*TRIGGER WARNING*

 International Suicide Hotlines

Complex PTSD Symptoms:

Depression

Shame and unworthiness are signature depressive symptoms of Complex PTSD. 

Depressive symptoms of complex trauma are often the hardest to resolve. C-PTSD sufferers have a higher incidence of psychiatric comorbidities, including suicidality.

Sections:

• Symptoms of Depression
• Managing Chronic Suicidal Ideation
• Suicide Warning Signs
• Learned Helplessness 
• Self-Harm
• Grief

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

Symptoms of Depression

When you have no ability to change your situation, you may be left feeling ineffective, powerless, and helpless.

Feelings of hopelessness, helplessness, despair, and shame can dominate your reality. When your mental and physical well-being becomes compromised, it is hard to see a way out.

About 1 in 10 adult Americans have some type of depression; however, depression is nearly four times more likely if you have a history of trauma.

Depression can cause you to lose interest in things you used to enjoy. Perhaps you sleep and eat more or less than you would like. Maybe you feel worn out or don't have the desire to do anything. You might believe things will never change, or wonder what's the point of trying.

It is important to recognize that the hopeless thoughts and feelings are part of the depression itself. These symptoms are remnants of your former existence in an environment where you were threatened and helpless to change the situation.

Through a multifaceted approach, you can learn ways to compassionately work with any depressive symptoms. With the help of therapy and education you can unwind any unresolved feelings of shame and helplessness.

Most people with C-PTSD must confront the hopeless thoughts, painful emotions, and intolerable sensations of depressive symptoms. The goal of trauma treatment is to support your physical and emotional wellness by integrating new positive feelings and beliefs about yourself into your life. 

Cognitive behavioral therapy suggests that there is a triad of negative thinking associated with depression. This triad consists of a negative view of the self, a negative view of the world, and a negative view of the future.

For instance, you might say, "I am a failure, bad things always happen to me, and nothing is ever going to change." These beliefs are derived from learned helplessness and shame. Freeing yourself from the trap of depressive symptoms requires gentleness, acceptance, and persistence.

Managing Chronic Suicidal Ideation

Written by Jocelyn Leo

There are not a ton of resources for those who struggle with this as a long-term, chronic problem. However, there are a lot of resources for those are acutely suicidal. I decided to put together eight tips and resources I often use to manage my chronic suicidal ideation, in hopes it helps someone who may be in a similar place.
 

1. Find your safe people.

This has single-handedly been my saving grace countless times. As a complex trauma survivor, my outlook on the world is sometimes clouded with alienation, isolation, shame and a persistent feeling of ¨not belonging¨ in the world. But, there are other people out there who understand the complexities of being a human. There are people in the world who truly do ¨get it,¨ and finding those people was the first step to keeping myself safe. I have a list in my bedroom of five people I can reach out to when the world seems like an unsafe place. I can always trust them to get me out of my house, my mind or my thoughts, and show me the world can be safe, and people can be safe.
 

2. Create something out of the pain.

You don't have to be an artist to follow this tip. Just get creating. Paint, write, draw, color, photograph, splatter, rip, carve, burn. (Just make sure you are doing these activities safely!) For me, creating something out of the painful feelings and thoughts I experience was always something I tried to do first and foremost, because looking back at the art you create once the feelings have lessened, it feels like something productive has come from the pain. For some, this can be a way of lessening the guilt of struggling.
 

3. Go to a safe place.

This is a really important one for those living with complex PTSD, because oftentimes, trauma can make survivors feel like no place is truly safe. If you are able to identify one or two places that do feel safe to you (for me, it's the beach or the woods) and you are able to spend the day there, that can be just enough to help you get through the pain you are experiencing at the time the suicidal ideation sits in.
 

4. Weighted blanket.

It can sometimes be difficult to allow yourself comfort when you are struggling with suicidal ideation. I often felt undeserving of the comfort that came with a safe person or a safe place, but putting a weighted blanket on me could give me this feeling of safety without the unwanted thoughts of ¨bothering¨ people. Weighted blankets have helped me through many panic attacks and times of crisis. (Now they make weighted hoodies, too!)
 

