Complex PTSD Symptoms: Why You Feel Stuck in Relationships

Are you living in constant survival mode, hypervigilant in relationships, or wondering why safe environments feel uncomfortable? You might be living with Complex Post-Traumatic Stress Disorder (CPTSD). In Part 2 of this deep dive on RECOVERable, host Terry McGuire sits down again with licensed clinical therapist and trauma expert Amanda Stretcher Lewis, MA, LPC-S, to explore how chronic relational trauma shapes the developing brain and nervous system.

Find mental health and addiction treatment near you: https://recovery.com/

Unlike single-event PTSD, complex PTSD stems from repeated interpersonal trauma, emotional neglect, or attachment wounds during childhood. In this episode, Amanda Stretcher Lewis—a trauma-informed therapist, supervisor, and co-founder of Crescent Counseling Dallas—explains why complex trauma leads to deep-seated feelings of shame, self-blame, and dissociation. Amanda breaks down why CPTSD is frequently misdiagnosed as depression, anxiety, BPD, or ADHD, and why it is currently omitted from the DSM-5 despite being recognized internationally in the ICD-11.

Discover how somatic therapies like Brainspotting, Sensorimotor Psychotherapy, and the Safe and Sound Protocol help process trauma stored in the body beyond traditional talk therapy. Learn actionable tools to expand your window of tolerance, navigate relationship triggers, overcome trauma bonding, and step out of survival mode into genuine post-traumatic growth. Subscribe to RECOVERable for more expert mental health guidance, leave your thoughts in the comments, and share this video with anyone healing from childhood trauma!

Chapters: 00:00 – PTSD vs. CPTSD 00:01:29 – Brain Development & Relational Trauma 00:06:13 – Childhood Validation & Internalized Shame 00:08:49 – Developmental Tasks & CPTSD Deficits 00:10:44 – Understanding Dissociation & Coping Mechanisms 00:15:29 – Relational Healing & Trauma Therapy 00:23:12 – Why Survivors Minimize Childhood Trauma 00:31:36 – Trauma Bonding & CPTSD Triggers 00:37:01 – Misdiagnosis & Why CPTSD Isn't in the DSM-5 00:45:10 – Somatic Therapies & Signs of Recovery

Questions the Video Answers:

1. What is the difference between PTSD and Complex PTSD (CPTSD)?
2. How does childhood relational trauma affect brain development?
3. Why do trauma survivors internalize shame and self-blame?
4. What developmental milestones are missed due to childhood CPTSD?
5. What is dissociation and how does it manifest in daily life?
6. How does dissociation impact performance in high-stress jobs?
7. How can you support a romantic partner living with CPTSD?
8. What is trauma bonding and how does it affect relationships?
9. What are common relational triggers for people with CPTSD?
10. Why is CPTSD often misdiagnosed as depression, anxiety, or BPD?
11. Why is Complex PTSD included in the ICD-11 but missing from the DSM-5?
12. Can Complex PTSD be completely cured or healed?
13. What are the best somatic therapies for complex trauma recovery?
14. How do modalities like Brainspotting and EMDR help process trauma?
15. What are the early signs that CPTSD healing is taking root?

#CPTSD #ComplexPTSD #TraumaRecovery

Transcript

SPEAKER_02 0:13

CPTSD is complex post-traumatic stress disorder.

SPEAKER_00 0:17

Licensed clinical therapist Amanda Stretcher joins us to unpack complex PTSD and reveal the deep, often invisible ways it impacts our daily lives.

SPEAKER_02 0:28

You question your own reality and your own judgment. I must be wrong, and therefore there must be something wrong with me, not the environment.

SPEAKER_00 0:41

Welcome to Recoverable. I'm your host, Terry McGuire. Today we continue our deep dive into complex PTSD or CPTSD, a trauma response that could be affecting everything from your sense of self to how you're able to show up in relationships. We are joined again by trauma expert Amanda Stretcher Lewis, who will answer more of the questions that you are asking online as you search for information about CPTSD. Amanda, welcome back. Thank you for having me. So in case somebody didn't watch last episode or if they didn't need a little refresher, if you could again tell us what is CPTSD, how is it different than PTSD?

