Complex PTSD

by Pete Walker

  Years ago, I customarily responded to awakening in flashback with hypochondriasizing ruminations about my health: “What’s happening to my energy? Something must be seriously wrong with me. I feel like death warmed over. That ache in my back is probably a tumor. I lost two pounds this month. I just know its cancer! I wish I could just die and get it over with.”

  This kind of drasticizing could and did sometimes go on for hours – even days. Moreover, it typically pulled me out of the abandonment depression by creating so much anxiety, that I was forced out of bed into busyholic rushing. I would then hurry through the day unconsciously rushing to outdistance myself from this awful thinking process, as well as the abandonment pain underlying it.

  Because of a great deal of practice, I now quickly realize that hypochondriasizing means that I am in a flashback. Accordingly, I work to shift the focus of my thought processes to the theme of generating love and kindness to the child within me. I dedicate this work to my historical child who woke up countless times feeling horribly abandoned in my love-impoverished family of origin. For me, this is now my most practiced flashback management process: breaking my merge with the critic to concentrate on caring for myself.

  There is another type of flashback message that seems to come from my inner child. It is that I have slipped back into my old habit of neglecting him. Often it occurs when I ignore him by regressing into overusing my flight response. My flashback then seems to be his clamoring for some proof that my compassion for him is not merely empty rhetoric. And typically when I slow down and go inside, I find that old pain of self-abandonment - that old pain that I now think of as “being lonely for myself.” Often this brings up some tears. Almost as often, crying initiates a release from my flashback.

  Flexible Use Of The Flashback Management Steps

  Helen started her session in a deep state of self-alienation: “I am just such a hopeless case! For no reason at all, I got myself stuck in a terrible flashback yesterday. And it wasn’t one of those impossible-to-figure-out, waking up-flashbacks you keep telling me about. I was fine all morning, and then Bam! I was in it up to here, and there wasn’t any stupid trigger. Nothing caused it. It’s just me. Hopelessly screwed up! Mentally defective!”

  Discerning the trigger of a flashback is a slippery slope. Seeing the trigger can often rescue us from blaming and hating ourselves for the flashback, but there is not always an identifiable trigger. In such situations, looking for the trigger can quickly deteriorate into self-pathologizing vivisection. This slippery slope can quickly become a cliff as we plummet deeper into the abyss of the flashback.

  It is almost always a matter of perspective. Am I trigger-searching from a place of being on my side or a place of fault-finding? When it is the latter, it is best to abandon the search and move toward invoking self-acceptance, as there will always be triggerings that are unfathomable. The process of self-support needs to trump the healthy urge to “figure it ALL out” at such times.

  The process of self-acceptance also needs to trump any of your efforts to fix the flashback when this striving becomes tainted with self-irritation and self-disappointment. Sometimes, as described above, the best understanding you can achieve is an overarching one that your inner child is feeling profoundly abandoned. She is cowering from a humiliating attack from your critic and needs for you to switch gears and demonstrate that you will care for her no matter what.

  Existential Triggers

  Many psychologists use the term existential to describe the fact that all human beings are subject to painful events. These are normal recurring afflictions that everyone suffers from time to time. Horrible world events, difficult choices, illnesses and periodic feelings of abject loneliness are common examples of existential pain. Existential calamities can be especially triggering for survivors, because we typically have so much family-of-origin calamity for them to trigger us into reliving.

  Another particularly triggering existential phenomenon is the fact that we all suffer invisible, unpredictable mood shifts. Good moods sometimes inexplicably deteriorate into bad ones. As novelist, David Mitchell wrote “Good moods are as fragile as eggs… and bad moods as fragile as bricks”.

  Unpredictable shifts in your emotional weather are typically problematic in Cptsd. These shifts can quickly trigger you into a full-fledged flashback. This is usually because you were punished or abandoned in the past for showing your full complement of feelings. So now, out of old habit, you automatically dissociate when your emotional weather is inclement.

