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What are the signs of C-PTSD (Complex Trauma)?

Ela was happily married –or that’s what others thought— until the day her husband came home with a DVD he had bought. Not a common practice for him. The name of the movie was “Sleeping with the Enemy” with Julia Roberts. Ela loved movies and made some popcorn to watch it with her husband. “Who recommended it?” she asked. “Myself” he responded. “I think it’s time for you to wake up.”

That day marked the beginning of Ela’s understanding of her dissociation, her depression, her lack of enjoyment, her submissiveness, and many other symptoms that she developed through several years of emotional abuse and neglect, manipulation, gaslighting, and objectification in the hand of her husband.

Ela would visit countless doctors for all sorts of illnesses, aches, and pains before she realized that her medical problems were rooted in the abusive relationship she was in. She kept herself mentally “stable” carrying an eternal sense of dread and sadness that just a few noticed, but her body was not able to stand all the physiological consequences of the complex trauma. It was not until she fell into a deep clinical depression that the C-PTSD was identified. Ending the abuse was imminent; otherwise, her complex trauma would have continued unfolding. By making the decision, the submission subsided and she started healing.

Like Ela, there are many people that don’t notice the complex trauma until something bad happens.

The more of those symptoms are present, the higher the probability that the person suffers from C-PTSD. Here you can read a list of the less known symptoms of C-PTSD.

But more than the symptoms, I take a very focused history of the client and I find out if complex trauma is present by the narrative, the structure of the family, the relationship among family members, etc.

If you know how complex trauma develops, then you’ll be more prepared to identify it.

What is the cause of C-PTSD? What really causes complex trauma is not really the type of terrifying situation(s) we go through and have to endure, but the fact that our mind gets engulfed in the terror/fear/drama of the event, and succumbs —consciously or unconsciously— to the belief that we are “doomed.”

I know that this is not the traditional way of thinking about what causes trauma; we prefer to “blame” the event, which is normally caused by something or someone else, and we wish someone could be held accountable. It should be, but it doesn’t happen. The person that stabs you is never the one that will do the stitches to close your wound.

Trauma is caused by the way the brain understands the instructions from our thoughts, which normally come from our emotions. For example, if we feel fear (the emotion), then we get scared (the thought that we are in danger), and then our brain will activate the defense that is designed from birth to protect us from danger. The brain doesn’t care if the danger is about a mouse, a bomb, or an angry parent. The brain just reacts to our perception of being at risk, and triggers the defense mechanisms.

Why does trauma happen? It happens because the brain doesn’t receive the instruction to go back to normal. It stays activated in a loop of reactivity thinking that it still needs to protect the system from perishing.

Using the previous example, let imagine that the sequence goes like this:

  • there is danger,

  • we experience fear,

  • we get scared (thoughts and concepts),

  • our brain interprets the affect of fear and the thoughts of “scared” as instructions to activate the defense that is designed from birth to protect us from danger,

  • fight-flight tries to protect us by priming us to punch, kick, run, etc. Anger adds to the fear;

  • if we can defeat the adversary (source of danger) or if we can escape from it, our system goes back to normal. It may take some time (from minutes to days) but it “reboots” the system;

  • if we can’t defend ourselves by fighting or escaping, if we subjectively feel that there is no way out, or objectively can’t or if we fear increases, anger may be suppressed or replaced by frustration, exasperation, discontent, disappointment and/or more fear, while the sense of helplessness triggers more intense defenses, like submitting, or getting immobilized —not in an attentive way, but in a collapsing way;

  • now the brain has defenses activated that are arousing —as in fighting-fleeing— and defenses that are setting the system into an inert mode —as in collapse or faint;

  • if the person is experiencing total terror or total exhaustion, the feeling of hopeless may arise;

  • the brain will interpret hopelessness as the instruction to keep activating the defenses and the system will move into working focused on surviving, whatever the cost. The cost is dissociation, numbing, shutting down, etc.

  • If the person instead, “decides” to submit and accept the situation controlling the terror and the hopelessness (consciously or unconsciously), the brain will interpret the reduction of the fear as the instruction of not needing to continue defending the system with the same intensity and will deactivate the defenses;

  • if the terror disappears because the person’s assessment of the risk is such that reaches some sense of safety or hope to be ok, the brain will stop the defenses and will start rebooting the system to go back to normal (it may take months to years, but it will work hard in recovering balance as optimization).

  • If instead, the person can’t get back his/her the cognitive functions and find a way to feel safe, the emotional brain will stay living in fear and hopelessness, and having the defenses active permanently; it will become the new way to function for that brain and that’s called trauma.

  • The defenses will keep shooting stress hormones destabilizing the production of neurotransmitters, and the vital functions like digestion, temperature, heart rate variability, sweat, etc., with the consequence of losing the internal equilibrium.

  • This new constant way of living in hyperalert with no hope or trust, just looking for danger or to be defeated, will be a loop of endless retraumatization, that will end up damaging perception, cognition, emotions, introspection, action, behaviors, and brain/organ operation and connection, which is called complex trauma.

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