Complex Trauma Quotes

Being healed isn’t about feeling nothing. Being healed is about feeling the appropriate emotions at the appropriate times and still being able to come back to yourself. That’s just life.

Beneath the surface of the protective parts of trauma survivors there exists an undamaged essence, a Self that is confident, curious, and calm, a Self that has been sheltered from destruction by the various protectors that have emerged in their efforts to ensure survival. Once those protectors trust that it is safe to separate, the Self will spontaneously emerge, and the parts can be enlisted in the healing process

In situations of captivity the perpetrator becomes the most powerful person in the life of the victim, and the psychology of the victim is shaped by the actions and beliefs of the perpetrator.

Recovery can take place only within then context of relationships; it cannot occur in isolation.

Here’s a theory: Maybe I had not really been broken this whole time. Maybe I had been a human—flawed and still growing but full of light nonetheless

...repeated trauma in childhood forms and deforms the personality. The child trapped in an abusive environment is faced with formidable tasks of adaptation. She must find a way to preserve a sense of trust in people who are untrustworthy, safety in a situation that is unsafe, control in a situation that is terrifyingly unpredictable, power in a situation of helplessness. Unable to care for or protect herself, she must compensate for the failures of adult care and protection with the only means at her disposal, an immature system of psychological defenses.

The happy family is a myth for many.

Over and over, the answer is the same, isn’t it? Love, love, love. The salve and the cure. In order to become a better person, I had to do something utterly unintuitive. I had to reject the idea that punishing myself would solve the problem. I had to find the love.

But the sadness of a lost childhood feels like yearning, impossible desire. It feels like a hollow, insatiable hunger.

Recovery unfolds in three stages. The central task of the first stage is the establishment of safety. The central task of the second stage is remembrance and mourning. The central focus of the third stage is reconnection with ordinary life.

By developing a contaminated, stigmatized identity, the child victim takes the evil of the abuser into herself and thereby preserves her primary attachments to her parents. Because the inner sense of badness preserves a relationship, it is not readily given up even after the abuse has stopped; rather, it becomes a stable part of the child's personality structure.

The literature says this is normal for traumatized people. Experts say it’s all part of the three P’s: We think our sadness is personal, pervasive, and permanent. Personal, in that we have caused all the problems we face. Pervasive, in that our entire life is defined by our failings. And permanent, in that the sadness will last forever.

Self-destructiveness may be a primary form of communication for those who do not yet have ways to tame their excruciating inner conflicts and feelings and who cannot yet turn to others for support.

It made perfect sense to me later in life when I discovered that the Chinese word for endurance is simply the word knife on top of the word heart. You walk around with a knife in your heart. You do it with stoicism. This is the apex of being.

people with C-PTSD can often assume problems are about them—not out of selfishness or narcissism but because they want to have enough control to be able to solve the problem.

No matter what I do, no matter where I try to find joy, I instead find my trauma. And it whispers to me: “You will always be this way. It’s never going to change. I will follow you. I will make you miserable forever. And then I will kill you.

It is a rare person who can cut himself off from mediate and immediate relations with others for long spaces of time without undergoing a deterioration in personality.

Forgiveness is this act of love where you say to someone, ‘You’re an imperfect being and I still love you.’ You want to have this energy of ‘We’re not giving up on each other; we’re in this for the long haul. You hurt me. And, yes, I hurt you. And I’m sorry, but you’re still mine.’ 

Hatred, I learned quickly, was the antidote to sadness. It was the only safe feeling. Hatred does not make you cry at school. It isn’t vulnerable. Hatred is efficient. It does not grovel. It is pure power.

Unspeakable feelings need to find expression in words. However... verbalization of very intense feelings may be a difficult task.

When the sky falls, use it as a blanket,

Trauma isn’t just the sadness that comes from being beaten, or neglected, or insulted. That’s just one layer of it. Trauma also is mourning the childhood you could have had. The childhood other kids around you had. The fact that you could have had a mom who hugged and kissed you when you skinned your knee. Or a dad who stayed and brought you a bouquet of flowers at your graduation. Trauma is mourning the fact that, as an adult, you have to parent yourself. You have to stand in your kitchen, starving, near tears, next to a burnt chicken, and you can’t call your mom to tell her about it, to listen to her tell you that it’s okay, to ask if you can come over for some of her cooking. Instead, you have to pull up your bootstraps and solve the painful puzzle of your life by yourself. What other choice do you have? Nobody else is going to solve it for you.

because of its repetitive nature, complex trauma is fundamentally relational trauma. In other words, this is trauma caused by bad relationships with other people—people who were supposed to be caring and trustworthy and instead were hurtful. That meant future relationships with anybody would be harder for people with complex trauma because they were wired to believe that other people could not be trusted. The only way you could heal from relational trauma, he figured, was through practicing that relational dance with other people. Not just reading self-help books or meditating alone. We had to go out and practice maintaining relationships in order to reinforce our shattered belief that the world could be a safe place. “Relationships

It’s okay to have some things you never get over.

Here’s a theory: Maybe I had not really been broken this whole time.

The human need to be visible is countered by the need to be invisible to avoid further abuse, and the need for intimacy and the dread of abuse, all pose insoluble dichotomies which promote further withdrawal from human contact, which reinforces the sense of dehumanisation.

