A discussion about C-PTSD

[JNChell]

Hello, friends. When I finally took the plunge and made my first post here, I was in very bad shape and in a very dark place. I can say with confidence that I’m not in that place anymore. I finally understand myself and I’m moving forward. I was very high on the spectrum for C-PTSD when I found this community. I didn’t yet know that I was suffering from the condition and that  I was extremely triggered. I often feel a lot of guilt when I read here because I’ve presented with extreme symptoms that look like BPD. Becoming suicidal, destroying my property, dissociation, anxiety, depression, etc. when I ruminate about my symptoms, some no longer exist, I try to ground myself and look at the positives that I possess. Self awareness, empathy, compassion and the like. I also focus on how I’m gradually beginning to feel okay in this new skin as I shed the trauma and abuse. I’ve been feeling uncommonly calm recently and it feels good. Maybe I’ve been diminishing the cortisol as I’ve been pounding the weights with authority again. My muscles hurt, but I feel really good.

This condition is a new angle when it comes to complex trauma. Experts are bringing a new theory to light that many of the disorders that are discussed here are subsets of one common denominator. Complex trauma. I’m curious about what others think about this framework. Could it be more helpful in the therapeutic community in viewing complex trauma as just that without all of the subsets under an umbrella, or is the current momentum of diagnosing the subsets the right direction to continue?

I posted here because this board is a wealth of knowledge when it comes to PTSD/C-PTSD. I can spot it a lot while reading throughout the boards, but this board has a real grasp on it.

Anyway, I wonder if the paradigm shift to treating complex trauma as a whole, as opposed to trying to determine complex trauma and further outline it, would be beneficial for the people that suffer from it.

[CautiousHopeful]

Thanks for sharing your thoughts and experiences JNChell. It is great you are experiencing calmness and feeling good   Yes exercise really helps mop up the cortisol, burn off excess adrenaline etc. I feel like when our ancestors were hunter gatherers they did this all much more easily, because of the daily imperative to move to get food. Now our lives are so sedentary for many of us, and if we've had trauma as well, it's like we are not getting the necessary discharge of this trauma from our bodies.

I think the question of whether to look at things from the point of view of an overarching C-PTSD framework, or whether to focus on the subsets within that framework, is an interesting one. I think all categories are an attempt to classify something, but will always be to some extent approximate. The Diagnostic and Statistical Manual of Mental Disorders is itself a construct that changes with every new edition, so particular conditions have certain traits either added to or removed from them, and new categories of conditions are named while others are no longer used. I don't think C-PTSD is yet formally recognised in it, even though it is commonly recognised among many trauma therapists.

In my situation I fall into a C-PTSD category, while my mother, although undiagnosed, shows BPD traits, but could also be said to be C-PTSD as well, whereas I don't seem to have the BPD traits she has (splitting where people are all good or bad, acting out in sudden volatile rages etc). I do at times experience some emotional dysregulation, but this tends to turn inwards and is not expressed outwardly towards others.

Having read quite a bit about trauma neurophysiology, it all seems to come down to a dysregulated autonomic nervous system. I recently read an article about a neurophysiology study of people with BPD who were shown some videos with emotional content (with supports in place in case they became too distressed) and their physiological responses were compared with other participants without BPD. Those with BPD activated mobilisation responses such as fight-or-flight based on perceived threat as they started to emotionally dysregulate, while the non-BPD participants went in the opposite direction and were able to self-soothe themselves and activate the parts of the nervous system associated with emotional connection. It's a technical article but that is the gist I got from it, which is here if you want to see it: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2082054/ It relates to interesting work done by a guy named Stephen Porges who has developed something called Polyvagal Theory, whereby the autonomic nervous system is always (beyond our conscious awareness) scanning our environment for safety or threat (he calls it neuroception). If it perceives safety it switches on the social engagement system with the associated bonding and self-soothing neurochemicals etc, but if it perceives threat it switches off the social engagement system and becomes hypervigilant in relation to perceived threat, and if a threat seems insurmountable we can then go into a freeze, dissociative state. Hi gives a 10 minute explanation of it here: https://www.youtube.com/watch?v=ivLEAlhBHPM

I think pretty much everyone with complex PTSD has this tendency towards hypervigilance in that we've been through experiences that have more than understandably made us this way. The direction each of us might then go in may vary somewhat, so that some may get diagonsed with a certain type of personality disorder and others with another personality disorder and others are defined as complex PTSD but not diagnosed with a subset. I think there may be value in understanding C-PTSD plus all the subsets as types of autonomic nervous system dysregulation, that will vary from person to person as to what symptoms present from that dysregulation. I sometimes wonder if people with BPD understood what is really going on in their bodies that they would actually gradually over time become more aware and self-reflective about how they behave towards others and why this is happening. A lot of psychological definitions of disorders talk about the behaviours that present in them, without explaining underlying mechanisms for those behaviours.

