Episode 4: The Intricacies of Complex PTSD
Episode 4: The Intricacies of Complex PTSD
Episode 4 is a solo episode laying down some groundwork for future shows. Alyssa discusses a newer concept that is used to describe those who have survived a more specific type of trauma. It’s called Complex trauma, which often leads to Complex PTSD. Alyssa introduces a resource where people can apply for grant money to fund their treatment for PTSD, called: www.beautyafterbruises.org Click here to go to the Light After Trauma Patreon page Transcript:
Alyssa Scolari: Hey everybody, what is up? Welcome to the Light After Trauma podcast. I’m your host, Alyssa Scolari. And this is episode four. I’ve got a solo episode lined up for you today. We’ve got some pretty interesting stuff to talk about, so I’m just going to get right into it. I know that in episode one, we discussed PTSD and trauma and the symptoms of PTSD, the longterm effects of trauma.
[00:01:16] If it can go untreated. But in this episode, I want to break it down a little bit more because I think it’s really important to talk about this new disorder or almost like a sub category of trauma that has been getting a lot more attention recently. And it’s called see CPTSD. The C in CPTSD stands for complex.
[00:01:38] So you’ve got standard post-traumatic stress disorder, and then you’ve got complex post-traumatic stress disorder. Now in episode one, we talked a little bit about the DSM, which is basically the book. That’s the holy Bible of the psychiatric world, where all the disorders that could ever exist are listed.
[00:01:58] CPTSD is actually not listed in the most recent version of the DSM. So that’s how new it is. It hasn’t even been distinguished from standard PTSD. In fact, it’s not even something that’s recognized by most doctors or any insurance companies at this point. I think there’s a lot of work being done right now to bring more awareness to CPTSD.
[00:02:23] And on the surface, it seems like they’re very, like the two disorders are really similar to one another. Both can be developed after some sort of traumatic event and both include a lot of the symptoms that we talked about in episode one, like flashbacks, exacerbated startked response, difficulty sleeping, symptoms of chronic anxiety, depression, nightmares.
[00:02:49] But the main difference between PTSD and CPTSD is that the complex means that we tend to internalize the trauma. So what does that mean exactly? There’s a lot to it and PTSD, I by no means, want to imply that it’s not something that’s a serious disorder. It’s very serious. It definitely has a much higher suicide rate.
[00:03:19] But complex PTSD is usually something that occurs as a result of long-term endured trauma. So for example, let’s say somebody who is an adult gets into a car accident and they survive. But the other person that was in the car didn’t survive. That person could develop PTSD. This wouldn’t necessarily be complex PTSD because it is a one time incident.
[00:03:51] It’s not something that went on for years. And a lot of people who develop CPTSD endured trauma that had them feeling as if there was no end in sight to what they were going through. Now I would say that for the most part, those who end up developing, CPTSD, usually experience their trauma in their childhood.
[00:04:19] However, that’s not always the case. So, for example, veterans, people who go off to war and are away for extended periods of time with seemingly no end in sight. They are also prone to developing again, not just the standard PTSD, but complex PTSD, because I’m sure there are many times when soldiers are at war and they may think that the only way out of the situation is if they actually die.
[00:04:48] As a whole though, adults are much less likely to develop complex PTSD because as an adult, your brain is already fully developed. So it is expected that you have more resources and more tools at this point in your life to be able to cope with the trauma. It’s the childhood abuse survivors who are at greater risk of developing complex PTSD, because their trauma that they endured plays a monumental role on shaping their overall outlook on life.
[00:05:21] As they grow into adulthood. And again, I think I mentioned this in episode one, but I just want to point out it’s not necessarily the traumatic event itself that causes PTSD or CPTSD. Rather, it’s the lack of support that often comes after the event that causes the disorder. So for example, let’s say you have a family of four mom, dad, and an eight year old and a ten-year-old and the ten-year-old dies of leukemia.
