What is Complex PTSD?

Complex post-traumatic stress disorder (sometimes called complex PTSD or c-PTSD), is an anxiety condition that involves many of the same symptoms of PTSD along with other symptoms.

First recognized as a condition that affects war veterans, post-traumatic stress disorder (PTSD) can be caused by any number of traumatic events, such as a car accident, natural disaster, near-death experience, or other isolated acts of violence or abuse. 

When the underlying trauma is repeated and ongoing, however, some mental health professionals make a distinction between PTSD and its more intense sibling, complex PTSD (C-PTSD).

Complex PTSD has gained attention in the years since it was first described in the late 1980s. However, it is important to note that it is not recognized as a distinct condition in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), the tool that mental health professionals use to diagnose mental health conditions.

Both PTSD and C-PTSD result from the experience of something deeply traumatic and can cause flashbacks, nightmares, and insomnia. Both conditions can also make you feel intensely afraid and unsafe even though the danger has passed. However, despite these similarities, there are characteristics that differentiate C-PTSD from PTSD according to some experts.

The main difference between the two disorders is the frequency of the trauma. While PTSD is caused by a single traumatic event, C-PTSD is caused by long-lasting trauma that continues or repeats for months, even years (commonly referred to as “complex trauma”).

Unlike PTSD, which can develop regardless of what age you are when the trauma occurred, C-PTSD is typically the result of childhood trauma.

When it comes to Complex PTSD, the harmful effects of oppression and racism can add layers to complex trauma experienced by individuals. This is further compounded if the justice system is involved.

The psychological and developmental impacts of complex trauma early in life are often more severe than a single traumatic experience—so different, in fact, that many experts believe that the PTSD diagnostic criteria don’t adequately describe the wide-ranging, long-lasting consequences of C-PTSD.

Symptoms of Complex PTSD:

In addition to all of the core symptoms of PTSD—re-experiencing, avoidance, and hyperarousal—C-PTSD symptoms generally also include:

  • Difficulty controlling emotions. It’s common for someone suffering from C-PTSD to lose control over their emotions, which can manifest as explosive anger, persistent sadness, depression, and suicidal thoughts.4
  • Negative self-view. C-PTSD can cause a person to view themselves in a negative light. They may feel helpless, guilty, or ashamed.5They often have a sense of being completely different from other people.
  • Difficulty with relationships. Relationships may suffer due to difficulties trusting others and a negative self-view.6 A person with C-PTSD may avoid relationships or develop unhealthy relationships because that is what they knew in the past.
  • Detachment from the trauma. A person may disconnect from themselves (depersonalization) and the world around them (derealisation). Some people might even forget their trauma.
  • Loss of a system of meanings. This can include losing one’s core beliefs, values, religious faith, or hope in the world and other people.

All of these symptoms can be life-altering and cause significant impairment in personal, family, social, educational, occupational, or other important areas of life.

Anxiety vs. Anxiety Disorders

In a nutshell, anxiety becomes an anxiety disorder when the anxiety that you are experiencing is greater than what you might expect in a given situation, and when it begins to interfere with some aspect of your life. For example, if your anxiety prevents you from forming desired relationships with people or meeting your responsibilities at work or school, this may be a sign that normal anxiety has shifted to a disorder of anxiety. In addition, if you find that you are engaging in unhealthy behaviors in an attempt to avoid or reduce your anxiety (such as drinking or using drugs), there is a good chance that you have a problem with anxiety.

There are six main anxiety disorders:

Specific Phobia
The first anxiety disorder is specific phobia. In this disorder, people experience such intense fear (even to the point of having a panic attack) when they come into contact with certain objects or situations that they take steps to avoid these objects or situations. Common specific phobias include acrophobia (fear of heights), odontophobia (fear of dentists), arachnophobia (fear of spiders), ophidiophobia (fear of snakes), and claustrophobia (fear of enclosed spaces).

