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.