[00:05:51] That is absolutely considered a traumatic event in childhood for that eight year olds. But that doesn’t necessarily mean that eight year old is going to develop PTSD or even complex PTSD. It’s what happens afterwards that will determine the outcome for that child. So in my experience, when family members lose a child, They handle it in usually one of two ways. And one of those ways is they talk about it openly. They go through the grieving process. They grieve together. They use that grief to bring them closer. If they feel that it’s necessary, the family goes to therapy. The remaining children go to therapy and this overall puts the child and the family members at a lower risk of developing PTSD.
[00:06:46] And then on the other hand, I’ve seen families who lose a child and that starts the process of them ultimately falling apart. Mom and dad don’t get along. They’re fighting all the time. Nobody ever talks to the other children or the other child about what happened. Nobody goes to therapy, nobody processes the death in any way, shape or form.
[00:07:11] Instead families move on and almost act like that child never even existed. It’s not something that people feel like they are able to bring up. It’s not something people talk about. It’s swept under the carpet and then people go on with their lives. When families react like this to the death of a child or really any traumatic event, it makes me a lot more concerned for the overall outcome of the child because that child is much more likely to develop PTSD.
[00:07:46] And if it is that case where the family falls apart after the death, then that PTSD is likely to turn into complex PTSD because then that child has to witness mom and dad falling apart. Parents getting a divorce. One of the parents potentially turning to substance abuse, that child not feeling like he or she has any sort of support in this world.
[00:08:12] Nobody paying attention to that child. Nobody talking about the child’s deceased sibling it’s trauma on top of trauma on top of trauma for that child that ultimately seems never ending. With most of the kids that I’ve worked with so far in my career that have some sort of traumatic experience, a lot of them end up having CPTSD and not PTSD.
[00:08:40] I can remember one client in particular. She was 16 years old at the time that I met her. And she had been bounced around all over the United States between different foster homes for probably about two years before she had come to see me, she was removed from her mom’s care at 14 years old because mom was doing drugs and the stepfather was sexually abusing all of the children in the house.
[00:09:19] So just think about this for a minute. This girl went 14 years living in a home with five other siblings, all of whom were being sexually abused. Mom was doing drugs, selling drugs out of the home, and nobody intervened for 14 years. Her biological father was nowhere to be found. Her mother actually refused to even tell her who he was.
[00:09:47] And because stepdad was abusing all of them. And because mom constantly had dangerous people coming in and out of the house, buying drugs, this child would sleep under the bed at night just to have some sense of safety. So the first 14, 18 years of her life before foster care came into the picture consisted of physical danger, emotional instability, parents who could not take care of her trauma, on top of trauma on top of trauma. And then at 14 once foster care finally intervenes. She was only further traumatized by being placed into a system where at that point she was 16 and a lot of foster families weren’t willing to take her in.
[00:10:41] Because she was already showing signs of rage and inability to form attachments. She was using marijuana to self-medicate. She was failing school. She was showing signs of rage and aggression. Understandably so, but a lot of foster families were willing to take in her younger siblings, but they weren’t willing to take her.
[00:11:06] And so she was separated from all of her siblings. More trauma. And then she was bounced around to different foster homes where she was sexually abused in some of them. More trauma. Ultimately this girl ran away from the foster home that she was being abused in and she ended up being in a psychiatric hospital.
[00:11:33] After which she came to see me and I started working with her. I want to say it took me about a year of working with this girl before all of the details of her trauma started to come out. I knew a little bit about her based on the legal guardian that she was staying with, but I didn’t really know the details and she would come to the sessions a lot of times just wanting to make jokes or talk about the weather. Or sometimes she would come in really flat and wouldn’t say much of anything at all, but then she would leave the session and go home and be really upset and be suicidal. And she repeated this pattern. I’d say probably like I said for about a year until the details of her abuse finally started to come out as she started to trust me more.
