Complex PTSD 

Complex PTSD can result from experiencing chronic trauma, such as prolonged child abuse or domestic violence. The symptoms can be similar but more enduring and extreme than those of PTSD.

CPTSD is delineated from this better known trauma syndrome by five of its most common and troublesome features: emotional flashbacks, toxic shame, self-abandonment, a vicious inner critic and social anxiety.

Sections:

• Defining Complex PTSD

• Common CPTSD Symptoms

• Thinking Errors

• Risk Factors

• CPTSD Behaviors that Look Like Narcissism

SHAME - AVOIDANCE - HYPERVIGILANCE - DYSREGULATION - INTERPERSONAL DIFFICULTIES - DISSOCIATION - IMPULSIVITY - DEPRESSION -TRIGGERS - OBSESSIVE BEHAVIOR - PHYSICAL - TREATMENT

Defining Complex PTSD

Complex post-traumatic stress disorder, sometimes called C-PTSD, is an anxiety condition with the same core symptoms of Post-traumatic stress disorder along with some additional ones.

First recognized as a condition that affects war veterans, Post-traumatic stress disorder (PTSD) can be caused by any number of traumatic events, such as a car accident, natural disaster, near-death experience, or other isolated acts of violence or abuse.

When the underlying trauma is repeated and ongoing, however, some mental health professionals make a distinction between PTSD and its more intense sibling, complex PTSD.

Complex trauma describes exposure to multiple traumatic events—often of an invasive, interpersonal nature—and the wide-ranging, long-term effects of this exposure. These events are severe and pervasive, such as abuse or profound neglect. 

Emotional flashbacks are perhaps the most noticeable and characteristic feature of CPTSD. Survivors of traumatizing abandonment are extremely susceptible to painful emotional flashbacks, which unlike PTSD do not typically have a visual component.

Emotional flashbacks are sudden and often prolonged regressions to the overwhelming feeling-states of being abused/abandoned.

These feeling-states can include overwhelming fear, shame, alienation, rage, grief and depression. They also include unnecessary triggering of our fight/flight instincts.

It is important to state here that emotional flashbacks, like most things in life, are not all-or-nothing. Flashbacks can range in intensity from subtle to horrific. They can also vary in duration ranging from moments to weeks on end where they devolve into what many therapists call a regression.

Although Complex post-traumatic stress disorder most frequently stems from childhood trauma, CPTSD may arise at any age when someone experiences an ongoing source of trauma that they feel powerless to escape.

Traumatic stress can have a number of effects on the brain. Trauma is associated with lasting changes in key areas of the brain including the amygdala, hippocampus, and prefrontal cortex.

Someone with C-PTSD may be highly reactive to minor stressors, have emotional outbursts, or engage in reckless, self-destructive behavior. People living with complex PTSD tend to experience greater intrapersonal strife. They have a more negative perception of themselves; they may feel shame and have a sense that they are different from everyone else.

A person suffering with C-PTSD may also be emotionally numb, unable to experience pleasure or other positive emotions. They may come to believe that they are flawed or worthless and feel deep guilt or shame because they blame themselves for falling victim to their trauma or for failing to protect others who experienced it.
 

PTSD vs. C-PTSD 

Both PTSD and C-PTSD result from the experience of something deeply traumatic and can cause flashbacks, nightmares, and insomnia. Both conditions can also make you feel intensely afraid and unsafe even though the danger has passed. However, despite these similarities, there are characteristics that differentiate C-PTSD from PTSD.

The main difference between the two disorders is the frequency of the trauma. While PTSD is caused by a single traumatic event, CPTSD is caused by long-lasting trauma that continues or repeats for months, even years (commonly referred to as "complex trauma")

Complex post-traumatic stress disorder describes the results of ongoing relational trauma. Unlike Post-traumatic stress disorder, Complex PTSD usually involves being hurt by another person. These hurts are ongoing, repeated, and often involving a betrayal and loss of safety.

PTSD can develop regardless of what age you are when the trauma occurred, whereas C-PTSD is typically the result of childhood trauma. The psychological and developmental impacts of complex trauma early in life are often more severe than a single traumatic experience—so different, in fact, that many experts believe that the PTSD diagnostic criteria don't adequately describe the wide-ranging, long-lasting consequences of CPTSD.
 

