Complex PTSD

Complex Post Traumatic Stress Disorder (C-PTSD)

Out of the Fog (link to original information)

Definition:

Complex Post-Traumatic Stress Disorder (C-PTSD) – Complex Post-Traumatic Stress Disorder is a psychological injury that results from prolonged exposure to social or interpersonal trauma, disempowerment, captivity or entrapment, with lack or loss of a viable escape route for the victim.


C-PTSD Introduction

Note: Out of the FOG provides information and support for those with a family member or loved-one who suffers from a personality disorder. This page was written to describe how C-PTSD affects people in relationships with personality-disordered individuals. We welcome visitors who suffer from C-PTSD due to other kinds of trauma. However, please note that we are not a general C-PTSD or PTSD support site. See the links at the bottom of the page for general PTSD & C-PTSD information.

Complex Post Traumatic Stress Disorder (C-PTSD) is a condition that results from chronic or long-term exposure to emotional trauma over which a victim has little or no control and from which there is little or no hope of escape, such as in cases of:

  • domestic emotional, physical or sexual abuse
  • childhood emotional, physical or sexual abuse
  • entrapment or kidnapping.
  • slavery or enforced labor.
  • long term imprisonment and torture
  • repeated violations of personal boundaries.
  • long-term objectification.
  • exposure to gaslighting & false accusations
  • long-term exposure to inconsistent, push-pull,splitting or alternating raging & hooveringbehaviors.
  • long-term taking care of mentally ill or chronically sick family members.
  • long term exposure to crisis conditions.

When people have been trapped in a situation over which they had little or no control at the beginning, middle or end, they can carry an intense sense of dread even after that situation is removed. This is because they know how bad things can possibly be. And they know that it could possibly happen again. And they know that if it ever does happen again, it might be worse than before.

The degree of C-PTSD trauma cannot be defined purely in terms of the trauma that a person has experienced. It is important to understand that each person is different and has a different tolerance level to trauma. Therefore, what one person may be able to shake off, another person may not. Therefore more or less exposure to trauma does not necessarily make the C-PTSD any more or less severe.

C-PTSD sufferers may “stuff” or suppress their emotional reaction to traumatic events without resolution either because they believe each event by itself doesn’t seem like such a big deal or because they see no satisfactory resolution opportunity available to them. This suppression of “emotional baggage” can continue for a long time either until a “last straw” event occurs, or a safer emotional environment emerges and the damn begins to break.

The “Complex” in Complex Post Traumatic Disorder describes how one layer after another of trauma can interact with one another. Sometimes, it is mistakenly assumed that the most recent traumatic event in a person’s life is the one that brought them to their knees. However, just addressing that single most-recent event may possibly be an invalidating experience for the C-PTSD sufferer. Therefore, it is important to recognize that those who suffer from C-PTSD may be experiencing feelings from all their traumatic exposure, even as they try to address the most recent traumatic event.

This is what differentiates C-PTSD from the classic PTSD diagnosis – which typically describes an emotional response to a single or to a discrete number of traumatic events.


Difference between C-PTSD & PTSD

Although similar, Complex Post Traumatic Stress Disorder (C-PTSD) differs slightly from the more commonly understood & diagnosed condition Post Traumatic Stress Disorder (PTSD) in causes and symptoms.

C-PTSD results more from chronic repetitive stress from which there is little chance of escape. PTSD can result from single events, or short term exposure to extreme stress or trauma.

Therefore a soldier returning from intense battle may be likely to show PTSD symptoms, but a kidnapped prisoner of war who was held for several years may show additional symptoms of C-PTSD.

Similarly, a child who witnesses a friend’s death in an accident may exhibit some symptoms of PTSD but a child who grows up in an abusive home may exhibit the additional C-PTSD characteristics shown below:


C-PTSD – What it Feels Like:

People who suffer from C-PTSD may feel un-centered and shaky, as if they are likely to have an embarrassing emotional breakdown or burst into tears at any moment. They may feel unloved – or that nothing they can accomplish is ever going to be “good enough” for others.

People who suffer from C-PTSD may feel compelled to get away from others and be by themselves, so that no-one will witness what may come next. They may feel afraid to form close friendships to prevent possible loss should another catastrophe strike.

People who suffer from C-PTSD may feel that everything is just about to go “out the window” and that they will not be able to handle even the simplest task. They may be too distracted by what is going on at home to focus on being successful at school or in the workplace.


C-PTSD Characteristics

How it can manifest in the victim(s) over time:

Rage turned inward: Eating disorders. Depression. Substance Abuse / Alcoholism. Truancy. Dropping out. Promiscuity. Co-dependence. Doormat syndrome (choosing poor partners, trying to please someone who can never be pleased, trying to resolve the primal relationship)

Rage turned outward: Theft. Destruction of property. Violence. Becoming a control freak.

Other: Learned hyper vigilance. Clouded perception or blinders about others (especially romantic partners) Seeks positions of power and / or control: choosing occupations or recreational outlets which may put oneself in physical danger. Or choosing to become a “fixer” – Therapist, Mediator, etc.

Avoidance – The practice of withdrawing from relationships with other people as a defensive measure to reduce the risk of rejection, accountability, criticism or exposure.

Blaming – The practice of identifying a person or people responsible for creating a problem, rather than identifying ways of dealing with the problem.

Catastrophizing – The habit of automatically assuming a “worst case scenario” and inappropriately characterizing minor or moderate problems or issues as catastrophic events.

“Control-Me” Syndrome – This describes a tendency which some people have to foster relationships with people who have a controlling narcissistic, antisocial or “acting-out” nature.

Denial – Believing or imagining that some painful or traumatic circumstance, event or memory does not exist or did not happen.

Dependency – An inappropriate and chronic reliance by an adult individual on another individual for their health, subsistence, decision making or personal and emotional well-being.

Depression (Non-PD) -Depression is when you feel sadder than your circumstances dictate, for longer than your circumstances last, but still can’t seem to break out of it.

Escape To Fantasy – Taking an imaginary excursion to a happier, more hopeful place.

Fear of Abandonment – An irrational belief that one is imminent danger of being personally rejected, discarded or replaced.

Hyper Vigilance – Maintaining an unhealthy level of interest in the behaviors, comments, thoughts and interests of others.

Identity Disturbance – A psychological term used to describe a distorted or inconsistent self-view

Learned Helplessness– Learned helplessness is when a person begins to believe that they have no control over a situation, even when they do.

Low Self-Esteem – A common name for a negatively-distorted self-view which is inconsistent with reality.

Panic Attacks – Short intense episodes of fear or anxiety, often accompanied by physical symptoms, such as hyperventilating, shaking, sweating and chills.

Perfectionism – The maladaptive practice of holding oneself or others to an unrealistic, unattainable or unsustainable standard of organization, order, or accomplishment in one particular area of living, while sometimes neglecting common standards of organization, order or accomplishment in other areas of living.

