Crazy Talk is a mental health advice column, getting real about life with a mental illness. While I’m not a medical doctor, I’m living the good life with depression, OCD, and complex trauma, unapologetically owning my “crazy.” We’re talking all things mental health — trauma, happy pills, mood episodes, and whatever else you tweet me about! Check out last week’s column here.
Hey Sam! How do you know whether or not you have complex PTSD/trauma? I worry that what I went through wasn’t “traumatic” enough to warrant a diagnosis, and I don’t want to claim something that isn’t mine to claim. Where is the line drawn? And is it wrong to say I have C-PTSD if it’s a helpful label to me?
I’m really glad that someone asked me this question.
I’m glad because, too often, survivors diminish their own suffering — as Pete Walker, a trauma survivor and psychotherapist specializing in C-PTSD points out, the inner critic of a survivor is particularly strong.
I think when we combine this with a culture of invalidation (one which, generally speaking, does not believe or affirm survivors), it doesn’t surprise me in the slightest that coming to terms with trauma is such a challenge.
Before we go any further, let’s define C-PTSD. Complex PTSD is a condition that results from ongoing, chronic trauma, usually involving harm or abandonment within interpersonal relationships, particularly where there is an imbalance of power.
This is different from PTSD, which is usually the result of a particular event. C-PTSD is chronic in nature, meaning it was ongoing for some time.
The most common example is a neglectful or abusive caregiver, though that’s not the only kind of chronic trauma that exists. I would add that systemic oppression (like racism or ableism) is inherently imbalanced as well, which is why I think there’s such an abundance of trauma survivors in marginalized communities.
Complex PTSD, then, describes a very specific reaction to ongoing trauma.
Those symptoms can include difficulty regulating emotions; suicidality and self-injury; forgetting the trauma and/or reliving it through rumination or emotional flashbacks; dissociation or a sense of unreality; struggles within interpersonal relationships, like withdrawal or mistrust; intense helplessness, guilt, and shame; a sense of being distinctly different from other people; and even paranoia and psychosis.
I would encourage you to read the full list of symptoms on Wikipedia. As with any form of trauma, no two survivors will react the same way — C-PTSD, then, is an umbrella term that describes a dysfunctional reaction to prolonged trauma, a lot of which survivors may not even be consciously aware of.
Notice how the definition and criteria does not “draw the line” on whose trauma is severe enough to warrant a diagnosis. That’s because complex trauma is typically defined by a power dynamic, the chronic nature of the harm, and the resulting reaction to that harm.
Put another way: prolonged helplessness and harm, with a dysfunctional reaction to that state, is the recipe for complex trauma.
I’d encourage anyone who’s worried about whether they are “traumatized enough” to not compare themselves to other survivors but, instead, ask themselves the following questions:
- Do the symptoms of C-PTSD describe my experiences? Does this language resonate with me? Do I feel affirmed when I read about it?
- Does the framework of C-PTSD help me better understand myself? Could claiming this diagnosis help me gain more self-insight and support?
- Is my reaction to what I endured dysfunctional? Meaning, has it had some negative impact on my life, and would I benefit from addressing that impact?
Finding a trauma-informed therapist to explore these questions with you is, in my opinion, a really great place to start. Given how often survivors downplay their struggles and how often they are gaslit into thinking their perception is wrong, getting a second opinion from someone who deeply understands trauma can be an important part of healing.
I personally tend to depart from conventional ideas about diagnosing mental illness — I think that the most important part of any diagnosis is not that a clinician has given it an official stamp of approval, but rather, that it helps the person who’s diagnosed. This is why I think self-diagnosis, while imperfect, can be a very important tool for neurodiverse people.
(Sian Ferguson wrote a great article breaking this down over at Everyday Feminism, if you’re interested in the merits of self-diagnosis.)
To me, a “valid” diagnosis is one which helps that person access support, resources, and tools that aid them in recovery. So if claiming a complex PTSD diagnosis helps you to that end, I see no problem with it.