5. Keep notes from your safe people in an accessible location.

I have a pile of notes from my safe people right by my bed. When I begin to feel panicky or depressed, I read through the funny, kind, empathetic, genuine words of my safe people. Often, this is enough to remind me I am cared about, appreciated and not bothering those around me when complex PTSD tells me I am.
 

6. Making lists.

A skill I have been engaging in recently has been list making. In times of crisis or panic, I will pull out my journal and make lists. Some of the lists I have made frequently have been ¨memories that make life worth living,¨ ¨things I want to accomplish in my life,¨ and ¨things I am proud of in my life.¨ Looking at these on my hard days reminds me of my goals for my life and my future.
 

7. Going for a walk (preferably with someone else).

When all else fails, I will ask someone I trust to go on a walk with me. This gets me out of my environment and with someone who can hold some of the pain with me, even if it means being quiet and not speaking to them. This is often the comfort I need at the time, even if it's scary and vulnerable at the time.
 

8. Finding things to look forward to.

I like to set myself little things to look forward to every few days, kind of like a mini-celebration for myself when I get through a stretch of days. Little things to look forward to could be as little as a cup of coffee, or as big as a concert ticket or special event.

I hope some of these tips and resources can help you when you are struggling to manage chronic suicidal ideation. Remember, your traumatic reactions are not a personality flaw. They are real and valid. You can do this!

Suicide Warning Signs

A key construct tightly related to suicidality is hopelessness, described as a feeling of despair, with a state of mind giving low or negative expectancies regarding one's future.

Loneliness and lack of emotional support are predictors of suicide. People who survived complex traumatic events are at an increased risk for developing suicidal ideation and actions.
 

SUICIDE RISK FACTORS:

• Severe mental health conditions such as depression or anxiety disorders
   
• Social isolation 
   
• Access to lethal means such as firearms and drugs 
   
• Prolonged stress such as bullying, unemployment, or relationship problems
   
• Exposure to another person's suicide 
   
• Previous suicide attempts 
   
• Family history of suicide
   
• History of childhood abuse, neglect, or other trauma 
  

Survivors of complex trauma may exhibit warning signs that tell their friends or loved ones that they are contemplating dying by suicide.
 

SUICIDE WARNING SIGNS:

• The person talks about killing themselves, feeling hopeless, having no reason to live, that they would be better off dead, or of unbearable pain.
   
• They increase their use of alcohol or drugs.
   
• They withdraw from activities they used to enjoy.
   
• They isolate themselves.
    
• They may give away prized possessions. 
   
• The person may exhibit signs of depression, anxiety, irritability, loss of interest, shame, anger, or a sudden change in mood.
   
  

If you notice these warning signs and know they have risk factors, do not hesitate to talk to them directly about your suspicions. Talking about suicide WILL NOT cause the person you love to die by their own hand; indeed, you might open a conversation that saves that person's life.

Survivors who deal with complex post-traumatic stress disorder often struggle with chronic suicidal ideation and have experienced repeated suicide attempts. Still, other survivors may have passive suicidality where they do not take their medication, eat, drink sufficient fluids, or self-care items.

Many people living with the after-effects of complex trauma will have periods of no suicidal ideation only to have it come back again later. Because of the tremendous pain involved with dealing with complex trauma, survivors must have a "way out" of the pain and may consider suicide a "safety net," a way of escape.

LEARNED HELPLESSNESS

When there is no way to stop an abuse, end a situation of domestic violence, or convince a parent to stop drinking, a child feels powerless.

Persistent childhood trauma is characterized by a state called learned helplessness. This term was initially introduced to describe how animals that were repeatedly exposed to an unavoidable shock would make no attempt to escape, even when given an opportunity to exit.

Psychologists and researchers later extended an understanding of learned helplessness to people who feel and behave in a helpless manner when they have no control over a threatening situation.

Learned helplessness is the base of a pessimistic attitude.
 

The 3 P's of pessimism:

Personalizing, Pervasiveness, and Permanence.
In other words, it's like saying: "It's my fault, I mess everything up, and I will always be this way."
 

When you have been raised by untrustworthy caregivers or endured multiple traumatic events, it is common to generalize your experience—you may feel as though no one can be trusted or that the world is completely dangerous. As you heal from C-PTSD, it's important to recognize that you are safe now and have choices now. You are no longer stuck in the powerlessness of your past.