C-PTSD

• Caused by long-term, repeated trauma

• Typically arises from childhood experiences

• Occurs in those who have endured oppression

• Usually more severe than PTSD
  

PTSD

• Caused by a single event

• Can result from trauma experienced at any age

• Usually milder than C-PTSD
   
  

In addition to all of the core symptoms of PTSD (re-experiencing, avoidance, and hyperarousal)— Complex PTSD symptoms generally also include:
 

All of these symptoms can be life-altering and cause significant impairment in personal, family, social, educational, occupational, or other important areas of life.

Common CPTSD Symptoms

COGNITIVE DISTORTIONS
These include inaccurate beliefs about oneself, others, and the world.
 

EMOTIONAL DISTRESS
Frequent feelings of being overwhelmed, anxiety, helplessness, hopelessness, despair, deep loneliness, shame, unfairness, injustice, and depression and suicidal thoughts are often triggered by social loss, abandonment, and disconnection.
 

DISTURBING SOMATIC SENSATIONS
Historical threats are maintained as uncomfortable body sensations or somatization, in which psychological distress presents in the form of physical symptoms.
 

DISORIENTATION
Inaccurate beliefs, emotions, and body sensations contribute to a loss of distinction between the past and the present.
 

HYPERVIGILANCE
High sensitivity to tracking nuances and subtleties in body language and facial expressions within other people is developed as an attempt to keep oneself safe.
 

AVOIDANCE
Avoidance involves learned patterns of shutting out or pushing away uncomfortable sensations, memories, or emotions. This is often maintained by defenses such as denial, repression, dissociation; or addictive behaviors.
 

INTERPERSONAL PROBLEMS
Ineffective interpersonal relationship dynamics include withdrawing from, blaming, pushing away, or criticizing friends and loved ones unnecessarily. Patterns learned within dysfunctional family systems tend to get repeated in adulthood until new and effective interpersonal strategies are developed.
 

BRAIN DEVELOPMENT
Abuse and neglect produce measurable changes in brain structures that are associated with deficits in social skills and academic success.
 

HEALTH PROBLEMS
Unresolved C-PTSD is a significant cause of physical health concerns in adulthood.
 

-Thinking Errors-

ALL-OR-NOTHING THINKING

This error is also called black-and-white or polarized thinking, and involves a tendency to view situations in only two categories rather than on a continuum. For example: "I always mess up, what is the point of trying?"

 
CATASTROPHIZING

This error involves believing that the very worst thing is going to happen without considering other more likely and less negative possibilities. Like a fortune-teller, you might try and predict the future, but with negative expectations. For example: "I just know that I will fail the test!"

DISCOUNTING THE POSITIVES

this error disqualifies or excludes positive experiences and qualities as if they do not count. For example: "She said I did well in the audition, but I bet she didn't mean it."
 

EMOTIONAL REASONING

This error entails believing something is true because you feel it so strongly, while ignoring lacking or contrary evidence. For example: "I have an awful feeling about the party tonight; I'm sure I'll make a fool of myself."
 

OVERGENERALIZING

This error involves using current situations to develop broad conclusions about unrelated life experiences or events. For example: "Things never go my way; I have the worst luck."

MIND READING

This error involves believing you know what others are thinking without considering other possibilities, and failing to check in with other people about what they are actually thinking. For example: "My friends think I'm stupid, I'm sure of it!"

IMPERATIVES

This error involves holding unrealistic and fixed standards such as "shoulds" toward yourself or others. In this case, you are critical when such standards are not met. For example: "I should have been able to speak up at the meeting; I'm such a wimp!" 
 

It is important to note that you are not casting judgment on your thoughts as "good" or "bad." Rather, you are taking time to recognize that some thoughts are useful and others are less useful.
 

Mindful awareness of body sensations as they relate to thoughts helps you to see that some thoughts create greater ease, whereas others create more distress. Once you are aware of your negative or irrational beliefs, you can begin to replace them with more beneficial thoughts.
 

For example, when you say to yourself, "This will never work," "What's wrong with me," or "I'm worthless," you reinforce self-limiting beliefs and painful emotions. Replacing these kinds of statements with more positive or useful ones-such as, "It's okay to be nervous," "Remember to breathe," or "Most people will accept me if I make mistakes" -will likely create a greater sense of possibility and positivity.

