Week 5, Session 1: Understanding PTSD and Complex-PTSD
Hello and welcome to Week 5, Session 1.
If this is the first time you’re reading this, welcome! We’re so happy to have you here. However if you’re just starting out please do head back to the first session. We build on material throughout the weeks, and we don’t want you to miss anything!
You might need your thought diary for the homework, so take a moment to find it if you don’t have it with you.
We really appreciate the time that you have taken to be with us today. We know this session is an important one for many and we are so glad to have you here.
Let’s get to it!.
The goals for this session are…
- To explain how we develop “post-traumatic stress disorder.”
- To explain the difference between PTSD and C-PTSD (complex post-traumatic stress disorder).
- List their common symptoms.
- Begin to outline the tools to recovery. We will be going over multiple techniques next session, with full explanations and tricks for you to try out, so you can find which one works best.
Today’s grounding exercise will be…
We’re going to do a different kind of exercise today. We want you to think of a number and then think of 3 ways you could make the number (6 + 11 = 17, 20 – 3 = 17, 8 × 2 + 1 = 17, etc.)
Fun question: If you could only watch films that have in their cast a specific actor, which actor would you choose?
What is Trauma?
First, let’s take a step back and think about trauma according to its dictionary definition. Even though we’ve already been talking about ways our minds and bodies adapt to the trauma of abuse, it may help us to understand the lasting effects by describing it in exact terms.
At the root, trauma is called “a deeply distressing or disturbing experience”– one that threatens our lives and damages our sense of security. When we survive something terrible we learn the ways we’re unsafe. A traumatic experience is a time outside our control. In the case of abuse, this control was forcibly taken away from us by our abuser.
If you remember our discussion on the Mind and Body, your body constantly works to keep you alive. In breathing, eating, or sleeping, your body wants to live – and our brains are no less a part of that system. That’s why we repeat difficult memories, because our mind is trying to process and integrate that traumatic memory, to make sense of what happened. That includes integrating all the sensory information -- sight, sound, smell, touch -- as well as what happened. In repeating the memory over and over, however, our brains are in a continuous state of hyper-arousal, which makes it more difficult to process what’s happening in the present, including having a sense of the dangers in our present environment. So, we may become hypervigilant: alert and constantly scanning our environment for similar and potential danger.
We can also shut down and avoid our reminders entirely. It’s exhausting doing that much thinking and feeling every day. Forgetting is also a means of protection.
Whether we fixate through constant focus on potential ‘dangers’ or disassociate, these are both normal reactions to traumatic events. What happens with post-traumatic stress disorder, however, is that these feelings don’t go away. PTSD makes that past feel like the present, so our danger signals flare as though the trauma were happening now. Fear takes over, and we get locked in survival mode - those 3 fs: of fight, flight, or freeze, with all associated hormones, terror, and inability to think on anything else.
PTSD usually develops in the first six months after a traumatic event. But symptoms can also take years to form.
Now, as we go through the list of criteria for diagnosis, knowing these symptoms won’t always mean you have post-traumatic stress. Symptoms of regular anxiety are similar to those of PTSD. If you have experienced any of the features we’ve discussed for a month, however, please speak with a professional for a more thorough assessment.
The signs of PTSD:
Some of the signs or symptoms are:
- Flashbacks to what happened
- Feeling on edge and easily startled
- Lack of concentration and unable to focus.
- Associating various words, events, or “triggers” back to your trauma - “triggers” are the sights, sounds, or feelings you associate with your traumatic event, and avoidance of anything that might cause “triggers” to occur. This also includes refusing to talk about it, pretending it never happened.
- Mood swings -- can include irritability, anger, crying
- Difficulties sleeping or change in eating patterns
Some emotional signs can be:
- Not being able to feel your emotions; unable to connect to others or enjoy things you love.
- Extreme feelings of helplessness or horror
- A lack of trust, even in close relationships
- A feeling of low self-esteem and confidence.
- Deep embarrassment, shame, or guilt, blaming ourselves for what happened.
- If our trauma involved another person, we can also fixate on them – becoming preoccupied with the perpetrator rather than ourselves.
Whatever the symptoms, PTSD is only diagnosed in a single traumatic event. The trauma must be a one-time experience - as in an assault, or in a natural disaster.
However, as survivors of domestic abuse, our trauma often happens over a longer period of time, as opposed to a single, identifiable event. When we experience trauma like this, in a situation in which there are no certain means of escape, there is a different stress-related disorder known as complex post-traumatic stress disorder (or C-PTSD).
So what are some of the signs of Complex PTSD? Complex PTSD includes the symptoms of PTSD, but it also may alter a lot of the ways we think about ourselves as well. In addition to experiencing a learned fear response as the result of trauma, people with Complex PTSD have trouble knowing who we are. We manage deep feelings of shame, helplessness, and often falsely believe we’re responsible for our mistreatment. We may also experience deep feelings of distrust towards other people, including people who have not abused us.
Why? It has to do with our mind and body’s survival adaptations to trauma, as we’ve been discussing all along. Like we said, c-PTSD occurs when someone is exposed to trauma over a long period of time, in which there is no certain means of escape. This is what domestic abuse is: we are put into an environment we have little control over, where we are abused many times. Not only is it difficult to make sense of this cruelty, but because of our lack of control, we feel we have no choice but to suffer day after day.
But, we are creatures who are wired to survive. If we were to decide there’s nothing we can do, we’re doomed. There is no way to “survive” a world that feels hopeless; in the case of domestic abuse, it’s because our abusers convince us they are our world. In this situation, it becomes easier to blame ourselves for the behaviours of others or our circumstances, because we’re in control of our actions. If “we” become the problem, it’s something we can fix.
This feeling may be further solidified by the fact that our abusers often force us into depending on them for certain things -- maybe shelter or money, but also emotional needs like affection and protection. Internalising blame for our mistreatment may make it easier to accept that the abuser is in control of meeting our needs. Again, our minds are trying to make sense of what’s going on in our environment in order to adapt and keep us alive.
This is why we may feel a sense of shame, and decreased sense of self, as the result of abuse. We have adapted not only our behaviours but also our opinions of ourselves, to be able to survive the abusive environment. It’s also why it may be so difficult to let go of these feelings of shame at who we are outside of the abusive environment: if we have deeply internalised the feeling that there is something ‘wrong’ with us and we deserved our mistreatment, then even if the abuser is gone, we might still feel that we are inescapably bad.
But this shame is not our teacher. We did and are doing everything we can to survive, and that is nothing to be ashamed of. Remember our tree metaphor from week 3? We don’t have to be ashamed of the ways our branches grew in a terrible, adverse situation. But now, let us listen to love and not shame.
However difficult these symptoms, or deep these feelings, please know that your body was doing everything it could - or can - to keep you here. You are not the ways you’ve been hurt or how you have coped. There is a reason you feel the way that you do. It is not a flaw or a weakness. These diagnoses only prove how you’re already amazing.
In terms of working through these feelings of shame, remember: you did what you could then, but you are no longer helpless - and none of your feelings of shame are permanent. We can choose now who we are.
The work now comes in guiding ourselves into healthier patterns: by making the past the past, and to remember the present to build towards the future.
The work is intentionally light this week, because it takes enormous, incredible courage to remember a time when you felt helpless. So:
The homework for today’s session is…
To think about your favourite animal and then draw that animal. It is in no way about perfection, just exploring, being curious, and being able to laugh with or enjoy what comes out.
And as ever, keep working through your thought diaries. The more we make the internal external, the easier it is to make sense of our own stories and choose how we move forward.