Complex PTSD Symptoms:

Interpersonal Difficulties

A core dilemma of C-PTSD is that your longing for a relationship is in direct opposition to memories that tell you relationships aren't safe. As a result, developing healthy relationships can be challenging

• Attachment Theory
  
• Boundaries & Conflict Resolution
• Loving Someone with CPTSD
• How CPTSD Impacts Relationships
  
How to Nurture Your Relationship/How to Help
• Shame Responses

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

ATTACHMENT THEORY

Attachment theory describes how young children respond when they're separated from their primary caregiver. Attachment is defined as an emotional bond between two people, initially a caregiver and an infant, which provides a foundation for healthy relationships later in life.

Secure attachment forms when we can depend on a safe, predictable, attuned, and loving caregiver during infancy and early childhood. When caregivers are attuned, they are able to read the cues that signal a child's needs.

"Good enough" caregivers will inevitably misattune to their children on occasion, and these mistakes provide healthy opportunities to learn that ruptures in connection can be repaired. This type of parenting produces what is generally referred to as secure attachment. 

Secure attachment provides the home base that allows a child to feel confident to explore their world. 

Healthy attachment is associated with the ability to learn emotion regulation, stress tolerance, and the development of healthy boundaries. The neglect and early childhood abuse that often accompany complex PTSD are not associated with secure attachment.
  

Patterns of insecure & anxious attachment styles:

• INSECURE AMBIVALENT -
  The insecure ambivalent child has grown up with an inconsistent primary caregiver, who is at times highly responsive and perceptive, but can also be intrusive and invasive. The child cannot depend upon the caregiver for predictable attunement and connection, and consequently develops uncertainty and anxiety. Insecure ambivalent adults tend to feel overly dependent and suffer from abandonment anxiety and an overall sense that relationships are unreliable.
     

• INSECURE AVOIDANT -
  The insecure avoidant child has grown up with a distant or disengaged caregiver who is repeatedly emotionally unavailable and rejecting. As a result, this child adapts by avoiding closeness, disconnecting emotionally, or becoming overly self-reliant. Insecure avoidant adults tend to have grown up to be dismissive of their own and other people's emotions and face challenges when their partners long for a deeper, more intimate connection.
   
• DISORGANIZED -
  The most disturbing attachment settings result in a disorganized attachment style. This child has grown up with a primary caregiver whose behavior is overwhelming, chaotic, and/or abusive. The caregiver is a source of alarm and confusion, resulting in a paradox related to the child's biological drive to seek closeness from the very source of the terror that they are trying to escape. This is often referred to as "fright without solution," an unsolvable dilemma for the child. Disorganized adults tend to rely upon impulsive or aggressive behaviors to manage uncomfortable emotions. Relationship interactions can mimic the abuse they experienced during childhood with caregivers. They might act abusive themselves or choose abusive partners because it feels familiar.
   

CPTSD is associated with all of these attachment styles.

Boundaries & Conflict Resolution 

Interpersonal difficulties or losses can leave you feeling vulnerable and destabilized.

Importantly, living in the midst of ongoing relationship strife interferes with healing. Relationship crises can reenact painful relationship patterns that you learned in childhood. 

You can feel re-victimized or at risk of victimizing others. It is imperative that you feel safe in order to open the doors to your wounds from the past.

In even the healthiest of relationships, there will be moments of disconnection or unintentional misunderstanding. DBT skills that support interpersonal effectiveness will help you learn how to have healthy boundaries and resolve conflicts.

Sometimes, this process involves admitting when you have caused harm and taking responsibility for your actions. At other times, you might need to refrain from taking responsibility for another person's harmful behaviors.
 

BOUNDARIES

Having a boundary is an aspect of self-respect that allows you to assert your "no" and your "yes." Without a boundary, you will be more likely to give in to others because you long for approval.

Maintaining successful boundaries involves accepting the fact that you cannot please others all of the time. Boundaries are also meant to be flexible enough to allow for intimate connections with others.

Ultimately, healthy boundaries require that you tolerate both closeness and separateness. Let's take a look at the three most common ineffective boundary patterns:

• Unbounded: 
  If you have an unbounded boundary style, you may be hesitant to set clear limits with others for fear of rejection. You may tend to merge with others and in doing so, lose a sense of yourself for the sake of a relation-ship. You might be prone to taking care of others in lieu of yourself. If your boundaries are undefined, you might be prone to overriding your true feelings, which can result in resentment and anger. Healing involves a commitment to self-care and identification of your limits. Watch for a tendency to say yes without thinking things through.
   

• Rigid: 
  If you have a rigid boundary style, you may have a tendency to withdraw from relationships. You might feel safest when you're self-reliant. Maybe you have constructed walls around your vulnerable feelings. When boundaries are too rigid, you can become isolated or carry a burdening belief that you always have to take care of things yourself. Healing involves allowing yourself to be vulnerable and recognizing that you have needs that others can and want to provide. Asking for what you need may feel uncomfortable at first, but doing so is a sign of growth and progress.
   