SPEAKER_02 1:18

Yeah, so CPTSD is complex post-traumatic stress disorder. So different from PTSD, which usually involves one singular life-threatening traumatic event, CPTSD has this element of repeated, prolonged exposure to traumas that we said have an interpersonal relational component. So they happened within relationship. They happened during periods of time when the brain was still developing. And there was a powerlessness or like a trapped, an inability to escape from the situation.

SPEAKER_00 1:55

Why is it significant that the events happened while the brain was forming?

SPEAKER_02 2:01

Because with CPTISD, it it really um kind of encoded this blueprint of how to exist in the world, how to exist in relationships during really formative periods of time. So that means it it really took root. And so it's gonna show up kind of a across the lifespan and feel really difficult to change.

SPEAKER_00 2:26

Is part of the difficulty in changing that you don't really even know it's part of you or the cause of what you think of as just how you are?

SPEAKER_02 2:35

Yeah, it absolutely can be uh a part of that. Not having language, not having a name for CPTSD, not making that connection between the past impacting you and the present can leave you feeling so stuck and like you're spinning your wheels. You're maybe trying a lot of things. Um, you you've maybe read a lot of books, or maybe you've tried therapy before, but but somehow that connection hasn't been made. So there really is just the stuckness of like, why can't I do something different, even though I feel like I'm smart, I understand things, but I just can't seem to do something different.

SPEAKER_00 3:15

So you used the phrase life threatening when you were talking about PTSD. Is there that same element in CPTSD? Is it just believing that your very life was in danger, that things were so traumatic?

SPEAKER_02 3:27

Yeah, I think a little bit of both. I think life threat could have been like a very real actual part. And it could have also been like perceived life threat when I think of CPTSD and the fact that it is so often associated with events that happen in childhood and adolescence. When we're young, we depend on the people around us, especially the adults, to take care of us, to get us everything that we need. And so if there's something happening within our relationship with caregivers, with people who are responsible for us, that's gonna threaten our literal sense of survival and safety. I need to belong. I need to be accepted to fit in so that I can get some of my, my at least my basic needs met. And anything that threatens that is really scary. I think we may didn't say this last time, but some elements of CPTSG could even be pre-verbal. It could be things that happen really before memory was was able to be encoded at all because you weren't even able to talk. Think of a little infant. Uh, think of babies where where something may have happened where they literally depended on their caregivers. And if there was neglect or abuse, that's really not safe. Um that really is true life threat.

SPEAKER_00 4:44

I appreciate your use of the words uh basic needs, because it can be easy to think of that as roof over our head and food on the table, when it also includes being safe, being loved, being seen, being heard.

SPEAKER_02 5:00

Yeah, I think that's absolutely true. Uh we we have this need. Um, there's a quote in a book by Deb Dana. Her book's called Anchored that I read to my clients a lot that says, um, co-regulation is a biological imperative, meaning we don't survive without it. Um, she says something along the lines of like, we're born be needing to be welcomed into this world by a safe other. And like that need stays with us our entire life. Um so, so literally, co-regulation, mutual help, cooperation, we don't survive without that. So that is that's a basic need.

SPEAKER_00 5:38

So nature nurtured. Is CPTSD always environmental, not genetic?

SPEAKER_02 5:45

So interestingly, um, CPTSD often does have a generational component to it as well. So if if we get um kind of science-y for us uh for a moment, right? Like um things that happened to my mom um are gonna have impacted her, which when she was carrying me, that's gonna have impacted me. Um, so so things that didn't even directly happen to me could still be impacting me.

SPEAKER_00 6:14

Generational trauma.

SPEAKER_02 6:15

Generational trauma, even further, right? Um so I would have been an egg in my mom when she was in her mom. So things that happened three generations uh ago could be impacting me in the present. So sometimes with CPU T S D, part of why there's no memory is because some of what you're experiencing wasn't yours. It was the impact of a stressful, traumatic environment in generations past that has carried on to you.

SPEAKER_00 6:40

What common things have your clients heard, probably in their home environment, when they try to bring up like that really impacted me?

