Tag: C-PTSD

5 Ways to Lovingly Support Someone With C-PTSD

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I was watching Disney’s The Hunchback of Notre Dame when I felt myself starting to panic.

Right from the start, seeing Quasimodo be the recipient of so much gaslighting – being told that the world wasn’t safe, that he would never be accepted or loved, that Frollo had only his best interest at heart – struck a jarring but familiar chord with me.

Quasimodo’s isolation in the bell tower, unable to leave or connect with the outside world, eerily mirrored the control and entrapment I’d experienced years before.

“Hey,” my partner said softly, pausing the film. “Sam, you’re safe. It’s okay. But if this is too much, I’m more than happy to watch something else.”

In the midst of an emotional flashback, my fears were disrupted by my partner’s tender assurances. I could only nod. Without another word, my partner put on Steven Universe – my go-to show, having watched every episode at least three or four times, its familiarity and charm never failing to calm me down.

And I breathed (slowly and deeply) as I was lulled back into a sense of calm, my partner sitting quietly beside me. Sometimes seemingly “little things” can stir up something in survivors that becomes difficult to process in the moment.

But if I’ve learned anything over the years, it’s that sometimes our greatest healing can happen when we allow ourselves to love and be loved.

When my therapist told me that he believed I was struggling with C-PTSD, countless pieces of the puzzle rapidly clicked into place for me. The flashbacks, the fear of abandonment, the hypervigilance, the distrust, the dissociation, the deep and abiding emotional pain that I could swear I was born with – with one diagnosis, all of it seemed to make so much more sense.

Complex trauma, while not officially listed in the DSM-5, is still widely recognized by clinicians and survivors alike as a form of PTSD that occurs due to prolonged exposure to trauma – particularly interpersonal trauma, in which there was abuse and/or neglect that led to a significant imbalance of power.

Many culturally competent clinicians and survivors alike extend this framework to include the oppression that marginalized folks face, which can so often be traumatic.

My understanding of C-PTSD is largely influenced by the work of Pete Walker, a psychotherapist and survivor of complex trauma, whose words and affirmations helped bolster my own recovery (his book on complex trauma in childhood is a must-read).

While I am in a much better place with my trauma history, my loved ones – especially close partners who don’t share this kind of history – sometimes struggle to know how best to support me. I’ve had time to read, engage in trauma-informed therapy, and connect with community around these issues, but my loved ones haven’t necessarily done that work.

Friends and family of folks with C-PTSD don’t always have the same level of education and understanding that survivors do. That’s why I wanted to create this quick resource – to serve as a jumping off point to how to better support trauma survivors.

If you aren’t sure how to support a loved one with complex PTSD, here are some suggestions to start with.

1. Recognize That We Don’t Always Know Our Triggers, Either

Whenever I disclose to someone that I have C-PTSD, they often try to support me by asking, “What are the triggers I should know about?” I think this is a great question to ask if a survivor is aware of what can cause a flashback, but the reality is that many of us can be triggered on a level we aren’t even aware of.

That’s why it’s good to not only ask what triggers us but to ask what you can do if we find ourselves triggered.

What does your loved one find helpful? Is there something you can say, a kind of safe touch they want from you, or something else that’s comforting?

I use this guide to manage my flashbacks, and I think it’s a good point of reference for anyone who wants to help someone work through a particular episode. Give it a read, and invite your loved one to share what’s useful to them and what isn’t – assuming that this person is ready and able to have the conversation with you.

2. Encourage Us to Express Our Grief and Anger

A lot of trauma-informed therapists will say that survivors have a difficult time grieving the trauma they endured, and sometimes have difficulty expressing anger.

One of the best things a loved one can do is hold the space, then, for survivors to experience these emotions and express them in healthy ways.

Not sure how to do it? Here are some suggestions:

  • “I noticed that this conversation is bringing up a lot of anger for you. Do you want to share why?”
  • “What happened to you is absolutely unfair and unjust, and I’m open to hearing more if you want to talk about it.”
  • “If you need to cry, that’s okay. I can stay with you or I can leave if you need privacy. Just let me know.”
  • “Your feelings about this are absolutely valid. I hope you know that you’re safe now, and you’re allowed to feel those feelings.”

The key here is to (1) validate those emotions as real and understandable, and (2) open up a space in which those emotions can be felt and expressed more deeply.

Sometimes these conversations will happen when the trauma is referenced directly. Other times, a seemingly unrelated event can trigger a flashback. In both cases, it’s important to give survivors the space to navigate their feelings without judgment.

