The Difference Between PTSD and Complex PTSD

The world of psychology has been wrestling with a differentiation between Complex PTSD (CPTSD) and "regular" PTSD since such a distinction was initially publicized in 1992 by Judith Herman in her book Trauma and Recovery.  So it stands to reason that for many of you this is the first time you’ve ever heard of CPTSD.  

You’ve heard plenty about PTSD in reference to soldiers, rape victims, and others who have experienced a traumatic episode.  The “Complex” version of PTSD, a new addition to the DSM-5, speaks to the disorder sometimes suffered by victims of repeated and prolonged traumatic episodes: child abuse survivors, prisoners of war, those coming from concentration camps, etc. 

Most reading this will fall into the category of prolonged/repeated traumas as opposed to a singular incident, but if I can help anyone challenged by the commonly-known type, then wonderful!  I'm writing this blog in general to raise awareness of the difference between the two and help those like me who have CPTSD.

Coming across CPTSD earlier this year was a monumental turning point for me because I had never felt that my official clinical diagnoses of PTSD; Panic Disorder with Agoraphobia; Generalized Anxiety Disorder; and ADHD were truly appropriate for describing my particular set of symptoms. 

This is not a shot at my clinicians, both of whom are incredible.  Clinically speaking, the diagnoses were made correctly, but they just never sat well in my mind.  My now ex-wife, who’s a juvenile psycho-therapist, opined that I was also Bi-Polar, but a psychiatrist dismissed that quickly.  

(I mention this situation with my ex-wife as a warning to you that you need professionals who aren’t related to you in order to get the most appropriate care.  You obviously can’t be your own therapist, but your mother the doctor, your uncle the psychiatrist, or your best friend the barista are simply too close to you to make clear-minded diagnoses or treatment plans.  It’s wonderful to use them as a resource and emotional support, of course, but only for those purposes.) 

Anyway, it was so difficult to wrap my head around how to approach, design, and execute my recovery plan with this array of diagnoses.   

(Here's another tip I want to interject here: You should have an integral role in setting up your treatment plan, or you will run the risk of not owning the plan and therefore not following it.  If your therapist pushes back on this, then go find another one because this is a relationship unto itself and needs to be functional for you to recover effectively.)

Then I came across CPTSD and could safely relegate the PD/A and GAD to being offshoots of CPTSD instead of having 3 different disorders simultaneously.  I consider ADHD as my secondary diagnosis but it has very little, if anything, to do with the abuse I experienced as a child so I won't talk about it much on this blog. 

Therefore, I went from juggling four or five discrete and sometimes conflicting diagnoses to one primary and one secondary.  Remember I'm not a clinician, this is simply how my experience turned out, what works for me, and why I've made CPTSD the fulcrum of this blog upon which each post pivots.  

My diagnostic re-focus allowed me more progress in a couple of months than I had in years (though my therapist would point out that it took those years of work for me to be position to make such good use of those months… and he would be right!) 

Anyway, since I'm not a trained clinician, here are 2 amazing links from someone who is and which further explain CPTSD:

http://www.psychologytoday.com/blog/hijacked-your-brain/201306/ptsd-becomes-more-complex-in-the-dsm-5-part-1

http://www.psychologytoday.com/blog/hijacked-your-brain/201306/ptsd-becomes-more-complex-in-the-dsm-5-part-ii

Complex PTSD and Maladaptive Behaviors

Today I want to explore how our childhood traumas have such a profound impact on who we became as adults.  Many men, such as myself, instinctively dissociated from the pain and confusion inflicted upon our newly-forming sense of self and nascent understanding of the world.  In other words, we had no real choice but to avoid confronting the horrors we endured simply to survive as we awaited and reached for the false safety of adulthood.  

I specifically detached from my experiences until I was 32 years old - over 12 years after the final incident - by subconsciously dismissing what happened (repression), consciously pushing aside thoughts and memories (suppression), or flat out deceiving myself and others by downplaying the true severity or impact. 

It came easy to simply insist my childhood was normal and that “of course” there aren’t any ongoing consequences.  To do otherwise was, in my mind, admitting that I was weak-minded and so soft that I couldn’t even get past things which happened when I was a child.  I'm a strong and resilient man who toughs things out damn it! 

Yet it isn’t about being tough-minded or strong-willed.  There were plenty of signs that I had some deep-seated issues which needed to be addressed.  Back in the day when I used to get into fights, I would never remember the first shot I took.  The beginnings of those altercations were never part of my memory.  I always blacked out for a split second (even when it wasn't a blow to the head) and then I'm back.  It's the most bizarre thing, but I never really contemplated why that happened. 

Then through therapy and research I began learning about the dissociative aspects of my mind, which stemmed from the prolonged physical and psychological abuse I sustained as a child.  It was my brain's way of shutting off right when I would start to absorb the blows from my father in an apparent attempt to anesthetize and protect me.  I’ve since tried to explain this as going into mini-shock.  Of course, the pain of successive blows brought me right back to reality... but it is truly bizarre (and a little awe-inspiring) to recognize how adaptive the human brain is. 

