The Truth About Complex PTSD and Essential Recovery Tools

Hey there, everybody, and welcome to today's presentation on complex PTSD or cptsd, what it is and some helpful interventions. I'm your host, Dr. Donnellice Snipes. The biggest difference between Post Traumatic Stress disorder and complex Post Traumatic Stress Disorder is that PTSD or Post Traumatic Stress Disorder typically occurs after a single event, a discrete event that has a beginning, a middle, and an end. So people's sense of safety, their sense of security and disempowerment is limited to, if you will, that particular event and things that remind them of that event in the future. Cptsd, on the other hand, is associated with multiple forms of prolonged, sustained or repeated interpersonal trauma. This can be from child abuse, exposure to domestic violence, being in a domestically violent relationship, or even soldiers or people who are in law enforcement emergency services. Any situation where a person is regularly feeling like they are unsafe and disempowered and that their life or the life of someone they care about is, is in peril. Cptsd. Complex PTSD results in significantly greater functional impairments than people with ptsd. And this makes sense. With cptsd, the person doesn't see an end to their sense of powerlessness, their sense of hopelessness. They start experiencing changes in, literally in their brain structure. They start experiencing changes in their perception of the world because it feels increasingly hopeless and dangerous and negative and chaotic to them. So it makes sense that they're going to have more severe symptoms than someone who experiences ptsd. Complex PTSD includes the core PTSD symptoms of re experiencing, like flashbacks and nightmares, avoidance of reminders of the trauma. You know, whether it happens once or it happens every day, you don't want to remember it. Mood alterations. So this can be anger, anxiety, irritability, depression, cognitive changes. A lot of times people with PTSD become. Become more negative, and they may have more difficulty being flexible in the way they perceive the world or think about things, and hypervigilance. They tend to become more easily startled and more aware of everything that's going on, which can be exhausting. And because they are operating from a place of fear, a place where they don't feel safe or empowered, they're also noticing all of those negative or threatening stimuli a lot more than the average person. In addition to those symptoms, people with CPTSD often experience difficulties with emotional dysregulation, which means they may go from feeling numb or flat to being enraged at the drop of a hat. And that is due to alterations in the functioning of their threat response system or their HPA axis. It's not just, you know, all in their head. There are actual physiological changes that result in what I call the flat and the furious. So going from being kind of calm to being dysregulated to feeling completely emotionally out of control. They may also experience changes in their sense of self organization, including body integrity, which means they may not, you know, kind of have a sense of themselves or they may dissociate a lot and relational security. Their sense of the ability to trust other people often changes and they may have. Alterations or variations in how they respond to people depending on their stress levels. Note for clinicians out there, CPTSD is not currently accepted as a psychiatric diagnosis in the DSM. 5. They are talking about considering it for future manuals. There's significant overlap between the symptoms of borderline personality disorder and complex post Traumatic stress disorder. All of the new or revised PTSD symptoms, which also overlap with borderline personality symptoms are cardinal features of complex PTSD. 2 Borderline personality disorder criteria related to attachment, disorganization or insecurity are not included in the diagnosis of PTSD or cptsd. Those two criteria are terror of abandonment or rejection and alternating idealization and devaluation. From a clinical standpoint, it's important to recognize that people with BPD don't have to have these criteria in order to be diagnosed with bpd. However, people with PTSD or cptsd, this is not a symptom that we will commonly see. 81% of adults diagnosed with borderline personality reported histories of physical and sexual abuse, witnessing domestic violence, emotional abuse and neglect, or living with impaired caregivers. Traumatic experiences and a compromised primary attachment. That means insecure attachment, have been hypothesized as key contributors to borderline personality. People with borderline personality or ptsd, both of them show alterations in hippocampal and amygdala volume. Those are areas in your brain that are responsible for fear and emotion processing. So there are actual brain changes that happen in people who experience trauma and develop ptsd, cdc, cptsd, or borderline personality. Adults with borderline personality also are at risk for abuse or revictimization in adulthood. Why am I talking about bpd? Because there is such significant overlap between these three diagnoses, cptsd, ptsd, and bpd, that it's important to recognize that they may coexist and to effectively recognize the different symptoms so we're not missing, so we're not failing to address a symptom. You know, I don't get too caught up in diagnostic criteria because I think that causes us to get too hemmed in and miss potential areas for intervention. But for those people who really like to hold on to their diagnostic labels, it's