 RISK FACTORS 

8 Contributing Factors to the Development of Complex PTSD

Children require consistency. Caregivers who are predictable help children develop clear expectations about themselves and the world. Such predictability provides a groundwork of safety and allows a child to adapt to the many inner changes they go through during early development. But this isn't the case in a household of neglect or abuse.

C-PTSD often arises out of interactions that occur in the first years of life. Sometimes the trauma begins within the first months of being born. Such early childhood memories are not like typical memories that occur later in life. You may not have images or a clear story. Instead, you might experience emotions without understanding why, or even physical sensations of unknown origin.

Why will two people with similar histories have different outcomes? The development and expression of C-PTSD is multifaceted, and is not just influenced by exposure to childhood trauma.

Why some people may be more susceptible to developing an adverse reaction to trauma:

1. Intensity duration, & timing
Needless to say, the longer the abuse or trauma continues and the greater its intensity, the greater the likelihood you will develop C-PTSD. It is also important to consider the timing of the traumatic stress. Children are most susceptible to the impact of such stressors during critical growth periods, such as the first three years of life when the nervous system is extremely fragile and during adolescence when they are forming their identity.
 

2. Genetics
Research indicates that anxiety disorders, including PTSD, tend to run in families. While not a direct cause of PTSD, having a parent with PTSD is associated with a greater risk for the development of PTSD after exposure to a trauma. Research suggests that there is a biological predisposition among these children.
 

3. Environment
Parents with PTSD respond differently to their children, resulting in greater disruptions in care and attachment. Mothers with PTSD tend to be both overprotective and overreactive, which can result in children feeling both intruded upon and abandoned. As children respond in fear or anger, an environmental cycle of abuse can occur, in which a parent may become increasingly abusive.
 

4. In-utero influence
Infants born to mothers who were pregnant during a traumatic event that could have resulted in a diagnosis of PTSD (such as during the /11 attacks) had lower birth weights and decreased levels of cortisols (chemicals that respond to stress). Although this does not necessarily result in childhood abuse or neglect, such infants can be harder to soothe, more prone to colic, and at increased risk for PTSD.
 

5. Family dynamics
Parents develop different relationships with different children. Factors that influence this bond with a child can include such things as comfort level with a child's gender, readiness to have a child, and events surrounding the pregnancy or birth. For example, unplanned or unwanted pregnancies can lead to resentment or anger toward a child, or a difficult pregnancy or traumatic birthing process might cause a parent to reject or blame a child.
 

6. Modeling
Children who grow up in abusive homes tend to be exposed to multiple risk factors. Medical care may not be consistent. There may be insufficient modeling of hygiene practices, or a lack of encouragement of health-promoting behaviors such as exercise or healthy eating. There may also be excessive modeling of high-risk behaviors like smoking or substance abuse.
 

7. Presence of a learning disability or ADHD
There is a strong correlation between children with learning disabilities, including Attention Deficit/ Hyperactivity Disorder (ADHD) and child abuse. This connection appears to be bidirectional. Children who are abused are at greater risk for the development of learning disabilities because of the impact of chronic stress and trauma on their developing brain. Additionally, children who have a learning disability or ADHD are at greater risk of being abused when parents misunderstand or are triggered by their child's cognitive differences, distractibility, or impulsivity.
 

8. Lack of resilience factors*
Resilience factors are those protective resources, such as parents, that alleviate the impact of childhood trauma. Research suggests that when parents are not supportive, even an attachment to an adult in your community who understands, nurtures, and protects you can lessen the impact of traumatic childhood events.

Additional protective factors include participation in activities outside of the home and developing positive peer relationships. 

When resilience factors are lacking, the impact of neglect or abuse can be amplified by a feeling that those around you have failed to protect you.

CAUSES OF COMPLEX TRAUMA

Traumatic events that may lead to the development on complex trauma:

• Sexual abuse
• Narcissistic abuse
• Physical abuse
• Emotional abuse
• Witnessing domestic violence
• Natural disasters
• Accidents
• Living in a war zone
• Medically painful procedures
• The loss of a parent/caregiver

Diagnosis of C-PTSD

An accurate diagnosis can become a part of your growing toolbox of knowledge to help you better understand yourself and move forward with wisdom. A diagnosis can allow you and your treatment providers to work together to face and address your symptoms. Whether you live with PTSD or CPTSD, you are not alone.