Selective Memory and Selective Amnesia – The use of memory, or a lack of memory, which is selective to the point of reinforcing a bias, belief or desired outcome.

Self-Loathing – An extreme hatred of one’s own self, actions or one’s ethnic or demographic background.

Tunnel Vision – A tendency to focus on a single concern, while neglecting or ignoring other important priorities.


C-PTSD Causes

C-PTSD is caused by a prolonged or sustained exposure to emotional trauma or abuse from which no short-term means of escape is available or apparent to the victim.

The precise neurological damage that exists in C-PTSD victims is not well understood.


C-PTSD Treatment

Little has been done in clinical studies of treatment of C-PTSD. However, in general the following is recommended:

  1. Removal of and protection from the source of the trauma and/or abuse.
  2. Acknowledgement of the trauma as real, important and undeserved.
  3. Acknowledge that the trauma came from something that was stronger than the victim and therefore could not be avoided.
  4. Acknowledgement of the “complex” nature of C-PTSD – that responses to earlier traumas may have led to decisions that brought on additional, undeserved trauma.
  5. Acknowledgement that recovery from the trauma is not trivial and will require significant time and effort.
  6. Separation of residual problems into those that the victim can resolve (such as personal improvement goals) and those that the victim cannot resolve (such as the behavior of a disordered family member)
  7. Mourning for what has been lost and cannot be recovered.
  8. Identification of what has been lost and can be recovered.
  9. Program of recovery with focus on what can be improved in an individual’s life that is under their own control.
  10. Placement in a supportive environment where the victim can discover they are not alone and can receive validation for their successes and support through their struggles.
  11. As necessary, personal therapy to promote self-discovery.
  12. As required, prescription of antidepressant medications.

What to do about C-PTSD if you’ve got it:

Remove yourself from the primary or situation or secondary situations stemming from the primary abuse. Seek therapy. Talk about it. Write about it. Meditation. Medication if needed. Physical Exercise. Rewrite the script of your life.

What not to do about it:

Stay. Hold it in. Bottle it up. Act out. Isolate. Self-abuse. Perpetuate the cycle.

What to do about it if you know somebody else who has C-PTSD:

Offer sympathy, support, a shoulder to cry on, lend an ear. Speak from experience. Assist with practical resolution when appropriate (guidance towards escape, therapy, etc.) Be patient.

What not to do about it if you know somebody else who has it:

Do not push your own agenda: proselytize, moralize, speak in absolutes, tell them to “get over it”, or try to force reconciliation with the perpetrator or offer “sure fire” cures.


C-PTSD Links

Use the following links to learn more about C-PTSD and get support:

PTSD Forum Contains a Wiki page and Active Support Forum.

Psych Forums PTSD Forum.

http://healmyptsd.com/ – Resources & info about recovery from PTSD & C-PTSD

C-PTSD Page – by Author Sarah Tata

Trauma: Complex PTSD MentalHelp.net C-PTSD Article by Dr. Allan Schwartz


C-PTSD Support Groups & Links:

Out of the Storm – Support Group for people who suffer from C-PTSD.

Out of the FOG Support Forum – The Support Forum here at Out of the FOG.

PTSD Forum Contains a Wiki page and Active Support Forum.

Psych Forums PTSD Forum.

http://healmyptsd.com/ – Resources & info about recovery from PTSD & C-PTSD

C-PTSD Page – by Author Sarah Tate

Trauma: Complex PTSD MentalHelp.net C-PTSD Article by Dr. Allan Schwartz


For More Information & Support…

If you suspect you may have a family member or loved-one who suffers from a personality disorder, we encourage you to learn all you can and surround yourself with support as you learn how to cope.

 

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Complex Post Traumatic Stress Disorder (C-PTSD)

Definition:

Complex Post-Traumatic Stress Disorder (C-PTSD) – Complex Post-Traumatic Stress Disorder is a psychological injury that results from prolonged exposure to social or interpersonal trauma, disempowerment, captivity or entrapment, with lack or loss of a viable escape route for the victim.


C-PTSD Introduction

Note: Out of the FOG provides information and support for those with a family member or loved-one who suffers from a personality disorder. This page was written to describe how C-PTSD affects people in relationships with personality-disordered individuals. We welcome visitors who suffer from C-PTSD due to other kinds of trauma. However, please note that we are not a general C-PTSD or PTSD support site. See the links at the bottom of the page for general PTSD & C-PTSD information.

Complex Post Traumatic Stress Disorder (C-PTSD) is a condition that results from chronic or long-term exposure to emotional trauma over which a victim has little or no control and from which there is little or no hope of escape, such as in cases of:

  • domestic emotional, physical or sexual abuse
  • childhood emotional, physical or sexual abuse
  • entrapment or kidnapping.
  • slavery or enforced labor.
  • long term imprisonment and torture
  • repeated violations of personal boundaries.
  • long-term objectification.
  • exposure to gaslighting & false accusations
  • long-term exposure to inconsistent, push-pull,splitting or alternating raging & hooveringbehaviors.
  • long-term taking care of mentally ill or chronically sick family members.
  • long term exposure to crisis conditions.

When people have been trapped in a situation over which they had little or no control at the beginning, middle or end, they can carry an intense sense of dread even after that situation is removed. This is because they know how bad things can possibly be. And they know that it could possibly happen again. And they know that if it ever does happen again, it might be worse than before.

The degree of C-PTSD trauma cannot be defined purely in terms of the trauma that a person has experienced. It is important to understand that each person is different and has a different tolerance level to trauma. Therefore, what one person may be able to shake off, another person may not. Therefore more or less exposure to trauma does not necessarily make the C-PTSD any more or less severe.

C-PTSD sufferers may “stuff” or suppress their emotional reaction to traumatic events without resolution either because they believe each event by itself doesn’t seem like such a big deal or because they see no satisfactory resolution opportunity available to them. This suppression of “emotional baggage” can continue for a long time either until a “last straw” event occurs, or a safer emotional environment emerges and the damn begins to break.

The “Complex” in Complex Post Traumatic Disorder describes how one layer after another of trauma can interact with one another. Sometimes, it is mistakenly assumed that the most recent traumatic event in a person’s life is the one that brought them to their knees. However, just addressing that single most-recent event may possibly be an invalidating experience for the C-PTSD sufferer. Therefore, it is important to recognize that those who suffer from C-PTSD may be experiencing feelings from all their traumatic exposure, even as they try to address the most recent traumatic event.

This is what differentiates C-PTSD from the classic PTSD diagnosis – which typically describes an emotional response to a single or to a discrete number of traumatic events.


Difference between C-PTSD & PTSD

Although similar, Complex Post Traumatic Stress Disorder (C-PTSD) differs slightly from the more commonly understood & diagnosed condition Post Traumatic Stress Disorder (PTSD) in causes and symptoms.

C-PTSD results more from chronic repetitive stress from which there is little chance of escape. PTSD can result from single events, or short term exposure to extreme stress or trauma.

