Complex PTSD – aka Relationship Trauma – is like PTSD on steroids
~ Glynis Sherwood

Is it PTSD or Complex PTSD?

Post Traumatic Stress Disorder (PTSD) and Complex Post Traumatic Stress Disorder (C-PTSD) are both debilitating psychological disorders triggered by terrifying, atypical life events that impact relationships. They share much in common but differ in their root causes.

PTSD is triggered by discrete, limited catastrophic occurrences, such as natural disaster, a serious accident, a terrorist act, war/combat, life threatening illness, or violent personal assault. Often these are isolated events, but they can also be extended incidents, as in the case of combat trauma, or life threatening illness where traumatic stress is cumulative and compounding.

Complex PTSD triggers are caused by prolonged, repeated interpersonal or relationship trauma, where the individual has little or no chance of escape. This may include childhood narcissistic abuse and scapegoating, adult domestic violence, living in a war zone, being held prisoner, human trafficking and extended kidnapping.

Vulnerability to C-PTSD increases with a history of childhood abuse or trauma 

Similarities and Differences Between PTSD and C-PTSD – Signs and Symptoms

PTSD is characterized by intense, disturbing memories, thoughts and feelings related to a terrifying experience or events that last long after the traumatic event has ended.

PTSD is akin to a ‘memory’ disorder, in that the sufferer often feels like a past trauma is recurring in the present. The emotional brain – which controls instinct, mood, drives, motivation, learning and memory – also plays a major role in processing and regulating trauma. While this is a highly important function, unfortunately the emotional brain does not have a linear sense of past, present and future.

The problem occurs when a person with PTSD gets emotionally triggered in the present. The emotional brain does a version of ‘if it looks like a duck and quacks like a duck, then it must be the same duck’. In other words, if a present day situation triggers emotional distress – aka a threat response – the emotional brain may believe that the old trauma or threat is happening all over again, leading to traumatic re-enactment, such as flashbacks, emotional overwhelm or dissociation.

Because the emotional brain doesn’t ‘know’ that the trauma is over, the PTSD sufferer can be plunged back into re-experiencing the old emotional trauma all over again. This recycles the trauma, making it difficult to impossible for the mind to heal and recover.

C-PTSD can present with all the anxiety based characteristics of PTSD, including intrusive and destabilizing thoughts, beliefs and emotions, as well as low self worth, identity disturbances and relationship difficulties.  However, people who develop Complex PTSD tend to experience more emotionally intrusive symptoms – aka flooding – whereas PTSD tends to involve an overuse of avoidant coping. So emotional containment strategies are highly indicated in C-PTSD therapy.

The experience of childhood abuse or neglect can lead to attachment or developmental trauma. People with Complex PTSD based attachment disorders may not develop any cohesive sense of positive self identity, nor learn the communication skills that engender closeness and a sense of belonging. The lack of nurture may lead to chronic abandonment anxiety and feeling all alone in the world.

Mistreated children often identify with false narratives projected by abusive parents that they are somehow ‘bad’ or undeserving of love and protection, leading to ‘toxic shame’. When it comes to relationships, they may be plagued by debilitating social anxiety, or feel chronically insecure and controlled by rejection fears in intimate relationships. This can lead to avoiding relationships – including friendships, and living in a perpetual state of loneliness. Conversely, insecure attachment can contribute to gravitating towards abusive and/or emotionally unavailable people aka ‘the devil you know’, which reinforces false beliefs about unlovability, heightening false shame.

Recurring abuse and neglect conditions abused children to live in a state of fear, abandonment depression, and persistent nervous system overactivation. In addition to chronic mood disorders, nervous system overactivation causes persistent muscular tension, sleep disruption and hormone dysregulation. An ongoing state of hyperarousal based on not feeling loved or safe makes abused children vulnerable to fear and shame triggers that are compounded by depression and abandonment anxiety.