If Freud turns to literature to describe traumatic experience, it is because literature, like psychoanalysis, is interested in the complex relation between knowing and not knowing, and it is at this specific point at which knowing and not knowing intersect that the psychoanalytic theory of traumatic experience and the language of literature meet.

I have met many, many severely distressed people whose daily lives are filled with the agony of both remembered and unremembered trauma, who try so hard to heal and yet who are constantly being pushed down both by their symptoms and the oppressive circumstances of post traumatic life around them.

First, the physiological symptoms of post-traumatic stress disorder have been brought within manageable limits. Second, the person is able to bear the feelings associated with traumatic memories. Third, the person has authority over her memories; she can elect both to remember the trauma and to put memory aside. Fourth, the memory of the traumatic event is a coherent narrative, linked with feeling. Fifth, the person's damaged self-esteem has been restored. Sixth, the person's important relationships have been reestablished. Seventh and finally, the person has reconstructed a coherent system of meaning and belief that encompasses the story of trauma.

You don’t have to fix anything to deserve love. I love you for who you are. You can fuck up. You can do whatever you want and you’ll still deserve love.

For our physiology to calm down, heal, and grow we need a visceral feeling of safety. No doctor can write a prescription for friendship and love: These are complex and hard-earned capacities. You don't need a history of trauma to feel self-conscious and even panicked at a party with strangers – but trauma can turn the whole world into a gathering of aliens.

Dissociation exists for a reason. For millennia, our brains and bodies have removed us from our pain so we can keep moving forward. A tiger just ate your wife? Bummer, but breaking down or freezing up is not an option. You better go out hunting today or your kids will starve. Your house was just destroyed in an air raid? Okay, but you have to pack up what’s left and find new shelter, now. Feelings are a privilege.

The PTSD had always told me I am alone. That I am unlovable. That I am toxic. But now, it is clear to me: That was a lie. My PTSD clouded my vision of what was actually happening.

I learned two critical things that day. First: Just because the wound doesn’t hurt doesn’t mean it’s healed. If it looks good and it feels good, it should be all good, right? But over the years I’d smoothed perfect white layers of spackle over gaping structural holes. And the second thing I learned was: My parents didn’t love me.

The difference between regular PTSD and complex PTSD is that traditional PTSD is often associated with a moment of trauma. Sufferers of complex PTSD have undergone continual abuse—trauma that has occurred over a long period of time, over the course of years. Child abuse is a common cause of complex PTSD.

It takes an intellectual and physical effort to shove aside the comfortably worn neural pathways and go in a different direction.

But unfortunately, I do not have one foundational trauma. I have thousands. So my anxious freak-outs are not, as the books say, "temporal." They don't only occur when I see an angry face or someone pulls a driver out of their golf bag. My freak-outs are more or less constant, a fixed state of being. That infinite plethora of triggers makes complex PTSD more difficult to heal from than traditional PTSD. And the way the books seem to think about it, our fixed state of being also makes us more problematic.

Changes in Relationship with others: It is especially hard to trust other people if you have been repeatedly abused, abandoned or betrayed as a child. Mistrust makes it very difficult to make friends, and to be able to distinguish between good and bad intentions in other people. Some parts do not seem to trust anyone, while other parts may be so vulnerable and needy that they do not pay attention to clues that perhaps a person is not trustworthy. Some parts like to be close to others or feel a desperate need to be close and taken care of, while other parts fear being close or actively dislike people. Some parts are afraid of being in relationships while others are afraid of being rejected or criticized. This naturally sets up major internal as well as relational conflicts.

The essence of what trauma does to a person is it makes them feel like they don’t deserve love,” the voice in my headphones said. I was on the train, on my way to yet another doctor’s appointment, but this statement rang so true that I dug furiously through my bag and pulled out a notebook to write it down. I was about to put away my pen when I heard another especially good line, so I kept it out, writing furiously on my lap. My friend Jen, who often sends me little poems and links throughout the day, sent me this podcast—Road to Resilience,

Generally the rational brain can override the emotional brain, as long as our fears don’t hijack us. (For example, your fear at being flagged down by the police can turn instantly to gratitude when the cop warns you that there’s an accident ahead.) But the moment we feel trapped, enraged, or rejected, we are vulnerable to activating old maps and to follow their directions. Change begins when we learn to "own" our emotional brains. That means learning to observe and tolerate the heartbreaking and gut-wrenching sensations that register misery and humiliation. Only after learning to bear what is going on inside can we start to befriend, rather than obliterate, the emotions that keep our maps fixed and immutable.

Truth for anyone is a very complex thing. For a writer, what you leave out says as much as those things you include. What lies beyond the margin of the text? The photographer frames the shot; writers frame their world. Mrs Winterson objected to what I had put in, but it seemed to me that what I had left out was the story’s silent twin. There are so many things that we can’t say, because they are too painful. We hope that the things we can say will soothe the rest, or appease it in some way. Stories are compensatory. The world is unfair, unjust, unknowable, out of control. When we tell a story we exercise control, but in such a way as to leave a gap, an opening. It is a version, but never the final one. And perhaps we hope that the silences will be heard by someone else, and the story can continue, can be retold. When we write we offer the silence as much as the story. Words are the part of silence that can be spoken. Mrs Winterson would have preferred it if I had been silent. Do you remember the story of Philomel who is raped and then has her tongue ripped out by the rapist so that she can never tell? I believe in fiction and the power of stories because that way we speak in tongues. We are not silenced. All of us, when in deep trauma, find we hesitate, we stammer; there are long pauses in our speech. The thing is stuck. We get our language back through the language of others. We can turn to the poem. We can open the book. Somebody has been there for us and deep-dived the words. I needed words because unhappy families are conspiracies of silence. The one who breaks the silence is never forgiven. He or she has to learn to forgive him or herself.