If only the most clinically severe cases of PTSD (or any mental illness) were diagnosed, we would be leaving out millions of people who can benefit from support. I see literally no benefit in doing that. I would rather see those people get the help that they need, rather than imposing some kind of “purity test” or gatekeeping that doesn’t actually serve anyone.
If trauma is affecting your mental health, you deserve compassion, care, and support. Full stop.
It’s important to note that while complex PTSD is becoming a popular framework in clinical settings, it hasn’t yet made it into the DSM (Diagnostic and Statistical Manual, a tool typically used by clinicians to diagnose mental illness — it was a pretty contentious decision to not include it, for what it’s worth).
That doesn’t mean, however, that a trauma-informed clinician can’t help you navigate recovery (there are well-established treatments for this form of PTSD). Many survivors are dissuaded from treatment believing that just because it isn’t in the DSM, there’s nothing that can be done and it can’t be diagnosed.
But this isn’t true — some clinicians, for example, will flag the existence of complex trauma by noting it as a “history of psychological trauma,” and offer resources accordingly. This is worth discussing with a trusted clinician who can help you decide next steps.
The bottom-line? The mere fact that you’re wondering if you’re traumatized indicates that you could benefit from some support. Interrogating yourself won’t help you to this end, but seeking out resources will.
I hope that we eventually live in a world where survivors don’t feel that they have to “prove” themselves to be worthy of care. But until then, please take this advice column as a permission slip — your trauma matters. And getting support for that pain you’ve been carrying is long overdue.
Let's Queer Things Up! 
I agree that if you have symptoms of CPTSD, whether or not it “officially” is CPTSD, the best thing to do would be to see a counselor. After all the symptoms (both on their own and together) are devastating, whether or not they suit that particular diagnosis.
The problem I have seen in PTSD forums, most of all, is that the people on these forums have had excruciatingly awful life experiences, and want to be sure that others do not just come in there claiming they have PTSD from say, their pet hamster who died.
To an extent, it invalidates their own experiences. So I think, the best thing for both parties (both diagnosed and not yet diagnosed) would be to try and understand each others point of view. Thank you for the post, food for thought and also good advice.
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This is the same reasoning transmedicalists use, though, when they say that unless you’ve suffered extensively and undergo a medical transition, you’re not “really” trans. I just don’t abide by gatekeeping in any form. I understand the impulse, as someone who has had some pretty awful life experiences, but I don’t cosign it and I don’t think it’s okay to normalize gatekeeping — it’s understandable but that doesn’t make it acceptable, you know?
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Every ‘counselor’ I’ve been to so far– in the past 5 years since I first learned about CPTSD– has not even heard of CPTSD and insisted on calling it PTSD until I corrected them a million times. Just a heads up for people reading this: I’ve had to educate therapists on CPTSD before they could help me at all. It paid to read “CPTSD: From Surviving to Thriving” by Pete Walker BEFORE going to counseling — that way you can know if they are bullshitting you to part you with your money or not
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Also, I should add, I’ll gladly allow the person whose hamster died the self-diagnosis if it means that thousands of folks with complex trauma feel valid enough to get help. When we gatekeep, people who very much need help end up being the ones who lose the most, because it delays their access to treatment.
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I understand your point of view. However, I do not see it as gatekeeping. Everybody is free to go see a therapist and get the diagnosis, just like trans people are free to see a therapist and get a diagnosis. Diagnosing yourself is a good idea to the extent that you can figure out how to get help, for example, I did diagnose myself with CPTSD years ago and it helped me to seek specialized help, after which I got the “official” label.
But a self-diagnosis is not always accurate and if misdiagnosed can actually take power away from you. If you have a painful experience this is not the same thing as having trauma for life, which is pretty much what CPTSD will do for you. That´s quite a terrible perspective to have if it is not accurate. On the other hand, everybody should feel valid enough to trust their own intelligence, and discuss their findings with a therapist.