  The inner child often experiences this as you reverting to the pre-recovery adult who had no time for feelings. The child then feels that he is once again trapped in the past where he was so devastatingly abandoned. Perhaps, the resultant flashback is his only way to really get your attention. This is, again, why I try to make my default position turning to myself and my inner child with unconditional positive regard as much as possible.

  Later Stage Recovery

  When your recovery matures sufficiently, you realize that much of the emotional pain of your flashbacks is appropriate but delayed reactions to your childhood abuse and neglect. You process your feelings in a way that resolves flashbacks, and also builds an increasingly healthy, sense of self.

  This, in turn, leads to an ongoing reduction of the unresolved childhood pain that fuels your emotional flashbacks. Flashbacks then become less frequent, intense and enduring. Eventually, you learn to invoke your self-protective instinct as soon as you realize that you are triggered. As flashbacks decrease and become more manageable, the defensive structures built around them (narcissistic, obsessive-compulsive, dissociative and/or codependent) are more readily deconstructed.

  At this stage of your recovery, you may now experience an ironically satisfying experience when you come out of a flashback. You may sense on many levels of your awareness that life as a child in your parents’ house was even worse than you realized. Simultaneously, you may feel a corresponding sense of relief that you are now freer from your parents’ life-spoiling influence than ever before.

  HELPING KIDS MANAGE EMOTIONAL FLASHBACKS

  This list is for social workers, teachers, relatives, neighbors and friends to help children from traumatizing families. It is adapted from the steps at the beginning of this chapter. Depending on the age of the child, some steps will be more appropriate than others. Even if you are not in a position to help other kids, please read this list at least once for the benefit of your own inner child.

  Help the child develop an awareness of flashbacks [inside “owies”]: “When have you felt like this before? Is this how it feels when someone is being mean to you?”

  Demonstrate that “Feeling in danger does not always mean you are in danger.” Teach that some places are safer than others. Use a soft, easy tone of voice: “Maybe you can relax a little with me.” “You’re safe here with me.” “No one can hurt you here.”

  Model that there are adults interested in his care and protection. Aim to become the child’s first safe relationship. Connect the child with other safe nurturing adults, groups, or clubs.

  Speak soothingly and reassuringly to the child. Balance “Love & Limits:” 5 positives for each negative. Set limits kindly.

  Guide the child’s mind back into her body to reduce hyper-vigilance and hyperarousal. a.Teach systemic relaxation of all major muscle groups

  b.Teach deep, slow diaphragmatic breathing

  c.Encourage slowing down to reduce fear-increasing rushing

  d.Teach calming centering practices like drawing, Aikido, Tai Chi, yoga, stretching

  e.Identify and encourage retreat to safe places

  Teach “use-your-words.” In some families it’s dangerous to talk. Verbal ventilation releases pain and fear, and restores coping skills.

  Facilitate grieving the death of feeling safe. Abuse and neglect beget sadness and anger. Crying releases fear. Venting anger in a way that doesn’t hurt the person or others creates a sense of safety.

&
nbsp; Shrink the Inner Critic. Make the brain more user-friendly. Heighten awareness of negative self-talk and fear-based fantasizing. Teach thought-stopping and thought substitution: Help the child build a memorized list of his qualities, assets, successes, resources.

  Help the child identify her 4F type & its positive side. Use metaphors, songs, cartoons or movie characters. Fight: Power Rangers; Flight: Roadrunner, Bob the Builder; Freeze: Avatar; Fawn: Grover.

  Educate about the right/need to have boundaries, to say no, to protest unfairness, to seek the protection of responsible adults.

  Identify and avoid dangerous people, places and activities. [Superman avoids Kryptonite. Shaq and Derek Jeter don’t do drugs.]

  Deconstruct eternity thinking. Create vivid pictures of attainable futures that are safer, friendlier, and more prosperous. Cite examples of comparable success stories.