Again, women who experienced childhood trauma are 80 percent more likely to experience painful endometriosis.[4] They’re much more likely to develop premenstrual dysphoric disorder. More likely to develop fibroids.[5] It may affect fertility.[6] They’re at greater risk for postpartum depression[7] and depression in menopause.[8]

There's no hierarchy of abuse. Trauma is complex and very personal.

Eighty two percent of the traumatized children seen in the National Child Traumatic Stress Network do not meet diagnostic criteria for PTSD.15 Because they often are shut down, suspicious, or aggressive they now receive pseudoscientific diagnoses such as “oppositional defiant disorder,” meaning “This kid hates my guts and won’t do anything I tell him to do,” or “disruptive mood dysregulation disorder,” meaning he has temper tantrums. Having as many problems as they do, these kids accumulate numerous diagnoses over time. Before they reach their twenties, many patients have been given four, five, six, or more of these impressive but meaningless labels. If they receive treatment at all, they get whatever is being promulgated as the method of management du jour: medications, behavioral modification, or exposure therapy. These rarely work and often cause more damage.

Recovery can take place only within then context of relationships; it cannot occur in isolation. In her renewed connection with other people, the survivor re-creates the psychological facilities that were damaged or deformed by the traumatic experience. These faculties include the basic operations of trust, autonomy, initiative, competence, identity, and intimacy. Just as these capabilities are formed in relationships with other people, they must be reformed in such relationships. The first principle of recovery is empowerment of the survivor. She must be the author and arbiter of her own recovery. Others may offer advice, support, assistance, affection, and care, but not cure. Many benevolent and well-intentioned attempts to assist the survivor founder because this basic principle of empowerment is not observed. No intervention that takes power away from the survivor can possibly foster her recovery, no matter how much it appears to be in her immediate best interest.

The traumatic stress field has adopted the term “Complex Trauma” to describe the experience of multiple and/or chronic and prolonged, developmentally adverse traumatic events, most often of an interpersonal nature (e.g., sexual or physical abuse, war, community violence) and early-life onset. These exposures often occur within the child’s caregiving system and include physical, emotional, and educational neglect and child maltreatment beginning in early childhood - Developmental Trauma Disorder

The symptomatology of PTSD. In PTSD a traumatic event is not remembered and relegated to one's past in the same way as other life events. Trauma continues to intrude with visual, auditory, and/or other somatic reality on the lives of its victims. Again and again they relieve the life-threatening experiences they suffered, reacting in mind and body as though such events were still occurring. PTSD is a complex psychobiological condition.

no recovery from trauma is possible without attending to issues of safety, care for the self, reparative connections to other human beings, and a renewed faith in the universe. The therapist's job is not just to be a witness to this process but to teach the patient how.

If a child’s emotional and intellectual freedom is restricted, their development and well-being suffer, which leads to complex problems in later life. Deprivation of thought and emotion results in an irrationality of cognition, feeling, and communication.

In this climate of profoundly disrupted relationships the child faces a formidable developmental task. She must find a way to form primary attachments to caretakers who are either dangerous or, from her perspective, negligent. She must find a way to develop a sense of basic trust and safely with caretakers who are untrustworthy and unsafe. She must develop a sense of self in relation to others who are helpless, uncaring or cruel. She must develop a capacity for bodily self-regulation in an environinent in which her body is at the disposal of others' needs as well as a capacity for self-soothing in an environment without solace. She must develop the capacity for initiative in an environment which demands that she bring her will into complete conformity with that of her abuser. And ultimately, she must develop a capacity for intimacy out of an environment where all intimate relationships are corrupt, and an identity out of an environment which defines her as a whore and a slave.

Complex PTSD consists of of six symptom clusters, which also have been described in terms of dissociation of personality. Of course, people who receive this diagnosis often also suffer from other problems as well, and as noted earlier, diagnostic categories may overlap significantly. The symptom clusters are as follows: Alterations in Regulation of Affect ( Emotion ) and Impulses Changes in Relationship with others Somatic Symptoms Changes in Meaning Changes in the perception of Self Changes in Attention and Consciousness

Those who were molested or beaten as children or teenagers might later be vulnerable to sexual abuse or violence, because their natural impulses to protect themselves and protest (physical and verbal) were extinguished. Expectation of hurtful treatment by others or one's own failed capabilities can stubbornly persist despite overwhelming evidence that such is no longer the case.

Psychiatry, as a subspecialty of medicine, aspires to define mental illness as precisely as, let’s say, cancer of the pancreas, or streptococcal infection of the lungs. However, given the complexity of mind, brain, and human attachment systems, we have not come even close to achieving that sort of precision. Understanding what is “wrong” with people currently is more a question of the mind-set of the practitioner (and of what insurance companies will pay for) than of verifiable, objective facts.