[00:12:29] And just as a disclaimer, I know I share quite a few anecdotes about the patients that I see in my private practice on this podcast. And I do want you guys to know that I take the privacy of my patients very seriously. So a lot of times when I am telling you anecdotes, I have changed a lot of the details of the stories behind my clients in order to protect their privacy.
[00:12:55] So, if anybody out there is concerned about that, I just wanted to make that clear. Not everything you are hearing is exactly true in order to protect my clients. However, the gist of the story is still the same. The message is still the same. So as you can see with all of the different types of trauma that my client had endured she ultimately developed complex post-traumatic stress disorder. She had years like a decade and a half of abuse that ultimately she couldn’t see an end to. She had no parents that were there to take care of her, nobody to guarantee her physical or emotional safety. And she internalized the abuse and therefore had symptoms that were much more difficult to treat than somebody who would have one instance of trauma, such as getting into a car accident.
[00:13:56] As you can see the trauma that usually causes complex PTSD is chronic, it’s long-term. And it’s not just with child abuse. It’s also, for example, if somebody is taken as a prisoner of war and they are held for months at a time that’s chronic long lasting, there’s no end in sight. There’s no assurance of any sort of physical safety, emotional safety, appropriate human connection.
[00:14:27] All of these things are ultimately what caused CPTSD. And that disorder is something that has much more serious long-term consequences. And when you’re a child, it also can change the way your brain develops making you more likely to develop substance abuse issues, more likely to have anxiety, depression, more likely to commit suicide, et cetera.
[00:14:55] People with complex PTSD are also more likely to repress their trauma versus suppress their trauma. So there’s a big difference between repressed memories and suppressed memories when it comes to trauma work. And for the most part, what people do when they endure trauma is they tend to suppress their memories.
[00:15:19] So that means that the flashbacks and the awareness of the incident is still in your conscious mind. You’re aware of it, that it happened, but you more or less take active measures to avoid thinking about it. So you avoid maybe going to the place where you got into a car accident, or you avoid going back into your childhood home because you know that you grow up in an abusive households.
[00:15:46] You develop an addiction to alcohol, because you’re trying to find ways not to have to think about your trauma, but all the while you are aware and you are conscious of what happened to you, what you went through and what you endured. Repressed memories are a whole different type of beast. And people usually repress their trauma when it is childhood abuse.
[00:16:13] And more specifically when it’s childhood sexual abuse. When you repress your trauma, you are not consciously aware that it happened. So it’s buried somewhere in your unconscious and it may come out in different ways sometimes in the form of what’s called body memories, where if somebody is talking about, let’s say you were sexually abused as a child and if somebody starts talking about sex, maybe you might feel yourself being assaulted in your body, but you might not really understand it. Maybe you might have chronic depression and not really understand why or where it comes from. Maybe you might be afraid to be in relationships with somebody or afraid of intimacy and you don’t understand it could be a result and, not always, but it could be a result of repressed memories.
[00:17:10] So you don’t actually have any consciousness of what happened to you, but it’s still affecting your daily life and your overall quality of life. And again, I just want to emphasize that those who have repressed memories, aren’t just victims of sexual abuse, really people with any type of abuse have the ability to report, repressed memories. On a personal note, I have experience with repressed memories. I had suppressed some of my abuse, so I knew on some level that some things had happened to me, but most of what happened to me, I ended up repressing. So I did not remember if you had asked me before I started, what’s called the uncovering process. Which, the uncovering process is basically when you start to have all those repressed memories from your unconscious come into your conscious mind.
[00:18:13] So you start to become aware of them. When I started the uncovering process or before I started, rather, or if you had asked me if I had abuse as part of my history, I would have looked at you and I would have said “hell no, I don’t know what that’s like at all.” But then throughout my adolescence, I battled a raging eating disorder.
[00:18:37] I battled a lot with suicidality, just feeling worthless. Like nobody wanted me on this earth, but I didn’t understand why. And if I ever opened up to anybody about feeling that way, a lot of the feedback that I had gotten was: “W why do you feel like that? There’s no reason for you to feel like that you have this wonderful life.”