SPEAKER_02 6:51

Yeah, I think some really common things are um you're just sensitive, you're too sensitive. Oh, stop being so dramatic. Um, you're really making a mountain out of a moh molehill. Oh, it wasn't that bad. You know, it could have been so much worse. Um, or maybe, well, let me tell you about my childhood and how much worse it was than yours. You should just be grateful. Um so ungrateful to say that anything wasn't okay. That that's so ungrateful of you. I think are some really common things my clients hear.

SPEAKER_00 7:24

So when you hear that, does that dissuade you from seeking counsel, treatment, help? Because it just is turning it right back in and saying you're just, you know, all the things that you just said.

SPEAKER_02 7:38

Yeah, it's absolutely internalizing it. And and then I I think I see a lot of my clients have kind of taken on those identities of well, you know, I'm just I'm just dramatic. Um, I just make such a big deal out of everything. I'm I'm just overly sensitive. They really internalize that. And so it carries. And so there is almost then like re-traumatizing that happens later because things continue to happen. And instead of saying something, instead of setting a boundary or letting someone know how they're impacted, they go to that narrative of, I took that too seriously. I probably should learn to just let that go. Oh, it that wasn't that bad. Um, so people may stay in uh really unhealthy relationships or even like work environments because they they've so normalized it to themselves that um they they just kind of stay stuck in things that just continue to hurt them.

SPEAKER_00 8:33

And you're questioning your own judgment because you've been told since you were a child, you're wrong. You're off, you're seeing it in a skewed way.

SPEAKER_02 8:40

Yeah. Yeah. You question your own reality and your own judgment. You say, I must be wrong. And therefore there must be something wrong with me, not the environment.

SPEAKER_00 8:50

We talked before we started recording about Pete Walker's book on CPTSD. And he defined it not only as a learned set of responses, but also a failure to complete numerous important developmental tasks, which I hadn't really thought about. And I'm wondering how many what what does somebody who was raised in a traumatic environment that led to them having CPTSD, what have they not developed as a result?

SPEAKER_02 9:16

Yeah. So as a result of what was happening and how it started to impact their system, um, we may have, we may miss some kind of like developmental milestones or not learn some developmental things. We may not learn how to be in relationships with other people. We may not learn how to uh communicate for ourselves, to, to set boundaries, oftentimes both with the frightening things that happened and the things that didn't happen that were needed, something like nurturing or something like guidance. We maybe didn't learn how to self-soothe or how to ask other people for help and how to receive that help. Um, we may not have learned really, really important things on how to kind of take care of self and how to exist in relationship.

SPEAKER_00 10:06

Which sound like huge deficits trying to survive in the world as an adult.

SPEAKER_02 10:12

Yeah, absolutely. And and then later in life can leave someone feeling, I guess I'm just like so bad at this whole adulting thing. And then we miss that compassion of, well, did anyone ever show you how to do that? Was it even safe enough to do that in your environment? And and if not, then it makes so much sense that you have a hard time. Maybe we can experiment with and learn and try to do something different now.

SPEAKER_00 10:38

I remember a couple of years ago, and I think it was Oprah, but when the the conversation shifted from what did you do to what happened to you?

SPEAKER_02 10:45

Yeah.

SPEAKER_00 10:45

Is that what we're talking about?

SPEAKER_02 10:47

Yeah, I think that that that's absolutely a piece of what we're talking about here is that really getting curious of what what happened or like what was missing from your early experience that didn't happen, and how is that impacting you instead of like what's wrong with you?

SPEAKER_00 11:04

So part of CPTSD can be dissociation. What is it and how does it impact one's life?