3. Let Us Vent Without Trying to Fix Things

One of the biggest mistakes that my loved ones made was that every time I tried to process aloud what I had been through, they would interrupt with advice on how to “fix” things.

In my recovery, I’ve found that coping with C-PTSD is not so much about fixing something. For me, a big part of the work has been about breaking through the denial of what I’d been through, and learning to love and protect myself in a way that I’d never believed I could.

I didn’t need to change or “fix” my relationship with the people who’d hurt me – more than anything, I needed to work through the ways I internalized that harm so I could, in turn, address the ways I’d been hurting myself.

More than anything, I’ve needed to be able to talk about what happened and feel seen when I did, so that I could begin to process what I’d been through and treat myself with more compassion.

And while every survivor’s recovery will look different, remember that when we want advice, we’ll ask for it – but what we need more than anything is your compassion.

4. Give Us Permission to Be Imperfect

For a lot of us with complex trauma, we struggle with perfectionism. Pete Walker calls this the “inner critic,” which so many survivors grapple with in recovery.

For some of us, perfectionism was a coping mechanism run amok, in which we desperately tried to better ourselves to “earn” the love or attachment that we lacked by correcting our supposed shortcomings. (Spoiler alert: No amount of perfecting ever changed this, but we continued trying anyway)

This “inner critic” can also be the voice we internalized, like when “you’re a bad child” suddenly becomes “I’m a bad child.” The external criticisms or neglect we endured suddenly became the mantras we took on as we were further and further traumatized.

Which is to say, a lot of survivors who are dealing with complex trauma really struggle with being imperfect.

For me personally, I believed for a long time that if people truly got to know me, they wouldn’t be able to love me. So I spent a good amount of time trying to make myself “better,” with the hopes that I would someday be “good enough” for the people in my life.

I think this is why it’s powerful when our loved ones give us permission to be imperfect. Some examples:

  • “You don’t have to be perfect for me or for anyone else. I’m going to be in your corner no matter what.”
  • “It’s true that you make mistakes. But you always work hard to make things right, and that’s what matters.”
  • “In my eyes, you’re already lovable and you’re already worthy.”
  • “Trust me. If something’s wrong, I’m going to tell you, and I promise we’ll work through it.”

An important thing to remember is that you’re responsible to your loved one, but not for your loved one – so their perfectionism, self-esteem issues, and unresolved trauma aren’t yours to fix.

Instead, support your loved one as they do the work to untangle those issues for themselves. That begins with simply letting them be human – creating the kind of space where you can both show up as yourselves, without the “all or nothing” expectation that the only people worthy of love are perfect people.

5. Educate Yourself About C-PTSD

Not sure where to go? A great place to start is this FAQ about complex trauma. While it’s written with survivors in mind, it’s still extremely useful for loved ones who aren’t sure what this C-PTSD stuff is all about.

I also think that this Wikipedia article on C-PTSD is one of the better online resources, along with this book that I mentioned earlier on in this piece.

Ask your loved one if there’s a particular resource that they’d like you to familiarize yourself with, or if they’re open to having a conversation about how complex trauma affects their life and relationships. If they’re interested in a conversation, make sure that you’re committed to holding the space for whatever emotions might arise, and that your approach is validating and compassionate.

Pete Walker also has a great resource on the concept of “co-counseling,” which offers a nice structure on how to have these conversations in a productive and safe way. I’d highly recommend it. You can also reach out to a therapist to facilitate this conversation between you if more guidance would be helpful.

Part of supporting a survivor is being open to learning and realizing that this learning is an ongoing process, rather than a single event. There’s no singular article or resource that will give you the expertise needed to support someone – rather, in the process of building trust between you, you’ll teach each other how to create a mutually safe and supportive space.

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When my partner paused The Hunchback of Notre Dame, it was a simple but important gesture that said to me, “Your trauma is not a burden. I’m here to support you.”

More than anything, I think survivors withhold a lot of what they’re going through for fear of being “too much” – but when invited, we can find the kind of safety necessary to open up and allow our relationships to truly grow.

If you’re looking to support a survivor, it can be as simple as noticing. As simple as validating us. As simple as saying, “I believe you.”

All I really wanted was someone to believe me. And every time someone does, I can feel a part of me learning to trust again, learning to love with abandon and without fear.

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This piece that I wrote originally appeared at Everyday Feminism.

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

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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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