[00:19:04] And truthfully, I did have a lot of great things going for me. I truly did not understand why I felt like I wanted to end my life, why I felt like I needed to self-harm why I felt like I needed to self-medicate until, probably about a couple of years ago. And I started the uncovering process and I think it’s really important to note that not everybody actually does go through the uncovering process.
[00:19:37] Some people repress their memories of abuse for forever. Some people stay in that level of denial forever. And that could be for a number of reasons. Not everybody who endures trauma is able to go through the uncovering process if they’ve repressed. In order for somebody to go through the uncovering process, they ultimately have to find themselves in a safer space in their lives. So they have to find themselves surrounded with a good support system, a good therapist, and ultimately a goal for their future so that they are able to do the work of uncovering and do the trauma work that it takes in order to recover.
[00:20:22] Because uncovering memories after having repressed is a very difficult thing to do. It’s one of the best things that somebody can do for themselves, because it really frees them from the chains of their abuse. But it’s extremely difficult, especially if you’re still in the trauma. So people who were abused by their parents, if they live with their parents until they’re 30 and then have a kid.
[00:20:53] And then have an apartment. Well at that point in their lives, they’re too busy moving out of their abusers home, trying to raise a child, trying to afford an apartment that they honestly don’t have the time, the support, the money or the resources to be able to uncover their repressed memories. So this uncovering process, it’s not for everybody and that’s okay.
[00:21:21] There’s honestly so much more that I could say about repressed memories and the difference between repression and suppression. But I am going to just leave it at that for now, because we will have plenty of time to get more into it in the future. But, I just wanted you guys to know that repressed memories are often a big part of CPTD.
[00:21:46] And I want to transition back to some of the long-term effects of CPTSD. They are more chronic and more long lasting than standard PTSD. Because when we go through a complex trauma. So for example, let’s use like prolonged childhood sexual abuse. It can be so confusing. We have a different way of seeing ourselves when somebody violates us at such a young age.
[00:22:20] So we have difficulty trying to gain a sense of ourselves. We have difficulty trying to figure out how to stay present. So we have a lot of what’s called interruptions in our consciousness. We do something called dissociate quite a bit, which is basically a fancy word for disconnect. So we find ways to emotionally, mentally check out of the situation when we can’t physically escape.
[00:22:52] So children who live in abusive homes may picture themselves almost as having like an outer body experience. Or sometimes they’ll picture themselves being at the opposite end of the room when their abuse is happening, or sometimes they may feel like their bodies are filling up with water when they’re being abused.
[00:23:15] It’s just a way to disconnect from the present moment. It’s basically the brain’s way of trying to protect yourself and down the line, this can actually develop into what’s called dissociative identity disorder which is also a disorder that can be a result of trauma, not something we’re going to get into today, but dissociation definitely lends itself more so to complex trauma, as well as that.
[00:23:44] It also lends itself to difficulty with relationships. So think about it like this. If you’re a child and you are enduring abuse by your mom, let’s say you are being physically abused by your mom. That’s one of your first relationships that you have in your life. The first relationship that you have is with your parents.
[00:24:09] And if you’re in a relationship with somebody who is abusing you, then it can be really confusing to figure out later on in life. What’s appropriate in a relationship and what’s not appropriate in a relationship. And when you have a perpetrator in your life or somebody who abused you ongoing for months or years, or however long, it can be especially confusing to try and figure out, how you’re supposed to feel about that person. So a lot of people struggle with this idea of like I can’t be mad at my mom because she raised me. She’s my mom, or I can’t be mad at my dad because we had a lot of good times together. There were lots of happy moments where he would take me to the park or where we would go to the beach or where he would babysit me or, my mom bought me clothes or my mom would take me to my friend’s house.