SPEAKER_02 11:11

Yeah. So dissociation typically shows up when um the nervous system has identified something as being too hard to be with, too hard to tolerate. So it kind of creates this distance, this barrier for self-protection, really. We can put dissociation on a spectrum. Um, so in a more mild way, dissociation might look like doom scrolling on social media, or it might look like um you drive home from work and you don't remember the drive, or you're just kind of like not all there. You're a little bit checked out. Um, watching, watching a lot of maybe trashy reality TV shows on the other end of the spectrum. Um, kind of more bigger impact of dissociation could be something like depersonalization or derealization. In those cases, uh, you may feel like outside of yourself, like you're watching yourself from a distance, or um, it may feel like the world isn't real. The world feels like a dream or feels like like a movie playing out. You don't feel like like you're really in um in the world. Um, so dissociation in in those ways is another adaptive strategy. It's something that the system learned to do to try and keep itself safe, to say that whatever's happening is way too much to be with. I cannot process this. So I'm gonna have to remove myself from it. Um, but what can happen is that dissociation carries over into situations that are safe, but can leave someone feeling like they're not really an active part of their life. Then they're they're always um a little bit checked out, a little removed from their life. This is something that I look for a lot in my office with my clients, because, you know, I kind of think of it as you can't process what you aren't present for. So I'm I'm always kind of make trying to make sure my clients are really present and they're with me within their window of tolerance. If we move outside of that window, we're we may trigger this adaptive strategy of dissociation. And um dissociation can can even look like you're like the calmest person in crisis situations for some of my clients. It actually makes them so good at jobs they do. I work with a lot of healthcare professionals, surgeons, um, nurses, people who maybe really need that, that skill in work settings, they need to be able to stay calm, but we have to be able to come back to it after the fact and really process what happened and acknowledge there was an impact on your system in the moment, whether you realized it or not.

SPEAKER_00 13:59

So, how does someone get to the point where they can recognize that some of the behaviors I currently have, like dissociation, were actually a protective behavior mechanism, I don't know what word to use next, in previous times, but they're no longer serving me? How do you get to that level of consciousness?

SPEAKER_02 14:18

So I think when it comes to kind of recognizing it, it takes someone being willing to start to get curious, to start to wonder. Your tagline. It's my favorite. Um is this just specific to now and my present-day situations, or is this something that I've done for a really long time? If you let yourself start to think about it and and you realize you're asking yourself some of those questions, like, gosh, what's wrong with me? I must be broken, I must be defective. We can kind of shift that to, I've been doing something for a long time. Like I wonder why, and I wonder what purpose that served for me. Um, we need, we need that self-compassion, my other time tagline of um it worked. So if someone's listening to this podcast right now and really relating with CPTSD, like what you did then worked in some way, because here you are listening, taking in this information. So it got you here. But if you're starting to recognize you're you're not feeling as close in relationships as you'd like to, or you're just so exhausted by this like inner critic, that negative track that just keeps replaying in your mind. You're really ready to feel more connected to your body, to your emotions, then those you might be in a place where you're starting to recognize, hey, something in the past is impacting me in the present. And I can't go back in time and change the past, but I there are some things I might be able to do with that so the present can feel different.

SPEAKER_00 15:53

What are some of the things you can do so the present feels different?

SPEAKER_02 15:56

Yeah. I think finding a good therapist who is trauma informed, who works with, has a history of working with CPTSD is really important. Um, I I say a lot that like the relational wounds of CPTSD have to heal in relationship. So finding someone that you can start to feel safe enough with is really important. You may not feel fully safe or connected from the start. We've got uh a lot of patterning that that we've got to change, but to find someone that that gives safe enough to start to experiment with doing something different, to start to experiment with um identifying your own wants and needs, to start to experiment with asking for and receiving help, um, to start to experiment even with yielding a little bit. Uh, there could be this for a lot of people with CPTSD, there's this chronic tension, that responsibility for everyone around you and and this um this constantly kind of holding self up and in. And so can we start to experiment with what is it like to just slow down and yield a little bit? So finding a good therapist who who's well versed in this and can be a safe enough place to do, to start to do some work is is a really important thing someone can do.

SPEAKER_00 17:16

Start now, you're not saying there are these three meds. You know, this it this is uh you said if the if the wounds were in relationship, the healing has to also be in relationship. And that's really where the the sweet spot is.

SPEAKER_02 17:30

Yeah, uh medication can certainly be a part of treatment for CPTSD for some people. Sometimes it can help shift baseline enough to do some of this work, or it may treat uh co-occurring. I again, I I think we said CPTSD doesn't have to be mutually exclusive from something like depression, anxiety, ADHD, even. Um, so so sometimes medication is a part of the puzzle, but I I think there is something really important in that, um, in that relational work.