Therefore a soldier returning from intense battle may be likely to show PTSD symptoms, but a kidnapped prisoner of war who was held for several years may show additional symptoms of C-PTSD.

Similarly, a child who witnesses a friend’s death in an accident may exhibit some symptoms of PTSD but a child who grows up in an abusive home may exhibit the additional C-PTSD characteristics shown below:


C-PTSD – What it Feels Like:

People who suffer from C-PTSD may feel un-centered and shaky, as if they are likely to have an embarrassing emotional breakdown or burst into tears at any moment. They may feel unloved – or that nothing they can accomplish is ever going to be “good enough” for others.

People who suffer from C-PTSD may feel compelled to get away from others and be by themselves, so that no-one will witness what may come next. They may feel afraid to form close friendships to prevent possible loss should another catastrophe strike.

People who suffer from C-PTSD may feel that everything is just about to go “out the window” and that they will not be able to handle even the simplest task. They may be too distracted by what is going on at home to focus on being successful at school or in the workplace.


C-PTSD Characteristics

How it can manifest in the victim(s) over time:

Rage turned inward: Eating disorders. Depression. Substance Abuse / Alcoholism. Truancy. Dropping out. Promiscuity. Co-dependence. Doormat syndrome (choosing poor partners, trying to please someone who can never be pleased, trying to resolve the primal relationship)

Rage turned outward: Theft. Destruction of property. Violence. Becoming a control freak.

Other: Learned hyper vigilance. Clouded perception or blinders about others (especially romantic partners) Seeks positions of power and / or control: choosing occupations or recreational outlets which may put oneself in physical danger. Or choosing to become a “fixer” – Therapist, Mediator, etc.

Avoidance – The practice of withdrawing from relationships with other people as a defensive measure to reduce the risk of rejection, accountability, criticism or exposure.

Blaming – The practice of identifying a person or people responsible for creating a problem, rather than identifying ways of dealing with the problem.

Catastrophizing – The habit of automatically assuming a “worst case scenario” and inappropriately characterizing minor or moderate problems or issues as catastrophic events.

“Control-Me” Syndrome – This describes a tendency which some people have to foster relationships with people who have a controlling narcissistic, antisocial or “acting-out” nature.

Denial – Believing or imagining that some painful or traumatic circumstance, event or memory does not exist or did not happen.

Dependency – An inappropriate and chronic reliance by an adult individual on another individual for their health, subsistence, decision making or personal and emotional well-being.

Depression (Non-PD) -Depression is when you feel sadder than your circumstances dictate, for longer than your circumstances last, but still can’t seem to break out of it.

Escape To Fantasy – Taking an imaginary excursion to a happier, more hopeful place.

Fear of Abandonment – An irrational belief that one is imminent danger of being personally rejected, discarded or replaced.

Hyper Vigilance – Maintaining an unhealthy level of interest in the behaviors, comments, thoughts and interests of others.

Identity Disturbance – A psychological term used to describe a distorted or inconsistent self-view

Learned Helplessness– Learned helplessness is when a person begins to believe that they have no control over a situation, even when they do.

Low Self-Esteem – A common name for a negatively-distorted self-view which is inconsistent with reality.

Panic Attacks – Short intense episodes of fear or anxiety, often accompanied by physical symptoms, such as hyperventilating, shaking, sweating and chills.

Perfectionism – The maladaptive practice of holding oneself or others to an unrealistic, unattainable or unsustainable standard of organization, order, or accomplishment in one particular area of living, while sometimes neglecting common standards of organization, order or accomplishment in other areas of living.

Selective Memory and Selective Amnesia – The use of memory, or a lack of memory, which is selective to the point of reinforcing a bias, belief or desired outcome.

Self-Loathing – An extreme hatred of one’s own self, actions or one’s ethnic or demographic background.

Tunnel Vision – A tendency to focus on a single concern, while neglecting or ignoring other important priorities.


C-PTSD Causes

C-PTSD is caused by a prolonged or sustained exposure to emotional trauma or abuse from which no short-term means of escape is available or apparent to the victim.

The precise neurological damage that exists in C-PTSD victims is not well understood.


C-PTSD Treatment

Little has been done in clinical studies of treatment of C-PTSD. However, in general the following is recommended:

  1. Removal of and protection from the source of the trauma and/or abuse.
  2. Acknowledgement of the trauma as real, important and undeserved.
  3. Acknowledge that the trauma came from something that was stronger than the victim and therefore could not be avoided.
  4. Acknowledgement of the “complex” nature of C-PTSD – that responses to earlier traumas may have led to decisions that brought on additional, undeserved trauma.
  5. Acknowledgement that recovery from the trauma is not trivial and will require significant time and effort.
  6. Separation of residual problems into those that the victim can resolve (such as personal improvement goals) and those that the victim cannot resolve (such as the behavior of a disordered family member)
  7. Mourning for what has been lost and cannot be recovered.
  8. Identification of what has been lost and can be recovered.
  9. Program of recovery with focus on what can be improved in an individual’s life that is under their own control.
  10. Placement in a supportive environment where the victim can discover they are not alone and can receive validation for their successes and support through their struggles.
  11. As necessary, personal therapy to promote self-discovery.
  12. As required, prescription of antidepressant medications.

What to do about C-PTSD if you’ve got it:

Remove yourself from the primary or situation or secondary situations stemming from the primary abuse. Seek therapy. Talk about it. Write about it. Meditation. Medication if needed. Physical Exercise. Rewrite the script of your life.

What not to do about it:

Stay. Hold it in. Bottle it up. Act out. Isolate. Self-abuse. Perpetuate the cycle.

What to do about it if you know somebody else who has C-PTSD:

Offer sympathy, support, a shoulder to cry on, lend an ear. Speak from experience. Assist with practical resolution when appropriate (guidance towards escape, therapy, etc.) Be patient.

What not to do about it if you know somebody else who has it:

Do not push your own agenda: proselytize, moralize, speak in absolutes, tell them to “get over it”, or try to force reconciliation with the perpetrator or offer “sure fire” cures.


C-PTSD Links

Use the following links to learn more about C-PTSD and get support:

PTSD Forum Contains a Wiki page and Active Support Forum.

Psych Forums PTSD Forum.

http://healmyptsd.com/ – Resources & info about recovery from PTSD & C-PTSD

C-PTSD Page – by Author Sarah Tata

Trauma: Complex PTSD MentalHelp.net C-PTSD Article by Dr. Allan Schwartz


C-PTSD Support Groups & Links:

Out of the Storm – Support Group for people who suffer from C-PTSD.

Out of the FOG Support Forum – The Support Forum here at Out of the FOG.

PTSD Forum Contains a Wiki page and Active Support Forum.