• Combined:
  The third and most common boundary style is actually a combination of the previous styles. You might alternate boundary styles between feeling a needy longing for connection and pushing people away when they get too close. Healing involves increasing your self-awareness about what boundary style is dominant at any given time. The need for closeness and space are both valid; however, you will feel greater satisfaction if you can advocate for those needs in healthy ways to your loved ones, such as speaking up when you need alone time to think, rather than pushing a loved one away. Healthy advocacy might involve saying, "I really need some alone time right now. I am going to go for a walk. I will be more available to connect with you when I get back."
   

Steps you can take to develop healthy boundaries include: 

— Self-awareness: 
Mindfulness skills can help you develop awareness about what is motivating your behaviors. If you are acting out of fear of rejection or fear of intimacy, allow yourself to slow down and connect to your breath and your body.
 

— Practice saying no:
An essential boundary skill is the ability to say no when something doesn't feel right to you. Absolving yourself of feelings of guilt and getting good at upholding your limits can take practice. Recognize that others may be disappointed with your choice, but this does not necessitate you giving in or getting angry.
 

— Practice asking for what you need:
It is equally important to learn assertive ways to express your wants and needs. Practice asking for things and making requests. This process requires tolerating your own disappointment when requests are denied. Moreover, if your request is honored, you may need to challenge yourself to tolerate the closeness of someone taking care of you. 

Respectful self-advocacy for your needs is a way of acknowledging that you are worth being cared for.
 

CONFLICT RESOLUTION

Dialectical behavior therapy skills for interpersonal effectiveness include learning to address conflicts in an assertive yet caring manner. Effective communication skills involve "I statements" that do not blame or judge the other person.

Healthy communication asks that you be aware of your own needs and have the ability to articulate them in an understandable way.

In addition, healthy communication involves a desire to understand the other person's perspective and investment in a continued relationship.

Conflicts happen even in the best of relationships. 

*Strategies that facilitate successful conflict resolution:

• Stay descriptive:
  Describe your situation by naming the facts and avoiding judgmental statements. Notice a tendency to fall into the trap of statements that start with "You always..." or "You make me feel..." Here's an example of more effective descriptive language: "When I come home from work, I am aware that you want to talk with me about your day."
   
• Name your feelings
  Talk about feelings, rather than assuming that the other person knows how you feel. For example, "I am tired when I come home, and it is hard to me to connect right away."
   
• Ask for what you want
  Nobody can read minds. Express yourself by telling that person what you need. For example, "I would like to take 15 minutes after getting home to settle down after work. Then I can give you my full attention." 
   
• Ask what they need
  Asking the other person about their needs and wants shows that you care. It can be valuable to repeat back what you've heard to ensure that you understand them correctly. For example, "I hear that you want to connect with me at the end of the day. Is that correct?"
     
• Give and take
  Healthy relationships generally involve some negotiation of both parties' needs. Let the other person know that you are willing to attend to their needs while continuing to advocate for your request. For example, "I will make sure that we have valuable and meaningful time together."
    
• Back off as needed
  If you find yourself feeling rejected or defensive, it is important to take a few minutes and calm down. When taking a "time out," it is effective to make an agreement about how long you need and assert your commitment to resolve the conflict. For example, "I am starting to feel defensive. I am committed to you and to our conversation, but I need to catch my breath. Can we take a break and agree to come back in 10 minutes?"
   

Healthy interpersonal relationships are supported by communications that are clear, fair, and kind. Refrain from putting other people down and calling them names. Do your best to be respectful and truthful.

If you have acted in a hurtful manner, being willing to admit it and apologize goes a long way to soothe hurt feelings.

Loving Someone with CPTSD

Written by Maxine Dolma, CPTSDFoundation.org
How to Support a Loved One with CPTSD

If you were to ask me what I would want a romantic partner to know about loving and lending support while dealing with the reality of CPTSD, this is what I’d say:

I have complex post-traumatic stress disorder (CPTSD). Yes, I have a mental illness and you need to know that my CPTSD doesn't mean I'm broken. It means I have a brain injury from trauma because someone I loved and trusted -who was supposed to take care of me- abused me instead. 

The abuse happened again and again over days, months, and years. I lived in a constant state of terror that caused my brain and body to be soaked in stress hormones. Living like this meant my nervous system and brain got wired to be sensitive to anything that reminds me of the abuse. These reminders are called triggers.

I could be triggered by anything: it could be the way that you breathe or shuffle your feet. It could even be the sunshine, a man with a beard, or a bite of a cookie that reminds me of my abuser or the abuse.