This was also how I came to truly comprehend how my coping mechanisms, which were so effective in childhood, were utterly destructive when implemented in the adult world.  This is essentially what is meant by “maladaptive.”  For example, the "mini-shock" reaction helped me not feel the initial attacks from my father during childhood, but it put me at an absurd disadvantage during fights once I got older.  It was adaptation to my traumatic world as a kid but ended up being quite bad for me later. 

I'm not terribly concerned with addressing the particular issue related to fighting because I'm not an idiot teenager/20-something anymore and my last fight was over a decade ago.  However, there are plenty more maladaptive behaviors from childhood which I've subsequently had to overcome or are currently still trying to overcome by re-wiring my brain little by little, day after day.

The significance of this makes it worth repeating: Those coping mechanisms which served us fairly well throughout our disturbing youth are at best unhealthy during adulthood in virtually any context.  It’s okay to be self-absorbed as a child/young adult because your job is basically to focus on yourself and become the best adult version of yourself possible.  Once adulthood hits - and I mean the adulthood of responsibilities - the problems arise as you navigate workplace politics… romantic relationships… new and ever-changing social groupings... parenting your children… and all of the other ways in which adults must become those social animals evolution demand we be. 

Those preservation tactics from my youth are predicated on withdrawal, sole reliance on self, and distrust of virtually everyone.  Those tactics continue to be the ones I initially reach for even now.  I cognitively know adults don’t effectively function this way with all of the responsibilities and pressures associated with career/family/etc, but I still have to work hard at recognizing when I do these things.  That’s what I mean by “doing the work” in recovery.

I do my best to recognize when I use these maladaptive tactics, but it continues to normally come after the fact.  But that’s okay for now.  My therapist uses a football analogy.  Very rarely do you get to score on the first play of a drive.  So I shouldn’t expect myself to completely change my behaviors in this area immediately.  As long as I’m being introspective and honest with myself each time I have these maladaptive behaviors, then I’m moving the ball forward a little bit down the field.  Recognize them often enough, continue to determine more productive and positive methods which would have been better, and I’m slowly but surely retraining my brain to respond differently to various triggers… and that’s the touchdown at the end.

There's a concept called neuroplasticity about which I will go into great detail in a future post because it lies at the heart of why we can fully recover from CPTSD, unlike other diagnoses which require medication and therapy for life.  The basic idea behind neuroplasticity is that parts of the human brain were “wrecked” to a certain extent by the traumas which resulted in CPTSD, but the brain is elastic enough to withstand the wreckage and be “rewired” through recovery as with the process I just explained above.  I’ve already started seeing the results, and I’m working harder than ever as a result.

No matter how much progress you and I make in our recovery, whatever occurred during our life to necessitate recovery in the first place will always be a part of our life story.  We’ve spent so much effort dissociating ourselves willfully or not from the pain of those incidents that the mere thought of outright owning them as our own seems absurd and terrifying.  During my recovery I begrudgingly acknowledged the need to own those parts of myself that I wanted so much to push away, but it was only after many false starts that I finally “got it.” 

I can tell you from experience that this is a painful process.  Those distressing realities of our past need to be embraced as obstacles we will conquer, and only then can we dispatch their current destructive power.  We can become free and whole again by embracing our traumatic history, understanding how our previous defenses have become our current maladaptive behaviors, and then doing the work to retrain our brain away from using them.

A Quest to Help Others Recover From Child Abuse

It's trite, I know, but this really is the first day of the rest of my life.  It’s another chance to shirk the negative consequences of yesterday, learn from those mistakes, and start from this very moment to generate my own positives.  Sharing my story will absolutely benefit me as a cathartic release, and I may just be able to reach and help one or two others at the same time.

Today I've decided to just jump head first into this blog and post a little bit of the writing I've been doing as part of my recovery.  A harrowing childhood of abuse left me with a variety of physical and emotional scars, the results of which have been the downward spiral of my life to its current nadir.

Right now I have no steady income, no permanent home, have virtually no money, and I lost the few close friends I had because of divorce and the subsequent self-imposed social isolation of the past couple of years.  I’ve also recently lost my girlfriend who essentially broke things off with me just recently because she couldn’t bear all of the stressors with which I have to deal.  There wasn’t any problem between us at all.  In fact, we were a great match for each other, but the timing couldn’t have been worse.  She had to bail to save her emotional self from bearing the weight of my problems… that’s how sweet she was.

This is just some of what Complex PTSD does to a person, but these challenges can all be temporary if I lock down and continue the difficult recovery work I started over two years ago.  I know, I know… two years of therapy and I’m just now at my nadir?!  The first 3-4 months were spent dancing around the issues, the next 7-8 months were spent pulling out all of the dark demons down inside of me, and since then I’ve gone from one false recovery to another.  Let me back up for a moment, however.

Physical and psychological abuse was the ever-present guillotine hovering over my youth until I was struck for the final time as a 20-year old sophomore home from college for a holiday break.  This long chapter of my life story is the single most problematic and complicated truth I have confronted, privately or not, to this day.  I was not sexually abused, however.