Adopting a positive set of thoughts is called "learned optimism." This process is achieved by consciously challenging negative self-talk and replacing inaccurate thoughts with positive beliefs.

Can you relate to the cognitive triad of depression and the 3 P's of pessimism? What core beliefs tend to hold you back? If you were to let go of these beliefs, what do you imagine your life might look like?

 Self-Harm 

Self-harm, also known as self-injury, happens when a person becomes overwhelmed and deliberately hurts their own body. The injuries inflicted on oneself can be anywhere from minor cuts to severe injuries that are life-threatening. 

There as many methods to self-harm as there are people who do it, but below are a few examples:

• Pulling out your hair
• Punching oneself
• Punching a wall to injure oneself
• Cutting oneself
• Bruising oneself
• Burning oneself
• Forcing oneself into extreme fasting

Not all people who self-harm have a mental health condition, nor is self-injury a mental disorder on its own. Many people who do self-harm, though, do have an underlying mental health condition. 

People who self-harm are not usually trying to die by suicide, but these behaviors can lead to a higher risk of suicide completion or death from self-injury complications.

Self-harm has been defined as a preoccupation with deliberately hurting oneself without conscious suicidal intent, often resulting in damage to body tissue.

People who harm themselves offer several reasons they do so, and their answers often surround either current ongoing trauma or trauma experienced in the past. 

Coping and dealing with feelings and emotions that accompany the memories of trauma is a substantial contributing factor.

Some of the reasons some people self-harm may include:

• To end the numbness they feel inside  
   
• To block upsetting memories of trauma
    
• To show others that they are in pain and need help
   
• To help and release intense emotions that make them feel overwhelmed
   
• To punish themselves
   
• To feel some sense of control over their lives

Typically beginning in the teen or early adult years, those at risk for self-injury are all ages and reach across all demographic lines. 

Self-harm more commonly affects those who:

There are many mental health disorders that can contribute to a person's need to self-harm, including:

• Clinical depression
• Post-traumatic stress disorder
• Complex post-traumatic stress disorder
• Eating disorders
• Borderline personality disorder
• Schizophrenia
• Bipolar disorder
• Dissociative identity disorder

The risk factors can cause a person to adopt self-harm as a learned coping behavior to help them compensate for the lack of adequate fulfillment of their desires and dreams for their lives.

There are many reasons besides those listed above that people may harm themselves. Such as: 

- To feel better.

Pain releases endorphins in the brain that releases pent-up feelings such as anxiety and anger.

- To communicate the emotional pain they feel.

People who self-harm may exhibit or display their wounds to gain the attention of others to get help.

- To feel they are in control.

Powerlessness (whether real or perceived) and low self-esteem are key contributing factors to self-harm. 

Feeling out of control of one's life, such as having survived but are living with the after-effects of childhood sexual abuse. 

Other emotions that accompany powerlessness are self-loathing and the absence of powerful self-esteem.
 

The Warning Signs That Someone is Self-Harming

While some people who self-harm take no precautions to hide what they are doing because they are crying for help, many others do not. Some who self-injure go to great lengths to hide their cuts, burns, and bruises. 

Some warning signs can scream that someone is self-harming. These warning signs can also be applied to oneself to see if you are in danger of self-harming or are committing self-injury yourself.

• Are acting withdrawn
  
• Are quieter and reserved than before
  
• Experiencing rapid mood swings
  
• Get angry and upset easily
  
• Have poor performance after doing well 
• Having had a significant traumatic event happen in life. 
• Wear clothes that make no sense, such as long-sleeves in sweltering weather
  
• Makes excuses for cuts or bruises
   
  

After realizing that someone is self-harming, what can you do? Should you accuse them of hurting themselves and try to make them feel ashamed? Absolutely not. 

Self-harm is the visible incarnation of deep pain that the person is having problems dealing with or expressing. 

If you've noticed suspicious injuries on someone you care about or they admit to you they are doing it, here are some recommendations that might help.
 

Be supportive. 

Although their actions make no sense to you, be supportive and tell them you care and are there for them.

Avoid judging them. 

If you judge your friend or loved one's behaviors, you can drive them away or cause them to shut down altogether.

Do some research of your own.

Being genuinely interested in understanding what drives self-harm and the reasons why people do it may help you. Remember, you are dealing with a highly stressful situation. Understanding the where, why, and how of self-injury can help your understanding of what you are dealing with and show your friend or loved one you are interested in helping them.