  SHRINKING THE INNER CRITIC

  This chapter explores what one of my clients calls the “nasty and sneaky tricks of the critic.”

  ORIGIN OF THE CPTSD CRITIC

  A flashback-inducing critic is typically spawned in a danger-ridden childhood home. This is true whether the danger comes from the passive abandonment of neglect or the active abandonment of abuse. When parents do not provide safe enough bonding and positive feedback, the child flounders in anxiety and fear. Many children appear to be hard-wired to adapt to this endangering abandonment with perfectionism.

  A prevailing climate of danger forces the child’s superego to over-cultivate the various programs of perfectionism and endangerment listed below. Once again, the superego is the part of the psyche that learns parental rules in order to gain their acceptance.

  The inner critic is the superego gone bad. The inner critic is the superego in overdrive desperately trying to win your parents’ approval. When perfectionist striving fails to win welcoming from your parents, the inner critic becomes increasingly hostile and caustic. It festers into a virulent inner voice that increasingly manifests self-hate, self-disgust and self-abandonment. The inner critic blames you incessantly for shortcomings that it imagines to be the cause of your parents’ rejection. It is incapable of understanding that the real cause lies in your parents’ shortcomings.

  As a traumatized child, your over-aroused sympathetic nervous system also drives you to become increasingly hypervigilant. Hypervigilance is a fixation on looking for danger that comes from excessive exposure to real danger. In an effort to recognize, predict and avoid danger, hypervigilance is ingrained in your approach to being in the world. Hypervigilance narrows your attention into an incessant, on-guard scanning of the people around you. It also frequently projects you into the future, imagining danger in upcoming social events. Moreover, hypervigilance typically devolves into intense performance anxiety on every level of self-expression.

  Like the soldier overlong in combat, ptsd sets in because you feel as if you are constantly under attack. Unfortunately, internal attack is now added to external attack, and you become locked into hypervigilance and sympathetic nervous system arousal.

  A traumatized child becomes desperate to relieve the anxiety and depression of abandonment. The critic-driven child can only think about the ways she is too much or not enough. The child’s unfolding sense of self [the healthy ego], finds no room to develop. Her identity virtually becomes the critic. The superego trumps the ego.

  In this process, the critic becomes increasingly virulent and eventually switches from the parents’ internalized voice: “You’re a bad boy/girl” to the first person: “I’m a bad boy/girl.” Over time, self-goading increasingly deteriorates: “I’m such a loser. I’m so pathetic… bad... ugly…worthless…stupid...defective.”

  This is unlike the soldier in combat who does not develop a toxic critic. This process whereby the superego becomes carcinogenic is a key juncture where ptsd morphs into Cptsd. The cruel, totalitarian inner critic is a key distinguishing feature of Cptsd.

  One of my clients grief-fully remembered the constant refrains of his childhood: “If only I wasn’t so needy and selfish…if only my freckles would fade...if only I could pitch a perfect game...if only I could stop gagging on the canned peas during dinner...if only I could pray all the time to get mom’s arthritis cured, then maybe she’d stop picking on me, and then maybe dad would play catch with me.”

  In my work with survivors, I am continuously struck by how often the inner critic triggers them into overwhelming emotional flashbacks. The Cptsd-derived inner critic weds our fear of abandonment to our self-hate about our imperfections. It then tortures us with the entwined serpents of perfectionism and endangerment. Endangerment is the process of constantly projecting danger onto safe enough situations.

  Your recovering depends on learning how to recognize and confront the 14 inner critic attacks listed below. When this process of recovering is bypassed, these deeply engrained programs continue to send you tumbling back into the overwhelming fear, shame and hopelessness of your childhood abandonment.