In Gretchen Schmelzer’s excellent, gentle book, Journey Through Trauma, she insists on the fifth page: “Some of you may choose a therapist: a psychiatrist, psychologist, social worker, counselor, or member of the clergy. Some of you may choose some form of group therapy. But I am telling you up front, at the beginning: in order to heal, you will need to get help. I know you will try to look for the loophole in this argument—try to find a way that you can do this on your own—but you need to trust me on this. If there were a way to do it on your own I would have found it. No one looked harder for that loophole than I did.

The symptoms of trauma can be stable, that is, ever-present. They can also be unstable, meaning that they can come and go and be triggered by stress. Or they can remain hidden for decades and suddenly surface. Usually, symptoms do not occur individually, but come in groups. They often grow increasingly complex over time, becoming less and less connected with the original trauma experience.

I have tried to communicate my ideas in a language that preserves connections, a language that is faithful both to the dispassionate, reasoned traditions of my profession and to the passionate claims of people who have been violated and outraged. I have tried to find a language that can withstand the imperatives of doublethink and allows all of us to come a little closer to facing the unspeakable.

Changes in Meaning: Finally, chronically traumatized people lose faith that good things can happen and people can be kind and trustworthy. They feel hopeless, often believing that the future will be as bad as the past, or that they will not live long enough to experience a good future. People who have a dissociative disorder may have different meanings in various dissociative parts. Some parts may be relatively balanced in their worldview, others may be despairing, believing the world to be a completely negative, dangerous place, while other parts might maintain an unrealistic optimistic outlook on life

A few years ago I heard Jerome Kagan, a distinguished emeritus professor of child psychology at Harvard, say to the Dalai Lama that for every act of cruelty in this world there are hundreds of small acts of kindness and connection. His conclusion: "To be benevolent rather than malevolent is probably a true feature of our species." Being able to feel safe with other people is probably the single most important aspect of mental health; safe connections are fundamental to meaningful and satisfying lives. Numerous studies of disaster response around the globe have shown that social support is the most powerful protection against becoming overwhelmed by stress and trauma. Social support is not the same as merely being in the presence of others. The critical issue is reciprocity: being truly heard and seen by the people around us, feeling that we are held in someone else's mind and heart. For our physiology to calm down, heal, and grow we need a visceral feeling of safety. No doctor can write a prescription for friendship and love: These are complex and hard-earned capacities. You don't need a history of trauma to feel self-conscious and even panicked at a party with strangers - but trauma can turn the whole world into a gathering of aliens.

The reason why you need emotional support is because it's important for survivors to be heard. To be understood. To be able to express yourself without fearing criticism or harsh judgement. To be validated for your pain, suffering, and loss. For others to be there for you to encourage you, especially if you're having a bad day or feeling triggered.

Isolation of catastrophic experiences. Dissociation may function to seal off overwhelming trauma into a compartmentalized area of conscious until the person is better able to integrate it into mainstream consciousness. The function of dissociation is particularly common in survivors of combat, political torture, or natural or transportation disasters.

Patients with complex trauma may at times develop extreme reactions to something the therapist has said or not said, done or not done. It is wise to anticipate this in advance, and perhaps to note this anticipation in initial communications with the patient. For example, one may say something like, "It is likely in our work together, there will be a time or times when you will feel angry with me, disappointed with me, or that I have failed you. We should except this and not be surprised if and when it happens, which it probably will." It is also vital to emphasize to the patient that despite the diagnosis and experience of dividedness, the whole person is responsible and will be held responsible for the acts of any part. p174

One of the reasons a survivor finds it so difficult to see herself as a victim is that she has been blamed repeatedly for the abuse: "If you weren't such a whore, this wouldn't have to happen." Each time she is used and trashed, she becomes further convinced of her innate badness. She sees herself participating in forbidden sexual activity and may often get some sense of gratification from it even if she doesn't want to (it is, after all, a form of touch, and our bodies respond without the consent of our wills). This is seen as further proof that the abuse is her fault and well deserved. In her mind, she has become responsible for the actions of her abusers. She believes she is not a victim; she is a loathsome, despicable, worthless human being—if indeed she even qualifies as human. When the abuse has been sadistic in nature...these beliefs are futher entrenched.

Alterations in regulation of affect (emotion) and impulse: Almost all people who are seriously traumatized have problems in tolerating and regulating their emotions and surges or impulses. However, those with complex PTSD and dissociative disorders tend to have more difficulties than those with PTSD because disruptions in early development have inhibited their ability to regulate themselves. The fact that you have a dissociative organization of your personality makes you highly vulnerable to rapid and unexpected changes in emotions and sudden impulses. Various parts of the personality intrude on each other either through passive influence or switching when your under stress, resulting in dysregulation. Merely having an emotion, such as anger, may evoke other parts of you to feel fear or shame, and to engage in impulsive behaviors to stop avoid the feelings.

The only way to bear the overwhelming pain of oppression is by telling, in all its detail, in the presence of witnesses and in a context of resistance, how unbearable it is. If we attempt to craft resistance without understanding this task, we are collectively vulnerable to all the errors of judgement that unresolved trauma generates in individuals. It is part of our task as revolutionary people, people who want deep-rooted, radical change, to be as whole as it is possible for us to be. This can only be done if we face the reality of what oppression really means in our lives, not as abstract systems subject to analysis, but as an avalanche of traumas leaving a wake of devastation in the lives of real people who nevertheless remain human, unquenchable, complex and full of possibility.

