Am I ‘Traumatized Enough’ For a Complex PTSD Diagnosis?

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.

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Crazy Talk: My Anxiety Makes Me Give Up Too Easily

Crazy Talk is an advice column powered by your donations on Patreon, written by Sam Dylan Finch (that’s me!), and hosted by your fave queer blog, Let’s Queer Things Up! While I’m not medical doctor, I am a card-carrying member of Club Crazy, living the good life with a mood disorder, anxiety, and complex PTSD (gotta catch ’em all!). We’re talking all things mental health — trauma, happy pills, mood episodes, and whatever else you tweet me about. I’m kicking the stigma where it hurts, one question at a time. Check out last week’s column here.

Hey Sam,

For my whole life, I’ve been the kind of person that, if I’m anxious that I’m not good at something, I give up almost immediately. When I was a kid, I quit piano lessons after just two weeks because I got frustrated that I wasn’t good at it. As an adult, I find it difficult to do my work because I get discouraged very quickly, which leads me to procrastinate, blow deadlines, and flake out. I’m tired of being so hard on myself. What do I do?

I’m going to kick off this column the way that I often do: with a story.

Recently, I had the opportunity of a lifetime come up. A job opportunity, in fact, that I wanted so badly I couldn’t see straight. My first interview went better than I could’ve hoped for. And then I was asked to complete a written test, to show off different skills that would prove I could do the job.

When that test appeared in my email inbox, I froze. It was lengthy, involved, intense. And I only had a few hours to do it.

Immediately, I thought to myself, “I can’t do this. I better find a way to email back and graciously decline.” I started drafting that email in my brain, despairing about how such a perfect opportunity was slipping out of my grasp.

And then I stopped. “Old Sam would’ve given up on this because he was afraid to fail,” I told myself. “But what is New Sam going to do?” 

I’ll tell you what “New Sam” did. He opened up that test and took it a tiny step at a time. He accepted that it might not be perfect, but that this was an opportunity worth fighting for. He used all of the productivity apps and strategies that he knew of, reminding himself that “New Sam” came prepared for this. He held his nose and worked through it. He turned in that test.

Not even twenty minutes later, he– well, I, had a second interview lined up.

A few days later? I got the job.

I keep thinking about what might have happened if I’d listened to my gut and backed out before I’d even tried. And I have to wonder how many amazing opportunities I’ve let slip away because I was too afraid of being imperfect.

But lately? I’ve been more scared of not reaching my true potential than I am of making mistakes. Yes, I still hear that voice trying to steer me off-course, but I’ve crafted an alter ego to talk back to it. Whenever I hear that self-doubt echoing in my brain, I repeat to myself, “Yeah? That’s what I used to think. But that’s not what I believe now. I believe that this is something worth doing.”

Beyond finding concrete tools to help me deal with procrastination (which, I can’t emphasize enough, is really important), I needed to shift my perspective. Doing something imperfectly has way more opportunities for self-insight and happiness than just throwing in the towel. Embracing that has really helped me push through a lot of my doubts.

I’ve found a new kind of joy in the process, even if things get messy, because I know these are experiences that have real value and potential.

And building on each success — Doing The Thing, whatever it is — has helped my confidence grow. Because now, when I encounter moments in which I want to give up, I remember landing that job, or that cool thing I published, or that project I was so proud of, and I’m reminded that life is so much more exciting when you give yourself permission to participate, however imperfectly.

As the incomparable Jenni Berrett pointed out in this article, this isn’t about you being lazy or incapable — you, my dear reader, are just scared. And knowing that this is about fear, you can approach this like any monster under the bed. You can grab your flashlight (i.e., get whatever tools you need), take a deep breath (short inhale, long exhale), and look under the bed (or at least, take some small step in the right direction). You have to realize that there’s nothing to be scared of.

(And yes, sometimes we need to call a friend and ask them to remind us.)

Prove to yourself that this Horrible Scary Thing that will happen if you’re not perfect isn’t actually real. Prove to yourself that there are risks worth taking, even if it’s scary at first. Prove to yourself that you can do this so that, the next time you feel doubtful, you can remember the truth: There are no monsters under that damn bed.

You’ve got this.

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Essential readings to pair with this advice: 

ADHD Survival Guide: How I Stopped Procrastinating and Got My Sh!t Together

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Crazy Talk: Why Do I Keep Making Myself Sad On Purpose?