SPEAKER_00 18:04

How does someone know when it's time to seek some kind of treatment or help for CPTSD?

SPEAKER_02 18:11

I think when someone feels like just that absolute stuckness, like the pattern just keeps replaying. Um, a lot of my clients show up saying, you know, I've I've been trying, I've been reading, I've been researching, and still nothing's changing, um, especially if they've been trying all of this on their own. There, there's where that relational piece is important again. Um, so someone who who is just feeling, I think, really exhausted, really burnt out by um the same pattern replaying over and over again. Someone who is really, really recognizing that part of them that wants something different, that wants connection, um that wants to be in relationships in a different way, probably shows someone who who's maybe ready to do some work.

SPEAKER_00 18:58

Why do people with CPTSD so frequently feel shame or self-blame?

SPEAKER_02 19:02

Yeah, shame is really like um such a such an integral part of this CPTSD picture. And I think when we think about the people who were supposed to be safe actually causing harm of some sort, not being safe, that is really hard to make sense of, especially for a child. Um, so the shame and self-blame often starts to show up to say, it's me. I it must be something wrong with me. That feels more tolerable often than the idea of the world isn't a safe place. My caregivers aren't safe people. That is just really overwhelming for the system. So shame often starts as um this protective factor, as this sense of, you know, if I'm to blame, um, then I might be able to control it. I can do something different. Maybe I can, I can stop it from happening, I can prevent it from happening again. Um, so a lot of the roots are in self-protection, in, and needing the world to be a safe place. It's really scary to think the world is in a safe place. And I think from there, the shame and the self-blame can kind of become this like internal feedback loop. I work a lot with um in kind of somatic ways. I like to work with the body bottom up. And so we can see where shame often takes root in maybe like a collapsed posture or in this like wanting to hide, to make yourself really small, to be invisible. Um, so when that kind of starts to show up, then that feeds that thought again of yeah, see, I I guess I shouldn't take up space, make myself small, try not to be seen. And now we've got the thoughts and the way it's showing up in your body just fueling one another until that shame monster really grows.

SPEAKER_00 20:58

So a child would rather believe that they are fundamentally flawed than that they cannot trust the adults in their life who are supposed to keep them safe.

SPEAKER_02 21:08

Yeah. Oftentimes it feels it feels safer, feels more like um maybe a sense of control. Um it feels it it starts in a place where it feels better than than thinking the world is in a safe place.

SPEAKER_00 21:22

Am I correct in assuming that most of the trauma we're talking about happens in the home? Or is it with in your experience with clients? Is that not the case?

SPEAKER_02 21:33

I think a lot of it happens in the home. I think that's a a place where a child adolescent is gonna be a lot when we think of our caregivers, whether that be parents or whoever that looks like, those people are gonna have a really big impact on our day-to-day life. Um, certainly not mutually exclusive. This uh CPTSD could happen outside of the home too. It could have happened um somewhere that you visited often, maybe grandparents' house. Um, it could certainly happen at school. Um, I think we touched on bullying last time and and the the very serious impact that that can have. So um Common oftentimes starts in the home, uh, but could certainly happen in other environments as well.

SPEAKER_00 22:20

And as you said last time, the if the bullying's at school and you go home and they say it's on you. Yeah. Or, you know, now it's both.

SPEAKER_02 22:28

Yeah, now it's just piling on. Now there's really, really no escape. There's no place that you go that you get any relief.

SPEAKER_00 22:36

Breaks my heart. This podcast is a production of recovery.com. Getting help for an addiction or mental health concern is one of the best decisions you will ever make. But once you make that decision, it can be tough to know what to do next. That's why we built recovery.com. It's the best place to find mental health and addiction treatment for anyone, anywhere. Here's how it works. Search over 22,000 facilities, compare your options, and connect directly with treatment providers that meet your needs. So if you need treatment that goes beyond an occasional therapy session, go to recovery.com. Your recovery starts today. I think we've sort of touched on this, but I'm gonna ask it because it was asked on the internet a lot. Why do trauma survivors often think there's something wrong with them? Is it because it's easier to think?