Complexly traumatized children need to be helped to engage their attention in pursuits that do not remind them of trauma-related triggers and that give them a sense of pleasure and mastery. Safety, predictability, and "fun" are essential for the establishment of the capacity to observe what is going on, put it into a larger context, and initiate physiological and motoric self-regulation.

Changes in the Perception of Self: People who have been traumatized in childhood are often troubled by guilt, shame, and negative feelings about themselves, such as the belief they are unlikable, unlovable, stupid, inept, dirty, worthless, lazy, and so forth. In Complex Dissociative disorders there are typically particular parts that contain these negative feelings about the self while other parts may evaluate themselves quite differently. Alterations among parts thus may result in rather rapid and distinct changes in self perception.

And scientists have found that some people who suffer from depression, anxiety, or C-PTSD have overactive DMNs. Which makes sense. The DMN is the seat of responsibility and insecurity. It can be a punishing force when it over-ruminates and gets caught in a toxic loop of obsession and self-doubt. The DMN can be silenced significantly by antidepressants or hallucinogenic substances. But the most efficient cure for an overactive DMN is mindfulness.

It isn’t just racism. Being part of an oppressed minority group—being queer or disabled, for example—can cause C-PTSD if you are made to feel unsafe because of your identity. Poverty can be a contributing factor to C-PTSD. These factors traumatize people and cause brain changes that push them toward anxiety and self-loathing. Because of those changes, victims internalize the blame for their failures. They tell themselves they are awkward, lazy, antisocial, or stupid, when what’s really happening is that they live in a discriminatory society where their success is limited by white supremacy and class stratification. The system itself becomes the abuser. When my boss said I was “different,” I thought it meant broken. Now I think it meant something else.

Hyperarousal causes traumatized people to become easily distressed by unexpected stimuli. Their tendency to be triggered into reliving traumatic memories illustrates how their perceptions have become excessively focused on the involuntary search for the similarities between the present and their traumatic past. As a consequence, many neutral experiences become reinterpreted as being associated with the traumatic past.

At the same time, in my readings, I discovered some evidence that traditional talk therapy might not actually be particularly effective for C-PTSD. In The Body Keeps the Score, van der Kolk writes about how talk therapy can be useless for those whom “traumatic events are almost impossible to put into words.” Some people are too dissociated and distanced from these traumatic experiences for talk therapy to work well. They might not be able to access their feelings, let alone convey them. For others, they’re in such an activated state that they have a hard time reaching into difficult memories, and the very act of recalling them could be retraumatizing. One study showed that about 10 percent of people might experience worsening symptoms after being forced to talk about their trauma.

But after a couple of weeks of listing things I was grateful for, I came to see that the little things were everything. The little things were what I held on to at the end of the day. Single jokes that gave me the giggles. A beautiful flower arrangement, viewed through the window of a café. The fact that my cat came to cuddle me when she saw I was sad. These things gave me hope, pleasure, solace. Together, they added up to a fulfilling life. If a simple flower arrangement could make this world just a little more bearable, then perhaps my own small actions meant more than I was giving them credit for. Maybe when I made dinner, or listened to a friend rant, or complimented a woman on her incredible garden, I was helping make this world survivable for others. Perhaps that evening, when tallying up their own wins and losses for the day, someone would think of something I’d done and smile.

these negative emotions are not simply something to endure and erase. They are purposeful. Beneficial. They tell us what we need. Anger inspires action. Sadness is necessary to process grief. Fear helps keep us safe. Completely eradicating these emotions is not just impossible—it’s unhealthy. These negative emotions only become toxic when they block out all the other emotions. When we feel so much sadness that we can’t let any joy in. When we feel so much anger that we cannot soften around others. True mental health looks like a balance of these good and bad feelings. As Lori Gottlieb says in her book Maybe You Should Talk to Someone, “Many people come to therapy seeking closure. Help me not to feel. What they eventually discover is that you can’t mute one emotion without muting the others. You want to mute the pain? You’ll also mute the joy.

Somatic Symptoms: People with Complex PTSD often have medical unexplained physical symptoms such as abdominal pains, headaches, joint and muscle pain, stomach problems, and elimination problems. These people are sometimes most unfortunately mislabeled as hypochondriacs or as exaggerating their physical problems. But these problems are real, even though they may not be related to a specific physical diagnosis. Some dissociative parts are stuck in the past experiences that involved pain may intrude such that a person experiences unexplained pain or other physical symptoms. And more generally, chronic stress affects the body in all kinds of ways, just as it does the mind. In fact, the mind and body cannot be separated. Unfortunately, the connection between current physical symptoms and past traumatizing events is not always so clear to either the individual or the physician, at least for a while. At the same time we know that people who have suffered from serious medical, problems. It is therefore very important that you have physical problems checked out, to make sure you do not have a problem from which you need medical help.

Childhood trauma can range from having faces extreme violence and neglect to having confronted feelings of not belonging, being unwanted, or being chronically misunderstood. You may have grown up in an environment where your curiosity and enthusiasm were constantly devalued. Perhaps you were brought up in a family where your parents had unresolved traumas of their own, which impaired their ability to attend to your emotional needs. Or, you may have faced vicious sexual or physical attacks. In all such situations, you learn to compensate by developing defenses around your most vulnerabe parts.