Social Anxiety Disorder
Social anxiety disorder (also called “social phobia”) is another anxiety disorder, in which a person experiences intense fear and anxiety in social situations due to a fear of negative evaluation (for example, being judged). And, just as with specific phobia, this intense fear often results in the avoidance of these social situations. The most common type of situation that people fear in social anxiety disorder is public speaking; however, there are other situations that people with social anxiety disorder may also fear, such as eating in front of people, urinating in public restrooms, or writing in front of people

Panic Disorder
A person with panic disorder experiences frequent, out-­of-­the-blue panic attacks, as well as worry about the meaning or outcome of those panic attacks. For example, people with panic disorder might fear that a panic attack is a sign that they are dying or going crazy. As a result of these panic attacks, people with panic disorder often try to avoid activities or situations that might bring on symptoms of arousal, such as exercise or eating heavy meals. In extreme cases, people with panic disorder may fear leaving home, because it is the only place where they feel safe. If this happens, a person may be diagnosed with panic disorder with agoraphobia.

Obsessive-­Compulsive Disorder
This disorder has received a fair amount of attention in the media recently. In obsessive-­compulsive disorder (OCD), a person experiences intense, intrusive, and repetitive troublesome thoughts and ideas that might be viewed as strange and that are not about real-­life problems. These out-­of-­the-­ordinary thoughts and ideas are called obsessions. For example, people with this disorder may have persistent fears that they are going to accidentally poison their children, catch a disease, or harm someone else. As a result of these obsessions, people with OCD then engage in repetitive behaviors (or compulsions) to reduce the anxiety associated with those obsessions, such as excessive hand washing, ordering, checking, or performing mental rituals (such as counting).

Generalized Anxiety Disorder
Generalized anxiety disorder (GAD) is characterized by excessive, persistent, and uncontrollable worry about many different concerns. Sometimes people confuse GAD with OCD because both include the experience of repetitive thoughts. However, worry is different from obsession, because the worry in GAD is about real-­life or daily concerns, such as finances, work, and relationships. Worry in GAD is actually viewed as an attempt to avoid or distract a person from more-­upsetting and anxiety-­provoking thoughts and feelings

Post-­Traumatic Stress Disorder
Finally, post-­traumatic stress disorder (PTSD) is unique among the anxiety disorders, because it is the only one that requires people to have experienced some type of traumatic event before they can be diagnosed with it. PTSD is diagnosed when a person experiences a set of symptoms more than thirty days after exposure to a traumatic event. The symptoms of PTSD include intrusive thoughts and memories about the traumatic event (for example, flashbacks or feeling as if the event were happening all over again), avoidance of reminders of the traumatic event, difficulties experiencing positive emotions, feeling detached from others, and hyperarousal and hypervigilance (or always feeling on guard). If someone experiences these symptoms within one month after a traumatic event, we call the disorder acute stress disorder.

Sources: The Dialectical Behavior Therapy Skills Workbook for Anxiety

The Fight, Flight or Freeze Response

The fight or flight response has been around as long as human beings have been around. It’s the body’s hardwired alarm system. If you think of the human body as a computer, the fight-­or-­flight response is an essential part of the operating system. You couldn’t really function (or live that long) without it.

When you encounter a dangerous or threatening situation, this alarm system goes off, and your body goes through a number of changes. For example, during the fight-­or-­flight response, you may experience the following symptoms:

  • An increase in heart rate
  • Perspiration or sweating
  • Narrowing of field of vision (also called “tunnel vision”)
  • Muscle tension
  • Sensitive hearing
  • Racing thoughts
  • Shortness of breath
  • Goose bumps
  • Dry mouth

These experiences aren’t random; they all serve a very important purpose. They prepare you for immediate action. They are preparing you either to flee the situation to avoid any harm or to fight if escape is not possible. In situations where fleeing or fighting is not necessarily a good option, your body may also freeze (kind of like a deer caught in a car’s headlights).

This response is automatic. It occurs without thinking. This is important because it allows you to respond quickly when you are in a dangerous situation. For example, let’s say that you are walking through the woods and come across a bear. Your fight-­or-­flight response will be activated, and you will likely freeze or flee. The sudden and automatic changes that your body goes through will help keep you alive in this dangerous situation. Now, if you had to think about the situation before the fight-­or-­flight response was activated, you would waste precious time. You would have to evaluate the size of the bear and the sharpness of its claws and teeth. And, by the time you figured all of that out, you would probably be supper for the bear! Therefore, the fight-­or-­flight response is incredibly helpful and adaptive. We likely wouldn’t be alive as a species today without it.

