Symptoms of Complex PTSD (C-PTSD)

August 10, 2022

5 Symptoms of Complex PTSD (C-PTSD)

Although Complex PTSD is not a diagnosable condition, (it’s not listed in the DSM-V, which is the manual therapists and psychiatrists use to make diagnoses), the symptoms are real and the impact can be long-lasting when it’s misunderstood as something else like depression, anxiety, or ADHD, alone. Complex PTSD can encompass a lot of symptoms that I won’t be able to cover in one blog post, but generally speaking folks with C-PTSD often experience bouts of anxiety and depression, have difficulty managing emotions and can become easily overwhelmed, and experience low self-worth, negative self-talk, and feelings of shame. In addition, folks with C-PTSD often have difficulties in relationships whether it’s the ability to maintain relationships, struggling to trust others or feel safe in relationships, and/or not knowing how to communicate feelings and needs in relationships. If you relate to a majority of the following symptoms, I’d recommend speaking to a therapist who specializes in Complex PTSD or a therapist who specializes in trauma and uses a relational/attachment approach to their work.

1. Complex PTSD, Anxiety, and Depression
You experience anxiety and depression and often cycle between the two, having periods of high anxiety that turn into depressive episodes. The anxiety leaves you feeling drained at the end of the day and you don’t want to do anything, which leads to isolation and sometimes annoyance at people you care about. As depression takes over you might experience brain fog, lack of motivation, low mood, and have difficulty taking care of yourself and your obligations. When things are stressful in your life (work is demanding, your partner(s) is/are going through their own struggles, the last couple years of living through a global pandemic), it gets even harder to manage your symptoms. When things get really bad you might even wish you were dead and fantasize about ways it could happen. Thinking about not being alive is a familiar thought that you might have learned to live with from time to time.

*If you are currently experiencing suicidal thoughts with active plans please go to your nearest emergency room or call or text 988 for emergency assistance (but please know this may involve police).

2. An Inner Critic and Feelings of Shame
You have a critical voice in your head that rears its ugly head when you make mistakes, when you feel emotional, or when you think about experiences you regret from your past. Sometimes it shows up when you’re sick or in pain and sometimes it seems to come out of nowhere. The critic yells at you, calls you names, and/or curses at you to the point you feel fatally flawed or worthless, like a piece of shit. The inner critic attack that results in this toxic shame is usually the result of an emotional flashback. Pete Walker defines emotional flashbacks as “sudden and often prolonged regressions to the overwhelming feeling-states of being an abused/abandoned child.” Complex PTSD survivors did not often experience safety with their parents or caregivers because they were neglected or outright abused (physically, emotionally, sexually) and the critic developed to attempt to gain the love, approval, and acceptance of your parents. The inner critic is an adaptive strategy that is often carried into adulthood, showing up in your work, romantic relationships, and ultimately how you view yourself, especially in instances that remind you of being abused or abandoned.

3. Easier To Take Care of Everyone But Yourself
It’s easy for you to take care of everyone around you, difficult to say no and let others down, and almost a habit (or instinct) to put yourself last. You prioritize your romantic partner(s), what your boss or co-workers want from you, and the needs of your friends, which results in your own needs and desires being neglected. You may even become resentful of others who don’t seem to care about others like you do. You may also find it difficult to take care of basic needs and find yourself missing meals, struggling to make time for exercise, or overall find it hard to maintain self-care habits. When you were neglected or abused and/or grew up in chaos, you were likely not provided with structures that taught you how to care for yourself (going to bed at a certain time, regular meals and clean clothes available, being given expectations to follow). If you had siblings you may have been put in charge of their emotional and physical care. These experiences become internalized, resulting in negative self-worth and a false sense of worth based on helping others, making it much harder to set boundaries and take care of yourself.

4. Overeating, Drinking, Busy-ness
You find it very difficult to relax or rest, may have been diagnosed with ADHD, or think you could have ADHD. Eating may be a source of comfort that feels out of your control. Drinking or smoking pot are your main sources of decompression. You overwork to avoid your emotions or stressors at home. In Sensorimotor Psychotherapy we call these resources survival strategies because they have played a role in helping you survive your trauma and emotional abandonment/neglect. These strategies, which are sometimes termed negative coping, play a role in regulating experiences of fight, flight, or freeze in the nervous system. Staying busy and overworking can be a flight response to perceived threat (which could be having emotions that don’t feel safe to experience). Drinking, smoking pot, and eating can be ways to numb or soothe activation of the nervous system. By understanding these strategies as resources that help you regulate your nervous system, you can begin to develop alternative strategies.

5. Chronic Pain/Digestive Issues
You experience chronic pain, tension, or headaches that are not easily explained. The pain or tension may relate to your experiences with emotions, stress, or relationships. This could be experienced as a physical guarding in the body (bracing, a shield over the chest, or headaches) when emotions feel too intense. Complex PTSD survivors learned to minimize their emotions due to the intensity of those feelings, combined with the lack of parental support or abuse/punishment from parents/caregivers for showing emotions. There may be a pattern of chronic tension in the shoulders, neck, lower back, or pelvis/hips that has led to the need for chiropractic care, massage, or physical therapy. Additionally, digestive issues like irritable bowel syndrome, diarrhea, and nausea can be associated with having Complex PTSD. This is due to the chronic activation of the nervous system, and the impact on digestion because your body is spending all of its energy on survival.

