Finding Hope in a CPTSD Diagnosis

Light inside a complex disorder

PTSD is no mystery to the American public. Thanks to veterans initiatives, “simple” PTSD — while still far from simple —has made its way to our national dialogue. It’s often associated with soldiers returning from combat, and the story goes like this: Man is exposed to traumatic event in a war setting, has trouble processing or making sense of event, and has difficulty adapting to life at home. With movies like American Sniper and the newly launched third season of True Detective, PTSD is better acknowledged if still widely misunderstood and stigmatized. We’re beginning to scratch the surface as to what this disorder means for the people it afflicts: auditory and visual flashbacks, emotional surges, feelings of general fear and paranoia in response to triggers.

But complex PTSD, a disorder that affects many people from childhood on, is widely misdiagnosed. A study in the Journal of Clinical Psychological Science suggests that up to half of people that meet the criteria for PTSD actually have CPTSD. And it’s not just soldiers affected: In fact, studies suggest that foster children are twice as likely to suffer from PTSD or CPTSD than U.S. war veterans.

Studies suggest that that up to half of people that meet the criteria for PTSD actually have CPTSD.

Why are foster children at risk for complex post-traumatic stress disorder? CPTSD is a crippling but often misdiagnosed condition. It occurs when a person faces many traumatic events in an ongoing manner. This often happens in childhood, when a small percentage of children are exposed to some combination of sexual or physical abuse, emotional or physical neglect, warring parents or consistent instability and change.

These children often form insecure attachments with caregivers and have no outlet for their pain. So for survival, they develop traits like excessive reliance or independence, buried emotions, and mistrust as a general approach to relationships. They often disbelieve their own capabilities and do not feel like they can overcome the repetitive shackles of their past, even though those event patterns did not reflect them at all.

The circumstances of CPTSD can and do hide in plain sight. Otherwise happy or well-meaning families can cause trauma that doesn’t leave bruises, such as emotional neglect, bullying, covert emotional incest, parentification, and caretaker relationship instability. For this reason, it’s often difficult for survivors to come forward. Their family lives can seem normal to others outside and even within their own families. And coming forward can often result in gaslighting and disbelief from abusers or their communities. For that reason, CPTSD is an often isolating condition that results in excessive shame, isolation, guilt, and longing for acceptance and approval.

Otherwise happy or well-meaning families can cause trauma that doesn’t leave bruises.

While mental health professionals are more likely now to diagnose CPTSD than in the past, it is commonly misdiagnosed in ways that can harm survivors. Its symptoms can mimic other issues like generalized anxiety or bipolar disorder (BPD). But the causes — and therefore treatments—for CPTSD are markedly different.

With generalized anxiety healing, you’re often encouraged to rationalize your fears and distance yourself from negative thoughts. Talk therapists encourage mindfulness that your worst fears will probably not happen. But with CPTSD, you’re stuck in lock-step with a traumatic situation that’s already happened to you. In fact, many survivors of traumatic childhoods were instructed or threatened to minimize their pain for years, and “treatments” or well-meaning advice that instructs them to avoid painful thoughts in adulthood can actually re-traumatize them.

Distancing from this very real pain can cause disassociation, a kind of emotional bubble wrap that numbs any emotion and leaves one feeling detached and often with poor short-term memory. It’s like an autopilot mode that prevents awareness of pain but also joy. Therefore effective treatment often centers around processing the pain rather than quieting it.

In my own experience with disassociation, I buried the most painful aspects of my childhood trauma for years until I felt I had a safe distance and supportive community to help me process my experiences. I had forgotten years of my childhood, which resurfaced in my mid-20s alongside the delayed onset of CPTSD: emotional and visual flashbacks, frequent night terrors, relationship problems and persistent self-doubt and fear.

Processing the various aspects of my trauma took many months for me. It’s an ongoing effort to identify triggers—simple things like being left alone at night, not hearing back from a loved one, or tiny instances of broken trust—that feel like life-or-death situations, since for some time in childhood they really were survival instincts. Healing is about realizing how monumental these triggers can feel in proportion to the real-life threat, and processing the original cause for the pain rather than the trigger. Recovery is a long and winding path, filled with ups and downs in which the painful events seem more or less “real.” But there is hope.