Psych Forums PTSD Forum.

http://healmyptsd.com/ – Resources & info about recovery from PTSD & C-PTSD

C-PTSD Page – by Author Sarah Tate

Trauma: Complex PTSD MentalHelp.net C-PTSD Article by Dr. Allan Schwartz


For More Information & Support…

If you suspect you may have a family member or loved-one who suffers from a personality disorder, we encourage you to learn all you can and surround yourself with support as you learn how to cope.

Objectification

Definition:

Objectification – The practice of treating a person or a group of people like an object.

Description:

A common practice among people who suffer from personality disorders is objectification. Objectification is normally a form of prioritization where the needs and concerns of other individuals are ranked below the needs and concerns of the personality-disordered individual. As such, objectification is rarely emotional in nature.

Objectification is often associated with gender discrimination, as-in “objectification of women” which refers to the practice of treating women as domestic servants or as sexual property. However, objectification has a broader meaning.

University of Chicago Professor Martha C. Nussbaum classified Objectification into the following categories:

  • Instrumentality – Instrumentality is when a person is treated like a tool for another person’s own purposes.
  • Denial of autonomy – Denial of autonomy is when a person is denied the right to make decisions for themselves.
  • Inertness – An Assumption of Inertness describes when a person is treated as if they lack the capacity to act for themselves.
  • Ownership – Ownership describes a condition where one person is treated as if they are owned by, or is a slave to, the other person.
  • Fungibility – Fungibility describes a condition where one person is treated as if they are dispensable or can be traded or discarded by another person.
  • Violability – Violability describes a situation where a person is treated as if it is ok to hurt, or destroy them.
  • Denial of subjectivity – Denial of subjectivity describes a condition where a person is treated as if there is no need to show concern for their feelings.

Acts of objectification typically enrich the perpetrator at the expense of the victim. What the perpetrator fails to recognize is the cost to themselves in the form of long term personal security. People who objectify others build their own form of solitary confinement, knowing that by sacrificing the trust and good will of others, they are vulnerable to eventual demise of their power. Dictatorships generally last for years or decades but typically collapse very quickly.

Objectification is common among people who suffer from Narcissistic Personality Disorder and Antisocial Personality Disorder. Objectification also occurs among people who suffer from Histrionic Personality Disorderand Borderline Personality Disorder.

Examples of Objectification:

  • A young adult only contacts parents as a means of extracting money.
  • A spouse is forced to work as a domestic slave, against their will.
  • Many violent crimes and incidences of theft are manifestations of objectification.
  • A company owner drops a key business partner after a long relationship causing the other to go bankrupt.
  • An elderly person is neglected.
  • Children are forced into labor.
  • A tyrant throws his/her political opponents in jail.

What it feels like:

If you have been the subject of objectification, you are probably familiar with the emotions of fear and anger. Anger comes from having your dignity and your rights violated by another person who has considered their own needs to be more important than yours. You may feel an urge to retaliate or get even. Fear comes from knowing that they may hold a certain amount of authority or influence and that if they did it once, they are likely to do it again.

A secondary but perhaps more significant effect of being objectified is a loss of self-worth. Many of us derive a significant portion of our self-worth from the validation that comes from other people. This affects all victims of objectification but it is especially true of children who live with a personality-disordered parent. It is very difficult for a victim of objectification not to look at themselves and ask “What did I do to deserve this?” or “What is wrong with me that they treat me this way?” In this way the victim can become vulnerable to blaming themselves for the actions of the abuser and to assume that their abuse is normal, deserved, inescapable and inevitable. See our information onShame and Shaming.

Coping with Objectification – What NOT to Do:

  • Don’t beg or plead with someone who objectifies you to be kind. Ask for what you want once and if they don’t give it to you then you have your answer.
  • Don’t allow yourself to become isolated from others by a person who objectifies you.
  • Don’t make alliances with a person who objectifies others. If they do it to others they will someday do it to you.
  • Don’t become envious of the apparent rapid success of a narcissist. Work to build the kind of success that lasts a lifetime.
  • Don’t take objectification personally – objectification is the act of a disordered individual. It says nothing meaningful about your own value or worth as a person.
  • Don’t try to gain control over a person who mistreats you. Focus on controlling yourself.
  • Don’t react with indignation, anger or retribution. If your feelings are being disregarded then your reaction will not have a big impact.
  • Don’t treat mistreatment at the hands of another as some sort of investment that will pay off in the long run. If you are being hurt by the deliberate choice of another individual it is not likely to be repaid in the future.
  • Don’t accept treatment that is anything short of respectful, considerate and appropriate.

Coping with Objectification – What TO Do:

  • If possible, accept small sacrifices to remove yourself from the influence of a person who objectifies you.
  • Build relationships with people who respect you, admire you, treat you well and who give as much as they take.
  • If you see someone else being abused or neglected, report it.

 

Gaslighting

Definition:

Gaslighting – The practice of brainwashing or convincing a mentally healthy individual that they are going insane or that their understanding of reality is mistaken or false. The term “Gaslighting” is based on the 1944 MGM movie “Gaslight”.

Casting You as the Crazy One

In the classic suspense thriller, Gaslight, Paula (Ingrid Bergman) marries the villainous Gregory Anton (Charles Boyer), not realizing that he is the one who murdered her aunt and is now searching for her missing jewels.
To cover up his treachery, he tries to persuade Paula that she is going mad, so he can search the attic for the jewels without her interference. He plants missing objects on her person in order to make her believe that she has no recollection of reality. He tries to isolate her, not allowing her to have visitors or to leave the house.

If this sounds somehow familiar, you have probably encountered the form of psychological abuse we call Gaslighting. Essentially, it describes forms of manipulation which are designed to make the victim lose their grip on the truth or doubt their perception of reality.

What it Looks Like

  • A family member who steals something from you tries to convince you that it belongs to them.
  • A person acts threateningly and then accuses you of abuse when you react in self-defense.
  • A spouse tries to persuade you that you said or did something that you know is inaccurate.

How it Feels

Gaslighting can be a terrifying experience. It can quickly put you on the defensive – trying to justify your own actions or behaviors – when you started out by challenging someone else’s questionable behavior.

A gaslighting perpetrator’s fabrications may be presented so convincingly and with such conviction you begin to question yourself and your own memories and judgment. You may begin to fear that other people – who don’t know the truth – might be persuaded believe some of the distortions.

What NOT to do:

  • Don’t equate intelligence with character – just because someone can run rings around you in an argument doesn’t mean they are right.
  • Don’t waste your time trying to convince someone who has already made up their mind about you that they should reconsider.
  • Don’t argue with a person who is fabricating the facts. Wait for them to return to reality before engaging them in a discussion and do it on YOUR terms – not theirs.
  • Don’t allow yourself to be isolated from others against our own better judgment. Insist on your right to have your own friends and family.
  • Don’t blame yourself for what the other person is feeling or how they are behaving. Don’t look for ways to change yourself to try to fix another person. As the OOTF 3 C’s mantra says: “You didn’t cause it, you can’t cure it and you can’t control it.” You are only responsible for your own words and actions.
  • Don’t stay in the room if the situation becomes physically, verbally or emotionally unhealthy or unsafe.
  • Don’t go it alone or keep what you are experiencing a secret.

