Updated: Sep 11
To really find out whether —or in which ways— you were hurt by having been exposed to toxic stress for a prolonged period of your life is a difficult task.
The first step is to understand the story.
There are circumstances that increase the possibility of having developed C-PTSD. Everything that qualifies as a scary environment besides the obvious (like neglect, sexual or physical abuse, etc.):
unstable family members (alcoholic relative, incarceration, aggression, mental illness, physical illness, sudden or painful losses, etc.)
emotionally abusive relationships (relatives, leaders, spouses, job environment, oppressive/racist systems, etc)
the use of weapons in the house or neighborhood (living in a dangerous building, war zones, shelters, political instability and abuse, military, etc.)
living under difficult and challenging circumstances (undocumented, political asylum, racism, poverty, religious intolerance, divorce, prolonged chronic illness, foster care, etc)
experiencing constant rejection, bullying, criticism, shaming, unpredictability, surgeries, frequent or prolonged separation from caregivers, instability, frequent relocation, etc.
The story and circumstances tell you how often and how severe the system may have felt threatened. The more threatening and the longer the situation was endured, the higher the probability of having negative consequences that affect the way your nervous system operates.
Assess emotional stability
After learning about the possible situation that destabilized the system, it’s important to learn what type of strategies the person’s system “chose” for survival. Living in a threatening environment continuously activates survival strategies until it reaches the point where the system can’t handle any more small changes and make the changes permanent, becoming traumatized. After that, the system operates differently than before with the goal to stay afloat. This means that during the threat and after developing C-PTSD, the body suffers alterations trying to “adjust” to the circumstances. These adjustments could be seen as strategies for survival. They become automatic reactions that modify personality, behavior, and the sense of who the person is.
To assess emotional stability is necessary to understand what type of strategies developed due to the circumstances, and which ones are healthy and which ones are unhealthy, and how much control the person can exercise over them. An emotionally stable person can withstand difficult situations, handle adversity, and remain productive and capable throughout. If the person is not emotionally stable, that will reflect on the way they react, and the way they feel out of control.
Executive functions are altered by trauma. Having an assessment of them can also be an indication of whether trauma developed or not. People that suffer from C-PTSD will lack many of them. The list is extensive but it’s worth checking them. The more executive functions missing, the higher the probability of suffering from C-PTSD. That means that the prefrontal cortex (PFC) may have not developed appropriately, or that became inactive, slow, or imbalanced.
A good list of them could be found here What are the signs of poor executive functioning?
The list of symptoms is even longer than of all the functions of the prefrontal cortex. Here I included a very long list Antonieta Contreras's answer to What are some unusual signs of C-PTSD?
Checking for symptoms is obviously necessary to evaluate the presence of C-PTSD. The more symptoms, the higher the probability of suffering complex trauma. Some of the most important symptoms are those similar to PTSD plus:
feelings of shame or guilt
difficulty controlling emotions
periods of losing attention and concentration (dissociation)
physical symptoms, such as headaches, dizziness, chest pains and stomach aches
self-cutting and self-destructive behavior
isolating from friends and family
extreme anxiety and irritability; uncontrollable anger and rage
paranoia and being suspicious of other people
feeling empty, hopeless, and worthless.
Recognizing the way the system reacts and in what circumstances it reacts is a life long pursuit, but also necessary to evaluate whether complex trauma is present. We all have emotions and therefore, emotional reactions, but complex trauma reactions are out of the ordinary.
Their characteristic is that most people won’t understand them, while they are extremely evident for the sufferer. The sufferer would consider evident why they react the way they do, and spend log time trying to explain it or justifying themselves for it, while others may consider it inappropriate, extreme, illogical, and will may call it drama.
That creates confusion and further activation since the reason for the reaction and the reaction itself get invalidated. The sufferer believes s[h]e knows the reason but in reality, most people with C-PTSD won’t be aware of the connection with trauma, and therefore, don’t know the real reason for their reactions. They will attribute it to the event, or the actions of others when it’s really a reaction based on trauma. The traumatized person can’t let go easily the feelings of hurt, and the emotional dysregulation.
Once the nervous system gets altered on a semi-permanent basis, the perception of time, safety, and meaning get distorted.
Time gets distorted and the past feels current, and the present may feel absent. People carry believes that were developed during the time of extreme stress, making them pervasive throughout their lives. For instance, If someone made fun of them and made them feel inadequate, they will feel inadequate in many circumstances even when they have proof that they are not. A series of events will make them feel inadequate even when it’s only them that perceive it that way. The way they felt during the development of the complex trauma will remain and will feel real years after the stressful/traumatizing situation is over.
People with complex trauma feel unsafe in general. They lack trust in others and in themselves. What for someone could be a comment, for someone that got traumatized due to criticism will sound like an attack. Something that seems mildly dangerous would be extremely scary for them.
Since the person lives in survival mode, situations that seem “normal” to others could seem extreme (unfair, threatening, hurtful, infuriating, etc.) to someone with C-PTSD. They feel like victims or accept a martyr stance feeling less than others. They suffer from self-doubt constantly, and/or dissociate from the sense of who they are, and what the actions of others mean. They may lack a sense of style, or an understanding of social norms. Very often they find their own meaning of things trying to make sense of life.
Triggers are a good indication that the nervous system got altered and therefore there is trauma. Triggers have to do with the type of events, circumstances, or any other element that can cause distress either in an exaggerated way, or in an incomprehensible way. For example, people can get activated and start getting angry, feisty, ruminating, etc., because of someone throwing the garbage on the floor. For a person with no traumatic responses, the event will pass inadvertent or will fade away in minutes, while to someone with C-PTSD the distress could last hours or even days. They may seem illogical or extreme, but they have an effect on the person that feels absolutely real.
Even when it’s very hard to identify triggers right away, noticing that there are certain things that could create more distress that what could be considered normal is a good indication of dysregulation and possible traumatization.
Inexplicable medical issues
Most people that suffer from C-PTSD complain about medical issues that are hard to explain for medical professionals. They can also present chronic illnesses that are not congruent with their age or with their family medical histories. They could be allergies, digestive problems, pain, insomnia, and even rheumatoid arthritis.
The more of these indicators you have, the higher the probability of suffering from complex trauma.
This question reflects the reason so many people have been pushing to have complex trauma accepted as an official diagnosis. There is trauma without an identifiable traumatic event and there is no recognized diagnosis —and therefore treatment plan— to describe the process that happens when a person suffers either a series of traumatic events, or a prolonged state of high stress. Those events can happen at any time in life and in circumstances that don’t seem traumatic to the naked eye but create a state of alertness in the person that lives in a constant situation of unsafety.
When the sense of being at risk is constant and prolonged, even without the awareness of it, the nervous system activates the survival mechanisms that make changes in the system’s functioning little by little until it can’t make more changes without suffering an injury. That injury is what we call C-PTSD and has not been recognized.
The events or circumstances could be many: an abusive romantic relationship, living with an aggressive alcoholic or substance user, being in foster care without knowing what would be next, living in a war zone or political asylum, abusive or neglectful parents, an abusive dominating boss, divorce without clear future, etc. All situations where the safety of the person —physical, emotional, financial— is at risk. They may not seem traumatic but for the person that lives it, it’s destabilizing and stressful.