It's helped me a lot learning about trauma neurophysiology anyway, in that I realise my body does what it does to try to protect me. My default state has been fear my whole life, so I am gradually trying to unlearn this and develop self-soothing skills. I do wonder if treating C-PTSD as a whole may be more helpful than the subsetting of things in a formal way, and it might help all of us wherever we sit on the trauma spectrum, to realise what our emotional and physical minds-bodies are doing based on experiences of trauma. At the same time it may still help to have a category such as BPD because of the specific traits that tend to manifest there, but also to keep the big picture that we are all human beings with vulnerabilities who may sit somewhere on a trauma spectrum.

There is a lot of stigma attached to BPD, so in some ways maybe some people with BPD traits might have more chance of improving if they were more defined under the banner of C-PTSD, if that makes sense? They may feel less stigmatised perhaps?At the same time there are specific challenges with BPD traits, and I think that's why a forum like this is so valuable, as we are all struggling (or have struggled) with a relative with it, so having some kind of definition around it does help. In fact, the BPD category may be more useful for the relatives, partners and friends of people with BPD than the BPD person themselves.

So perhaps C-PTSD can be seen as a broad spectrum that has variation within it? Whether that variation is further defined as anything else may need to be considered on a case by case basis, as humans are so complex, and personality disorders are attempts at understanding what is going on, but can also be restrictive and even distort perceptions of a person if a diagnosis doesn't quite fit, or lead to stigma in some cases which might be counterproductive. I think a nervous system affected by trauma does have an innate capacity to heal, but it does take time and it helps to have supports in place, and I guess it comes down to whether a certain diagnosis is actually helping a person or not.

So go my thoughts... Sorry, that was a bit longer response than I intended!

[HappyChappy]

Anyway, I wonder if the paradigm shift to treating complex trauma as a whole, as opposed to trying to determine complex trauma and further outline it, would be beneficial for the people that suffer from it.

Good question JNChell. I can confidently say that this shift in the UK is driven by cost. Our most common PTSD treatments are for the emergencies services and army. They say you need weekly CBT Therapy equivalent to the length in time the abuse lasted. CBT examines each of your traumatic incidents, corrects your thinking about them and then lays the thought to rest. The more incidents you had, the long that will take. EMDR on the other hand, works well for PTSD but has anyone here found it accelerates your healing ?

The NHS allows 8 to 12 weeks of CBT. Having gone through this, I found the knowledge of BPD among those dealt with was very basic. In fact a very senior consultant told me “Work through a book, that’s all these therapist will do.”. Offering 16 years to one CPTSD person, would treat between 70 and 104 other patients. Also they priories the emergency services, who’s period of trauma normally falls within 12 weeks. Considering how popular being a Dr or Politician is with Narcissists, mental health in the UK has long been known as the “Cinderella service” so much so that some empathetic Drs will prescribe mental health medication using physical health budgets.

CPTSD was initially discovered in hostage victims, so 16 years is less common than say 12 weeks. I believe we children of BPD fall between the gaps somewhat if you don’t have private health insurance. Hence why this forum, or other forms of group therapy are a way forward. As a point of interest the NHS favours group therapy with BPD, they would say because its works better, but the NHS never admits to doing things due to financial pressures, as people would always campaign that point. As it is the white middle class get far more out of the NHS than lower income groups that don’t  have the same level of entitlement or means to campaign.

CautiousHopeful and WLF you both mention the similarities with BPD. But for me the important difference is we have empathy and are more likely to damage ourselves than others. We are more likely to help than be selfish. In short we are more human. There is a chasm between the two aliments, woolied mainly by BPD preferring that label to BPD, which in itself indicate there must be an important difference.

[CautiousHopeful]

Hi Happy Chappy,

Yes I think you are right in saying that we are more likely to damage ourselves than others, and I think that's an important distinction to make. I guess I'm seeing things through the prism of my own experience, as when my uBPD mother is not in a state of major emotional dysregulation, she can actually be empathetic, but at other times she can act out in very cruel ways. This is a profoundly confusing dynamic I've been trying to come to terms with my whole life. Certainly I have damaged myself in my life rather than others, and I'm only just beginning to learn not to do this. It still puzzles me that she and I both had trauma in childhood, but she has taken that trauma out on me by acting out in the same way her mother treated her, but I have never taken out my trauma on anyone because I would never want anyone to suffer like that. I don't know if I will ever fully understand that riddle.