What TO do:

  • Remind yourself that you are not to blame for the other person’s behavior.
  • Detach yourself from feeling responsible for how another person is feeling, behaving or thinking.
  • Turn your attention on your own behavior and your own thought patterns. Discard the unhealthy and learn what is healthy for yourself and pursue it – regardless of what reaction you get from the person with the Personality Disorder.
  • Talk about it! Talk to trusted friends and family about what you are dealing with.
  • If you are ever confronted with violence or abuse, get yourself and any children immediately out of the room and call for help. Report all acts of violence, threats of violence or self-harm to the police immediately every time.
  • Maintain your healthy lifestyle and thought life. You will need them. If necessary, explain to your loved-one gently, but firmly that you are doing what you need to do for yourself and then close the conversation.

For More Information & Support…

If you suspect you may have a family member or loved-one who suffers from a personality disorder, we encourage you to learn all you can and surround yourself with support as you learn how to cope.

False Accusations and Distortion Campaigns

Definition:

False Accusations – Patterns of unwarranted or exaggerated criticism directed towards someone else.

The pointed finger

Almost everyone has felt the injustice of being unfairly accused at one time or another. However, for some people who are close to a Personality-Disordered individual, being falsely accused can be a frequent, almost routine experience.

False Accusations, Distortion Campaigns and Smear Campaigns can all be used with or without a grain of truth, and have the potential to cause enormous emotional hurt to the victim or even impact their professional or personal reputation and character.

What they look like

  • A man who gets sick accuses his wife of trying to poison him.
  • A woman falsely accuses her husband of having an affair and repeats this to everyone in the community.
  • A mother falsely tells friends and neighbors that her daughter has an eating disorder.
  • A teenager files a false police report about one of his parents committing child abuse.

Why they do it

False Accusations can be forms of Baiting, or Proxy Recruitment used by abusers to instigate or win in a dispute.

Sometimes false accusations are used by abusers as a deflection technique, to discredit their victim and promote the idea that the abuse is merited or has been overstated. For example, an abusive parent may tell other relatives the child is a chronic liar and ‘drama queen’.
Some false accusations are rooted in Dissociation – where a Personality-Disordered Individual confuses their feelings with facts.

How it feels

It is a frightening, humiliating and upsetting experience to discover you are a victim of false accusations. When dealing with Personality-Disordered individuals, the nature of the accusations may seem clever and manipulative or may seem illogical or absurd. However the reaction a Non has is usually the same: there is an overwhelming urge to clear your name and set the record straight.

What NOT to do

  • Don’t believe everything a Personality-Disordered person says to you or about you, even when they say they love and care about you. If they are vulnerable to deceiving themselves they will occasionally try to deceive you too.
  • Don’t ask the Personality-Disordered individual to retract their accusations more than once. The goal of the false accusation may be simply to bait you into a fight.
  • Don’t over-analyze false claims. If someone believes something untrue, that is their problem, not yours.
  • Don’t blame yourself for being falsely accused. You are responsible for the truth in your own words, not someone else’s.

What TO do

  • Remind yourself that one person’s opinion of you does not define you.
  • Pay close attention to the way a loved-one talks about other people. That is likely to be the way they will eventually talk about you.
  • Seek out the counsel of wise, caring and supportive people who you can trust to tell you the truth and help you rebuild your self-esteem.
  • If someone says something which you believe isn’t true, it is appropriate to state your truth clearly. Once!

False Accusations, Distortion Campaigns and Smear Campaigns can all be forms of Baiting, Projection orProxy Recruitment.

Baiting – A provocative act used to solicit an angry, aggressive or emotional response from another individual.

Projection – The act of attributing one’s own feelings or traits to another person and imagining or believing that the other person has those same feelings or traits.

Proxy Recruitment – A way of controlling or abusing another person by manipulating other people into unwittingly backing “doing the dirty work”

Examples of False Accusations:

  • A man accuses his wife of trying to poison him when he gets sick.
  • A woman accuses her husband of having an affair and tells this to a marriage therapist.
  • A mother falsely tells friends and neighbors that her daughter has an eating disorder.
  • A teenager who files a false police report about one of his parents committing child abuse.

It can be a frightening, humiliating and annoying experience when you discover that you are a victim of false accusations. When dealing with personality disordered individuals, the nature of the accusations may seem clever and manipulative or may seem illogical or absurd. However the reaction is usually is the same: there is an overwhelming urge to clear your name and set the record straight.

What NOT To Do:

  • Non-personality-disordered individuals can sometimes be stunned to discover that the personality disordered individual in their lives completely believes a false reality that they have invented. It is common for non-personality-disordered individuals to spend a great deal of effort fruitlessly trying to reason, cajole or argue with a personality disordered individual into “snapping out of it”, “waking up and smelling the coffee” or “facing the facts”. It can be hard for non-personality-disordered individuals to accept that for a person who is dissociating, the denials they are expressing are the facts – at least at that time – for them.
  • Under such circumstances, standard communication or negotiation techniques are ineffective – since they are built on the premise that both parties can agree on what the facts are and can work towards a compromise.
  • Arguing or trying to reason with a person who is dissociating will typically result in a frustratingCircular Conversation.

What TO Do:

  • Accept that each person’s reality is their own property and everyone has the right to believe what they want to believe, think what they want to think and experience their own world without intimidation, control or persecution. That applies to the personality-disordered individual in your life and it also applies to you. That will mean you may have to “agree to disagree” on important facts, history or conclusions.
  • Remind yourself that one person’s opinion of you does not define you. You are you.
  • Seek out the counsel of wise, caring and supportive people who you can trust to help you rebuild your self-esteem.
  • Visit our Working On Ourselves section for some ideas.
  • If someone says something which you believe isn’t true, it is appropriate to declare “I don’t see it that way”. Once!
  • If you, or any children in your care, are being exposed to abuse of any kind, take appropriate action to protect yourself and your children.
  • After that it is appropriate to walk away from any further discussion and go about living your life in an emotionally and physically safe, healthy, and productive way.

Splitting – Idealization and Devaluation

Definition:

Splitting – The practice of regarding people and situations as either completely “good” or completely “bad”.

No Middle Ground

Splitting is described in the American Psychiatric Association’s Diagnostic & Statistical Manual (DSM-IV) as “A pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation.”

People who are regarded as being “all good” are sometimes referred to as being “split white” or “painted white”. People who are regarded as being “all bad” are sometimes referred to as being “split black” or “painted black”.

When a person or a group of people is “split white” by a person with a Personality Disorder, they may just as suddenly be “split black” (and vice versa). Because there is no middle ground – no shades of grey – it’s an either/or proposition. For the targets, this can be confusing and upsetting.

