Thread by @HeyMaliniK

Because last month was #MentalHealthAwarenessMonth and this month is #PTSDAwarenessMonth, let’s talk about classic PTSD, and another related mental illness, which is c-PTSD, or complex PTSD. A thread.

PTSD, or post-traumatic stress disorder, is an anxiety disorder that can occur in both humans and animals after experiencing or witnessing any sort of traumatic situation. Its symptoms are grouped into four categories: intrusive thoughts, avoidance, arousal, and negative mood.

Intrusive thoughts include negative memories related to trauma, flashbacks (there are multiple types— we’ll get to that later), upsetting dreams or nightmares related to issues surrounding the trauma, and feeling physically or emotionally uncomfortable when reminded of the trauma

Avoidance just refers to the fact that people with PTSD typically try to avoid thinking about, talking about, or being reminded of anything related to their trauma. In other words, avoiding triggers.

Arousal (and/or reactivity) symptoms can include getting startled easily, feeling the effects of adrenaline and the fight or flight response when you’re not actually in danger, getting angry or irritable easily, self-destructive behaviors in which you sabotage your own wellbeing,

happiness, or success, self-harming behaviors, insomnia, and difficulty concentrating.

Negative mood and/or thought symptoms can include symptoms of sadness, apathy, fear, guilt, shame, disgust (with yourself or someone else), feeling mentally, emotionally, or physically detached, lack of trust in others, negative body image, self-concept, or self-worth, etc.

Any of these symptoms can range from mild to severe, and are sometimes severe enough that they warrant additional diagnoses of mental illnesses such as OCD, AD(H)D, generalized anxiety, depressive disorders, bipolar, dissociative disorders, etc.

When these symptoms occur within a month of the trauma, that is considered Acute Stress Disorder, not PTSD. When these symptoms last longer than a month following the trauma, they are considered symptoms of PTSD.

It is important to understand that PTSD does not always occur directly after experiencing a trauma. It can occur months, years, or even decades later.

PTSD in pop culture is generally associated with being a war veteran. Most of the research on PTSD has been done by studying veterans. In fact, PTSD only came to be recognized as a specific mental illness following anecdotes from World War II veterans.

This strong association between Western veterans and PTSD is harmful for anyone who does not fit this criteria. Civilians whose loved ones, lives, land, and/or homes have been destroyed by war and war crimes can have PTSD, as can people who have no experience whatsoever with war.

Now, to get to flashbacks. Flashbacks are probably the most well-known symptom of PTSD, except they tend to all be portrayed the same way in movies and on TV.

In pop culture, someone experiencing a flashback consciously believes they are experiencing their trauma again or for the first time, and they often react violently, mimicking the actions of wartime. In reality, flashbacks take many different forms.

Flashbacks are commonly divided into three categories: Visual, Somatic, and Emotional. People with PTSD can experience any or all of these types of flashbacks, although “classic” PTSD is normally characterized by visual and somatic (sensory) flashbacks.

Complex PTSD (c-PTSD) is characterized more by emotional flashbacks, but we’ll discuss those later in the thread.

Here is a screenshot which describes a basic example of a visual flashback involving a dog attack, from a @TheMightySite article. Visual flashbacks often include not only images, but also sounds, smells, and other sensations that were present during the trauma.

Somatic, or “body memory” flashbacks, can be chronic or intermittent, and manifest as muscle tension/pain, headaches, tremors, chest pain, gastrointestinal symptoms like nausea and abdominal pain, shortness of breath, numbness or tingling sensations, and other physical discomfort

Before we talk about what emotional flashbacks are, let’s get a sense of what complex PTSD is, and how it differs from typical PTSD.

Complex PTSD is an anxiety disorder that was first proposed by a psychiatry researcher and Harvard Medical School professor named Judith Lewis Herman in 1992, in the Journal of Traumatic Stress. It is not currently considered a separate disgnosis from “regular” or classic PTSD,

because research has shown that as many as 92% of people whose symptoms fit the criteria for complex PTSD also have all the symptoms required for a diagnosis of classic PTSD. Because of this, they are thought of as slightly different manifestations of the same disorder.

