy or disapproval. Something I never knew until I did the hard work of trauma recovery – putting emotional and cognitive memories where they belong and filling the space left behind with accurate information.
To re-iterate, regardless of what my brain or body deals with, my core is safe. I had to get acquainted with it (my core) in order to establish that innermost sense of safety and security – a missed development stage involving basic attachment needs. Unlike PTSD, there isn’t a single memory or set of memories to contend with and file away appropriately. I am “constantly” facing triggers that I need to process and put in their place. It is a near daily experience on some level to reprogram my amygdala that it is remembering, not reliving. However, the return on investment is incalculable!
And so, I encourage my readers to consider how they have handled tragedy in their lives. What have you done to keep a healthy, balanced sense of self? How do you maintain a sense of safety and security deep within yourself regardless of what your brain or body experiences? Feel free to submit a comment or question or send an email.
Journey well, my friends.