I don't always know when I'll be triggered or how those triggers will affect me. I'll do my best to let you know what my triggers are and work to deal with all the feelings that come up.

But sometimes, I'll pull away from you and when I do, it doesn't mean I've stopped loving you. What's really happening is that I can't cope with what's going on in my mind and body and how I'm feeling.

Instead of backing away from me because you think I don't love you, I need you to be brave and ask me what I'm going through and how you can help. I don't need you to fix me. I don't need you to make my feelings or problems go away. I just need you to be patient and compassionate.

Sometimes, I'll have a crisis where I am so triggered that I get stuck in a spiral of self-destructive talk, self-harm, or shame. Maybe I will experience an emotional or physical flashback where I'm remembering the abuse or feeling overwhelmed to the point where I can't talk, and I retreat into my own mind or leave my body entirely. If it's that intense, I'm in crisis.

When I'm in crisis, I need you to have so much patience and understand that the part of my brain that is usually able to talk, reason, and deal with feelings has shut down and I have stress hormones pumping through my body. 

I need you to know that I can't control what I'm going through. If things get bad, you'll need to call my therapist or the crisis line, or emergency services. Yes, it might happen that you'll be the person who makes the tough calls. I know it's hard. Remember that I appreciate your bravery, your strength, and most of all your love.

If during our time together, you feel like it's all too much and you can't support me, please let me know. I can understand that you need time to take care of yourself. DO take care of yourself. If you need to see a therapist, I will support you as much as I can.

Have boundaries with me. Don't hesitate. We need to keep things healthy between us. It helps me heal.

After all of this, you might still wonder how you can be a good partner. Show me you're trustworthy, reliable, and compassionate. I can't say this enough: understand that you don't need to fix me or stop me from having my very messy, sometimes confusing feelings. Instead, I need you to practice detached compassion which means that you allow me space to have my feelings without reacting to them.

I also need you to remember that I'm responsible for my feelings, what I say, and what I do just as you are responsible for what you feel, say, and do. If I hurt you, don't make excuses for me. If you hurt me, I need you to be responsible too.

If you are serious about wanting to stick around and be in my life, I need you to know where I'm at with therapy -if I invite you. But if I can't, I'm not trying to keep you in the dark. It most likely means that it's hard for me to deal with my own stuff right now and I just can't share; I need to figure it out on my own.

I need you to know that it will take time for me to heal. And while I'm healing, I am taking my mind apart from its very foundations and working my way up. I will change. I will grow. Sometimes you won't recognize me, but if I'm still here, know that I love you and I'm profoundly grateful for your love and support.
 

How CPTSD Impacts Relationships

Complex PTSD can impact your life in many ways. These can play out in relationships with family and friends. They may also prevent you from wanting to form new bonds, leading you to self-isolate in order to stay safe.

Since relational trauma plays an important role in the development of CPTSD, many of the symptoms may be triggered in relationships.

In fact, many symptoms of CPTSD overlap with those of borderline personality disorder (BPD), which is marked by challenges in interpersonal relationships.

You may experience difficulties with:

• emotional regulation in front of others
• intimacy (physical and emotional)
• closeness to others
• trusting other people 

For example, some people may find it easy to brush off a hurtful comment and move on with their day. However, if you live with CPTSD, it may not be so simple for you.

These events may trigger a strong emotional response and possibly an outburst, leaving your romantic partner shocked and confused. This kind of emotional dysregulation can be stressful and hurtful for others to experience.

As another example, if one of your beliefs from trauma is that people are untrustworthy, you may find intimacy to be difficult. This could lead you to disengage or withdraw from your partner.

You may even feel skeptical about your partner's words and actions, or perhaps look for signs of dishonesty where there aren't any. A fear of abandonment may conflict and fracture the foundation of a relationship.

While many of these symptoms may present challenges, remember, healing is possible. Don't give up hope.

How to Nurture Your Relationship

If you live with complex PTSD, a nurturing and healthy relationship is possible. Like all relationships, it takes hard work and dedication from both you and your partner.

Recognize the past

While it may be difficult not to compare what happened in the past with your present circumstances, try to separate the two, if possible.

Communicate

You may find it helpful to openly communicate with your partner about your feelings and experiences to create trust and a sense of security. Use "I" statements, like, "When you say that, I feel hurt and confused."

Practice self-care

Self-care techniques may help reduce stress and emotional reactivity. These include:

• sleeping adequately
• eating a balanced diet
• practicing creative hobbies
• exercising
• meditating

Know your worth

Try to recognize that you're worthy of happiness and a loving relationship. With some work, it's possible to accept the difficult things that have occurred in the past with your partner and move forward toward a better future.

My partner lives with complex trauma: How can I help?

If your partner has CPTSD, recognize that you cannot change or fix their past, as much as you'd like to. If possible, try to focus on moving forward.