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This assumes everyone can access and afford therapy, which is not true and a super privileged stance to take. I’d recommend reading Sian’s article that I linked in this piece.
And therapists do not “diagnose” people as being transgender, so I’m not sure about why you drew a parallel there.
Self-diagnoses may not always be accurate, but diagnoses by professionals are not always accurate, either. I should know — I was misdiagnosed as bipolar for almost eight years by multiple clinicians.
The point is? There are very few people who gladly claim a complex PTSD diagnosis for kicks. And we should trust people to use diagnoses as a tool to empower themselves — I don’t think it’s right to take that away from anyone.
But we can disagree on that… I’d just be careful how you frame your critique, because it can hurt people who are most vulnerable in our community.
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This is an especially important sentence for me, having been on the diagnosing side of the desk: “To me, a “valid” diagnosis is one which helps that person access support, resources, and tools that aid them in recovery.” It is easy for harried clinicians to get caught up in “The Book” definitions and forget this part. A diagnosis has to be more than a formality or a the numbers and name the insurance company or other payer needs to process a bill. It first and foremost has to be a tool in the hands of the client.
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Reblogged this on cabbagesandkings524 and commented:
Sam answers a question from someone wondering whether they might qualify for a diagnosis.
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Good article, thank you for posting.
I can’t say I agree that our reactions to the traumas are ‘dysfunctional’ though. They were devised in order to keep us as safe as we could be, in profoundly unsafe situations, and were therefore perfectly normal and sensible responses in that setting. That we carry them into adulthood is an indication of how deeply we were affected, and I believe we can adapt again and make new, safe, habits.
Calling ourselves dysfunctional, calling our brave and clever methods ‘disorder’ unsettles me. Bravo! instead, to anyone who has survived the dreadful circumstances which led to our current difficulties. Please take heart that we can grow change and self-care and acceptance within ourselves in the here and now.
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I understand what you’re saying! And I think in an article about diagnostic criteria, it’s also my ethical obligation to be transparent about what those criteria are. And also, I’m not saying that the self-protective methods are dysfunctional in themselves, but rather, create dysfunction in our lives that can be very disabling, which I think is a subtle but important difference.
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I heard that medical marijuana can cure mental illnesses. I started my research on the consequences and effectiveness of using marijuana to treat children, teens, and young adults with attention deficit hyperactivity disorder continues to evolve. Like this article from http://www.ilovegrowingmarijuana.com/lucid-dream/. Luckily, they’ve also found new ways to infuse cannabis on food and beverages. I would like to hear any personal experience or testimonial would be highly appreciated. Thanks
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Unfortunately my history of substance abuse made my foray into this form of treatment incredibly detrimental to my health. But I imagine it works for some people. ❤
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I love this! This helped me so much in understanding my trauma and how it has effected me. I think it is very likely that I have had complex PTSD. Thank you for this! 🙂
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I thought this was a great! article… really helpful. thank you.
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Wonderfully written and extremely helpful. I’d add that one common characteristic of C-PTSD is diminishing one’s own emotional triggers, traumas and thus, their need for therapy. I can imagine there are plenty of folks out there who are afraid to self-diagnose for this reason (myself one of them), but this post has certainly helped to remove that anxiety. I’ll be reading future posts from now on; thank you so much! 🙂
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Well put together, Sam. In the future, when I need a resource to explain cPTSD to someone, this is the article I’ll send them to.
My experience may be of interest to other trans people. I was diagnosed with cPTSD a year and a half ago, after 13 years of unsuccessful treatment for depression, most of it post-transition. And with that new approach, I’ve finally been moving into recovery.
My therapist and my psychiatrist agree that growing up trans, and having to act like I wasn’t trans, was *in and of itself* long-term trauma. It wasn’t that my parents actively abused me for being trans; they were just a normal part of the social environment of the 1950s, which was 99.99% trans-antagonistic.
This anti-trans attitude wasn’t even so much explicit (though some of that too), it was just part of the 1950s atmosphere. In fact, my earliest memory of a cross-gender thought or action is of an incident when I was 4, and part of that memory is that I somehow knew, even at that young age, that I must never let anyone find out about this.