I go from Wikipedia to a government page about C-PTSD as it relates to veterans. I read the list of symptoms. It is very long. And it is not so much a medical document as it is a biography of my life: The difficulty regulating my emotions. The tendency to overshare and trust the wrong people. The dismal self-loathing. The trouble I have maintaining relationships. The unhealthy relationship with my abuser. The tendency to be aggressive but unable to tolerate aggression from others.

Origins Of Cptsd How do traumatically abused and/or abandoned children develop Cptsd? While the origin of Cptsd is most often associated with extended periods of physical and/or sexual abuse in childhood, my observations convince me that ongoing verbal and emotional abuse also causes it. Many dysfunctional parents react contemptuously to a baby or toddler’s plaintive call for connection and attachment. Contempt is extremely traumatizing to a child, and at best, extremely noxious to an adult. Contempt is a toxic cocktail of verbal and emotional abuse, a deadly amalgam of denigration, rage and disgust. Rage creates fear, and disgust creates shame in the child in a way that soon teaches her to refrain from crying out, from ever asking for attention. Before long, the child gives up on seeking any kind of help or connection at all. The child’s bid for bonding and acceptance is thwarted, and she is left to suffer in the frightened despair of abandonment. Particularly abusive parents deepen the abandonment trauma by linking corporal punishment with contempt. Slaveholders and prison guards typically use contempt and scorn to destroy their victims’ self-esteem. Slaves, prisoners, and children, who are made to feel worthless and powerless devolve into learned helplessness and can be controlled with far less energy and attention. Cult leaders also use contempt to shrink their followers into absolute submission after luring them in with brief phases of fake unconditional love.

People with Complex PTSD suffer from more severe and frequent dissociation symptoms, as well as memory and attention problems, than those with simple PTSD. In addition to amnesia due to the activity of various parts of the self, people may experience difficulties with concentration, attention, other memory problems and general spaciness. These symptoms often accompany dissociation of the personality, but they are also common in people who do not have dissociative disorders. For example everyone can be spacey, absorbed in an activity, or miss an exit on the highway. When various parts of the personality are active, by definition, a person experiences some kind of abrupt change in attention and consciousness.

The results of the study were astoundingly clear: The more childhood trauma someone had suffered, the worse their health outcomes were in adulthood. And their risk for contracting diseases didn’t go up just a few percentage points. People with high ACE scores were about three times as likely to develop liver disease, twice as likely to develop cancer or heart disease, four times as likely to develop emphysema.[2] They were seven and a half times more likely to become alcoholics, four and a half times more likely to suffer from depression, and a whopping twelve times more likely to attempt suicide.[3] Scientists have learned that stress is literally toxic. Stress chemicals like cortisol and adrenaline surging through our bodies are healthy in moderation—you wouldn’t be able to get up in the morning without a good dose of cortisol. But in overwhelming quantities, they become toxic and can change the structure of our brains. Stress and depression wear our bodies out. And childhood trauma affects our telomeres. Telomeres are like little caps on the ends of our strands of DNA that keep them from unraveling. As we get older, those telomeres get shorter and shorter. When they’ve finally disappeared, our DNA itself begins to unravel, increasing our chances of getting cancer and making us especially susceptible to disease. Because of this tendency, telomeres are linked to human lifespan. And studies have shown that people who suffered from childhood trauma have significantly shortened telomeres.[4]

As I discussed in the previous chapter, attachment researchers have shown that our earliest caregivers don't only feed us, dress us, and comfort us when we are upset; they shape the way our rapidly growing brain perceives reality. Our interactions with our caregivers convey what is safe and what is dangerous: whom we can count on and who will let us down; what we need to do to get our needs met. This information is embodied in the warp and woof of our brain circuitry and forms the template of how we think of ourselves and the world around us. These inner maps are remarkably stable across time. This doesn‘t mean, however, that our maps can‘t be modified by experience. A deep love relationship, particularly during adolescence, when the brain once again goes through a period of exponential change, truly can transform us. So can the birth of a child, as our babies often teach us how to love. Adults who were abused or neglected as children can still learn the beauty of intimacy and mutual trust or have a deep spiritual experience that opens them to a larger universe. In contrast, previously uncontaminated childhood maps can become so distorted by an adult rape or assault that all roads are rerouted into terror or despair. These responses are not reasonable and therefore cannot be changed simply by reframing irrational beliefs.

Posttraumatic stress disorder (PTSD) also has dissociative symptoms as an essential feature. PTSD has been classically seen as a biphasic disorder, with persons alternately experiencing phases of intrusion and numbing... [T]he intrusive phase is associated with recurrent and distressing recollections in thoughts or dreams and reliving the events in flashbacks. The avoidant/numbing phase is associated with efforts to avoid thoughts or feelings associated with the trauma, emotional constriction, and social withdrawal. This biphasic pattern is the result of dissociation; traumatic events are distanced and dissociated from usual conscious awareness in the numbing phase, only to return in the intrusive phase.