Sources: The Dialectical Behavior Therapy Skills Workbook for Anxiety

Dealing With Trauma Triggers

Most of us are aware of the larger trauma triggers. We can recognize some of the people, places, and things that harmed us, and do our best to avoid them all. For example, if our trauma had something to do with the beach we can avoid any area with sand or any sounds of the beach. We can sit down with our therapist and make a list of all of the things that we know trigger our trauma response or bring us back to those frightening events. But what about the unconscious triggers? The ones we don’t recognize, and often find upsetting us, pulling us into flashbacks and causing us to dissociate.

National PTSD (Post Traumatic Stress Disorder) Awareness Day

It’s National PTSD (Post Traumatic Stress Disorder) Awareness Day! Please don’t tell someone just to get over it that it’s in the past or they can’t allow it to define them! Do you honestly think they haven’t tried that? So what does that mean, what are the symptoms…

—> Intrusive memories

~ Recurrent, unwanted distressing memories of the traumatic event
~ Reliving the traumatic event as if it were happening again (flashbacks)
~ Upsetting dreams or nightmares about the traumatic event
~ Severe emotional distress or physical reactions to something that reminds you of the traumatic event

—> Avoidance

~ Trying to avoid thinking or talking about the traumatic event
~ Avoiding places, activities or people that remind you of the traumatic event

—> Negative changes in thinking and mood

~ Negative thoughts about yourself, other people or the world
~ Hopelessness about the future
~ Memory problems, including not remembering important aspects of the traumatic event
~ Difficulty maintaining close relationships
~ Feeling detached from family and friends
~ Lack of interest in activities you once enjoyed
~ Difficulty experiencing positive emotions
~ Feeling emotionally numb

—> Changes in physical and emotional reactions

~ Being easily startled or frightened
~ Always being on guard for danger
~ Self-destructive behavior, such as drinking too much or driving too fast
~ Trouble sleeping
~ Trouble concentrating
~ Irritability, angry outbursts or aggressive behavior
~ Overwhelming guilt or shame

Schizophrenia and Trauma

Trauma and psychosis can each derail a person’s daily life by causing mental and physical disturbances which significantly disrupt even basic day-to-day functioning and skills. When experienced together, they can wreak emotional and mental havoc if left untreated.

When the onset of a psychotic disorder like schizophrenia happens to occur after a traumatic event, it can be tempting to blame the development of the former on the occurrence of the latter. Causality is comforting, in a way—being able to answer the larger question of why your loved one is living with the symptoms and challenges they currently face is somehow less daunting than having no answer at all.

What causes Schizophrenia?

Scientists identify a variety of causes and risk factors for schizophrenia. Research shows the disorder is brought on by a combination of neurological, genetic and environmental factors, including life experience. Schizophrenics have an imbalance of the neurotransmitters dopamine and serotonin in their brains, which is why they are often prescribed antipsychotic drugs. There may also be a genetic component; the risk factor of one person developing schizophrenia goes up if other close blood relations have been diagnosed with it.

Other factors which play a part in the development of schizophrenia include psychoactive drugs, such as methamphetamines or LSD. These drugs can cause brain damage, psychotic episodes, or trigger a schizophrenic onset.

Childhood factors may also affect onset and development. Fetuses exposed to malnutrition or viral infections in the womb may have a higher chance of getting schizophrenia. And childhood trauma can significantly change how children’s brains and thought processes develop and affect their adult lives.

Can trauma cause Schizophrenia?

While the jury is still out on whether trauma directly causes schizophrenia, according to research conducted by the University of Liverpool, children who experienced trauma before the age of 16 were about three times more likely to become psychotic in adulthood than those who were randomly selected. The more severe the trauma, the greater the likelihood of developing illness in later life. They even found indications that the type of trauma experienced may determine what specific psychotic symptoms will manifest themselves later on.

It is also certainly true that trauma which occurs after the onset of schizophrenia can exacerbate psychotic symptoms—especially if it leads to the development of a co-occurring trauma disorder, such as PTSD. Separately, these conditions can pose serious challenges to a person’s ability to live a “normal” life—together, they can become overwhelming and debilitating without proper care and support.

