COMPLEX PTSD

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COMPLEX PTSD…( DESNOS: disorder of extreme stress not otherwise specified…PTPD:Post-Traumatic Personality Disorder…SURVIVOR)

I’m a survivor of childhood sexual, physical, and emotional abuse.  It began when I was a toddler, when my mother married my abuser (unknowingly), and continued on and off throughout my entire life at home.  I am Bipolar, I have ADHD, I have Dissociative Amnesia, Depersonalization, Anxiety (obviously), Dissociative Fugue, and Complex PTSD.  When the Complex PTSD began to really fester in me (one year ago, though there were ptsd symptoms since ten years ago)–just before I admitted myself to “the bin”–I was also suffering from psychotic episodes and those–now THOSE were mind-shattering and terrifying–like I wasn’t scared enough with the flashbacks and the delusions and the hearing of voices brought on by extreme stress.  Complex PTSD is the mother of them all, except the Bipolar–that’s the only disorder I was not given but was born with.  These words do nothing to explain the loss that occurs and the fragmentation of your identity, self, and soul.  There is no way to ever explain feeling the terror and fear as if you were a little girl again, helpless, alone, and with no way out from the terror.  For a long time (half a year), the psychotic episodes were extreme and growing and multiplying–they overshadowed the Complex PTSD.  I’d get the taste of rubber in my mouth and panic, then I was gripped with something I’ll never be able to explain, except that I had to have someone hang on to me and tell me I was going to live, though it didn’t calm me really but it was someone to squeeze until the psychosis stopped (this psychosis eventually developed into psychotic delusions and began to only occur around my period, so I got on birth control and they stopped–praise the Lord!).  But anyways, before the treatment of the psychosis, I was in the mental hospital A LOT, having flashbacks of blood on my face and blindfolds over my eyes and complete horror.  I am not willing to share (I don’t think it’s necessary) the sexual abuse parts except that it involved either being in or forced to watch a home-recorded porn of me with my step-brother and step-sister when I was four or five.  Anyway, I went through about a year of having completely lost who I was.  I dissociated and depersonalized all of the time, another, different scary thing all together.  I wasn’t even real, just this rumbling mess who kept breaking and re-breaking, losing my faith and hopes, believing the future was gone–I saw nothing, there was nothing.  And I knew the girl I was was dead.  She was gone.  I believed I would be left empty forever.  I thought about suicide a lot.  I thought (during the psychosis) that I would lose control and some force outside of myself would kill me.  I was in danger everywhere I turned.  I lost so much, I lost a year.  We also lost our house, I lost my job, I lost my friends, my fiance left me, and I had to move in with my mother.  And I’m 29. 

I now have my own place, just me and my little girl.  I’m getting better day by day.  Sometimes I feel like I’ve come so far, and sometimes it’s slow motion.  I’ve taken to studying Christianity, Buddhism, and Hinduism.  They all share the same message.  They all bring me to my knees, in utter gratitude that the worst of it has ended.  It’s a new life.  Time to start building.

I’m going to start with a very clinical definition that I just found aside from my other research.  This definition threw me because I hadn’t really realized or seen it in words that what I have (complex ptsd, among others) is a personality disorder.  Honestly for a long time I believed I had Borderline Personality Disorder, though I learned the two are easily confused and misdiagnosed at first. 

From Campbell’s PSYCHIATRIC DICTIONARY: The Definitive Dictionary of Psychiatry; Ninth Edition 2009, Robert J. Campbell, MD; Oxford:

post-traumatic personality disorder   PTPD; complex PTSD, which in DSM-IV is classified as a disorder of extreme stress not otherwise specified (DESNOS).  Complex PTSD is a chronic adaptation to PTSD (post-traumatic stress disorder) that shapes the personality.  The symptoms of PTSD itself are usually described in terms of three domains–re-experiencing, avoidance and numbing, and hyperarousal.  But failure of these initial symptoms to resolve provokes a secondary adaptation to them, complex PTSD or DESNOS.  Adaptation to a chronically aroused fear system requires extreme defensive measures, manifested in such symptoms as severe avoidance, alterations of consciousness and self-perception, identity disturbances, overreliance on dissociation, affect dysregulation characterized by cycling from hyperarousal to hypoarousal, difficulty with interpersonal relationships, and somatization.  Dissociative adaptations, used to escape conflict, may alternate with angry and violent acting out. 

PTPD requires a history of severe chronic traumatization beginning in childhood; less severe traumatization is associated with BPD–borderline personality disorder.  In comparison with patients with BPD, those with PTPD have less ability to access positive emotions, have more self negation, and are more avoidant of others.  In their need to avoid conflict, patients with PTPD learn to please, placate, and manage others; dissociation is frequent, not brief and transient as it is in BPD.

 

It’s a very good, but very brief, and very understated explanation.

I like mine.