Too often the survivor is seen by [himself or] herself and others as "nuts," "crazy," or "weird." Unless her responses are understood within the context of trauma. A traumatic stress reaction consists of *natural* emotions and behaviors in response to a catastrophe, its immediate aftermath, or memories of it. These reactions can occur anytime after the trauma, even decades later. The coping strategies that victims use can be understood only within the context of the abuse of a child. The importance of context was made very clear many years ago when I was visiting the home of a Holocaust survivor. The woman's home was within the city limits of a large metropolitan area. Every time a police or ambulance siren sounded, she became terrified and ran and hid in a closet or under the bed. To put yourself in a closet at the sound of a far-off siren is strange behavior indeed—outside of the context of possibly being sent to a death camp. Within that context, it makes perfect sense. Unless we as therapists have a good grasp of the context of trauma, we run the risk of misunderstanding the symptoms our clients present and, hence, responding inappropriately or in damaging ways.

Many survivors of relational and other forms of early life trauma are deeply troubled and often struggle with feelings of anger, grief, alienation, distrust, confusion, low self-esteem, loneliness, shame, and self-loathing. They seem to be prisoners of their emotions, alternating between being flooded by intense emotional and physiological distress related to the trauma or its consequences and being detached and unable to express or feel any emotion at all - alternations that are the signature posttraumatic pattern. These occur alongside or in conjunction with other common reactions and symptoms (e.g., depression, anxiety, and low self-esteem) and their secondary manifestations. Those with complex trauma histories often have diffuse identity issues and feel like outsiders, different from other people, whom they somehow can't seem to get along with, fit in with, or get close to, even when they try. Moreover, they often feel a sense of personal contamination and that no one understands or can help them. Quite frequently and unfortunately, both they and other people (including the professionals they turn to for help) do misunderstand them, devalue their strengths, or view their survival adaptations through a lens of pathology (e.g., seeing them as "demanding", "overdependent and needy", "aggressive", or as having borderline personality). Yet, despite all, many individuals with these histories display a remarkable capacity for resilience, a sense of morality and empathy for others, spirituality, and perseverance that are highly admirable under the circumstances and that create a strong capacity for survival. Three broad categories of survivorship, with much overlap between them, can be discerned: 1. Those who have successfully overcome their past and whose lives are healthy and satisfying. Often, individuals in this group have had reparative experiences within relationships that helped them to cope successfully. 2. Those whose lives are interrupted by recurring posttraumatic reactions (often in response to life events and experiences) that periodically hijack them and their functioning for various periods of time. 3. Those whose lives are impaired on an ongoing basis and who live in a condition of posttraumatic decline, even to the point of death, due to compromised medical and mental health status or as victims of suicide of community violence, including homicide.

The term dissociation is ordinarily used to describe the phenomenon of compartmentalization or fragmentation of mental contents. It does not ascribe any particular mechanism by which the dissociative process occurs. Does dissociation occur as a result of automatic, nonconscious processes, or are there other specific mechanisms by which it occurs? Especially in the context of describing amnesia, the term repression is widely used in connection with several different mechanisms. As it is commonly used, it often implies how individuals may block our memories of uncomfortable or conflictual experiences. If done consciously, the mechanism is more accurately called suppression, which results from actively trying not to think about negative experiences.

Their experiences led them to create assumptions about others and related beliefs about themselves such as "this is my lot in life" and "this is what I deserve". Some also learned that personal safety and happiness are of lower priority than survival and that it may be safer to give in than to actively fight off additional abuse and victimization. When abuse is perpetrated by intimates, it is additionally confounding in terms of attachment, betrayal, and trust. Victims may be unable to leave or to fight back due to strong, albeit insecure and disorganized, attachment and misplaced loyalty to abusers. They may have also experienced trauma bonding over the course of their victimization, that is, a bond of specialness with or dependence on the abuser.

A healthy heart doesn’t pump at the same rate all the time. That would actually be a really unhealthy heart. The healthiest hearts are adaptable, and the quicker they adapt, the better. When you start running, your heart should ideally speed up quickly. Then, when you rest, it should slow down quickly. It’s the same for your emotions. When something really tragic happens, it would be weird if you were still happy, right? Or if you just sat there with no reaction. When something tragic happens, you should be there with that pain, feeling that sadness. When something unjust happens, you should feel how aggravating it is. And then, after you’ve sat with those feelings for the appropriate amount of time—and it could be an hour, or a day, or months, depending on the severity of what happened—then, you can go back to a state of rest. Or joy. Or whatever. Being healed isn’t about feeling nothing. Being healed is about feeling the appropriate emotions at the appropriate times and still being able to come back to yourself. That’s just life.

There is overwhelming evidence that meditation can increase focus and decrease anxiety, depression, and cortisol flooding. There is evidence that it decreases activation in the amygdala, one epicenter of fear in the brain, and increases activity in the prefrontal cortex. People who meditate are able to unstick themselves from cyclical, dangerous thinking and see things from a calmer, more positive perspective. The sympathetic nervous system, or the fight or flight system, is activated by stress. This is the system that gets us ready to run. The counter to this is the parasympathetic nervous system, the resting and digesting system. It lowers heart rate and blood pressure, slows breathing, and directly counters the stress response. Meditation activates the parasympathetic nervous system. It’s literally the antidote to stress. Plus, it’s what all the evolved, cool girls who look good without makeup are doing, according to social media.