Source: BrightQuest

What is Rape Culture?

What is the “Rape Culture?”

Rape Culture is an environment in which rape is prevalent and in which sexual violence against women is normalized and excused in the media and popular culture.  Rape culture is perpetuated through the use of misogynistic language, the objectification of women’s bodies, and the glamorization of sexual violence, thereby creating a society that disregards women’s rights and safety.

Rape Culture affects every woman.  The rape of one woman is a degradation, terror, and limitation to all women. Most women and girls limit their behavior because of the existence of rape. Most women and girls live in fear of rape. Men, in general, do not. That’s how rape functions as a powerful means by which the whole female population is held in a subordinate position to the whole male population, even though many men don’t rape, and many women are never victims of rape.  This cycle of fear is the legacy of Rape Culture.

Examples of Rape Culture
  • Blaming the victim (“She asked for it!”)
  • Trivializing sexual assault (“Boys will be boys!”)
  • Sexually explicit jokes
  • Tolerance of sexual harassment
  • Inflating false rape report statistics
  • Publicly scrutinizing a victim’s dress, mental state, motives, and history
  • Gratuitous gendered violence in movies and television
  • Defining “manhood” as dominant and sexually aggressive
  • Defining “womanhood” as submissive and sexually passive
  • Pressure on men to “score”
  • Pressure on women to not appear “cold”
  • Assuming only promiscuous women get raped
  • Assuming that men don’t get raped or that only “weak” men get raped
  • Refusing to take rape accusations seriously
  • Teaching women to avoid getting raped instead of teaching men not to rape
How can men and women combat Rape Culture?
  • Avoid using language that objectifies or degrades women
  • Speak out if you hear someone else making an offensive joke or trivializing rape
  • If a friend says she has been raped, take her seriously and be supportive
  • Think critically about the media’s messages about women, men, relationships, and violence
  • Be respectful of others’ physical space even in casual situations
  • Always communicate with sexual partners and do not assume consent
  • Define your own manhood or womanhood. Do not let stereotypes shape your actions.
  • Get involved! Join a student or community group working to end violence against women.

The Karpman Victim – Drama Triangle

The magical tool to figure this pattern out is called the Drama Triangle. Stephen Karpman created the model in 1968 within the framework of Transactional Analysis. Thanks to this tool we can analyze clearly what is happening in the relationships since the Drama Triangle sheds light on the automatic and dysfunctional interaction between 2 (or more) people.

In a relationship within the Drama Triangle, there are 2 main characters (male or female) who shift from one role to another:

  • The Rescuer
  • The Persecutor
  • The Victim.

The Three Roles In The Drama Triangle

What do the roles entail? 

The Rescuer

Rescuers get involved in other people’s lives eagerly waiting for recognition and approval. By making assumptions on other people’s needs they are stepping in to help before anyone has asked them for anything and create a debt of gratitude. They believe that others need them and they impose their solution. In doing so they prevent others from solving their problems themselves. At the same time they manifest their moral superiority.

Feeling responsible for others

Since Rescuers feel responsible for the happiness and well-being of others, they immediately strive to comfort, pacify or calm people down so that these people don’t get to feel their disagreeable emotions like pain, anger, disappointment or sadness. Rescuers also want to have good relationships with everyone, as they like harmony. That is why they avoid conflicts or standing their ground at all costs, even if they end up wasting their time, money or energy. They have a tendency to please people in order to avoid criticism and rejection. After all, they aspire to feel accepted and loved by everyone.

Emotionally disconnected

For all these reasons they are disconnected from their own emotions. Therefore, it is difficult, if not impossible, to have emotional intimacy in a relationship with them. They will flee in “doing”, they are busy at all times … the evidence is their diary: they don’t have a minute.

Codependent relationships

Despite having good intentions, they need Victims to be Rescuers. As a result their behavior encourages the Victim’s dependence and lack of autonomy. Rescuers will continue to be involved in codependent relationships (as with addicts, for example) that are harming them because they do not realize how damaging they are for them. 