The experience of childhood abuse makes people particularly susceptible to developing C-PTSD later in adulthood, if there is additional trauma, such as domestic abuse. Furthermore, trauma based ‘Repetition Compulsion’ may drive childhood abuse survivors to seek out relationships that traumatically reenact the abusive and/or abandoning dynamics of their childhood caretakers. Childhood abandonment fears can also keep women and men tied to abusive or emotionally unavailable relationships, as terror can be triggered by the prospect – no matter how healthy – of being alone.

How PTSD and C-PTSD Present

PTSD Symptoms tend to cluster under the following categories, with specific symptoms varying in severity:

Intrusive Symptoms:

• Repeated, involuntary memories of the traumatic event.
• Emotional overwhelm/Flooding or Numbness/Going Blank/Feeling Empty.
• Recurring nightmares with traumatic themes/content.
• Re-experiencing/Flashbacks of the traumatic event, including memories, feelings, sights, smells, sounds. This may be unconscious or conscious. Flashbacks may be so vivid that people feel they are reliving or reexperiencing the traumatic experience.
• Ruminative thoughts.

Dissociation
Dissociative disorders are typically experienced as startling autonomous intrusions into the person’s usual ways of responding or functioning that feel upsetting or unsettling.

Dissociation causes varying degrees of detachment from reality, from mild daydreaming, to ‘spacing out’, to not experiencing emotions. Dissociation may also result in altered states of consciousness, including memory loss (I.E. Freeze response), feelings of unreality regarding oneself, one’s body or the world.

Avoiding Reminders of the Traumatic Event
This anxiety based response may include avoiding people, places, activities, objects and situations that bring about distressing memories or associations. People may try to avoid remembering or thinking about the traumatic event. They may resist talking about what happened or how they feel about it. Avoidance brings about temporary relief, but traumatic stress remains in charge.  Avoidance tends to be overused as a PTSD, whereas emotional ‘flooding’ can be more of a problem in Complex PTSD.

Negative Beliefs, Thoughts and Feelings About the Self and Others
Traumatic stress sufferers may develop distorted ongoing beliefs about themselves or others. For example, “I am a bad person”; or “No one can be trusted”. Ongoing feelings of fear, horror, anger, guilt or shame may be prevalent. People may feel detached or estranged from others. There may also be a significant decrease in interest in previously enjoyed activities.

Emotional Dysregulation, Hyper-Arousal and Reactive Symptoms:

• May include mood swings, such as chronic anxiety and/or depression.
• May also encompass feelings of anxiety based irritability and/or having angry outbursts. Some sufferers engage in reckless or self-destructive behavior.
• Being easily startled.
• Having problems concentrating or sleeping.
• Hypervigilance – Feeling on guard and keyed up all the time.

As can be seen, PTSD has broad reaching negative effects that adversely impact mental health, work, relationships, healthy coping skills and sleep. Furthermore, individuals with PTSD are particularly vulnerable to self medicating addictive behaviors, and may experience suicidal ideation or attempts at rates much higher than the national average in the United States.

C-PTSD Symptoms may encompass all of the symptoms of PTSD, including an ongoing sense of threat, avoidance behavior and re-experiencing of traumatic memories, thoughts and feelings, plus:

A Toxic Shame Based Core Identity
A distorted negative self image based on continuous feelings of worthlessness, self loathing, believing one is bad and not deserving of better treatment. Toxic shame may be conscious or unconscious. It triggers shame spirals that cause intense feelings of inadequacy, hopelessness and despair.

Toxic shame is almost always accompanied by a harsh Inner Critic, which is usually the internalized voice of a punitive and shaming parent. It creates a false narrative or ‘shame story’ where the individual believes they are fundamentally bad, flawed and unredeemable. Toxic shame can lead to problems with false guilt and self blame, perfectionism, and intimate relationships, such as codependency and love addiction.

Relationship Problems 

• Difficulty trusting others
• Clinging or distancing behavior
• Chronic rejection fears/Abandonment terror in close relationships
• Avoiding intimacy and closeness
• Gravitating towards unavailable, unreliable or abusive partners and friends, leading to,

Love Addiction
Believing you have to be in a relationship to feel whole, choosing an emotionally unavailable partner, and panicking when the unavailable partner inevitably abandons the relationship.