Consequently, there is usually some justification presented by the person with the Personality Disorder for their actions, decisions or sudden changes of heart but their logic is frequently flawed, contradictory or incomplete

What it Looks Like

  • A woman praises her husband as a wonderful husband and father in public but accuses him of abuse later the same day.
  • A mother habitually tells her daughter she is “useless” or “worthless” but when she gets a good grade at school gushes: “We are all so proud of you!”
  • A friendly co-worker or neighbor suddenly, without warning, begins giving you the cold shoulder.
  • A person persistently moves on from one social group to another, praising each group at first before becoming harshly critical.

Splitting is an example of Dissociation – or “Feelings Create Facts” – where a Personality Disordered person’s feelings take priority over what the facts actually tell them. If they experience a mood swing and suddenly feel good or bad about a particular person or situation, they can instantly modify their opinions, memories or attitudes to be consistent those feelings, regardless of any apparent contradictions.

How it Feels

When you come into contact with someone who engages in splitting, you may feel threatened by how easily or how quickly they can idealize or demonize you or other people for no apparent reason. Even if you are currently “split white” yourself, you may still feel insecure because you know that your favored “status” may change without warning.

If you are close to a person who uses splitting, you may occasionally find yourself being asked to choose between agreeing with them, or defending yourself or other people whom they have “split black”. This can become a real problem if you feel there is a matter of principle involved or if a valued relationship is suddenly challenged or threatened. You may be very uncomfortable trying to reconcile your relationship with the Personality Disordered individual and your personal values or valued relationships with other family members, friends and co-workers.

You may suddenly come under a lot of pressure to cut off contact with specific people and find yourself sacrificing friendships and social settings just to “keep the peace”. The problem with doing this is while it may seem to avoid conflict in the short term, you may hurt yourself and starve yourself of support and social interaction that you need in order to stay emotionally healthy.

You may also come under sudden pressure to neglect or compromise your own values or principles when they come into conflict with the black and white thinking of someone who is splitting. The trouble with giving in to this kind of pressure is you are likely feel to worse about yourself afterwards.

What NOT to do

  • Don’t argue with a person who is splitting or try to talk sense into them. That’s a recipe for a Circular Conversation.
  • Don’t blame yourself. People with Personality Disorders can easily distort facts to fit the way they feel. That’s their concern, not yours.
  • Don’t act like the Thought Police. Don’t use any tricks, intimidation or ultimatums to try to get someone to see things differently. Everyone is entitled to think what they want to think and believe what they want to believe.
  • Don’t become angry with them or try to retaliate.
  • Don’t yield your own reality about a person or group or isolate yourself from healthy friendships, family, social groups just to “keep the peace”. Don’t try to hide those relationships. It’s OK for you to have differences of opinion.
  • Don’t automatically assume that everything the other person believes or says is untrue. Don’t automatically run for the opposite corner or play “devil’s advocate”. Try to think objectively. Occasionally, like the boy who cried wolf, they may tell you something important.

What TO do

  • Handle disagreements with a person who is splitting as unemotionally, firmly and briefly as you can.
  • Try to “agree to disagree”. Acknowledge that you see things differently.
  • Respect their right to have their own point of view and assert your own right to have your own point of view.
  • Avoid ideological debates. Try to see the gray in each situation and judge on the merits.
  • Maintain and nurture your healthy friendships, family relationships and social groups, so long as they form no substantive threat to yourself or to another individual.
  • Find a support network, a group of people who understand what you are living with and who you can talk to about the tough situations.
  • If appropriate, talk to people who have been split black or white by your loved one to let them know that you are able to see the “gray”.

Push-Pull

Definition:

Push-Pull – A chronic pattern of sabotaging and re-establishing closeness in a relationship without appropriate cause or reason.

The Emotional Boomerang

Push-Pull describes the feeling many of us experience being in a relationship with someone who suffers from a Personality Disorder – sometimes they draw us close, other times they push us away either overtly or through behaviors which drive us away.

Because people with Personality Disorders have an inner world where strong and ever-changing feelings create the facts, they often treat people they come into contact with according to the way they are feeling, good or bad, regardless of what that person may truly deserve.

How It Feels

What often confounds the person on the receiving end of Push-Pull treatment is they can clearly see inconsistencies in the cyclical arguments and behaviors they are dealing with, yet the person with the Personality Disorder may be completely blind to the contradictions. This difference in perceiving reality can often lead to Circular Arguments between the PD Sufferer and the Non, which generally only pours more fuel on the dysfunctional fire.

It can be hard not to take a hit to your self-esteem as you try to guess from one day to the next what kind of mood your PD will be in when you wake up, or when you arrive late from work, or when you go to a social gathering. It’s entirely normal for humans to try to find patterns in a person’s behavior such as “Last time I said xyz it really pleased her,” or, “Every time I try <—> he always does <—->”.

However, when the behaviors are driven by the feelings of a PD the same actions do not always produce the same result.

How it Looks

  • A woman cycles between telling her husband she wants a divorce and begging him not to leave her.
  • A man hits his girlfriend and then tells her she means the world to him.
  • A mother tells her son he is the smartest kid in the world while telling his siblings he is stupid.
  • A father repeatedly spends the grocery money on entertainment and then begs his family for forgiveness.

What NOT to do

  • Don’t seek logic where it doesn’t exist – try not to look for a logical reason for every illogical thought, word or deed of a person with a Personality Disorder.
  • Try not to play the guessing game, where you try to change your own behavior in an attempt to control the reactions of another person.
  • Don’t assume anyone else’s bad behavior is based something YOU have said or done. Everyone is responsible for their own behavior.
  • Try not to react emotionally in anger or revenge when you don’t get what you want or deserve.

What TO do

  • Learn everything you can about the Personality Disorder your loved-one suffers from, and how that is likely to affect their behavior, their thoughts and their moods.
  • Develop an emergency plan for any scenario that may include violence or abuse being directed towards or your children.
  • Discover ways to get what you need/want, ways that are not solely dependent on your loved-one having a “good day”.

For More Information & Support…

If you suspect you may have a family member or loved-one who suffers from a personality disorder, we encourage you to learn all you can and surround yourself with support as you learn how to cope.

Raging, Violence and Impulsive Aggression

Definition

Raging, Violence and Impulsive Aggression – Explosive verbal, physical or emotional elevations of a dispute. Rages threaten the security or safety of another individual and violate their personal boundaries.

Off the Charts

Rage and Impulsive Aggression are different from anger. Anger is a feeling. Rage and impulsive aggression are actions or behaviors. Rages are also unprovoked however, in most cases a person who commits an act of rage will find an excuse which puts the blame for their behavior on others – usually the victim.

While some rages are brief, lasting from a few seconds to a few minutes, others can last for hours. However, it is not the duration but the intensity which makes a lasting impact on the victims and the relationship. In some case, fits of rage are bridged together by longer, passive-aggressive spells of contempt or silent treatment.

Rages occur most often in private settings such as the home, where there are no witnesses other than the victim, and are also more likely to occur after dark.