SPEAKER_02 23:31

Yeah, I think again, it it feels so much easier to think uh there's something wrong with me. If if there's something wrong with me, then I can do something about it. There's almost this false sense of like agency, of control in that idea. Um, and also just the internalization over time. It sometimes that inner critic takes on the voice of other people. And so it's kind of replaying that talk track of maybe you heard that a lot. Um, a parent, a caregiver often said, you know, there's really something wrong with you. You're really too much, you're dramatic, you're overly sensitive. Um, and that really, really stuck and just keeps replaying.

SPEAKER_00 24:10

Why do people feel like a fraud because their trauma isn't enough? Like you think of capital T trauma, and we can all think of horrible things we've seen or read about, and that ours just don't compare.

SPEAKER_02 24:23

Yeah, absolutely. I I think that reflects a few things for one, like trauma really is such a complex word and category. There's so much that falls within trauma. And so it's so easy to sit back and say, well, I had a roof over my head, I had food on the table, I had a bed to sleep in. So, like, how bad could it have been? There are people who don't have that. There are people who who have um all sorts of situations. I think so many of the wounds we've been talking about with CPTSD aren't outwardly visible, also. So physical abuse certainly can be a part of CPTSD, but it's not always. So I think these wounds um that have still impacted the brain and the body, just not in a in an outwardly visible way. It's it's really easy to minimize. Well, you know, I was never physically hurt. I never ended up in a hospital because of anything that happened to me. So how bad could it be? And then we we've got that piece of um, oftentimes if if it did happen within the family, so much minimization that says it wasn't, repeats that message, right? It says it really wasn't that bad. Um, and so it's so easy to kind of exist in this comparison place of well, gosh, I see trauma on TV and movies. Like I hear really, really big, really scary stories, and that's not me. So that must not be me.

SPEAKER_00 25:51

I'm I'm gonna bring up a podcast that I watched that I heard years ago. Um, I think it was this American life uh on MPR. And it was brothers whose older brother, when the parents left, would put on, I think, a Freddie Krueger mask or something, right? And chase them and they didn't know it was him. So at a certain point, one of the brothers just sat down on the couch and when he came in, he said, Don't do it, kill me. And we'd gotten to that point. So it can seem from the outside, and it can certainly sound, oh my god, big brother having all kinds of fun teasing, you know, his little brothers, but to him, he actually believed his life was on the line. And I would love to address the fact that it doesn't have to sound big. And and again, like you said, it can be two people in the similar situation who internalize it very differently, but it's what it felt like.

SPEAKER_02 26:43

Yeah.

SPEAKER_00 26:44

What you believed to be true.

SPEAKER_02 26:46

Absolutely. It's not just what happened, it really is that impact, what you perceived, what what that you believed to be true at the time, and and that experience, that impact on the nervous system, on the brain, on the body, is really so much more definitional than just the what happened of it all. And that also means two people could have experienced the same thing and and both have a different impact. So, in that example, maybe the one brother landed in that place, but but the other didn't. So it really is what happened and its impact on your nervous system, on your brain and your body developing that is gonna kind of define that trauma.

SPEAKER_00 27:30

How can a diagnosis of complex PTSD help replace shame with understanding?

SPEAKER_02 27:35

I think it really puts words and language to an experience in a way that adds that element of it's really not something wrong with you. Something happened, and that something had an impact on you, and it's been showing up in a certain way for a long time, and that's changeable. Just like your body learned that, it it can learn something different. I use this analogy sometimes of like learning to tie our shoes. Um, we all learned how to tie our shoes, and so now you do it almost without thinking. That's this procedural learning that your body had. So think about how many other ways our our body has learned to procedurally be in the world. And if I taught you a different way to tie your shoes right now, it'd be really hard. You'd go home, you'd forget, you'd say, Oh, Amanda told me to tie it that way, but I tied it the way. I missed my bunny ears. And I missed my bunny ears. Uh, you it would, it would take some time, but you'd start to get better and better at it. So the same thing here, we we can teach a new and a different way to be. It's gonna take time for for that to feel more familiar and to feel more routine. Um, but it it's definitely teachable.

SPEAKER_00 28:45

I keep thinking of the way the world uh separates physical from mental, because if you had a an injury, if you were injured as a child, and let's say, you know, a bone that was broken and didn't heal correctly and you carried a limp into your adulthood, nobody would deny that.