I was taught that punishment and shame were the logical and necessary reactions to screwing up. The benefit of punishment was that it would keep my wild and terrible natural tendencies in line. It would shame me into being better. “Justice is the firmest pillar of good government,” after all, and justice meant people had to pay for their mistakes. When something went wrong, there had to be fault. There had to be blame. There had to be pain. Now I knew I was wrong. Punishment didn’t make things better. It mucked things up even more. The father’s self-punishment did not grant him his daughter’s forgiveness. It did not whip his sins out of him. Instead, it removed him from his family by isolating him in a prison of self-loathing. Locked in this prison, he couldn’t hear what his daughter needed. He couldn’t give her what she was asking for. There was blame and pain in spades. But all of this actively prevented him from making amends, from healing his relationship with his daughter. Punishment did not ease Willow or Jeremy or the other children at Mott Haven back into their circles of friends. Punishment excludes and excises. It demolishes relationships and community. I could not believe it had taken me this long to realize that punishment is not love. In fact, it is the opposite of love. Forgiveness is love. Spaciousness is love.

Brain scans prove that patients who’ve sustained significant childhood trauma have brains that look different from people who haven’t. Traumatized brains tend to have an enlarged amygdala—a part of the brain that is generally associated with producing feelings of fear. Which makes sense. But it goes further than that: For survivors of emotional abuse, the part of their brain that is associated with self-awareness and self-evaluation is shrunken and thin. Women who’ve suffered childhood sexual abuse have smaller somatosensory cortices—the part of the brain that registers sensation in our bodies. Victims who were screamed at might have an altered response to sound. Traumatized brains can result in reductions in the parts of the brain that process semantics, emotion and memory retrieval, perceiving emotions in others, and attention and speech. Not getting enough sleep at night potentially affects developing brains’ plasticity and attention and increases the risk of emotional problems later in life. And the scariest factoid, for me anyway: Child abuse is often associated with reduced thickness in the prefrontal cortex, the part of the brain associated with moderation, decision-making, complex thought, and logical reasoning. Brains do have workarounds. There are people without amygdalae who don’t feel fear. There are people who have reduced prefrontal cortices who are very logical. And other parts of the brain can compensate, make up the lost parts in other ways. But overall, when I looked at the breadth of evidence, the results felt crushing. The fact that the brain’s cortical thickness is directly related to IQ was particularly threatening to me. Even if I wasn’t cool, or kind, or personable, I enjoyed the narrative that I was at least effective. Intelligent. What these papers seemed to tell me is that however smart I am, I’m not as smart as I could have been had this not happened to me. The questions arose again: Is this why my pitches didn’t go through? Is this why my boss never respected me? Is this why I was pushed to do grunt work in the back room?

Having DID is, for many people, a very lonely thing. If this book reaches some people whose experiences resonate with mine and gives them a sense that they aren't alone, that there is hope, then I will have achieved one of my goals. A sad fact is that people with DID spend an average of almost seven years in the mental health system before being properly diagnosed and receiving the specific help they need. During that repeatedly misdiagnosed and incorrectly treated, simply because clinicians fail to recognize the symptoms. If this book provides practicing and future clinicians certain insight into DID, then I will have accomplished another goal. Clinicians, and all others whose lives are touched by DID, need to grasp the fundamentally illusive nature of memory, because memory, or the lack of it, is an integral component of this condition. Our minds are stock pots which are continuously fed ingredients from many cooks: parents, siblings, relatives, neighbors, teachers, schoolmates, strangers, acquaintances, radio, television, movies, and books. These are the fixings of learning and memory, which are stirred with a spoon that changes form over time as it is shaped by our experiences. In this incredibly amorphous neurological stew, it is impossible for all memories to be exact. But even as we accept the complex of impressionistic nature of memory, it is equally essential to recognize that people who experience persistent and intrusive memories that disrupt their sense of well-being and ability to function, have some real basis distress, regardless of the degree of clarity or feasibility of their recollections. We must understand that those who experience abuse as children, and particularly those who experience incest, almost invariably suffer from a profound sense of guilt and shame that is not meliorated merely by unearthing memories or focusing on the content of traumatic material. It is not enough to just remember. Nor is achieving a sense of wholeness and peace necessarily accomplished by either placing blame on others or by forgiving those we perceive as having wronged us. It is achieved through understanding, acceptance, and reinvention of the self.

THE RETURN OF THE REPRESSED: RELIVING DISSOCIATED EXPERIENCES The reexperiencing of previously dissociated traumatic events presents in a variety of complex ways. The central principle is that dissociated experiences often do not remain dormant. Freud's concept of the “repetition compulsion” is enormously helpful in understanding how dissociated events are later reexperienced. In his paper, "Beyond the Pleasure Principle," Freud (1920/ 1955) described how repressed (and dissociated) trauma and instinctual conflicts can become superimposed on current reality. He wrote: The patient cannot remember the whole of what is repressed in him, and what he cannot remember may be precisely the essential part of it. .. . He is obliged to repeat the repressed material as a contemporary experience instead of remembering it as something in the past. (p. 18) If one understands repression as the process in which overwhelming experiences are forgotten, distanced, and dissociated, Freud posited that these experiences are likely to recur in the mind and to be reexperienced. He theorized that this "compulsion to repeat" served a need to rework and achieve mastery over the experience and that it perhaps had an underlying biologic basis as well. The most perceptive tenet of Freud’s theory is that previously dissociated events are actually reexperienced as current reality rather than remembered as occurring in the past. Although Freud was discussing the trauma produced by intense intrapsychic conflict, clinical experience has shown that actual traumatic events that have been dissociated are often repeated and reexperienced.