  14 COMMON INNER CRITIC ATTACKS

  [Each attack/program is paired with a therapeutic thought-correction response]

  Perfectionism Attacks

  1. Perfectionism. My perfectionism arose as an attempt to gain safety and support in my dangerous family. Perfection is a self-persecutory myth. I do not have to be perfect to be safe or loved in the present. I am letting go of relationships that require perfection. I have a right to make mistakes. Mistakes do not make me a mistake. Every mistake or mishap is an opportunity to practice loving myself in the places I have never been loved.

  2. All-or-None & Black-and-White Thinking. I reject extreme or over-generalized descriptions, judgments or criticisms. One negative happenstance does not mean I am stuck in a never-ending pattern of defeat. Statements that describe me as “always” or “never” this or that, are typically grossly inaccurate.

  3. Self-Hate, Self-Disgust & Toxic Shame. I commit to myself. I am on my side. I am a good enough person. I refuse to trash myself. I turn shame back into blame and disgust, and externalize it to anyone who shames my normal feelings and foibles. As long as I am not hurting anyone, I refuse to be shamed for normal emotional responses like anger, sadness, fear and depression. I especially refuse to attack myself for how hard it is to completely eliminate the self-hate habit.

  4. Micromanagement/Worrying/Obsessing/Looping/Over-Futurizing. I will not repetitively examine details over and over. I will not jump to negative conclusions. I will not endlessly second-guess myself. I cannot change the past. I forgive all my past mistakes. I cannot make the future perfectly safe. I will stop hunting for what could go wrong. I will not try to control the uncontrollable. I will not micromanage myself or others. I work in a way that is “good enough”, and I accept the existential fact that my efforts sometimes bring desired results and sometimes they do not. “God grant me the serenity to accept the things I cannot change, the courage to change the things I can, and the wisdom to know the difference.” - The Serenity Prayer

  5. Unfair/Devaluing Comparisons to others or to your most perfect moments. I refuse to compare myself unfavorably to others. I will not compare “my insides to their outsides”. I will not judge myself for not being at peak performance all the time. In a society that pressures us into acting happy all the time, I will not get down on myself for feeling bad.

  6. Guilt. Feeling guilty does not mean I am guilty. I refuse to make my decisions and choices from guilt. Sometimes I need to feel the guilt and do it anyway. In the inevitable instances when I inadvertently hurt someone, I will apologize, make amends, and let go of my guilt. I will not apologize over and over. I am no longer a victim. I will not accept unfair blame. Guilt is sometimes camouflaged fear: “I feel guilty and afraid, but I am not guilty or in danger.”

  7. “Shoulding”. I will substitute the words “want to” for “should” and only follow this imperative if it feels like I want to, unless I am under legal, ethical or moral obligation.

  8. Over-productivity/Wor
kaholism/Busyholism. I am a human being not a human doing. I will not choose to be perpetually productive. I am more productive in the long run, when I balance work with play and relaxation. I will not try to perform at 100% all the time. I subscribe to the normalcy of vacillating along a continuum of efficiency.

  9. Harsh Judgments of Self & Others/ Name-Calling. I will not let the bullies and critics of my early life win by joining and agreeing with them. I refuse to attack myself or abuse others. I will not displace the criticism and blame that rightfully belongs to my dysfunctional caretakers onto myself or current people in my life. “I care for myself. The more solitary, the more friendless, the more unsustained I am, the more I will respect myself”. - Jane Eyre

  Endangerment Attacks

  10. Drasticizing/Catastrophizing/Hypochondriasizing. I feel afraid but I am not in danger. I am not “in trouble” with my parents. I will not blow things out of proportion. I refuse to scare myself with thoughts and pictures of my life deteriorating. No more home-made horror movies and disaster flicks. I will not turn every ache and pain into a story about my imminent demise. I am safe and at peace.

  11. Negative focus. I renounce over-noticing and dwelling on what might be wrong with me or life around me. I will not minimize or discount my attributes. Right now, I notice, visualize and enumerate my accomplishments, talents and qualities, as well as the many gifts that life offers me, e.g., nature, music, film, food, beauty, color, friends, pets, etc.