important to recognize that there is a lot of overlap here. What do we do about it? Education. First, many people with complex PTSD think that their symptoms represent an innate constitution and have not yet recognized the association with their trauma. They just think that that's the way they are. They don't know why they react the way they do. They don't know why they emotionally dysregulate or have difficulty in relationships. And they just think that that's the way they were wired. And while that's the way they may be wired now, most of the time it's a result of prior trauma that changed their wiring. Now, we can help people develop skills to deal with that, but it's important to first recognize that this is something that is potentially modifiable. Create safety. And we're going to talk about how to do this more in depth in the next few slides. Develop somatic. That means bodily and emotional awareness. Yoga and meditation have both been identified as very helpful to teaching people to become more aware of their bodily sensations and their emotional sensations. And sometimes the connection between those two to a lot of people who've experienced trauma may have developed the skill, if you will, of not feeling. Not feeling their emotions, not feeling their bodily sensations, because that was the way they survived their trauma. In order to integrate that experience and develop a sense of safety, it becomes important to. To learn how to identify and integrate those parts. And there are a lot. There are a lot of steps to this. It's not something that happens overnight. And a lot of people who've experienced trauma have great difficulty with yoga and meditation at first. So it's very, very important to take this very slowly and gradually in a safe setting. The Body Keeps the Score by Bessel van der Kolk is an excellent book to read if you are a treatment provider. I do not recommend it for people who've experienced trauma because there are several examples in multiple different chapters that can be extremely triggering. They are written, you know, pretty descriptively. So I dissuade people who've experienced trauma and are still kind of struggling with it from reading that book for that reason, because I don't want the treatment to contribute to the problem. We want to empower people. Remember, core of trauma is disempowerment and unsafeness. So we're going to talk about creating safety. We're going to, through developing somatic and emotional awareness, help Them start to feel safe and connected in their own body and empower them to start being able to affect those sensations in their body. We're also going to empower them with internal family systems theory to heal the parts of themselves that were developed in the context of trauma. IFS proposes that we have different parts of ourselves that are all contained in our brain. We may have a wounded child that is part of us. Some people have a very happy, healthy, gregarious child that was created when they were younger. They want to hold on to that great. Other people experience trauma in childhood, and that child is still wounded. That child has never healed. So with ifs, the process of healing, healing, that child is going to start taking place. So the person can start letting go of the anger and resentment and whatever other feelings, grief and guilt and shame that that child has. Memory integration. It's kind of my shorthand for it, using emdr. EMDR really helps take those fragments of memories that are stored in the amygdala, our fear processing area of our brain, and make connections to help integrate them into our narrative of ourself, address underlying issues instead of simply struggling with symptoms in the present. A lot of people with CPTSD have always, because they thought that that's just the way they were, have, have struggled with just trying to control their emotions, trying to control their thoughts. And basically what they're doing is trying to control the superficial symptoms without knowing what's causing the problem. It's like trying to put a cap on a volcano without knowing what's causing the lava to erupt. You know, eventually you've got to do something with the, with whatever's causing the lava, or it's going to blow the cap off. And it's exhausting to try to fight against that lava all the time. What can we do to help people start developing a sense of safety and empowerment? Well, first, let's start looking at the symptoms, dizziness or nausea when remembering the trauma. This happens when we are flooded with stress hormones that increase our blood sugar remarkably, that increase our adrenaline levels. You know, we are flooded with all of these excitatory chemicals, if you will. And it's kind of like being, you know, intoxicated with caffeine. You know, way too much caffeine. You can start feeling dizzy and nauseous. Same thing's happening when you remember the trauma. You're having that flood of adrenaline and stress hormones. Helping people understand this is the first step to feeling empowered, to address those issues so they can feel safe, they can address the dizziness and nausea. They can recognize that these feelings, feelings will pass as they down regulate and are able to get into their wise mind or trigger the relaxation response. They may be always tense. Well, this makes total sense. When people are have experienced trauma and don't feel safe, they're going to be tense. They're always going to be preparing to defend, to fight. It makes sense. So we've got to ask the person what needs to happen to help you feel safe enough to relax. And for some