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>>> “My therapist and my psychiatrist agree that growing up trans, and having to act like I wasn’t trans, was *in and of itself* long-term trauma.”
BINGO! I totally agree with your therapist as I was raised in a similar situation. I was born in the ‘60’s. My parents were teachers who would never purposely abuse a child. But I knew at 5 that I should never speak of it. I’ve never been formally diagnosed, but once I read about C-PTSD I was on the path to getting better.
What hurts me is, I looked at the lists of what causes C-PTSD, and I’m not there. That feels a little invalidating. If psychiatrists like yours know this is a real cause, it seems they’re not writing papers about it and publishing them. I think they should. Imagine if it was widely known that simply growing up in the wrong gender, and thinking you couldn’t tell anyone, could be traumatizing.
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>>> “My therapist and my psychiatrist agree that growing up trans, and having to act like I wasn’t trans, was *in and of itself* long-term trauma.”
BINGO! I totally agree with your therapist as I was raised in a similar situation. I was born in the ‘60’s. My parents were teachers who would never purposely abuse a child. But I knew at 5 that I should never speak of it. I’ve never been formally diagnosed, but once I read about C-PTSD I was on the path to getting better.
What hurts me is, I looked at the lists of what causes C-PTSD, and I’m not there. That feels a little invalidating. If psychiatrists like yours know this is a real cause, it seems they’re not writing papers about it and publishing them. I think they should. Imagine if it was widely known that simply growing up in the wrong gender, and thinking you couldn’t tell anyone, could be traumatizing.
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Sam, your insights have turned around my entire week. This blog is an amazing resource. Thank you for sharing.
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I’m loving your blog, and reading about the fawn response is like looking in a mirror.
I don’t have complex ptsd, but I do have “little-t” trauma and a history of invalidation and attachment stuff and shame that was just passed down through the generations like a hot potato.
However, it’s affected my life in a really similar way and I’m healing from my stuff in a really similar way. Just minus a label. I have a wonderful therapist.
So the saying “if it quacks like a duck and looks like a duck, it’s probably a duck”… I shall re-phrase that to: I quack like a duck, fawn like a duck, so emdr (a type of trauma therapy) like a duck, have a really hard time accessing my by feelings like a duck, I don’t even want to talk about how my relationships are with friends (like a duck)…… but I’m not an a duck.
*doible checks to make sure I spelled “duck” with a “u” each time*
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>>>” I would add that systemic oppression (like racism or ableism) is inherently imbalanced as well, which is why I think there’s such an abundance of trauma survivors in marginalized communities.”
I agree, Sam. Unfortunately most of the Google “C-PTSD causes” links only say such things as abuse, neglect, abandonment, or war as being causes. People with systemic oppression might not think C-PTSD applies to them or, like me, wouldn’t think anyone would believe them.
So far I’ve only read one definition (on Quora) of what causes C-PTSD that is inclusive:
“What really causes complex trauma is not really the type of terrifying situation(s) we go through and have to endure, but the fact that our mind gets engulfed in the terror/fear/drama of the event, and succumbs —consciously or unconsciously— to the belief that we are “doomed.”” – Antonieta Contreras (Traumatologist, B. Cert. Neurofeedback, EMDR-AC)
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I finally know what it is that caused me C-PTSD. It was Childhood Emotional Neglect (CEN)!
When people discuss the parents who cause CEN, they say the parents were bad because they had their own mental problems or physical problems such that they didn’t have the energy to attend to their child’s needs. But that didn’t happen to me. My parents were loving and supportive.
So what need did my parents not attend to? My need to be SEEN AS MY GENDER! I didn’t tell them my gender because they taught me their outdated ideas about gender, and I, as a young child, thought that parents were always correct.
But these “outdated” ideas about gender are still alive in pockets of culture today. And Cisgender people don’t see this as a real emotional need, because they’ve never felt it.
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