Complex Post-Traumatic Stress Disorder (C-PTSD), also known as complex trauma, is a proposed diagnostic category of mental illness, one not yet recognized by the DSM, though more and more voices are shouting to have it included in the next edition. As its name implies, it is similar to PTSD, though crucial differences are to be noted.
Victims of PTSD generally experience one traumatic event (war, rape, disaster, or other life-threatening event); whereas C-PTSD victims experience repeated, ongoing traumatic events (continuous physical, sexual, and/or emotional abuse, day-to-day life in combat situations as a soldier, ordeals as POWs or in concentration camps), such that the victims either have no means of escape or feel as though they have none.
If one has ever read the Marquis de Sade‘s unfinished novel, The 120 Days of Sodom, or seen Pier Paolo Pasolini‘s film adaptation of it, Salò, the casual observation of the plight of the victims–adolescent boys and girls who are forced to indulge the paraphilias of four wealthy, politically powerful libertines–would cause one to draw the unmistakeable conclusion that the victims, assuming any of them survive the four-month ordeal, will each develop a severe case of C-PTSD. They are stripped naked, sexually abused, humiliated, force-fed shit, and made to endure numerous other torments, all for the sadistic pleasure of a duke, a banker, a judge, and an archbishop (the story is, in part, an allegory of political corruption).
Other differences between PTSD and C-PTSD include flashbacks (PTSD) vs. emotional flashbacks (C-PTSD), the former involving reliving the traumatic experience with the five senses, as if having been taken back by time machine to when it originally happened; whereas emotional flashbacks lack the physicality of the relived experience, and instead the painful emotions (fear, despair, anger) are re-experienced.
C-PTSD also involves many symptoms often not felt so much by PTSD sufferers, including the following: difficulty regulating emotions (explosive or inhibited anger, making catastrophes out of everything, etc.); difficulty relating to others socially, a feeling of being irreconcilably different from others; a lack of a sense of meaning or hope in life; preoccupation with the abuser (a sense that the abuser is all-powerful, while also feeling an urge to get revenge on him or her), overwhelming feelings of guilt, shame, and self-hatred; and dissociation, including the forgetting of traumatic memories.
Symptoms common to both PTSD and C-PTSD sufferers include nightmares, intense anxiety, emotional numbing, and avoidance of anything that, or anyone who, may trigger the traumatic memories. A veteran with PTSD will avoid places with loud noises, such as bursting fire-crackers, which may remind him of machine gun fire. A rape victim may avoid all romantic contact with men out of fear of a sexual encounter that would make her relive the rape. And a C-PTSD sufferer who has been in a concentration camp perhaps may try to avoid seeing anyone in a uniform, which gives memories of guards or prisoners in uniform.
When children develop C-PTSD as a result of ongoing physical, sexual, and/or emotional abuse, they may become clumsy, unable to concentrate, or lacking in empathy. Nervousness and fear can cause the clumsiness, self-hate and shame can cause the inability to concentrate (and vice versa, going in a vicious circle), and a lack of empathy can be the natural result of growing up in an environment devoid of empathy for the victim. “If they don’t care about me, why should I care about them?” is an attitude easily adopted.
Sensitivity to loud noises of any kind will be intolerable to victims of PTSD and C-PTSD. Startling noises can, if unconsciously, remind the victim of sudden slaps on the face, shouting, bombs going off, airstrikes, gunfire, etc.
I believe myself to be a sufferer of a mild form of C-PTSD, for I appear to have most of the symptoms. I must emphasize the word mild, for two reasons: first, having lived far from my emotional abusers for over twenty years has caused my symptoms to abate considerably; and second, I feel my suffering pales in comparison to that of people like Lilly Hope Lucario, whose wonderful website alerted me to this mental health issue. Perhaps I am wrong to say my suffering is less; after all, traumas are more a matter of being different than of being ‘lesser’ or ‘greater’ than each other.
I will now detail my symptoms to illustrate even further the experience of the sufferer of complex trauma.