people, you know, they may not be sure for other people. And I will give you a little pro tip here. Just the word relax can be triggering because that might be a word that the abuser used. So it's important to help people recognize what triggers their tension if they've ever felt not tense. You know, sometimes it's better to say that than to say relaxed and help them again through somatic awareness, emdr yoga and ifs to start feeling safer, at least in certain places and then eventually will expand this so they start feeling safer day to day. People who startle easily, again, that's an example of the stress response. Being stuck in the on position. The person is tense. They are preparing to defend themselves from threat. So when there is a dog that barks or somebody drops something or there's a loud noise and they're going to startle a lot easier. That's also part of that emotional dysregulation. When they go from calm or flat or numb or whatever they're feeling that's, you know, benign to being, you know, feeling like they're jumping out of their skin. That is that HPA axis dysregulation. Difficulty sleeping. Well, if you don't feel safe because of your history of trauma, if you never know when the next bad thing is going to happen, it's hard to sleep. It's hard to feel safe enough to actually be vulnerable, which is what you are when you go into deep sleep. As people start to figure out how to feel safer, then they can start working on improving their sleep quality. All of these are, are areas that we can put up on a whiteboard or on a treatment plan or whatever you want to call it. And people can feel empowered to say, okay, I want to start working on this. But it's important for the person to be able to really control and direct treatment where it's going, how fast it's going. Impulsive behaviors, including self harm, were often developed by the person as a way to survive in order to help them deal with the flashbacks. They can control what's going on. When they're acting, if they're using substances or self harming, they feel like they're in control of that. They feel like they're making a conscious decision. And whatever they're doing is often intense. So it overwhelms or pushes those flashbacks or those distressful internal states into the background. Affectively emotional dysregulation or mood swings, lability, what they call it in the clinical sense. We've already talked about that. When the HPA axis gets stuck in the on position, there are changes in the nervous system. There are changes in the HPA axis that end up causing people to be either flat or blah or numb or even depressed and then all of a sudden be enraged, terrified. You know, they're not just kind of irritable, they are ticked off. Depression, anxiety, guilt, shame, you know, these are all emotions that represent anger and fear and hopelessness and helplessness. So we want to help people understand what memories, what experiences, what things are contributing to this that are still kind of hanging out there and knocking on your door every day going, hey, remember me. Because until we can get those, you know, door to door memories to go away or to integrate, they're going to keep rearing their ugly head and contributing to distress. Feeling afraid for no obvious reason, Especially people who haven't recognized their trauma. But even people who have recognized their trauma may not realize all of the different triggers in the environment, in the world that trigger their memories. It can be a smell, it can be a sight, it can be a time of day, it can be, you know, something that's very fleeting, but it can trigger a memory of that trauma, which triggers the stress response, triggers them to feel afraid. And they may think, you know, I'm feeling afraid for no reason. But when we really dig deep into it, we can start figuring out, oh, here's a connection, here's what triggered it. And then they can start feeling more empowered to recognize that feeling of fear and address it in the present context to help them feel more empowered and safe. Cognitively reliving the trauma through flashbacks and nightmares. That's the brain trying to say, I've got this stuff and I don't know what to do with it. Can you help me figure out where to file it, where to put it? What does it mean? It's also the brain saying, I've got this stuff and it's really traumatic and I want to make sure that you learn from it or you have it in your memory banks to keep you safe. So again, help me figure out where to file it. And until you get it filed, until you get it out of the amygdala and into the proper places in your memory banks, it is going to continue to rear up. That's your brain trying in its own little way to protect you. Difficulty concentrating when people are in the fight or flight mode, they are not designed to think clearly. They are designed to fight or flee. If somebody has experienced trauma when they have cptsd, they are regularly again stuck in that on position of the threat response system. They're stuck in that fight or flight mode. So they're going to have more difficulty concentrating because of all those excitatory neurochemicals that are flooding their brain. A negative self view is often very common. A lot of people, because of shame and guilt and anger and other things, may develop a negative view of themselves as a result of the trauma. They may blame themselves, for example, but they also often additionally heap onto that negative self view a sense of hopelessness and helplessness and unlovability. Because of all of their symptoms and their inability to effectively connect with