Be consistent

You may find it useful to be deliberate and consistent in your actions and communication. Being predictable may make it easier for your partner to trust you and build a secure attachment.

Hold space for their emotions

Acknowledge their emotions so that they feel supported and heard. You can try mirroring language and asking questions. For example, "I hear you saying you want to be left alone. Do I have that right?"

Learn coping techniques

It may make you feel empowered to find helpful ways to support your partner when they're having a triggered moment or a flashback, such as deep breathing exercises or going for a walk together.

If your partner is in active treatment, you can also support them as they learn coping strategies and new techniques, and practice new behaviors with you.

Depersonalize conflict

Try to remember not to take things personally. If your partner has an outburst or withdraws after a triggering event, know that it's not about you. They've been through a lot, and they are doing the best they can.

Practice self-care

Loving someone with any mental health condition can be, at times, overwhelming. Be sure to establish your own boundaries and practice regular self-care. Recognize that not every day will go perfectly or be without difficulties.

Shame Responses:
Over-Apologizing, Over-Trusting, Over-Thinking, & Over-Sharing

What is commonly referred to as Complex Post Traumatic Stress Disorder (C-PTSD) is a combination of PTSD's characteristic symptoms and several other issues; such as immense emotional turmoil and a total lack of trust in people and the world.
  

The trauma of those individuals, manifested in extreme and delicate ways within this complicated pattern that has been influenced by their past experiences.
  

It is incredibly difficult to build self-esteem alongside complexity that comes with C-PTSD. There's a need to have a strong emotional base that will act as a foundation for continuous well-being, despite being engulfed in endless emotional tumults.
 

This concept serves as an illustrative manifestation of shame-based trauma responses common among people navigating through the complex landscape of Complex PTSD.
 

Different types of coping mechanisms represented here are woven into personal traumatic histories, making them more intricate: onerous paths toward recovery.
 

Here are four common shame-based reactions we often witness from those living with Complex PTSD:

OVER-APOLOGIZING

The world of Complex PTSD is populated by people who have experienced situations where they were treated like scapegoats unfairly.

Over-apologizing is a survival technique that arises from such experiences, and it means avoiding any form of conflict.

They believe that by not arguing, others will accept them; hence, it becomes their perceived protection against suffering harm.

Conflict avoidance for these individuals indicates a desperate attempt at self-preservation that may lead to harmonious relationships and ensure emotional well-being.

OVER-TRUSTING

Notwithstanding previous traumas, those who suffer from complex post-traumatic stress disorders often maintain an abiding faith in the basic goodness of people.

Hence, they tend to over-trust leading to being vulnerable emotionally and trusting each individual without any caution for what they do or have done before.

This openness however puts them at risk because when somebody eventually cheats on them or leaves them alone, it increases their pain.
 

OVER-THINKING

Complex PTSD's complex set-up makes its victims overthink ceaselessly – always trying to link today's realties with past events. 

By continuously forcing themselves into this never-ending mental activity where they endeavor to relate pieces of their past traumas with present occasions, these victims suffer from anxiety and depression due to rumination.

Consequently, these people are mentally and emotionally drained by the tedious processes of unraveling old terrors and worst likely scenarios.
 

OVER-SHARING

A tendency towards over-sharing by individuals with complex post-traumatic stress disorder (C-PTSD) reflects a deep yearning for emotional connection and intimacy.

They often share too many personal experiences deeply rooted in trauma to help establish an emotional bond.

Nevertheless, this innate wish for closeness might ironically result in other people being pushed away; a way of protecting themselves unconsciously from the possibility of being hurt or abandoned.

An element of over-sharing suggests that there is a complex interplay between the desire for emotional intimacy and an unconscious need for self-protection.

Complex coping mechanism, ingrained within the intricate landscape of C-PTSD, is responsible for this seemingly excessive disclosure of trauma-related details that balances on the fine line between seeking connection and fortifying emotional barricades.

The intricate spider web of shame-based trauma responses that pervades Complex PTSD is a compelling example of the lasting impact of past traumas on current behaviors. Professionals are widely aware that this disorder is multifaceted and acknowledges the complex entanglements it is marked with.

Nonetheless, there is an unwavering conviction amid these challenges, which derives from therapeutic interventions, building resilience and existence of compassionate backing networks.

Fundamentally, healing from Complex PTSD necessitates a comprehensive approach that recognizes the profound influence of shame-based reactions and also creates an environment that is nurturing.

This overall endeavor rests on blending different therapeutic approaches, enhancing resilience mechanisms and creating caring support systems which act as a foundation for hope and possibility for those with Complex PTSD to rebuild and find permanent wellness.

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

DISSOCIATION

IMPULSIVITY

DEPRESSION

TRIGGERS

OBSESSIVE BEHAVIOR

PHYSICAL

*TREATMENT*

PERSONAL EXAMPLES