I bring that up immediately because the media and society in general give relatively no attention to the men who have endured repetitive significant trauma but were neither molested as boys nor maimed physically and/or psychologically as adult combatants in armed conflict.  There’s a litany of resources for men who were young sexual-abuse victims or those who developed war-related debilitating psychological challenges.  However, I’ve been quite frustrated over the comparatively few opportunities for help specifically dedicated to the untold number of men who were “only regularly abused” as kids. 

I'm in a great position to provide at least a few more resources out there for men like me.  I'm slowly and carefully constructing a multi-faceted social media presence to that very end.  I began writing months ago, have already started by dipping my toe ever so gently into Twitter (@men_helping_men), and now this blog.  I'm not too concerned with display, layout, professionalism, etc. at this point.  I'll get to all of that eventually.

It's the information that's critical to the success of my endeavor.  I'm NOT very well acquainted with manipulating social media tools.  I write this for men like myself who’ve been too “tough” to ever ask for help with the problems they don’t like to admit even having because of a past that they don’t want to discuss.

For the record, I've been diagnosed with C-PTSD, Panic Disorder with Agoraphobia, General Anxiety Disorder, and ADHD.  I'll go into greater detail in future blogs.

I hope that my writing primarily for men with C-PTSD doesn't turn anyone else off, however.  Anyone wanting a fairly expansive first-person perspective, along with helpful details and resources, should find this blog and Twitter feed very helpful (unless I fail miserably, which I don't intend to do).

Don’t come here for sappy feel-good nonsense, either.  I'm putting nothing but reality (or at least my particular version of it) into this.  Be prepared for different reads depending on the post and my mood of the day.  One day I'll be writing as though it's a scholarly article for peer-reviewed publication, and other times I'll be very laid-back in my writing style. 

It’s important for the regular guy to "get" what I'm saying, and sounding like an academic is not the way to go.  Sometimes I'll just talk about what's happening with me that day because it's been very helpful to me to hear the stories other men have.  I've learned so much from the experiences of others, and I hope to pass along this knowledge to others.  If I'm fortunate, then I will accomplish 2 things with this:

1) Other men with experiences remotely similar to my own will come across this and realize they’re not alone.  They will understand they should not be ashamed of how their adult lives have suddenly or repeatedly been twisted up, even though the actual abuse may have ended years and even decades earlier.

2) The all-important loved ones of these men will read this and begin a path toward understanding why the guys they love so dearly repeatedly act as they do or suddenly seem to have become someone else entirely.  True recovery has a much greater chance of success if they develop a sense of what he's previously endured, how those experiences currently manifest, why they are unable or unwilling to adequately express it to you, and (most importantly) that this need not be a permanent state.  Maybe this blog will initiate the early stages of repair and end with eventual enrichment of your relationships.

I AM NOT A CLINICIAN AND DO NOT PROVIDE ANY CLINICAL ADVICE TO ANYONE.  I do have a Master's-level education in Public Health (and an MBA, for whatever that’s worth here), so I've been trained on researching and understanding medical issues.  This allows me to digest a wide variety of information about childhood abuse and CPTSD, in both academic and first-hand fashions, and then reframe in ways accessible to virtually anyone.  I want to encourage people to seek the help of a psychologist, therapist, or maybe even a psychiatrist to overcome the traumas of their past.

The thing is that I'm just now lifting myself off rock bottom... so the upshot is that anyone regularly following this blog can see the ups and downs of real recovery.  You've missed much of my opening phases of recovery, but I'll reference them from time to time.

While I’m a very cognitively-oriented guy, this isn’t about thinking my own way out of having these problems.  This is about emotions which hijack my ability to function properly or at all.  I might be the smartest guy in the room most of the time, but I still won't recover unless I'm willing to confront, accept, and process those emotions effectively.

It sucks, I won't lie.  At the outset of recovery, you'll unearth some ghastly shit that will frighten you, and then you'll realize it has been there all along seeping poison into the various parts of your life.  Just realize that this is not a permanent state of being.  Once you avail yourself of the support from your loved ones, follow the guidance of a professional clinician, maybe join a group, and you'll be on a solid path to recovery and living the life you deserve.

Finally, recovery will happen only if you truly commit to the difficult work while availing yourself of every source of assistance you can find.  Since you’re still reading, I’ll make the assumptive leap your life has imploded and is completely littered with the fragmented pieces of your former world and future dreams, and you’re desperate to reassemble them immediately.

Let me disabuse you of the notion that there are any shortcuts to true recovery… believe me because I’ve tried just about all of them.  The path you’re peering down is plagued with potholes and straight up roadblocks.  Yet so many others have successfully traversed these obstacles, as I continue to do myself, so there's no reason you can't as well.

What you find on my blog is NOT a blueprint for recovery.  Everyone’s recovery path is just as unique as the person.  What you see in my recovery as it's recorded here is not something you should necessarily follow.  Maybe it's something for you to bring into your sessions with your therapist, maybe it's discussed with your partner or best friend, or perhaps it’s just some place you can go to see there’s somebody out there even more screwed up than you are!