As you describe, I think complex PTSD falls between the cracks and gets overlooked, as PTSD is most recognised in the emergency services and military. CBT seems to be a major go-to therapy on a kind of cost-benefit analysis basis, but I feel that for many of us it fails to understand the nature of trauma in the body. It is about trying to use conscious cognition to change behaviours and symptoms in time-limited sessions, but as I know from my life, my conscious functioning has been hugely comprised by trauma from early life, and it is like trying to heal yourself with part of yourself that is already damaged and struggling to get by. A lot of my trauma is preverbal, before I had the conscious ability to even use language to make sense of anything, so CBT just doesn't reach those parts of me. But there are some people who are helped by it, so I think it depends on the nature of the trauma and each person's circumstances.

I've been learning about body-oriented therapies that work on healing the nervous system, which for me make a lot of sense. They are a kind of bottom-up approach rather than a top-down approach like CBT. I'm also interested in animal-assisted therapies as well, as I think my trust in humans has been so damaged that I feel more comfortable with animals. But of course most therapies cost money, so that makes a board like this so important for people struggling with particular issues.

[HappyChappy]

she can actually be empathetic, but at other times she can act out in very cruel ways. This is a profoundly confusing dynamic.

Hey CautiousHopeful,

High functioning BPD can fake empathy. I’ve seen it done when they make a big fuss over a pet or child. But as a BPD is quit child like, that’s easy for them to do. If your mom has true empathy, then she sounds more Bi-polar than BPD. Bi Polar can be very Jeckle and Hyde but the obvious distinction is they will feel remorse or true guilt for their bad behaviour. Where as a BPD will only ever admit to being at fault if it favours them (i.e. hardly ever). Also there’s no guilt. Your point about why does your mom turn it outwardly and damage others, that is very BPD, and it does suggest no to low empathy. Its done in part to manipulat us, the treat him mean and keep him keen approach. It works really well, unless you have a contious, unless you feel guilt.

You makes some interesting points CautiousHopeful.  Having studied psychology the theory is that we use neural networks to remember and process cognitivly. These networks are continually adjusting to new information. CBT adjusts these networks, by revaluating memories. So technically it doesn't matter if the abuse was nonverbal, or even if you remember it, what matters is that your memory holds healthy repsonces to the triggers, rather than the unhealthy PTSD ones.

Healing the nervous system, sounds more like a physical healing (also important) but how does this effect cognition ? I’ve heard of the animal assisted therapies, caring for horses is one that comes up a lot. But here again, exercise is good , because it creates endorphins, but thats not a cure, just a short term shot in the arm. So the underling issue is still there. In fact weed is commonly used by those with PTSD as it can lower anxiety. The main danger with that is it stops people addressing the underlying problem. A bit like alcohol.

I have often read that being with nature helps. In fact any connection that makes us feel part of something helps. A primival thing. It goes back to Maslow triagnle of needs. We need to feal safe and fed, the two most important things. Interesting my bro is a covert NPD, and they are known to attack those two things. He's tried several times to get me sacked and also evicted. He would sell his grandmother, he'd even dig her back up if you paid him. His lack of empthy was way more apparent than my BPD mom, probably because a NPD can seem cold and distant, but a BPD can appear full of emotion. They cry for themselves, they feel sorry for themselves and then pretend its for others.

[Harri]

I read the abstract and will tackle the full article later CautiousHopeful but I want to say thank you for posting this.  I think it is very relevant to those of us on this board and who are dealing with a history of trauma.

The youtube video is a must see also.  I can't recommend it enough for those of us who get upset with our self for shutting down or not fighting back.  Or even for fighting or fleeing.  Understanding this (neuro-ception- sp?) is often an automatic response that occurs without us being aware gives us a chance to change the narrative we have formed about our own experiences.  One other thing he talked about was that once we know

One of my biggest hurdles was and is the fact that I allowed the sexual abuse to continue for so long.  The more knowledge I have about the way my brain and body work to protect me, the better.

Thanks for sharing!

[JNChell]

Hi, CautiousHopeful. Thanks for joining the thread. I’m familiar with the DSM and that C-PTSD isn’t a diagnosis within that manual thus far. As you said, it changes with each revision.
As studying trauma evolves, it should change. Hopefully for the better.