5 Ways to Cope with C-PTSD

1. Start Relational/Attachment Focused Trauma Therapy
C-PTSD results from injuries (physical and/or emotional) that occur within relationships so recovery and healing need to happen in relationships. When I work with someone, the beginning of the work focuses on developing a solid relationship where you feel safe enough to be honest about what you’ve been going through and I provide a lot of validation for your feelings (because they probably make a lot of sense in the context of your life experiences!). I also help folks find stability and reduce symptoms of anxiety and depression by gaining new awareness of the nervous system and learn new coping strategies to manage intense emotions, overwhelm, and critical self-talk. It’s also important to help folks recognize how strategies (drinking, spending money, overeating, being busy, etc) that might be frustrating, have helped with survival. Once things are feeling more stable (you’re no longer feeling depressed, anxiety and/or ADHD is much more manageable), you’ve developed resources and tools to cope, we can start to move towards trauma processing and inner child work.
2. Find Information, Support, and Community
If you’re not ready to start therapy, or it’s not feasible due to lack of insurance or finances, I highly recommend seeking out resources on Complex PTSD. It will help you feel less isolated and begin to understand there’s nothing wrong with you. I recommend following #complextrauma#developmentaltrauma#complexptsd#adultchildrenofalcoholics, and #healingfromtrauma on Instagram or joining the Support Community for those Affected by C-PTSD on Reddit. You can also find free support by attending the 12 step group Adult Children of Alcoholics and Dysfunctional Families. If you haven’t already read the book Complex PTSD: From Surviving to Thriving by Pete Walker go buy it or get it from your local library! There is so much information that will validate your experience and lots of resources to help you manage the symptoms of Complex PTSD. I will say reading the book can bring up a lot of emotions so it’s okay to read it slowly and take breaks from it as needed. Another book I’d recommend that incorporates a somatic approach to healing Complex PTSD is Sensorimotor Psychotherapy: Interventions for Trauma and Attachment by Pat Ogden and Janina Fisher.

3. Emotional Flashback Management
Pete Walker’s tips on Emotional Flashbacks can be so helpful in managing C-PTSD. Here are some highlights that include some somatic resources.

  • If you’re experiencing an inner critic attack, feeling hopeless, or helpless, recognize and name that you’re having an emotional flashback. Say to yourself I’m having an emotional flashback.
  • Name what you’re feeling or experiencing: I’m feeling afraid, I don’t feel safe. If you are in danger or being treated unfairly you can leave the situation. You have choices now that you didn’t have as a kid.
  • If you are physically safe and do not need to leave, slowly look around your environment, including behind you, and remind yourself that you are safe in this moment. I am safe right here right now.
  • Breathe through your nose and extend the exhale if you can (this will activate the parasympathetic nervous system, which will bring calm).
  • Imagine how the reaction you’re having is coming from a younger version of yourself and provide that little one some soothing and care. It could be as simple as putting a hand on the heart and adjusting the touch to feel tender, wrapping yourself in a cozy blanket, hugging a pillow, or saying I’m here and I care about you.

4. Develop Self-Compassion
There are lots of resources out there to help you develop compassion for yourself. My favorite resource for self-compassion is Tara Brach. She is a Buddhist psychologist who hosts a weekly podcast that includes the release of a separate meditation often focused on developing self-compassion. The RAIN of self-compassion is one of my personal go to meditations when feeling shame, which I often use with clients. She’s also written a book about RAIN called Radical Compassion: Learning to Love Yourself and Your World. Another resource is Dr. Kristen Neff. She is a self-compassion expert who has written books on the topic and she offers free guided practices and exercises on her website. Additionally, Brene Brown is a shame and vulnerability researcher who has written a number of books that incorporate self-compassion. She also co-edited the book You are Your Best Thing: Vulnerability, Shame, and the Black Experience with Tarana Burke since most of her work is shared through the lens of her experiences as a white woman. You can also search self-compassion on the Insight Timer app to find other free meditations. 163

5. Self-Care
How can you start implementing more structure into your self-care habits? Start with the basics: are you feeding yourself regular meals, sleeping enough, drinking plenty of water, getting regular physical activity or exercise? Is your living space in disarray? It could be helpful to put reminders on your phone or calendar, or use post-it notes around your apartment or office that remind you to eat lunch, drink water, or go for a walk. You don’t have to do everything at once, but whatever you decide to do, pay attention to the effects. How is your body and mood impacted when you eat regular meals, go to bed at the same time, drink more water, or clean your living space? You could also assess the energy inputs and outputs of your life by paying attention to how you feel in your work, relationships, and other activities. Do you feel depleted or energized after you spend time with a certain friend? How do you feel after you say yes to another task for that co-worker? If you experience chronic pain, tension or digestive issues, you may want to try an anti-inflammatory diet and I’d recommend working with a naturopathic doctor who can help you heal through food and other simple changes. 209

To conclude, educate yourself about Complex PTSD and the ways it has impacted your life and relationships so you can begin recovering. Start seeing your inner critic, suicidal thoughts, and feelings of despair or overwhelm as a warning sign that you’re triggered and experiencing an emotional flashback. Practice emotional flashback management techniques and begin to develop compassion for yourself. There’s a reason for your struggles. And please know that healing from Complex PTSD takes time so be gentle with yourself. If you’re ready to address your Complex PTSD, I help LGBTQ adults in Chicago and Illinois quiet their inner critic and learn to thrive in spite of their upbringing. Request an appointment now.

Cher Hamilton-TekautzCher Hamilton-Tekautz is a Licensed Clinical Social Worker in Chicago. She graduated from the University of Minnesota-Twin Cities with Master's in Social Work and a Graduate Certificate in Complementary Therapies and Healing Practices.

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