What it Looks Like

  • Two people are involved in a heated argument and one person suddenly reaches out and strikes the other.
  • One person is sleeping and the other wakes them up to begin arguing.
  • During a heated discussion one party takes a glass object and smashes it.
  • A person deliberately destroys an item belonging to another family member while they are out of the house.
  • One person unexpectedly begins to berate the character of another who is silent.

How it Feels

When a person with a Personality Disorder whom you have known for a long time suddenly goes into an aggressive rage you may feel that sickening “Here we go again” feeling. You may find yourself quickly scanning your recollections of what happened the last time you went through this. Chances are you will know that these rages are temporary things and often blow over after a few hours or a few days, but you may still feel an intense sense of fear, anxiety or perhaps even your own, milder anger that the productive day at work, recreational activity or pleasant evening you had planned will now be interrupted, disrupted and invaded by someone else’s emotional tsunami.

All of it will make you feel trapped and powerless, as you face the “damned if you do and damned if you don’t” scenario and realize you have to choose the lesser of two evils – stay and fight or leave and fight.

If you stay – you know you are in for a rough ride. It may take hours. You may not get to sleep. As you witness the most outrageous affronts on your dignity, you will have to listen to the same well-worn record of reasons why this person’s behaviors are justified, what’s wrong with you, why if you just were more of this and less of that, this person would be able to stop abusing you. Staying during a rage is pure hell.

If you leave – you will keep more of you dignity but you need to have real nerve as you walk out the door. You know you’re going to hear something awful on the way out – maybe you will be called the most horrible names, maybe you will hear the smash of glass or the sound of a slanderous 911 call being placed. And once you’re out – where will you go? You may be all alone with nowhere to go and nothing to do but sit and fret about what will happen when you return. Leaving during a rage is pure hell.

How to Cope with Violence, Raging & Impulsive Aggression

When confronted by rage – you are faced with two unattractive choices – fight or flight. It is a time to choose the lesser of two evils. In the short run they are about equal in pain but in the long run, leaving during a rage is better for the following reasons:

  1. Leaving during a rage makes it impossible for you to do something stupid yourself (such as retaliate);
  2. Leaving during a rage makes it impossible for anything worse to happen directly to you (although the PD person my still try to hurt you by making slanderous phone calls, destroying a favorite possession, emptying your bank account, etc.);
  3. Leaving during a rage sends a clear “This is not OK” message. It won’t be appreciated at the time but it will not be forgotten quickly either;
  4. Leaving during a rage helps to remind you that YOU are in control – not the person with the Personality Disorder;
  5. Leaving during a rage gives you an opportunity to talk to a supportive friend to help you calm down.

We strongly urge you to have a plan of what you will do and where you will go the next time a rage hits. This will make it emotionally easier to make a gracious exit the next time you are confronted with a rage or impulsive aggression. If you have a friend or family member you can pre-arrange with that it’s OK to show up at a moment’s notice and spend the night that is ideal.

If not, maybe you can find a local low-cost hotel where you can show up at a moment’s notice and get a safe room for the night.

Perhaps you want to have a ready-kit which has your credit cards, essential medications, and important documents already packed so you don’t need to linger when you need to get out in a hurry.

If at all possible, pre-arrange with a friend whom you can call (even during the night) just to talk to if you find yourself in a situation like this. Just having someone on the end of the line who doesn’t judge you for the way you feel or say unhelpful things like, “But X really does love you”, is an enormous relief. If you have pre-arranged earlier you won’t feel so stupid calling them or showing up at the door at 2 in the morning – so talk to them now.

What NOT to do

  • Don’t remain in the same room with a person who is raging. Remove yourself from the situation as quickly as you safely can.
  • Don’t try to handle it on your own. Call the police or get a third party involved.
  • Don’t try to reason with someone who is raging. When you are confronted with aggressive behavior there can be a temptation to stand your ground, explain your position and argue for what you feel is right. A person who is raging is not thinking rationally and is unlikely to see reason.
  • Don’t fight fire with fire and reciprocate the aggressive behavior. You will regret it and still be apologizing for it years later if you do.
  • Don’t ignore it, steel yourself and tell yourself that you can handle it and that it does not affect you. Unless you are a robot your feelings are going to be hurt and your behavior is going to change far beyond the moment of rage, whether you admit it or not. The reality is that when your boundaries are being crossed you are being hurt. Ignoring it greatly increases the likelihood that the situation will repeat itself.
  • Don’t hide it from others. Most long-term cases of abuse stay that way because the victim stays silent.

What TO do

  • Get yourself and any children out of the room and out of the house as quickly as you can safely do it.
  • If violence or threats of violence have occurred, call the police immediately.
  • Stay away from the situation until you have assurances that the bad behavior.
  • If any of your personal property is threatened with harm, come back later with a friend and remove it to a safe place.
  • Call at least one trusted confidant and tell them what has happened.
  • Refer to our Emergency Page for more info.

Hoovering

Definition:

Hoovers & Hoovering – A Hoover is a metaphor taken from the popular brand of vacuum cleaners, to describe how an abuse victim trying to assert their own rights by leaving or limiting contact in a dysfunctional relationship, gets “sucked back in” when the perpetrator temporarily exhibits improved or desirable behavior.

Here We Go Again

Many Nons have experienced the phenomenon we call Hoovering, which is a metaphor derived from the popular (and effective) brand of vacuum cleaners. And just as dust gets caught up in the vacuum cleaner, many Nons get sucked back in to the status quo when they attempt to escape an abusive situation.

It is most likely to happen when:

  1. There has just been an emotional outburst, episode of violence or other extreme period of abuse; at the point where the perpetrator realizes the victim is likely to leave, retaliate or seek help from others.
  2. The victim starts to pull away from the relationship, leave the relationship or establish firmer boundaries within the relationship.
  3. The abuser internally feels unworthy and fears the loss of the relationship.

The abuser may shower their victim with gifts, compliments, promises, demonstrations of love and acts of affection in order to win back the victim’s trust or faith, and therefore maintain the status quo.

Hoovering is one of the key components of an Abusive Cycle. It is the tactic which ensures many abusers do not have to live alone. It can also act as the ‘plus’ side when the victim calculates the emotional balance sheet, manipulating them into sustaining the abusive relationship.

Like a tango, it takes two: the person doing the hoovering and the person being sucked in.

How it Feels

Hoovering feels good -and that’s the point! When you are being hoovered, your warm-and-fuzzy buttons are all getting pushed, your feelings are getting validated, your needs are being met, your wildest dreams are coming true, your opinions matter, you are the most important person in the world to that certain person.

It often feels like vindication. You might find yourself thinking “Finally! The message is getting through! I’m not crazy after all! Now THAT is what I’m talking about! They really DO love me!” But watch out…

When you are starving for any emotional food, just about any kind of personal validation tastes wonderful. However, just because it tastes good, doesn’t mean it’s actually healthy or nourishing.