SPEAKER_02 29:01

Absolutely. Um, but again, these things that aren't so physically seen sometimes are easier to dismiss, easier to internalize, um, but but really need the same care and attention. Um, and and I think too, like both exist for a person with CPTSD. There often are physical symptoms that that go along with CPTSD that could look like um chronic illness or or chronic pain. Um, it could look like fatigue, gut issues, because we know that trauma doesn't just live in the mind. Uh, trauma really does impact the entire system. So when when there's this chronic, chronic activation of the nervous system, that's gonna show up as tensions. That's that's gonna show up as uh really impacting the body as well as the mind.

SPEAKER_00 29:58

So our audience will have people, you know, who are just curious about this topic, some of whom might be wondering, you know, is that what's going on with me? But there's also the people who are in relationship with them. What should somebody who has a person in their life who they think, I think this might be what's going on here? What do they need to understand and what can they do?

SPEAKER_02 30:16

I think if they can understand that what happened in the past is impacting in the present so that they maybe can come to any sort of conversation, not taking things personally themselves, right? Like they may also be exhausted by or even frustrated with some of the patterns happening. Um, they may be, you know, taking on some responsibility or wanting to fix things. But if they can start to practice that same compassion for the person they're in relationship with, I think that's really important to know, gosh, something happened to this person that I care about that's showing up in our dynamic. And that doesn't excuse, that doesn't make what's happening here okay. But if I can understand it, it's not about me, it's about something in the past, then how can I start to have conversations about how I might be able to better support you, how I might be able to become an anchor of safety and of co-regulation for you in the present.

SPEAKER_00 31:16

Give me some language, if you will, if you're in that position and you want to be of support and also maybe get past it a little bit so it's not impacting your life as well. What are some things a partner can say to somebody with CPTSD?

SPEAKER_02 31:30

Yeah, I think finding kind of a gentle approach is really important. Um, to be able to say, you know, I'm noticing, I'm noticing how responsible you seem to make yourself for my feelings. You know, I'm I'm noticing your tendency to like shut down when we have conflict. And I'm I'm wondering if if there's something that might help so that we can be closer because you matter to me. I think really communicating the fact that like I'm saying this because I care and because I I want to, I want to help support you are really important things to say.

SPEAKER_00 32:07

And think of the, well, you do think of the person with CPTSD because now you're you're being validated. It's like what you experienced in the past was real. I care, I'm safe, I'm here. Yeah. That would be very healing.

SPEAKER_02 32:19

Yeah, absolutely. Uh sometimes at first it can be hard for them to be with. I believe they're still not sure about that, that safety. But I think to continue to to make those sort of statements and to then show up in that way. I think to be consistent, um, to to show that through both words and actions is really important. Um, yeah.

SPEAKER_00 32:39

So we've talked a lot about the impact on relationships when someone has CPTSD. How does trauma bonding work in all of this?

SPEAKER_02 32:48

That's a great question. So uh sometimes trauma bonding can, I think it can look a few different ways. Um, trauma bonding can look like two people who both experienced trauma, maybe the same trauma, maybe, maybe different trauma, really taking on that identity and that becoming the foundation of their relationship, which can be validating at first, but it might miss that piece of, hey, but we're safe now and maybe we can do something different. Uh, it can almost contribute to the stuckness. I think there can be um a trauma bonding as well, where um maybe one person does recognize the other person has trauma and becomes almost like codependent with that is trying to fix. We're saying relationship is an important part of the healing, but one person alone can't heal trauma for you. So that that sort of bond of I know your trauma and now I maybe tiptoe around you or I try and fix it. I'm always trying to make it better can can lead to some really unhelpful patterns.

SPEAKER_00 33:55

What are common CPTSD triggers?

SPEAKER_02 33:58

Yeah, so triggers really could be anything, something sensory, something relational, something situational that activates these um these survival strategies, um, these survival responses. Uh, when a trigger happens, often the body and parts of the brain are reacting really before that thinking part of the brain has time to come online and respond in a different way. So with within that, some common triggers that I see are feeling, feeling like someone's disappointed in you, feeling like someone's mad at you, um, maybe feeling like someone's pulling away and they're they're gonna leave you, or that they're rejecting you, um, or feeling like someone's trying to get really close to you. Um, that can activate that hang on, our relationships safe. Um are some of the common triggers.