Throughout my childhood, adolescence, and young adulthood, I was subjected to various forms of emotional abuse, including gaslighting from my mother, who fabricated an autism diagnosis out of thin air, independently corroborated by no psychiatrists (in fact, two psychiatrists I’d received therapy from said they saw no signs of autism in me); constant bullying and belittling from my older brothers and sister, from whom I’d received virtually no defence from my ‘loving’ mother; explosive outbursts of verbal abuse from everyone in the family, usually for only mildly irritating things that I’d done; and bullying from my classmates at school, from coworkers on the job, and strangers on the street. I saw no escape, anywhere, and this was all during crucial developmental years in my life.
Enduring this kind of thing from people outside the family wasn’t so bad as it was from within, because one expects more of a loving attitude from one’s own flesh and blood. I feel betrayed by the five I grew up with; in my early twenties, I’d fantasize about getting far away from them, escaping from Ontario and going to Quebec. When I ended up in Taiwan, my fantasy had come true.
Sometimes I remember those painful episodes from my past (which often included my brother, F., not only threatening and verbally abusing me with the shouting of four-letter words, but also slapping, shoving, and spitting on me, then gaslighting me about supposedly never having done anything wrong to me), and fantasize about what I’d say if I tried to stick up for myself; but the feeling of overwhelming power that my tormentors had over me meant I felt that asserting myself would be futile. In my fantasies, I’d get overly emotional, bursting with a rage I couldn’t control, even acting it out. My bullies almost seemed to be there, right in front of me and receiving my rage, instead of me really being all alone in the room. I’d snap out of it and end up feeling even more worthless than before, because of how foolish I’d feel, like that moment in Hamlet when the title character says:
“Am I a coward?/Who calls me villain? breaks my pate across?/Plucks off my beard, and blows it in my face?/Tweaks me by the nose? gives me the lie i’ the throat,/As deep as to the lungs? who does me this?/Ha!’swounds, I should take it: for it cannot be/But I am pigeon-liver’d and lack gall/To make oppression bitter, or ere this/I should have fatted all the region kites/With this slave’s offal: bloody, bawdy villain!/Remorseless, treacherous, lecherous, kindless villain!/O, vengeance!/Why, what an ass am I!” (Act II, scene ii)
I think these experiences I’ve had are examples of emotional flashbacks.
I have always had difficulty regulating my emotions, in particular, my explosive anger, something I learned from my family, since for them, blowing up was the solution to every problem. My wife finds it a terrible trial when I go crazy over every minor problem; but her minimal, controlled anger with my emotional excesses proves that my family’s explosive anger with me was not unavoidable–I hadn’t left them with no choice but to blow up. They just rarely considered other options.
Whenever I have a problem, or even contemplate the possibility of a problem, I tend to make a catastrophe of it in my mind; then, the problem usually gets resolved with relative ease, and I wonder why I got so upset about it. I’m a prophet of doom and disaster for my life. I lie in bed, imagining disasters befalling me, and my anxiety ensures that I often don’t sleep properly.
All that bullying from my family created bad object relations that resulted in bullying at school and elsewhere, causing me to have difficulty relating to others in general. The early relationships one has with one’s primary caregivers are crucial, for they provide the blueprints, as it were, for all future relationships. So if those early caregivers bully you, belittle you, and otherwise betray your trust, you take that with you and assume people elsewhere will treat you in the same way; for as a little kid, you scarcely know any other kind of relationship.
Though people with C-PTSD typically feel isolated from the world, none of us are islands. Every human personality is in symbiotic relationships with others of some kind or another, including the worst relationships that cause the loneliness of the C-PTSD sufferer. We internalize bad object relations, those of our abusers, and they frighten us away from the rest of the world. Those bad internal objects form the inner critic, an internalization of our abusive parents, elder siblings, bullying classmates, and anyone else who may have hurt us, and we ‘learn’ that this is just the way the world is.
These bad object relations haunt our minds like ghosts, like demons possessing us. WRD Fairbairn elaborated on this idea in his book, Psychoanalytic Studies of the Personality. In my analyses of The Exorcist and The Shining, I quote the relevant passages, so if you’re interested, you can look them up there.
In my mind, I do battle with an inner critic every day. I hear him accusing me of various things: lacking consideration for others when, for example, I’m riding my scooter to and from home (i.e., road rage); being mean or selfish; or doing stupid things in general. I feel myself fighting back against this inner critic, trying to show justification for my actions; and while many might agree with my justifications, my inner critic is never convinced, for he is an internalization of my ever-bullying family members.