Whereas typical PTSD occurs in response to a traumatic event that takes place on a scale from minutes to hours, c-PTSD results from chronic trauma that occurs over a space of weeks, months, or years. Examples would be child abuse, imprisonment, or chronic or long-term illness.

The traumas that result in a person developing c-PTSD most often occur in childhood, when the person’s brain, nervous system, personality, and internal coping mechanisms are still developing. However, chronic trauma in adulthood can also lead to c-PTSD.

c-PTSD differs from typical, classic PTSD in that in addition to the typical PTSD symptoms, it also involves significant emotional dysregulation, has a significant dissociative component, & seriously affects a person’s coping mechanisms and the way they view themselves & others.

c-PTSD often appears more similar to borderline personality disorder (BPD) than to PTSD, because both share some similar symptoms, and both are commonly related to developmental trauma involving a parent, guardian, or other caregiver.

Here are some symptoms commonly experienced by people with c-PTSD. I do not know how many of these symptoms a person must experience in order to be diagnosed with c-PTSD, as it is not currently an official, separate diagnosis from typical PTSD:

Emotional flashbacks. Emotional flashbacks can last for a very short time, or a very long time (hours or days, weeks.) Emotional flashbacks can arise in response to obvious trauma-related triggers, or can come seemingly out of nowhere.

When someone experiences an emotional flashback, they feel overtaken by any number of unpleasant emotions that they experienced during, or in response to their ongoing trauma or abuse.

The emotion(s) are not proportional to the situation that triggers them, and instead share the same intensity as the emotions experienced as a direct result of their trauma or abuse. Here is another screenshot from @TheMightySite, where a survivor describes an emotional flashback

In the screenshot, the person experiencing the emotional flashback described the fact that they did not experience any visual aspects, just emotions. This is significant, because many people with c-PTSD will not recognize what they’re experiencing as a flashback...

because they did not re-experience any visual, sonic, or other physical elements of their trauma. It is important to note that many people with c-PTSD will not know or remember which aspect of their trauma the flashback is related to, because of the dissociative aspect of c-PTSD.

Just so we’re clear, *all PTSD flashbacks are dissociative events*, even emotional flashbacks. There are many different types of dissociation that people with c-PTSD can experience as symptoms. The dissociation is sometimes so intense that they’re diagnosed with an additional...

dissociative disorder, such as depersonalization or derealization syndrome, or even dissociative identity disorder (DID.) Different kinds of dissociation differ by type, severity, and mechanism that causes each of them. They’re not always as obvious as you would think.

Many of the symptoms of this disorder are dissociative symptoms. I will point this out in the thread when they are.

It is common for people with c-PTSD to feel dead inside, like we are not being our true selves around other people, or to feel like we are behaving like robots.

This is because many people with c-PTSD have had such severe damage done to our concept of self as a result of prolonged, profound abuse, that we dissociate in a way that causes us to repress our emotions, personalities, and opinions around other people.

This form of dissociation understandably makes it hard to make friends, form relationships, and to function socially as a whole. Not expressing emotions or opinions around our abuser(s) serves to protect us from abusers who are unpredictable or easily annoyed, but it...

also forces us into an emotionally catatonic state that can become the norm, or predominate even when we are alone. This makes us feel like we are freaks, are damaged, or are less than human, and reinforces the low self-image that is common with this disorder.

This disconnect between ourselves and everyone else might explain why some abuse survivors also have social anxiety or schizoid personality disorder.

Another symptom: extreme fear of trust or vulnerability. If someone with c-PTSD comes to trust someone, that trust can be broken extremely easily. This doesn’t normally reflect on the person they trusted, but rather on a protective mechanism that our brains use to keep us safe.

Another symptom: Hypervigilance with respect to other people.

Hypervigilance means paying an extreme amount of attention to something or someone. We can be hypervigilant toward others’ reactions, body language, opinions of us, emotions, physical or mental wellbeing, and more.