Another point that I relate to, as you and HC have discussed, is that we will hurt ourselves. We turn inward. I relate to this, but I’ve also lashed out verbally when I felt cornered.

I’m completely on board with you that complex trauma causes hyper vigilance. How couldn’t it?

I’ve also learned that trauma is stored in the body. My T has asked me if welts or bruises have shown up on my body while processing. That hasn’t happened. The body stores trauma.

I agree with the nervous system being affected. I think that it’s one of the first things to be affected if the abuse is early and onset into adolescence.

Its bedtime.

[HappyChappy]

CautiousHopeful thanks for sharing the videos about neuroception. It explains why we dissociate, but are we aware of any treatment (covered by insurances) other than talking therapies that corrects this ? ( please say eating chocolate is the remedy ) . Is it about exercises and being close to nature ?

[CautiousHopeful]

Hi Happy Chappy, Harri and JNChell. Thanks for all your replies and comments!

Thanks HC for the thoughts on empathy. I'm still trying to figure this out. I don't think bipolar quite fits my mother, and so much of the BPD patterns I've read about do fit. However, she does seem to, at least sometimes, show genuine empathy. At other times it seems more loaded and basically about getting her needs met from me. Also, she can say some horrible things to put me down in front of others, such as saying to family friends that I have no confidence even though I'm in the room with them. The family friends pick this up as not normal and look at me straight away out of concern that this might be upsetting for me, but my mother just carries on like doing this is fine and normal, just as she would also scream crazy abuse at my dad in front of guests. I would be seriously embarrassed to behave this way, but she carries on as if it never happened, even though everyone else is now feeling like they are on tenterhooks. It's like she splits off into some weird universe that is compartmentalised from reality. But when she is not in such a split off state she can sometimes say wise and insightful things and show kindness. It is very confusing. I suspect I sometimes perceive empathy where it might actually be manipulation.

This has happened with certain friends who for a long time I trusted only to eventually realise they were getting their needs met through me and I was being exhausted, drained and used by them, and it took me a long time to realise. But they would act out like they were being nice and kind to me, as long as they were getting what they wanted (attention, someone to complain to about everything in their life, emotional support etc). However, when I've withdrawn from these situations when I've finally seen red flags (that most people would have picked up way earlier) they have become hostile and even abusive, and then I've really realised for sure what I'm dealing with. Still learning in this area!

And Harri I'm really glad you got something from the video on neuroception. Yes it is very much related to SE. It's certainly helped me to understand that all along my body has been trying to protect me. I think it's so important in your situation not to feel bad in anyway for the abuse continuing, and that symptoms like the dissociation/freeze response that are natural survival responses are completely understandable   The article there on a study on BPD is quite technical and is from 12 years ago, but I think at the time it was the first attempt to monitor neurophysiological responses in BPD relative to non-BPD people to try an understand what is going on with them.

And JNChell thanks for your comments too. It is totally understandable if you lashed out when cornered. I think when we have had harrowing experiences we go into survival mode. My dad was not BPD but he did have explosive rages which could involve a sudden random physical attack on me when I was a child for no reason, and to this day if someone raises an arm near me, even just to scratch their head, I will often flinch and duck down like I am waiting for the hit. It's interesting what your T said about asking whether welts or bruises appeared when you were processing trauma. I read something similar in a book by Robert Scaer called the Trauma Spectrum, where if someone was hit or held down say on their shoulder, then when recalling their trauma their skin might go red in that area, as the body actually carries memories of where it was hit. I don't think I've had this, but if under distress I see like a video of myself being punched really hard like I deserve it (and this goes back to an incident when I was five when my dad sent me flying with a major hit that crashed me into the wall and said 'sorry but you deserved it'). I am still trying to heal this part of my psyche.

And finally HC when it comes to therapies I have looked into a couple, and I really wish it was eating lots of chocolates  . There is a therapy called Somatic Experiencing developed by a guy named Peter Levine, and it is working exactly with the neuroception stuff that Stephen Porges is talking about. It's based on the way trauma can get stuck in our bodies, say following a car accident, an assault, war trauma etc. The idea of it is to first develop a sense of safety in the body, locating somewhere that feels safe and is not painful. From this island of safety we can gradually learn to tolerate the visceral sensations from the part of us where trauma is trapped, and through a very gently titrated process, pendulate between releasing the trauma and returning to our island of safety, so the body can finally do what it needs to do (which is often shaking, a natural trauma recovery response, or finishing a self-protection response that we never got to enact at the time, such as running to escape a dangerous situation where our legs might move up or down as if running, or push away an attacker). There's quite a few videos out there about it. This one is a 24 minute one on Levine's work with a war veteran https://www.youtube.com/watch?v=rTrqLsMsF6s and he also talks about how trauma gets trapped in the body in this one https://www.youtube.com/watch?v=fiq0sILHiJs One of the things I learned from a book I read of his (In An Unspoken Voice) is that the trauma circuits of the brain and the curiosity circuits of the brain can't work at the same time. So he also works at getting people to notice with curiosity what is happening in the body, which quietens down the trauma circuits and helps the body move towards recovery.