Although C-PTSD comes with its own set of symptoms, some believe the condition is too similar to PTSD (and other trauma-related conditions) to warrant a separate diagnosis. As a result, the DSM-5 lumps symptoms of C-PTSD together with PTSD.

Many mental health professionals do recognize C-PTSD as a separate condition, because the traditional symptoms of PTSD do not fully capture some of the unique characteristics shown in people who experienced repeat trauma. In 2018, the World Health Organization (WHO) made the decision to include C-PTSD as its own separate diagnosis in the 11th revision of the "International Statistical Classification of Diseases and Related Health Problems" (ICD-11).

Because the condition is relatively new and not recognized in the DSM-5, doctors may make a diagnosis of PTSD instead of complex PTSD. Treatment for the two conditions is similar, but you may want to discuss some of your additional symptoms of complex trauma that your doctor or therapist may also need to address.

CPTSD also can share signs and symptoms with borderline personality disorder (BPD). Although BPD doesn't always have its roots in trauma, this is often the case. In fact, some researchers and psychologists advocate for putting BPD under the umbrella of C-PTSD in future editions of the DSM to acknowledge the link to trauma, foster a better understanding of BPD, and help people with BPD face less stigma.

CPTSD Behaviors That LOOK Like Narcissism

written by Anna Runkle

Complex PTSD and narcissism are closely intertwined, although they're not the same thing. But in families, narcissism in a parent can cause complex PTSD in the child. The parent might be emotionally absent or controlling or completely self-centered and have no ability to see or recognize the child's unique and good self.
 

You hear all the time about how people struggle with the effects of a narcissistic parent — how they become wounded and vulnerable and self-attacking. But what's interesting — and what's never talked about– is how often the parent's narcissistic traits or behaviors are absorbed by the child, and become their behaviors when they grow up. 
 

It's often said that if you have the self-reflection to ask yourself "Am I a narcissist?" you're probably not a narcissist. I'm not sure if that's totally true, because you could just say those words, right? But if you're honest with yourself, you'd have to admit you do have some narcissistic behaviors. Everyone does. We all do.
 

These narcissistic tendencies are the elephant in the room around why people with CPTSD struggle with relationships. There's a tendency to focus on the fact that none of the abuse was your fault — you did not ask for this to happen to you, but it's worth asking yourself if you're sometimes driving people away with the very same narcissistic tendencies that hurt you in the first place.
 

In most cases, they are just tendencies. It's very unlikely that you actually have narcissistic personality disorder. Personality disorders are hard to change, but the wounds of Childhood PTSD that lead to these tendencies can be changed, and I can tell you how. But first let's talk about some of the behaviors that show up in traumatized people.
 

1. A Tendency to Focus on How We Feel

With CPTSD, we have a tendency to focus on how we feel all the time. It becomes dominant in our consciousness and can make it difficult to be sensitive to other people.

Have you ever had that happen when you're in a lot of emotional pain? It can be easy to overlook what's going on in your companion's day — what's going on in their life.

I had a period in my life where three close family members died in less than a year. I got attacked on the street, I got dumped by a guy I loved, and then still more bad things happened. It got so that I was drowning in sorrow. I was overwhelmed and my PTSD symptoms were taking over my brain. I was barely able to read or have a conversation. I'd be on the phone talking and I couldn't even remember who I was talking to sometimes.

At the time I was in shock, but friends noticed I had grown extremely self-centered. As much as we need help during hard times, few of our friends want a relationship where one person does all the talking.
 

2. A Tendency to Focus on What Others Think of Us

Everybody tends to focus on what other people think about them but with CPTSD, we often preemptively attack ourselves for the criticisms we think other people have of us, for example, "I'm stupid, old, fat, no good, not lovable, or that they're not including me." It's one of the hallmarks of a narcissist that they are very focused on other people's opinions of them.
 

3. A Tendency to Think No One Will Understand

With CPTSD, we have a belief that our problems are so unique that no one has ever experienced them. I hear this all the time. When I coach people, they say, "Well, you know, I have problems you couldn't possibly understand."

Here's the thing about me: I have problems. They're not as bad as some peoples', but they're worse than others'. I don't talk about most of my trauma because part of my healing is that I don't talk too much about it. If I did, it would dysregulate me and it might even dysregulate you. At this point, I know my experiences are real and valid, whether or not anyone understands.