Codependency
Avoiding oneself and seeking fulfillment – and cultivating a sense of superiority – by focusing on trying to ‘fix’ a troubled, emotionally unavailable partner.

Stockholm Syndrome / Capture Bonding
Bonding with ‘captors’ – usually abusive parents – as an essential survival strategy. Developing positive feelings and sense of connection towards the abuser. Identifying with or siding with captor, persisting into adulthood.

Trauma Bonding
Occurs when love becomes paired with abuse, often originating in childhood. Loving feelings fused with mistreatment dynamics feels normal and desirable. Trauma bonds have a high emotional charge, and are characterized by intensity. Anxiety is misidentified as ‘excitement’. Can lead to obsessive/addictive relationship dynamics, or avoidance of close relationships altogether.

Feelings of Terminal Aloneness
The belief that no one is there to support the individual. Feeling chronically alone in an unwelcoming world – neither understood nor known.

Complex PTSD negatively impacts all relationships and life functions found with PTSD and causes:

1. A pervasive sense of low self worth
2. Poor relationship choices (unreliable and/or abusive partners)
3. Chronic abandonment fears in close relationships
4. Searching for a rescuer to compensate for lack of secure attachment with parent(s)
5. Lack of trust in close relationships
6. Inability to relax causing chronic muscle tension (bracing oneself for attack) and other health problems such as hormone dysregulation, chronic fatigue and/or pain.
7.  Emotional overwhelm

C-PTSD Therapy

Complex PTSD requires psychotherapy as spontaneous remission is rare and injury is often severe. It’s extremely important to connect with a qualified and trained C-PTSD therapist.

Goals of C-PTSD Therapy:

• Cultivation of Safety, Trust and Nurturance through therapeutic alliance, and supportive witnessing of pain by client and clinician.
• Developing Emotional Self Regulation Skills by teaching containment and grounding strategies to overcome fear and emotional flashbacks that cause overwhelm and shame.  Has to be done repeatedly to calm nervous system and rebuild non-traumatic neural pathways.
• Reducing anxiety in order to experience and express blocked, healthy emotions.
• Developing the capacity to voluntarily contain or experience thoughts, beliefs, emotions and memories without eliciting distress, based on what’s best for individual healing and recovery.
• Healing Toxic Shame / Recovering From Harsh Inner Critic / Reparenting of Self by challenging toxic core beliefs, de-identifying with abuser’s projections aka ‘brainwashing’, cultivating self compassion and creating a new, positive and reality based narrative of the self.
• Reparenting the Wounded Child within – in the presence of a Supportive Witness Therapist or Coach – through the cultivation of self compassion, perspective, reassurance and validation.
• Supporting engagement with community life by developing healthy boundaries, trust and nurturance in their personal lives and relationships. Finding vocational and / or avocational activities that express interests and aptitudes.

Article Sources:

A Developmental Approach to Complex PTSD: Childhood and adult cumulative trauma as predictors of symptom complexity; Marylene Cloitre, Bradley C. Stolbach, Judith L. Herman, Bessel van der Kolk, Robert Pynoos, Jing Wang, Eva Petkova;Journal of Traumatic Stress, October 2009

Post-Traumatic Relationship Syndrome, Society for Personality Research, adapted from Social Behaviour and Personality, by Vandervoort, Debra, Rokach, Ami, 2003.

Rebuilding Shattered Lives: Treating Complex PTSD and Dissociative Disorders, By James A. Chu, 2011

Tarrier, N., & Gregg, L. (2004). Suicide risk in civilian PTSD patients: Predictors of suicidal ideation, planning, and attempts. Social Psychiatry and Psychiatric Epidemiology, 39.

Photo by Patryk Sobczak – Unsplash

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Glynis Sherwood – MEd, Canadian Certified Counselor, Registered Clinical Counselor (BC), specializes in recovery from Attachment and Relationship Trauma, Family Scapegoating, Low Self Worth, Anxiety, Depression, Complicated Grief, Couples Therapy and Love Addiction.