My mother used the autism lie to make me feel irreconcilably different from others. She explicitly said to me, “You’re different,” in a heavily condescending tone when she rationalized excluding me from being involved with my sister, J., and her dying husband back in the mid-2000s (see my blog post, Emotional Abuse, where I discuss my sister’s husband dying of cancer, and my mother not wanting me to fly back to Canada to visit the family). The consistent lack of empathy the family showed me, whenever I tried to tell them of my pain, added to this feeling of being too different to fit in socially, as well as to my learned helplessness.
I’m obsessively preoccupied with my abusers. In their assumption that I don’t care about anyone but myself (one of their rationalizations for abusing me), my surviving family members (R., F., and J.) probably think that I rarely think about them. How wrong-headed such an idea is! I think of them, as well as my dead parents, every day without fail. I rarely think of them with kindness, though, just as they assuredly never give me such consideration, despite their bogus claims of loving me. I’ve dreamed of revenge, or punishment, more accurately, on my late mother and siblings, not as spite for spite’s sake, but to get them to understand the wrongs they’d done me; since just telling them wasn’t enough, I had to hit them over the head, so to speak, with a sledgehammer.
But even hitting them with that figurative sledgehammer wouldn’t be enough, for they will never listen, so assured are they of their own would-be righteousness. They feel all-powerful to me, impossible to get through to, for they’re always ready with a rationalization, a minimizing of their guilt, or an invalidation to silence me. Even my mother seems all-powerful in death, since her internalized object remains forever in my head, as Norman Bates’s mother is in his head.
My abusers’ omnipotence in my mind leads inevitably to undying feelings of shame, guilt, and worthlessness in me, even though it was their emotional abuse of me that provoked my disowning of them. No contact was the only way to keep them from meddling in my mind; and this was especially true of my manipulative mother during her last few years on this earth, for she’d been the ringleader of them all.
As a child, I had an odd habit of playing alone, in a solitary world of my own imagination, since my devastation over losing my childhood friend, Neil–from a 1977 move from Toronto to Hamilton–combined with the bullying I received in my new schools (as the ‘new boy’) and neighbourhood, made me feel powerless to make new friends (see Emotional Abuse for more on that story). On top of these problems, my brother, F., and sister, J., were bullying me, and my mother was gaslighting me with the autism lie. My escape into a world of imagination–along with a bad habit of talking to myself–seems to have been a mild manifestation of dissociation, or maladaptive daydreaming, a retreat from the painful world around me.
What my remaining family–my siblings, R., F., and J., as well as their families–imagines is my contempt for them (i.e., my refusal to communicate with any of them), is actually my need to maintain avoidance of them, to protect myself from future abuse. My ‘uncaring’ nature is really emotional numbness.
My mother claimed that my clumsiness was from Asperger Syndrome; I’d say it was from the complex trauma I’d acquired already from childhood, combined with a lack of playing sports, in which I’ve never had any interest. My difficulty concentrating, sometimes resulting in foolish mistakes or absent-mindedness, would be disparaged by the family as ‘stupidity’. My relative lack of empathy was something I’d learned, as a child, from those five stony-hearted people. On top of that, I can’t bear loud noises, which again is typical of a sufferer of C-PTSD.
I really do hope C-PTSD gets acknowledged in the next DSM. I also hope therapies for it improve, and that we sufferers get a chance to be healed by them one day. For now, though, we have to engage in self-care: this means being gentle with ourselves when we make mistakes, paying more attention to our strengths and talents, rather than our faults; it also means using self-compassion, or being a friend to ourselves, that kind, sympathetic ear we never got from those who should have given it to us. Other effective ways to heal ourselves include meditation and writing about our pain, as I have done here.
All those university students who complain about how exposure to controversial political opinions is “triggering”, and claim they need “safe spaces” so they don’t have to be exposed to ideas they don’t like, should consider redirecting their wrath towards its far likelier cause–an emotionally abusive or neglecting family. Research has shown that in the U.S., such family dysfunction is almost universal. Taking one’s anger out on people who have nothing to do with it not only fails to solve one’s problems, but also adds to everyone’s.
When we feel pain, we must take it to its source, not displace it onto people or things we only associate with the source of that pain. Bad object relations with abusive and/or neglectful primary caregivers is a common source.