Now, I agree that, when you have CPTSD, a lot of people don't understand. They don't understand the nature of it, and they cannot understand why we don't just fix our problems. They ask things like, Why do you keep getting together with the same kind of jerk? Why don't you just not overreact? It's so simple for them, right?

It's easy to think no one can understand. But it's a narcissistic tendency to think that your problems are so much worse than anybody else's. It helps, when you're talking to other people, to look for commonality. Look for what you can learn from other people's experiences. Still, it's good to be with people who understand. It's also good to be comfortable with people who don't have your experience. They may never understand your wounds, but you can learn so much from people who were less traumatized.
 

4. Victim Identity

Feeling always like the victim comes up in both CPTSD and narcissistic personality disorder, but with CPTSD, there really was victimization. For the record, a lot of people who have narcissistic personality disorder were also traumatized as kids. It's not the only cause, but it can play a role in why people end up with that personality disorder. Even so, that doesn't excuse hurtful behavior in them or in us.

If you were abused and neglected, you were a victim. I encourage, however, you not to let it be your identity. Most of the discomfort and shame that you feel is no longer caused by other people, nor even by the past. Mostly, it's caused (in present time) by present-time fear and resentment (and I teach techniques to get free of that, which you can learn here).

The solution is not to deny that you were victimized in the past. The solution is to develop your real identity, your true self whose identity was temporarily disrupted when you were traumatized. You are no longer a victim.
 

5. Martyrdom, Blaming, and Being Too Nice

Another victim "format" that you'll see in CPTSD people (and in narcissists as well), is the long-suffering victim: "I'm so nice all the time, but everyone on the planet is just awful, and they're mean to me for no reason." I'm kind of making fun of that because, if you think that you're the only nice person on the planet, you might actually be a narcissist! People with CPTSD are like everybody — we have a mix of good and bad traits. And like everybody, we do better when we work on healing the bad traits and the vulnerabilities, and when we develop our strengths.
 

6. Arrogance

Sometimes we think we know how other people should live or how they should think or what they need to change about themselves. It pushes people away, to say the least, when we do that. Believing we know better than others what is best for them is arrogance.

When we do this, we're putting ourselves above other people. This can be expressed as control, criticism, unsolicited advice and pressure.

If you feel like you're just trying to be helpful to people and you're finding that they're not receptive, something you could ask yourself is, "Am I giving them advice in a way that makes them feel criticized or like I'm trying to control them?

This can be perceived as a narcissistic trait. The best thing you can do if you want to influence other people (in a good way) is to just do really well yourself — solve your own problems, and show up happy and free in their presence. They might ask you one day how you did that.
 

7. Failure to See the Role We Play in Our Problems

Another narcissistic tendency is that we have a hard time seeing our own role in our problems. It's not just that we think we're innocent victims and blame other people. We also have trouble realizing that we have agency to create problems or solutions, all by ourselves.

It's not easy. And some things are very difficult to change, but we have agency. That tendency to think, Everybody else controls everything and they make everything bad for me…"– that's a narcissistic tendency.

When we think that other people control things and we can't, what we're basically doing is taking our standard allotment of power (which is about the same as everybody else's, because everybody has some power over themselves) and we're giving it to somebody else.

It's better to keep your power, so you can use it to see where you made errors, and make the changes needed to become empowered and happy.
 

8. Sensitivity to Criticism

Just like actual narcissists, trauma has made some of us too fragile to hear criticism. In the case of narcissism, a person cannot tolerate disruption to their belief that they're perfect and above everything. But a person with CPTSD is often so hurt, they feel they can't afford even one more bit of criticism, that it will destroy us.

In this way, CPTSD sensitivity to criticism mirrors a narcissistic tendency.

What we need is a coping mechanism to deal with criticism so that it doesn't get in — so that we can keep it "on the front porch" of our listening and not let it into the house. We need to consider, Is it good criticism? Is it something I need to hear and can learn from, or is it just an attack?" Knowing the difference and opening our hearts to hear appropriate (and gentle) criticism strongly distinguishes us from actual narcissists.
 

9. A Tendency to Develop Unequal Relationships

People who have narcissism want to be surrounded by people who look up to them. But I've noticed that people with CPTSD tend to have difficulty with equal relationships. There's always one person who is up or down.