Another therapy I've looked into is Trauma Releasing Exercises by David Berceli https://traumaprevention.com/ This uses natural tremoring or shaking mechanisms in the body that help to restore homeostasis. He does this work all around the world with traumatised communities, such as people in war zones etc. It can look quite bizarre, but animals in the wild who have had a severe trauma and gone into the freeze response as a survival mechanism, often tremor like this when they are coming out of it. They might have to cycle back up through different stages, including sympathetic arousal (fight-or-flight), in order to come back to the calm, rest-and-digest parasympathetic state. I think for us humans, this may be why we encounter anxiety when we come out of dissociation, and we have to go through this a bit before we come back to homeostasis.

You mentioned being in the UK, so I am not sure about insurance cover there with these things, but I found there is a UK Somatic Experiencing site who might be able to answer that if you ask them https://www.seauk.org.uk/ and you could probably get that info from the TRE website also. Of course these therapies may not be for everyone, and some people may prefer therapies that are more cognitively-based. I'm planning to try a Somatic Experiencing session soon. I may not be able to afford it on an ongoing basis, but it might be a good starting point. I think C-PTSD is a bit different to PTSD as it is more complex to release trauma that's occurred over a long period of time, as opposed to a singular event.

Sorry I think I've totally hijacked this post! But I hope maybe some of that info helps.

[CautiousHopeful]

Hi again HC, just realised I didn't answer what you asked about exercise and being in nature. I think these most definitely help. I regularly go into nature and it is my safe place where I can start to breathe easy (as a lot of the time I breathe too shallow which I know is a trauma thing). I also go to the gym but do it at my own pace (rather than working with a trainer or doing classes), as I have a pain condition and want to be in control of how much I do. So nature and exercise are definitely in my toolkit and I think they can do a lot to help regulate the nervous system better. Bizarrely I often start to compulsively yawn at the gym, after doing cardio when I am doing weights. Apparently when we yawn our parasympathetic rest-and-digest response is activating which is a good thing, and must mean that this exercise at the gym is actually relaxing me. Much of the rest of the time I can't reach this level of relaxation.

[JNChell]

Hey you all. Sorry I haven’t responded to you properly yet. I’ll get to it when I have some time. I had to stop by and share this Ted Talk. I’ve been listening to it while doing my chores. I hope you can take something from it.

Charles Hunt
Adept at leveraging transparency to inspire and get results, this former College Recruiting, Talent Management, Diversity, and Supply Chain leader left the corporate world to fulfill his vision of building unbreakable spirits and cultivating resiliency for those who, like him, have The Audacity to Succeed. He helps students & young professionals build resilience, believe in bigger and greater for themselves, and create the educational, financial, and professional plans to get there.

As the founder of The Audacity Firm, LLC, his firm provides professional & personal development programs, coaching, and events to equip clients with financial literacy/education, workforce readiness, professional development, and career planning tips, tools, and strategies to LIVE, DO, and BE BETTER.

https://m.youtube.com/watch?v=3qELiw_1Ddg

[CautiousHopeful]

Hey JNChell, thanks for the great TED talk. I just watched it. I liked what he said about our unbreakable selves, the parts of us that remain strong no matter what, but also that there has, are and always will be challenges in our lives, and using resilience to face that reality. A teacher at a meditation class I sometimes go to recently said something similar, that there is part of us that remains untouched by whatever we have been through that can carry us through 

[JNChell]

Thanks for bringing facts and stats, HC.  :cursing:ing costs. Sorry, “costs” are frustrating factors. There’s a quote to the effect of being hungry but not being able to eat our money. Money takes presidence over humanity in this current society and it’s disheartening to see. Real values are an underground culture these days. I’m grateful to know your humor and insight.

[JNChell]

CH, thanks for your insight and for sharing your experiences. Especially, thanks for relating. It always helps to know that I’m not the only one. It’s easy to get lost in thoughts like that at times. I appreciate you and your strength and wisdom.