Recovery is a long and winding path, filled with ups and downs in which the painful events seem more or less “real.” But there is hope.

The brain will help us heal, and CPTSD and PTSD are both disorders that are best managed by working through the pain. In a healthy brain, survivors won’t receive more pain in the form of memories or flashbacks than they can bear. This can provide some comfort that those short, intense and painful bouts of emotion are indeed healing. Treatments like EMDR, or eye movement desensitization and reprocessing therapy, also help survivors dramatically.

EMDR uses the simple act of rapid eye movement — the same used in REM sleep—to process events while conscious just like we do in our dreams at night. It takes advantage of the brain’s high-powered computing skills to hyper-focus on the “problem” at hand and process it rapidly. A survivor follows the fast hand movements of a therapist, or uses another repeated motion or sensation, while visualizing their worst encoded memories.

With CPTSD there are often layers of trauma stacked on one another like a wobbly game of Jenga. Remove one block and others come toppling down, which can feel extremely overwhelming. For example, sexual abuse can be exacerbated by ongoing emotional neglect, and if children feel forced to “parent” themselves or their siblings and caretakers, it can worsen their perception of having no control or support. That’s why it’s best to proceed with CPTSD treatment with the help of a trained professional.

One of the most important aspects of healing is being in a safe and supportive environment. For some people this could involve leaving their families, moving in with a trusted friend or partner, or discovering a sense of capability within themselves. For people unable to leave their abusers for some time, there can be a delayed onset of PTSD treatment. Such is the case with repressed or otherwise denied memories that come to light after the symptoms get too strong and start interfering with life, work, and relationships. Traumatic events can often be recalled when the survivor transplants herself into a different, more supportive setting.

In my case, a few months traveling solo and processing my trauma led me to understand my own independence and capability. I built a relationship with a trusted therapist who understood and had experienced complex PTSD herself. That experience, partnered with stability in my social and romantic life, led me to crack open decades of memories I had pushed into my unconscious. Finally, all the methods I had tried and failed to corral what I thought was generalized anxiety started to make sense. And I could process the increasingly clear memory of my own sexual abuse and childhood instability.

Online support groups often act as a supplement to therapy, or as an alternative in situations where therapy isn’t financially feasible. Reddit forums like r/CPTSD are a watering hole for people who had similar childhoods or traumatic events in youth and adulthood. There lies an abundance of threads starting with “Does anyone else…” and digital hugs, and “upvotes” for the posts that most universally relate to the group of 23,000 subscribers and growing.

How can you help a survivor of CPTSD in your own life? Acknowledge that the depth of their pain likely goes deeper than they are willing to share with you. Think of what they reveal as the tip of a big but very treacherous iceberg. Statements like “Just focus on the positive” are often re-traumatizing for people who grew up without emotional support and so were forced to hide their pain. So offer support and be present with their pain, but do encourage them to seek outside help if they don’t already.

Also understand that certain events can be triggering to them: things like minor criticism, types of questions, or mentions of particular people. Often these can be worsened by a certain time of day, a season, or a circumstance — a certain layering of factors that remind them of their original trauma. It is often beyond your friend’s immediate control in how they react to these triggers. But it’s also not your job to walk on eggshells. So when you notice self-destructive behavior or outsized reactions to things, gently ask them to explain what’s going on and offer your listening ear.

If your friend decides to go “no contact” or NC with an abuser, do not judge their decision and understand it is informed by a lifetime of context. CPTSD survivors are immensely brave, and one of the most empowering things for them is often simply knowing they have the support system to enable them to take important forward steps on their own.

CPTSD survivors are immensely brave, and one of the most empowering things for them is often simply knowing they have the support system to enable them to take important forward steps on their own.

In an informal online poll I conducted with my fellow survivors, one of the most common things they longed to hear from someone was simple:

“You matter, I believe you, your pain is real, and I will not leave your side.”