• The Australian, November 4, 2016, Ruth Ostrow
  

However, it is also possible to have a form of PTSD based on less dramatic but insidious childhood experiences such as growing up with an alcoholic parent or feeling unsafe due to neglectful or warring parents, or bullying by teachers or caregivers.

This variant of PTSD is known as C-PTSD, or “complex” trauma, which is described by psychologist and trauma expert Christine Courtois as “a type of trauma that occurs repeatedly and cumulatively, usually over a period of time and within specific relationships and contexts”.

These contexts are prolonged, and most often interpersonal, and can involve maltreatment including neglect, abuse or abandonment by primary caregivers or other ostensibly responsible adults. The trauma is then carried into the rest of one’s life.

I recently had a discussion with a psychologist who has asked not to be named about his patient “Betty”, who is exhibiting signs of stress disorder following a break-up. Her marriage has been on-again, off-again, and each time they’ve broken up she’s fallen into a deep melancholia. But her reason for leaving was that her partner was acting in a way that she found depriving and abusive.

“She was trapped in this pattern of PTSD because of her childhood,” the psychologist says. “Her relationship with her alcoholic father was much the same. Based on an unstable foundation, she never knew if he loved her or he’d be there; sometimes he’d be kind, sometimes abusive to her and her mother. It was the uncertainty that she grew used to, so the marriage she went into felt familiar.”

In other words, she was constantly being retraumatised, reliving the nervousness, anxiety, feelings of abandonment, lack of control each step of the way, and it made her very depressed and insecure. The marriage, whether on or off, was a trigger for many of the old hurts, sitting up at night wondering if he’d come home, if he’d love her — indeed clinging to a sinking ship the way she used to do with her dad. Children tend to blame themselves. It’s easy to say “just leave”, as her friends did, but it’s never that simple.

In fact, many people in bad relationships stay because the pain or lack of control feels familiar. Alternatively, an original trauma may make a person hyper-vigilant for any signs that may not even be there. For instance, a husband staying out late or talking to another woman at a party might trigger feelings of abandonment, and the habitual overreaction might even lead to eventual abandonment — so it is very important to unravel any signs of PTSD before it unravels you.

According to the US-based National Institute of Mental Health, the lead federal agency for research on mental disorders, “Not everyone with PTSD has been through a dangerous event … the sudden, unexpected death of a loved one can also lead to PTSD. Symptoms usually begin early, within three months of the traumatic incident, but sometimes they begin years afterwards. Symptoms must last more than a month and be severe enough to interfere with relationships. In some people, the condition becomes chronic.”

It says about seven or eight out of every 100 people will experience PTSD at some point in their lives. Women are more likely to develop PTSD than men. Genetics also plays a part. To be diagnosed, an adult must have all of the following for at least one month:
• At least one re-experiencing symptom where the person has flashbacks of the events, bad dreams, or frightening thoughts.
• At least one avoidance symptom, where anything or anyone that is a reminder of the situation is avoided;.
• At least two arousal/reactivity symptoms, such as panic attacks, anger or fear, being easily startled, not sleeping, racing heart.
• At least two cognition and mood symptoms such as loss of pleasure (numb), self-blame, depression, or memory issues about the event.

In the case of C-PTSD from sustained trauma over time, symptoms may also include core characteristics of psychological fragmentation, the loss of a sense of safety, self-worth and trust, as well as the tendency to be re-victimised or re-traumatised. Victims might repeatedly engage in rescuer-persecutor relationships; or have troubles with boundaries, intimacy or attachment.

Courtois, in an article titled “Complex Trauma, Complex Reactions: Assessment and Treatment”, lists symptoms of C-PTSD as including difficulty regulating affective impulses such as anger and self-destructiveness, dissociative episodes, a chronic sense of guilt or responsibility, difficulty trusting people or feeling intimate, hopelessness or despair, and other somatic or medical problems.

The online publication HelpGuide.org, a collaboration with Harvard Medical School, says: “Any situation that leaves you feeling overwhelmed and alone (or shatters your sense of security) can be traumatic, even if it doesn’t involve physical harm.

“It’s not the objective facts that determine whether an event is traumatic, but your subjective emotional experience of the event. The more frightened and helpless you feel, the more likely you are to be traumatised.

“Trauma can be caused by: one-time events, such as an accident, injury, natural disaster, or violent attack; or ongoing, relentless stress, such as living in a crime-ridden neighbourhood, sexual abuse or battling a life-threatening illness. Commonly overlooked causes can be surgery (especially in the first three years of life), the sudden death of someone close, the break-up of a significant relationship, or a humiliating or deeply disappointing experience.”

So, how to recover from trauma? Experts say one of the main things is to avoid feeling helpless. It’s important to get back in control. Life planning, keeping a journal of positive ideas, being creative and proactive, all helps.

A key form of empowerment, according to Harvard’s HelpGuide, is to get moving. It says, “Trauma disrupts the body’s natural equilibrium, freezing you in a state of hyper-arousal (fight-or-flight) and fear. In essence, your nervous system gets ‘stuck’. As well as burning off adrenalin and releasing endorphins, exercise and movement can actually help your nervous system become unstuck. Try to exercise for at least 30 minutes most days.”

Experts recommend a good diet is crucial, instead of stuffing yourself with carbs and comfort foods that make the system sluggish. It’s important to avoid alcohol and non-prescribed drugs, as their use can increase your trauma symptoms and anxiety.

Don’t cocoon yourself. During trauma it’s common for people to withdraw from others, but isolation makes things worse. Connect to others socially; ask for support; volunteer for programs; reach out. Health is important. Self-regulate your nervous system with yoga, meditation, qi gong, and mindful breathing, and get plenty of sleep.

It’s important to consider medication and/or seeing a therapist. Cognitive behavioural therapy helps you process your thoughts; somatic psychotherapy focuses on bodily sensations and sensitivity to feelings; eye movement desensitisation and reprocessing can unfreeze traumatic memories; mind­fulness therapy soothes the soul.

The first step to feeling safe again is admitting you don’t feel safe. Only then can the healing begin.

Ruth.ostrow@hotmail.com