Saying no is difficult

Rescuers have an imperative need to feel useful to cover up their anxiety and low self-esteem … in short, to give their life meaning. They never stop giving; basically because they don’t know how to say no. However, if they dare to say no, they will feel guilty and label themselves as selfish or stingy. They prioritize others’ needs ignoring their own, because they project on others their own unmet needs. Most of all they have difficulties in identifying their needs and desires.

Am I just nice or too nice? 

In short, they sacrifice themselves because they want to prove that they are good, generous and selfless people, who deserve love and recognition. And when someone tells them: “You are too nice”, they feel accordingly offended.

But Rescuing creates resentment and anger in themselves and in the Victims, not recognition, nor gratitude or respect. Whereupon Rescuers confirm their belief that Victims are ungrateful and take advantage of them.

Benefice of the coaching sessions for the Rescuer

When Rescuers attend coaching sessions, working on boundaries and the Drama Triangle guarantees favorable results. Once they have understood the detrimental dynamics and know what their needs are, they are able to control their eagerness to rescue and consequently to change their behavior.

The Persecutor

Am I right  or … am I totally right? 

Persecutors know everything and are always right. Those who are wrong are the others. Therefore they pretend to know what is best for other people. They characteristically see everything either in black or in white; Grey does not exist. Their motto is: either you are with me or you are against me.

Like Rescuers, they feel morally superior and need Victims in order to play their role as a Persecutor.

Discounting others 

They ignore not only other people’s feelings but also their value. That is why they criticize, find fault, persecute, blackmail and abuse their power. In particular they use shame and guilt to manipulate. They can even punish (if only with their moodiness or their silence) so that Victims feel anxious and inferior. Persecutors always find a culprit or an enemy: the other. Thus there is no way to resolve a conflict with them since in each conversation you have to tread carefully and not contradict them. They use threats to get what they want because they have a sense of entitlement. And what they want is for others not only to learn their lesson and to agree with them, but also to change and do things the Persecutor’s way.

Relationships based on power and control

Persecutors feel a lot of anger and righteous indignation, which they vent on “innocent” Victims with gusto. They do not consider themselves as abusive or aggressive though because they believe that the Victims deserve their lot.
In order to feel safe Persecutors want to be in control and they fight for the power in the relationship. They impose their point of view to establish a Winner-Loser relationship that allows them to cover up their inferiority complexes, their insecurity and their vulnerability that they don’t recognize. Moreover they confuse having needs with being needy. Consequently they won’t accept any help or will refuse even to consider that someone can do something for them.

Others are to blame 

But there will always be somebody to blame, somebody who doesn’t meet their expectations. When something goes wrong, Persecutors hold others accountable for what happens to avoid blaming themselves. With that attitude it seems unlikely that they will attend coaching sessions since the person responsible or the culprit is always the other. They project on others (outside of themselves) what they don’t want to see in themselves. In effect, they would call others arrogant because they are not able to recognize and accept their own arrogance.

Childhood trauma 

As they have often suffered some kind of abuse in childhood, they always get defensive. They reproduce the behavior of the abuser because they hope that by dominating others they will preventively protect themselves from abuse or contempt.

The Victim

Discounting themselves

Victims feel powerless, incompetent, stuck and sometimes desperate. They discount their skills and their resources. They don’t recognize their own ability to change things or to influence their destiny either. Besides, precisely because life happens to them, they often suffer from depression. And if by miracle something good happens, they attribute it to luck.

Not owning it 

According to Victims they can’t be blamed for anything because they are not responsible. What’s happening is not their fault. They are convinced that life is very hard, that nobody understands them and that no matter what they do they will be unable to change their lot. They always find excuses that justify their situation.

Avoiding responsibilities 

Victims take any opportunity to complain; even their usual tone of voice is querulous. They are the eternal victims of life itself and manage to get sick, have ailments and attract misfortunes. As soon as they get stressed, which happens very easily, they make a mountain out of a molehill. They simply avoid responsibilities and don’t want to make decisions for fear of being wrong.

In addition, you can recognize Victims by their usual way of apologizing for everything and nothing. You can often hear them say “Sorry!”, “Excuse me!”, “I beg your pardon!”.

“A Victim is someone who is waiting for something bad to happen … and it usually does.”

~ Barry K. Weinhold

Not only do they live in an illusory world composed of all the things they imagine or assume (dire consequences, negative emotions or adverse reactions of others, …), they also make assumptions without relying on reality, without having sound evidence that would justify their beliefs.