Try to be accepting.

Self-harming is very isolating for those who do it. Accepting and obviously caring for the person who self-injures can make all the difference.

There is no reason at all for telling your friend or loved one that what they are doing is right because self-injury is harmful.

However, you can show by example how to cope with their fear differently, but you can only do this if you treat someone who self-harms as you would anyone else. Don't act differently around them when unnecessary to do so to help normalize their life.

SOURCE: https://cptsdfoundation.org/

Grief

Trauma often involves grief. You might grieve the loss of your safety. Maybe you grieve missed joys of childhood. Additionally, loss of those who were neglectful or abusive can bring forward unresolved pain and feelings of resentment.

Grieving involves letting go. However, releasing traumatic memories can sometimes feel at first like you are letting go of any last remnants of hope for redemption. 

Cognitive processing therapy (CPT) recognizes that unresolved grief can complicate recovery from PTSD and lead to depressive symptoms. Grief is not a disorder. It is a normal reaction to loss and does not have a timeline.

There are therapeutic techniques which aim to remove the barriers that interfere with the natural course of grief.

Distorted thoughts can block grief by either denying the reality of the loss or making you inaccurately blame yourself. You may have received messages that you need to "be strong," and therefore have learned to hide your pain.

By developing more accurate beliefs about yourself and the world, you can foster a healthier relationship to grief and accept the reality of any losses you have faced.
 

STAGES OF GRIEF

Grief is complex and can be disorienting. Models of the grief process can help you find your bearings. Stages of grief are neither universal nor linear. Nonetheless, such stages offer a way to validate and talk about feelings related to death and loss. 

Modern models of grief recognize that resilience, hope, and growth are also essential components of the grieving process; that attending to loss will bring about feelings of gratitude and forgiveness.
 

• Denial:
  You can think of denial as a protective mechanism that buffers you from the reality of trauma. You might feel as though life is surreal. At times, you might feel disoriented or have an inability to concentrate. In the context of C-PTSD, denial can be expressed as dissociation; it's a way to live as if the event didn't happen or as it you weren't impacted.
   
• Anger:
  It is common to experience anger, rage, resentment, and blame. You might feel abandoned, powerless, and helpless. Grief brings up unfulfilled hopes and wishes that things had been different. You might miss someone who'd been there for you, but now is gone. Or you might miss the chance to connect with some someone who hadn't been there for you. It is common to have regret and lingering resentment. You might feel angry at yourself, your loved ones, or life itself.
   
• Bargaining:
  The core emotion of bargaining is guilt. You might relate to self-blaming statements such as "I should have been able to stop them from fighting," or "If only I had done something I could have prevented the abuse." Bargaining is characterized by magical thinking and beliefs that you can somehow turn back time to make a different, often unrealistic choice.
   
• Depression:
  Grief is most recognizable in deep sadness. However, with depression there is an accompanying despair or feeling, as though your life is meaningless. You might ask yourself, "What is the point of living?" You might wonder how you can go on or why you should. Recognize that this is not something to fix directly; rather, it is the warning sign of what needs attending to-the feeling of emptiness that accompanies great loss.
   
• Acceptance:
  Acceptance is the ability to acknowledge what happened to you and to choose to live your life. This does not mean that you will feel okay about what happened. However, you can still invest in and find joy in your current relationships and engage in the world in a meaningful way.
   
• Resilience and growth: 
  Anger, fear, and sadness are not the only emotions associated with a traumatic history-it is also possible to feel profound appreciation for your life. As a result of your unique life experiences, you might experience a deeper capacity to connect to others in meaningful ways, have an increased willingness to be vulnerable, or be more willing to ask for help. Resilience is not innate, it is learned and developed as part of the healing process.
   

Therapy can help you work with conflicting emotions of resentment, regret, appreciation, and hope that are associated with grieving traumatic losses.

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

COMPLEX PTSD 

SHAME

AVOIDANCE

HYPERVIGILANCE

DYSREGULATION

INTERPERSONAL DIFFICULTIES

DISSOCIATION

IMPULSIVITY

TRIGGERS

OBSESSIVE BEHAVIOR

PHYSICAL

*TREATMENT*

PERSONAL EXAMPLES