[00:25:13] So I can’t be upset with her for abusing me. That’s one of the hardest parts of recovery from any kind of trauma, especially complex trauma, is just the confusion. How am I supposed to feel about somebody who took care of me in some ways, but utterly shattered my psyche in other ways? Another major example of this is in the Larry Nassar scandal.
[00:25:45] So I recently just finished and I did write a blog post about this. If you go to my website alyssascolari.com, you’ll be able to read more about it, but for those who are not familiar, Larry Nasser was the doctor for the USA gymnastics team. And he was also the doctor at Michigan state who was charged with child pornography and counts of sexual abuse.
[00:26:13] He had spent nearly three decades sexually abusing young women all under the guise of treating them. So basically what would happen is the girls who are training for gymnastics. If they got hurt, got an injury, they would go see the doctor and the doctor would be Larry. And Larry worked really hard at developing seemingly genuine relationships with not only the girls that he was treating, but also their families.
[00:26:45] He would make special visits to the family’s household. He would buy the girls gifts. He would write them letters. He would remember their birthdays. He would go out of his way to make all of these girls feel like they were so special. And then when he had them on his table in his office, he would sexually abuse them.
[00:27:08] And again, if you’ve not read “The Girls” by Abigail Pesta, which is a book that is all about this case, I highly recommend it. It is a earth shattering read to say the least, especially when it comes to giving a voice to survivors of sexual abuse. But basically Larry Nasser is the perfect example of a predator who can cause somebody to develop complex PTSD and can cause people to develop these really confusing and skewed perceptions of their predators.
[00:27:49] Because on one hand, he was so nice to them. He made them feel special and loved and like they really mattered. But then on the other hand, he was violating them in the most horrific way. And especially as a kid, it just leaves you feeling so confused and it leaves you feeling almost like you can’t be angry at that person, or you can’t tell on that person or you shouldn’t speak about what they did because then it negates all the good things they did for you.
[00:28:25] And it negates all the ways in which they made you feel special. And I do have to say in my experience in treating children who are survivors of prolonged sexual abuse in my private practice, I can say for certain that this long-term effect is the one that’s the hardest to recover from is the confusion of how could that person have hurt me so badly, but also made me feel so loved.
[00:28:58] And that’s something that ultimately, I think takes people years, if not decades, to be able to recover from. So again, this is just one of those topics that I honestly could talk about all day. There’s so much depth there and there’s. So much important information to learn about the differences between PTSD and complex PTSD.
[00:29:27] We will definitely talk more about it in this podcast, but I wanted to come on and do the solo episode today so that my listeners can get a baseline understanding of what the differences are and ultimately what the longterm effects are. And I invite you to read more about this topic. A lot of the information that I got today comes from this amazing website that I encourage you to go check out.
[00:29:57] I’m going to link it in the show notes, and I’m going to link it in the Facebook page. It’ll also be sent out in the weekly newsletter. It’s called beautyafterbruises.org. And it explains in much more detail about the differences between CPTSD, PTSD and the overall long-term effects. So that is all for today.
[00:30:24] I hope that this was helpful and informative for all of you. I know it’s a lot to process and some of it can be triggering if you’re feeling triggered by anything that I talked about today, I encourage you to reach out for support. I know for me, personally, this is a difficult episode. It’s a little bit hard for me to talk about some of this stuff.
[00:30:45] So, right after this, I am going to go order some delicious take out and snuggle with my dogs on the couch and engage in some good self-care and I hope that you guys do the same.
[00:31:01] Thanks for listening everyone for more information about today’s episode and to sign up for the Light After Trauma newsletter, head over to my website at alyssascolari.com.
[00:31:11] The really great thing about being a part of this newsletter is that not only do you get weekly updates on new podcast episodes and blog posts. But you also get access to the private Facebook community as well as access to all sorts of insider tips, resources, and infographs that supplement what we talk about on the show.
[00:31:29] You also can connect with me and other trauma warriors. I’m super active on the Facebook community. And I look forward to talking with you.