This sense of being uncomfortably attuned to other people often develops in response to an abuser whom we are afraid of, a parent, caregiver, friend, or sibling whom we are worried about and feel responsible for looking out for and/or protecting.

Our brains often generalize this hypervigilant response to people or categories of people who were not involved in our abuse. Some people mistakenly characterize hypervigilance as hyperempathy. It is important to recognize that this is a trauma response, not a personality trait.

Another symptom of c-PTSD: emotional dysregulation. The smallest things can trigger extremely intense, negative emotions, such as fear, anxiety, despair, loneliness, panic, guilt, shame, anger, and sadness. These emotions can be so intense that they trigger physical reactions.

You might feel that you are suddenly experiencing an extreme depressive episode, and then out of nowhere, a few minutes or hours later, you’re happy again. These extreme shifts in mood make it very likely for people with c-PTSD to also have other mood and anxiety disorders.

Suicidal ideation is also very common. It is common for it to come and go very quickly, in response to seemingly nothing.

So-called “toxic shame” is another symptom of c-PTSD. This is intense guilt, shame, or survivor’s guilt that can cause us to hate ourselves, self-harm, sabotage opportunities for our own happiness or success, or believe that we are disgusting and do not deserve to be alive.

Another symptom is being highly anxious. Our bodies and nervous are constantly primed for stress, and we are often hypervigilant and easily startled. We have a hard time ever feeling safe or secure, and we become overwhelmed and have breakdowns easily.

Another dissociative symptom of c-PTSD is dissociating from our trauma(s), the period(s) in our lives when the trauma happened, dissociating from triggering events, and/or dissociating from our distressing mental illness symptoms.

If you dissociate from traumatic memories like these, you either don’t remember them altogether, you remember them and feel as if they happened to someone else other than you, or you remember them in a way that is completely detached and unemotional.

Many people with c-PTSD gaslight themselves because of this. Thinking, “that never happened,” “I know something happened but I don’t remember what it was,” “it wasn’t really that bad/serious,” or “why did I ever consider myself mentally ill?”are all signs that you’re dissociating

I often go to see my therapist or doctor, after dealing with debilitating symptoms of mental illness, and say, “I’m fine/I’m not depressed/I haven’t been experiencing any symptoms of anxiety lately.” It’s really hard to get treatment when you don’t remember what happened to you.

Another personal example I can give is that I often try to reconcile with my abuser, thinking, “they’re really not a bad person. I don’t know why I judged them so harshly,” only to be re-traumatized again, because my mind dissociates so strongly from my past experiences of trauma

If you suddenly feel uncomfortable and unable to concentrate on what is going on in the present moment, there is a good chance you’re dissociating without knowing it. Same thing if you suddenly feel as if your emotions and your ability to care or feel sympathy have been shut off.

People who have experienced complex trauma also often have a hard time getting close to people, or an aversion even to the thought of intimacy (this very much includes friendship and platonic intimacy.)

Their mind’s protective mechanisms may have them believe that it is risky to expect anything from anyone, or also they may be fearful of being smothered, losing their personhood or identity, and losing their autonomy if they form any sort of attachment to another person.

Some people may form relationships easily & have all kinds of friends, but only they will know that they aren’t being their true, authentic selves in those relationships. They may even create a new persona for friendships & interpersonal interactions. This takes a lot of energy.

Another symptom that I have already mentioned in this thread is sabotaging opportunities for our own success and happiness, but I never mentioned why this is the case. Lots of people with c-PTSD have an underlying fear of betraying their abusers’ expectations.

Survivor’s guilt, toxic shame, anxiety, executive dysfunction, an overall self-destructive impulse, and any lies our abusers may have told us add to this compulsion to destroy any opportunity we have at improving our lives or being happy that is common with c-PTSD.

This is getting to be an *incredibly* long thread, but I hope this could help at least someone realize what they’re experiencing is valid and has a name. It sucks to be mentally ill in any capacity, and I wish us all hope and healing, regardless of diagnosis or lack thereof. ❤️❤️