Now, of course, unequal relationships have a place in the world. It's the case with a parent and a child, or an employer and a worker, that one has more power. Somebody is in charge there. So there's a place for that kind of imbalance. But for our closest relationships, we want to have the capacity for equal relationships.

Part of healing is to develop comfortable, equal relationships, even though real communication in such relationships can be tricky and complicated.

Unequal relationships allow you to skip over the nuanced and vulnerable parts of communication. As you heal, you may find you have a greater capacity to connect with and enjoy friendship with equals.
 

10. A Tendency to Make Sweeping Accusations

Another narcissistic tendency is that we sometimes make big sweeping accusations. We say things like, "Education is just brainwashing for the masses," "Religion is all about social control,"or "Everyone I know is a narcissist." I see this particularly in YouTube comments — people who just say, "It's a terrible world out there! Nobody cares about other people anymore." And we know when we read those comments, they're talking about their experience, and it feels like it's everybody.

But that's what happens with CPTSD when it's not healed:

Anxious thoughts tend to calcify to a bitter attitude toward life. It's self-centered and narcissistic to think that "I'm the only good person and everybody out there is bad." It puts us above everybody. And, of course, nobody likes it. It pushes people away. It's usually said by people who have unconsciously decided to isolate themselves.
  

11. A Sense of Entitlement

Finally, a narcissistic tendency in people with CPTSD is a sense of entitlement, where we believe that other people are responsible for making our lives better.

We sometimes blame "them" for failing to make the world better, or leaving us to pay our own way, or leaving us lonely.

This reflects an unhealthy belief that we have a special status as people who are damaged, that we are like children and "they" are the parents. We tend to very easily see the obligations that others have towards us. But we don't see our reciprocal obligations toward them.

We all need help sometimes. So see what you can do to become that person who is able to help others? Even if it's in a tiny way, just helping somebody in some simple way will help you to begin to see the goodness that is inside you

Source: https://crappychildhoodfairy.com/2021/12/08/cptsd-behaviors-that-look-like-narcissism/

SOURCES:

CPTSD Workbook, Arielle Schwartz PhD/ CPTSD Treatment Manual__CPTSD: From Surviving to Thriving, Pete Walker__www.verywellmind.com/what-is-complex-ptsd__psychcentral.com/ptsd/complex-posttraumatic-stress-disorder-symptoms#common-triggers__goodtherapy.org/dissociation-c-ptsd-role-of-detachment-in-complex-trauma___crappychilhoodfairy.com/cptsd-behaviors-like-narcissism__Crittenden, P. M., Heller, M. B. (2017). The roots of chronic posttraumatic stress disorder: Childhood trauma, information processing, and self-protective strategies. Chronic Stress, 1, 1-13 https://journals.sagepub.com/doi/10.1177/2470547016682965__Kessler, R. C., & Bromet, E. J. (2013). The epidemiology of depression across cultures. Annual Review of Public Health, 34, 119–138. https://www.annualreviews.org/doi/10.1146/annurev-publhealth-031912-114409__Lawson, D. M. Treating adults with complex trauma: An evidence-based case study. Journal of Counseling and Development, https://onlinelibrary.wiley.com/doi/abs/10.1002/jcad.12143 Sar, V. (2011, March 7)__Developmental trauma, complex PTSD, and the current proposal of DSM-5__European Journal of Psychotraumatology, https://www.tandfonline.com/doi/full/10.3402/ejpt.v2i0.5622__Tarocchi, A., Aschieri, F., Fantini, F., & Smith, J. D. Therapeutic assessment of complex trauma: A single-case time-series study. Clinical Case Studies, 12, 228–245. https://journals.sagepub.com/doi/10.1177/1534650113479442__https://www.verywellmind.com/agoraphobia-101-2584235__Avoidance Behavior, Written by Silvi Saxena MBA, MSW, LSW, CCTP, OSW-C/Reviewed by Raiy Abulhosn MD__ https://psychcentral.com/pro/complex-ptsd-and-the-realm-of-dissociation

SHAME 

AVOIDANCE

HYPERVIGILANCE

DYSREGULATION

INTERPERSONAL DIFFICULTIES

DISSOCIATION

IMPULSIVITY

DEPRESSION

TRIGGERS

OBSESSIVE BEHAVIOR

PHYSICAL

*TREATMENT*
PERSONAL EXAMPLES