Complex PTSD is not yet in the DSM-IV, though I believe DESNOS is.  Unlike PTSD, which can occur because of a traumatic time (I should word this better), Complex PTSD is due to a prolonged, repeated, extensive exposure to traumatic events.  This is not to say Complex PTSD is worse, it’s just a different type of trauma with different symptoms (though I believe chronic and involving changes in personality…more on that later).  You’re more likely to experience symptoms of Complex PTSD if your traumatization occured early in your life, was prolonged, and was interpersonal. 

Now, there are 7 (yes, 7) symptoms groups of Complex PTSD (Judith Herman and other sources…again, later) besides the symptoms of general PTSD; this is a brief overview and I will go into detail afterwards:

1. Alterations in regulation of affect (emotion) and impulses

       *chronic affect dysregulation

       *difficulty modulating anger

        *self-destructive or suicidal behaviors

        *difficulty modulating sexual involvement

         *impulsive and risk-taking behaviors

2. Alterations in attention or consciousness (dealing with this part really sucks)

         *amnesia

         *transient dissociative episodes

         *depersonalization (will define at the end)

3. Somatization (how your body holds your trauma…”Your body remembers”)

      *digestive system problems

       *chronic pain

       *cardiopulmonary symptoms

      *conversion symptoms (psychological problems get converted into physical)

       *sexual symptoms

       *panic

4. Alterations in Self-Perception (this one really REALLY screws with you)

      *chronic guilt, shame, and self-blame

      *feeling that you’re permanently damaged

       *feeling ineffective

      *feeling nobody understands you

       *minimizing importance of the traumatic events in your life

5. Alterations in perception of perpetrator (this is not needed for a diagnoses of Complex PTSD). 

      *adopting distorted beliefs of the perp about yourself, others, and what

         happened as true

      *idealizing of the perp/abuser

     *preoccupation with hurting the perp/your abuser

6. Alterations in relation with others

       *inability to trust (not that you don’t want to, you can’t)

       *revictimizing yourself

       *victimizing others

7. Alterations in systems of meaning (how you see life, others, and spirituality)

      *despair, hopelessness

      *loss of beliefs that previously sustained you

Is that all?

….Other tidbits of info…

If you have Complex PTSD, you may have some or all of these personality traits:

-problems with ability to regulate emotions

-find it hard to “stay present” without becoming amnesic (unable to remember), dissociative, depersonalized, or preoccupied with trauma

-may not see yourself as a functioning individual who can avoid feeling helpless, shameful, guilty, stigmatized, alone, special, or full of self-blame (I don’t like the way this is worded because it makes it sound as if we choose to feel these–they are inescapable)

-may not have the ability to separate yourself from your abuser or perpetrator without either being peroccupied with revenge, feeling gratitude, or accepting the perp’s interjects as true

-may not have the ability to have positive, healthy relationships with others without being isolated, withdrawing, being extremely distrustful, failing repeatedly to protect yourself, or constantly searching for someone to rescue you (or for someone you can rescue)…you may even find it impossible to attach at all, your relationships are heywire

-may not have the ability to find meaning in your life and maintain faith, hopefulness, and a sense of the future without feeling despair and hopelessness (more like feeling like you’re certainly going to die and that there is no God–yes I believe in God but no I didn’t at my worst)

(from The PTSD Workbook; cited at the end):

“Do you feel you have lived in a war zone for most or all of your life? Do you have a hard time even thinking you have a sense of self?  Do you generally feel unsafe and untrusting, and believe that personal power is an illusion? Do you lack good self-esteem and positive intimate relationships?  Are you isolated, without connections to others?  Do you find it hard, if not impossible, to attach to others?  Do you find it difficult to monitor how you act or to stop yourself before you act in an impulsive way that sometimes hurts you?”

“A person who has experienced type II traumas (prolonged, repeated.) tends to either be too dependent on others in an intimate relationship or is so terrified by any intimate connection that he/she flees from a relationship to aloneness (I’m the latter).  However, when alone, the survivor often feels an unbearable sense of ABANDONMENT and again longs for connection.  So the survivor tries to connect and again becomes terrified of rejection and abuse.  His or her relationshiops begin to take on a pattern of being too close and running away.  Can you keep a clear sense of who you are when you are with others or with a partner or spouse (God I wish, I’ve been like that for years)? Can you self-soothe?  When you’re very emotional can you still make good decisions?”

“…if you were repeatedly traumatized, you may have developed learned helplessness in order to endure abusive situations; that is, you learned that it was useless to try to get away.  Later, even if you could have escaped, you may not have done so, or you went from one abusive situation into another.”

“…Exposure to repeated trauma, type II trauma, may prevent you from ATTACHING in a healthy way to others.  It may cause you to be unable to control your emotional arousal…you may also find you don’t have enough trust in others or yourself to allow yourself to develop a stable relationship.”

(this one hits home) “Your capacity to regulate your own internal emotional states, your body sense, and your response to external stress helps to define who you are.  If you were a victim of type II trauma, you may LACK A PREDICTABLE SENSE OF YOURSELF, have a poor sense of separatness from others, have a disturbed body image, have poor impulse control, and become suspicious and distrusting in social situations.”

It does get better.

Don’t give up.

…to be continued…