Of course Victims adopt a passive behavior: they don’t take action, they don’t make any effort to get out of the pothole. They are experts in manipulating others to get what they need without getting too involved in the result. They usually sabotage the help they receive and secretly rejoice in their failures. No matter how often they attend coaching sessions, their passivity and lack of commitment may cause the attempt to fail, so that they can blame the coach for the lack of results and prove them incompetent.

Two types of Victims 

Victims attract either Rescuers or Persecutors. On the one hand, Victims create codependence – an excessive emotional or psychological dependence on the Rescuer. This attitude encourages a passive behavior that prevents them from developing fully their abilities. On the other hand, Victims confirm their belief that life is hard and unfair when they are abused by Persecutors.

Therefore, to play their role as Victims they need Rescuers or Persecutors … or both.

Shards of My Soul

You left the broken shards of my soul,

Scattered in the dirt, in the filth,

I did not ask for the gift you bestowed upon me,

“Fuck You,” my lover, my sweet rapist.

The revulsion your memory conjures up,

Consumes me with a need to wretch,

The callousness of your existence,

“Fuck You,” my lover, my sweet rapist.

The trickle of my blood down the length of the blade,

The knife you hold to my quaking throat,

The heat of your body behind me,

“Fuck You,” my lover, my sweet rapist.

I gasp staring up at you my mouth slightly agape,

I know what you desire, what you require of me,

A shiver, I slowly nod closing my eyes,

“Fuck You,” my lover, my sweet rapist.

I bite my lower lip my body jerking in revulsion,

Your cruel commands echo in my mind,

I indolently open my mouth and swallow,

“Fuck You,” my lover, my sweet molester.

“Ugh,” I groan through a kick in my ribs,

Painfully I crawl back to my hands and knees,

My head jerked back by my hair so I smell your breath,

“Fuck You,” my lover, my sweet rapist.

I know what you need as you kick my knees apart,

I won’t succumb that easily,

What you will not have offered, you shall take by force,

“Fuck You,” my lover, my sweet rapist.

I bite my tongue, my mouth filling with blood,

The ravishing of my body has begun in earnest,

The blood trickles down my chin as tears swell,

“Fuck You,” my lover, my sweet rapist.

The burning inside me makes my stomach churn,

My eyes clenched shut in revulsion,

The flames inside me grow as they burn,

“Fuck You,” my lover, my sweet rapist.

Your grunts sound rapidly in earnest,

What you have needed these long hours is almost here,

Your sharp slaps of my ribcage loudly echo,

“Thank You,” my lover, my sweet…

Trauma: The Next Morning, Every Morning

I inhale the stench of an eternal wait,

A breath, a gasp, a momentary lapse,

My eyes burn, my fingers bleed,

Scratching at my lack of patience,

I sigh, a tear trickles down my cheek,

A silent scream in the middle of the night,

Echoes through the darkness of my mind.

I’m consumed by the violation of my body,

The corruption of my soul,

Blood seeps from my eyes where tears once stood,

Involuntarily I wince as my body,

Wracked by the repeated violations,

Struggles to fight against my mind,

The disease of my own conception.

I stare transfixed upon the glistening mirror,

My clothes crumpled about my ankles,

The hollow eyes scrutinize my own,

The purple swelling and welts of my neck,

Coerce my eyes lower, down my bruised and battered torso,

My fingers trace over the blackish-purple festering welt,

Running down my throbbing ribcage.

My eyes linger over my aching waist,

Pleading me to stop, that I look away,

The stinging of my thighs makes me shudder,

Deep bruises traverse the muscles,

A yellowish fluid courses beneath my battered wounds,

Begging for release from my body,

Which holds it captive to my mind’s secrets.

I am engrossed as my body slowly turns in the mirror,

The lesions crisscross my stinging inner thighs,

My ass throbs as if a cruel joke,

Blood trickles down my thighs,

Reminding me of my past transgressions,

Conjuring visions of all that has been done,

My memories fashioned out of my past, my life.

The world around me swirls and contorts,

Reality drips down through my consciousness,

A gasp, a nightmare, a corruption of my mind.