Crazy Talk is an advice column powered by your donations on Patreon, written by Sam Dylan Finch (that’s me!), and hosted by your fave queer blog, Let’s Queer Things Up! While I’m not medical doctor, I am a card-carrying member of Club Crazy, living the good life with a mood disorder, anxiety, and complex PTSD (gotta catch ’em all!). We’re talking all things mental health — trauma, happy pills, mood episodes, and whatever else you tweet me about. I’m kicking the stigma where it hurts, one question at a time. Check out last week’s column here.

Hi Sam, 

I struggle with anxiety and depression and I have for years. I’ve noticed that sometimes, when I’m at a low point, I’ll get sucked into listening to sad music, revisiting sad memories, watching sad movies, and basically making myself worse. I know that it doesn’t help, but it’s almost like a compulsion. What’s wrong with me?

Let’s start with what I think is a pretty important disclaimer: Not knowing your particular history, I can’t say with any certainty what drives you to make particular choices. I’m crazy… but I’m not a mind reader! I can, however, remark on my own experiences and observations. Hopefully that will give you some food for thought. Bonus points if those thoughts are then shared with a therapist!

I want to validate this for you upfront: Emotional self-harm? It’s a thing.

I find this question to be really relevant, as I used to do this a lot myself. At my worst, you could find me listening to angsty music; reading old, despairing blog entries; or camped out on my couch watching really triggering shows on an endless loop. No matter how many times my friends told me to give it a rest, it kept pulling me back in.

But as you’ve noticed, it never helps. It only sustained the depression that I was already feeling, often making it worse than when I started. So why did I do it? I have some theories:

Depression is predictable. While depression isn’t an ideal state to be in, it’s not necessarily full of surprises, either. I had a therapist once tell me that people who are dealing with depression can sometimes feel drawn to it, even unconsciously, because its familiarity and predictability feels safe. It makes sense, then, that we might engage in activities that sustain our sadness or keep us numb; we might feel afraid of the unpredictability that comes with doing something differently (I touch on this in my article about self-sabotage as well!).

I had unresolved trauma. Sometimes we force ourselves to relive the pain we’ve experienced because it’s unresolved. For me, I found myself purposefully triggering myself because I hadn’t yet found a way to accept and release the trauma I’d been through. This is what eventually led to my diagnosis of complex PTSD (which I wrote about here and here).

We might make ourselves feel pain because we’re hoping that, by re-experiencing it, there might be a different outcome. We’re usually looking for some kind of epiphany or realization to help things feel more conclusive, but we’re seldom able to do this effectively without guidance. Our brains are saying, “Hey! We have unfinished business here!” And in a way, they’re pushing us to relive something, hoping we’ll actually resolve it this time — but we aren’t always equipped to do so.

If your strolls down memory lane have become compulsive, triggering, and intrusive, it might be best to seek out a therapist that can help you process your pain in a more productive way.

I needed to feel understood/seen. Everyone wants their pain to be recognized and affirmed. We might seek this out by looking for representation in music, television shows, movies. I used to watch every TV show that featured a PTSD survivor, because I wanted to know I wasn’t alone; I especially wanted to see someone “overcome” that struggle so I could live vicariously through them.

I mean, you’re reading this article now. And you might have had a moment already of, “Wow, this is so me.” It’s a validating feeling, right? It makes a lot of sense, then, that we might subject ourselves to content that’s triggering with the hopes that it’ll make us feel validated, even if that validation is accompanied by pain.

I didn’t have the tools that I needed. When we gravitate towards unhealthy coping mechanisms, we’re often doing this because we don’t have healthy alternatives in place. I was most likely to seek out my triggers when I was already vulnerable — when I didn’t have a team of clinicians in place, when I was isolated from my support systems, when my meds were out of whack, and when I didn’t have a real treatment plan in place.

So where do you start? I have a list of free mental health apps that have personally helped me pivot away from emotional self-harming, and it can offer pretty immediate relief. If you don’t have a clinical team already (a therapist or psychiatrist), consider looking for those as well.

Remember: Be gentle with yourself. In all likelihood, you’re not engaging in these behaviors because you enjoy being depressed (I have yet to meet someone who does). This behavior is indicative of a lack of effective coping skills and unresolved pain. Rather than treating it as something that’s “wrong” with you personally, look at it as a red flag. This is your brain’s weird way of letting you know that you need additional support.

I know it’s easy to slip into the whole, “What the hell is wrong with me?” mentality. But what I’ve found to be true is that there’s always some form of method to our madness — or in this case, sadness.

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