Complex Post-Traumatic Stress Disorder

By Sara Staggs, LICSW, MSW, MPH

Complex Post-Traumatic Stress DisorderMichelle was terrorized for much of her childhood. Her father was an inconsistent presence and her mother expressed outright disdain for her. Often when Michelle went to her mother for comfort, she was accused of exaggerating or being a “crybaby” and sent away.

Starting at age 4 until she was out of the house at 16, Michelle was molested by several family members — including her brother, her uncle and a couple of cousins. As she grew up, different men in the neighborhood also sexually assaulted her.

At 19, she began dating Carl, who initially was very affectionate. However, he then began to be suspicious of different friends of hers and concerned about how she spent her time. This escalated into more and more controlling behavior and occasionally he was physically violent.

After two years of dating, Michelle managed to escape the relationship. A couple of months after leaving, she was in a car accident that left her in a coma for a week. After she woke, she spent months learning to walk again. A few years ago, her mother became terminally ill and for months Michelle worked hard to provide her mother with superb nursing care. She hoped that this, plus having earned a master’s degree would lead to her mother accepting her and recognizing her as good. Instead, her mother complained about Michelle’s laziness and incompetence until she died. Now, Michelle has had difficulty mourning her mother’s death and feels that she needs support to do that.

Because Michelle’s trauma happened throughout her development, many of her trauma symptoms present as part of her personality. She is extremely insecure, and is constantly vigilant to signs that she is disliked and plotted against. As a result, she finds it extremely difficult to say no to any requests or to make her needs known. Since as a child, her primary caregivers were abusive and negligent, this is what she has learned to expect from others, and finds it very difficult to trust anyone.

Michelle also dissociates when she feels threatened physically or emotionally. For her, this means that her vision and hearing get “cloudy” and it is difficult for her to understand what is happening around her. She finds it frustrating that she feels so disconnected from her environment and feels that she must look stupid to those around her. She also experiences nightmares and intrusive memories of different events, though the memories are not as common as a general sense of dread that seems to come out of nowhere, such as when she needs to go to her basement.

After many years, Michelle finally sought help at her local women’s center. Initially she started by attending group therapy, since she was hopeful that she would be more likely to blend in. From the groups, she learned that others shared many of her symptoms and feelings and also got to process some parts of her story. She also learned some coping strategies to deal with some of her symptoms.

Eventually Michelle decided that she was ready to open up to an individual therapist, even though she was terrified of being judged and rejected. Her therapist was trained in EMDR, a specific therapy known to work with those suffering from PTSD. She uses this approach integrated with mindfulness and cognitive behavioral therapy.

Michelle and her therapist continued working on her ability to regulate her emotions, recognize and challenge her irrational thoughts, and identify triggers that caused her to disconnect and stay grounded when she began to dissociate. When she was ready, she and her therapist began to process her history. Because Michelle has hundreds of traumatic incidents, they organized their approach according to her current triggers. For example, Michelle has a bullying coworker whom she finds extremely upsetting. Her therapist helped Michelle identify the emotions and body sensations that this coworker arouses in her.

Then, Michelle identified incidents in her past where she felt the same way. From this shorter list, Michelle picked a particular memory that was particularly early and vivid. They processed this memory, knowing that the other memories in the list are connected to this memory and in processing one, they are all desensitized.

Michelle also was able to disconnect her mother’s treatment of her and her childhood sexual assault from the sense of defect that she had long carried. She was able to internalize that the events she experienced were things that had happened to her as an innocent child and that she hadn’t deserved them. This has allowed her to relearn how to respond to other people in a less anxious way.

Michelle started seeing significant changes in how she responded to her coworker. Instead of wondering what she did wrong, Michelle was able to see that her coworker was being cruel. Rather than try to find ways that she could make the coworker like her better, Michelle disengaged from the dynamic and focused on her work. While the coworker didn’t change, like a lot of bullies, she found less satisfaction in targeting Michelle and bothered her less.

Michelle has begun to set boundaries with friends, family and coworkers and ask for time to herself, to see the movie she wants to see, or anything else that she wants. Because of the complexity of her trauma and symptoms, this was not her only set of complaints and she will be in therapy for at least a year or two to continue to process different triggers, relearn beliefs and coping skills and integrate all that she is doing. However, because of the success of her first round, she is very excited to continue.

 

APA Reference
Staggs, S. (2014). Complex Post-Traumatic Stress Disorder. Psych Central. Retrieved on October 21, 2014, from http://psychcentral.com/lib/complex-post-traumatic-stress-disorder/00018554
Scientifically Reviewed
    Last reviewed: By John M. Grohol, Psy.D. on 16 Jan 2014
    Published on PsychCentral.com. All rights reserved.