Manipulative abusers are often adept at giving their victims enough of what they want to keep them where they want them. Even slave owners know that they have to feed them enough to keep them healthy and productive.

How do I know if a hoover is “real”?

It can be a struggle to work out whether a hoover really is a hoover, because it initially looks like it could be a sincere attempt at change by the personality-disordered person whom they care about. And as Nons, that’s what we want!

The mistake in that logic is that it assumes that it can’t be both. Many abusers and personality-disordered people really are sincere and really are trying when they also are hoovering. People who are hoovering you may not be consciously trying to manipulate you or deceive you. They may sincerely be trying, even hoping, to make it “better this time”. They may not be consciously lying when they make promises of change and put them into practice. They may be so convincing because they are so convinced, at least right now.

You are going to have to be like the adult in a parent-child relationship, who listens to their child’s black-and-white promises and says “Hmm, we’ll wait and see”.

If you’re not sure if you’re being hoovered you should wait and see. Take the long-term view. A person’s character is like an average of their behaviors over their lifetime. People can and do make positive changes in their lives sometimes, deciding to change their behavior for the better. Wait a year and see.

If you feel you can’t wait a year, it could be your relationship balance sheet is deeply in the red, which is an alarm bell worth listening to.

How to Cope

If somebody who has been treating you abusively starts to treat you well, there’s no harm in letting them knock themselves out and give yourself a break, just be careful not to take the bait to erode your boundaries, settle for less than you deserve, stop doing things that are healthy for you or stop exercising your own independence.

What NOT to do

  • Don’t change any of your boundaries or allow them to be broken during a hoover.
  • Don’t relax or give up on any consequences of previous poor decisions for the abuser.
  • Don’t stop any healthy activities or relationships you may be engaged in elsewhere.
  • Don’t assume the hoover will last forever.
  • Don’t use a hoover to bargain for a better life. You are setting up the abuser to break a promise and setting yourself up for a disappointment.

What TO do

  • Remember that mood swings are a normal part of a number of personality disorders and that what goes up must come down.
  • Accept that highs and lows are a part of everyone’s emotional life and that, for a personality-disordered person, those may be more intense and lead to swings in behavior.
  • Maintain all your healthy lifestyle habits and relationships with others.
  • Take the long-term view. Wait a year if it is safe to do so.
  • Get yourself off the roller coaster. Position yourself so that your safety and happiness isn’t dependent on a personality-disordered person’s mood.
  • If the hoovering was preceded by acts of violence towards you, a child, or a pet, get advice from a Domestic Violence service immediately.

—————————————————————————————————————————————————————————————————————-

Complex Post-Traumatic Stress Disorder

By SARA STAGGS, LICSW, MSW, MPH

 

Complex Post-Traumatic Stress Disorder (link out to article-test link)

Complex Post-Traumatic Stress DisorderMichelle was terrorized for much of her childhood. Her father was an inconsistent presence and her mother expressed outright disdain for her. Often when Michelle went to her mother for comfort, she was accused of exaggerating or being a “crybaby” and sent away.

Starting at age 4 until she was out of the house at 16, Michelle was molested by several family members — including her brother, her uncle and a couple of cousins. As she grew up, different men in the neighborhood also sexually assaulted her.

At 19, she began dating Carl, who initially was very affectionate. However, he then began to be suspicious of different friends of hers and concerned about how she spent her time. This escalated into more and more controlling behavior and occasionally he was physically violent.

After two years of dating, Michelle managed to escape the relationship. A couple of months after leaving, she was in a car accident that left her in a coma for a week. After she woke, she spent months learning to walk again. A few years ago, her mother became terminally ill and for months Michelle worked hard to provide her mother with superb nursing care. She hoped that this, plus having earned a master’s degree would lead to her mother accepting her and recognizing her as good. Instead, her mother complained about Michelle’s laziness and incompetence until she died. Now, Michelle has had difficulty mourning her mother’s death and feels that she needs support to do that.

Because Michelle’s trauma happened throughout her development, many of her trauma symptoms present as part of her personality. She is extremely insecure, and is constantly vigilant to signs that she is disliked and plotted against. As a result, she finds it extremely difficult to say no to any requests or to make her needs known. Since as a child, her primary caregivers were abusive and negligent, this is what she has learned to expect from others, and finds it very difficult to trust anyone.

Michelle also dissociates when she feels threatened physically or emotionally. For her, this means that her vision and hearing get “cloudy” and it is difficult for her to understand what is happening around her. She finds it frustrating that she feels so disconnected from her environment and feels that she must look stupid to those around her. She also experiences nightmares and intrusive memories of different events, though the memories are not as common as a general sense of dread that seems to come out of nowhere, such as when she needs to go to her basement.

After many years, Michelle finally sought help at her local women’s center. Initially she started by attending group therapy, since she was hopeful that she would be more likely to blend in. From the groups, she learned that others shared many of her symptoms and feelings and also got to process some parts of her story. She also learned some coping strategies to deal with some of her symptoms.

Eventually Michelle decided that she was ready to open up to an individual therapist, even though she was terrified of being judged and rejected. Her therapist was trained in EMDR, a specific therapy known to work with those suffering from PTSD. She uses this approach integrated with mindfulness and cognitive behavioraltherapy.

Michelle and her therapist continued working on her ability to regulate her emotions, recognize and challenge her irrational thoughts, and identify triggers that caused her to disconnect and stay grounded when she began to dissociate. When she was ready, she and her therapist began to process her history. Because Michelle has hundreds of traumatic incidents, they organized their approach according to her current triggers. For example, Michelle has a bullying coworker whom she finds extremely upsetting. Her therapist helped Michelle identify the emotions and body sensations that this coworker arouses in her.

Then, Michelle identified incidents in her past where she felt the same way. From this shorter list, Michelle picked a particularmemory that was particularly early and vivid. They processed this memory, knowing that the other memories in the list are connected to this memory and in processing one, they are all desensitized.

Michelle also was able to disconnect her mother’s treatment of her and her childhood sexual assault from the sense of defect that she had long carried. She was able to internalize that the events she experienced were things that had happened to her as an innocent child and that she hadn’t deserved them. This has allowed her to relearn how to respond to other people in a less anxious way.

Michelle started seeing significant changes in how she responded to her coworker. Instead of wondering what she did wrong, Michelle was able to see that her coworker was being cruel. Rather than try to find ways that she could make the coworker like her better, Michelle disengaged from the dynamic and focused on her work. While the coworker didn’t change, like a lot of bullies, she found less satisfaction in targeting Michelle and bothered her less.

Michelle has begun to set boundaries with friends, family and coworkers and ask for time to herself, to see the movie she wants to see, or anything else that she wants. Because of the complexity of her trauma and symptoms, this was not her only set of complaints and she will be in therapy for at least a year or two to continue to process different triggers, relearn beliefs and coping skills and integrate all that she is doing. However, because of the success of her first round, she is very excited to continue.

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Remembering Jennifer Shea McGee

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