other people, they may start taking it personally. They may start feeling like they are not lovable. Instead of recognizing the impact of their symptoms that resulted from the trauma is what is contributing to this distress. Environmentally, people may avoid situations that remind them of a trauma. And regardless of where they're at, they may be hypervigilant or way attuned to whatever is going on around them because they believe that the world is a dangerous place. If you experience ongoing trauma, you are likely going to, you know, feel like there's no way out, feel a sense of learned helplessness. So nowhere in the world offered you safety or security when you were experiencing that trauma. So why should you believe that It's a safe place. And it's important to address these behaviors, but also to help people understand that avoiding situations that remind them of the trauma. Of course you wouldn't want to expose yourself to danger again. So of course you're going to avoid reminders of the trauma because you don't want to trigger that that stress response. You don't want to trigger that unpleasant experience. Hypervigilance is your mind's way of protecting you because it's saying you still haven't integrated all these memories. So I'm going to make sure you stay safe and I'm going to pay attention to everything that's going on, which is exhausting. Relationally. People may have a loss of trust in themselves or others. They may blame themselves for what happened. They may think that if If I would have only done this, you know, I didn't make a good choice, therefore it's my fault. They may lose trust in others because as a result of trusting somebody, they were, they got injured or experienced a trauma. Helping them understand where this comes from and address their grief and anger that results from that is going to be vitally important to developing future secure attachments. Problems with maintaining relationships, switching between loving and hating, trusting and distrusting or flying into rages can be very common in people with PTSD as well as bpd. And again, it's important to recognize that a lot of times this is a result of, of their prior experiences that have destroyed their ability to feel secure in relationships, destroyed their ability to feel safe, and altered their brain structure. So they have difficulty with emotion regulation. It doesn't mean that it can't be rebuilt, that they can learn how to develop secure attachments again in the future. But right now, while they're symptomatic, they may have difficulty with it. They may feel detached from themselves. And we talked about yoga and meditation and becoming more somatically aware as an important step, feeling different from others because of their experience. So normalizing trauma can be helpful so people recognize that their symptoms, you know, are functional in some way to help them stay safe. You know, we understand how these symptoms came about and help them understand how common it is for other people to experience this. Unfortunately, the majority of people in our world have experienced at least one trauma. Low levels of social support are very common because a lot of times people with cptsd, PTSD and borderline personality may push others away. They may have difficulty because they have difficulty trusting or maintaining relationships. They don't have social support that can help them feel safe and secure. Sometimes they'll even get into unhealthy relationships that are characterized by rescuing or people getting into relationships with people who are emotionally unavailable. And this can be a way of trying to assert or prove control, or just a way to try to get into any relationship that they can get into in order to try to feel some sense of connection. Ongoing or repetitive traumas alter the person's schema, increase the number of trauma related stimuli. So every time there's a trauma, the smells, the sights, the sounds that are present become associated with trauma. And when you have these experiences in multiple different settings over multiple periods of time, there's going to be thousands of different stimuli that are associated with that trauma. This ongoing stress causes structural changes in the brain and promotes the development of survival strategies such as dissociation, which can lead to an ongoing sense of disempowerment and unsafeness. If you can't feel like you're even in your own body, it can feel very uncontrollable. These changes ultimately lead to alterations in the stress response system or the HPA axis and corresponding problems with emotional regulation, hypervigilance, concentration range relationships and more. Addressing the superficial symptoms without also healing the underlying cause of those symptoms is like putting anesthetic in a person's broken leg to numb it up, but then never setting the bones so they're just walking around with those bones flapping everywhere. It's not going to heal. It's important to address the underlying cause to set the fracture. Cptsd, PTSD, and Borderline are all strongly correlated to trauma. Addressing the symptoms the person is experiencing and the causes of those symptoms is far more important than arguing about a diagnostic label. Until people feel safe in their own skin as well as in their environment, they will continue to experience symptoms. Learn more about trauma and grief@docsnipes.com YouTube this episode was produced by Mr. Charles Snipes and presented by Dr. Donnellyce Snipes. They can be reached at 1633 West Main Street, Suite 902, Lebanon, Tennessee 37087 or by email@supportocsnipes.com.