SPEAKER_00 34:54

So when I think of PTSD and I think of triggers, uh they seem more obvious to me. So I was at a play recently and they made the point that there was going to be a very loud sound in a flash so that people were just aware of that before it happened. But when I think of CPTSD triggers, it could be silence. It could be a look or the lack of a look. I mean, you when you're hypervigilant, you're looking for everything. So can the trigger be anything?

SPEAKER_02 35:24

The trigger can can really be almost anything. It can be, that's a great example, as subtle as silence. Or um, oftentimes it it could be where someone does something different than they normally do, than you expect them to do. And instead of wondering, oh gosh, I wonder why they just did that. I wonder how their day was. There's this assumption of, oh my gosh, they they meant they're mad at me, they hate me, uh, they're about to leave me. So the the triggers for CPTSD can be so subtle and and again, so relational, which means they can happen so often because we're in relationship really throughout our day. Um, so there, there's so many uh triggers, which means some of the work of healing and treatment for CPTSD isn't about removing triggers. There's no way we can do that. But we we've got to start expanding that window of tolerance so we have more capacity so we can slow down. So when I notice a change in the tone of your voice, I might notice that thought of, oh gosh, her her tone changed. Did she think that I said something wrong there? But if I didn't know, but if I can slow down a little, then I can say, ah, or or maybe she's thirsty and needs a sip of her water, or maybe her voice just did a little something there, or she's having a thought, or maybe she thinks she said something wrong before I assume and take on responsibility and start acting accordingly.

SPEAKER_00 36:49

In your previous answer, it sounded like, is it anxious attachment disorder? Is there an overlap with CPTSD?

SPEAKER_02 36:56

Yeah, there absolutely can be some overlap with attachment disorders in general. So it could look like that more anxious picture could also look like a more avoidant picture. And the same person may even notice themselves kind of oscillating back and forth between those two patterns.

SPEAKER_00 37:14

Why can a person intellectually know they're safe now, but still feel unsafe in their body, in their relationship, in their daily life?

SPEAKER_02 37:22

Yeah. So here we're really talking about that implicit memory, which is this type of memory that doesn't necessarily have um story or or narrative attached to it, but it's it's a remembering. It's a remembering in the mind and body of like I've been here before. This is familiar. I know what's gonna happen, and I know what I need to do here. And all of that happens before the thinking brain is even aware of it.

SPEAKER_00 37:50

It sounds exhausting.

SPEAKER_02 37:51

Absolutely exhausting. Uh, I think again, I see so much burnout with a lot of my clients. By the time they make it to me, they're like, I'm just so tired of existing like this all the time. Um, it's really exhausting.

SPEAKER_00 38:06

What do most of the people who come to your office with CPTSD that you end up diagnosing, what do they think they have when they come in?

SPEAKER_02 38:13

Yeah, kind of a variety of things. A lot of my clients have been given either one or kind of a combination of certain diagnoses in the past. So I see a lot of people who've been diagnosed with depression, anxiety, maybe borderline personality disorder, bipolar disorder, or ADHD. And I think we've said like there certainly can be overlap. And someone can have two diagnoses. But I see a lot of people who come in with some kind of combination of that. I'm I'm all of these things. When really we take that step back and look at it, and it's like, I I think, I think this CPTSD, a lot of that falls under the umbrella. I think that may actually better account for a lot of of these things.

SPEAKER_00 39:01

So if someone comes to you having a one or a pile of diagnoses and you realize that CPSD is right in there or under there, it doesn't mean they don't have those other things, or does it?

SPEAKER_02 39:14

I I think it kind of depends, would be the answer. There are some people may have um some something else going on as well. And the two may be exacerbating each other. But I I think for a lot of people, sometimes CPTSD really is a better, more clear answer of what's going on.

SPEAKER_00 39:34

So then how is CPTSD diagnosed?

SPEAKER_02 39:37

So, really interestingly, um CPTSD is included in the ICD 11, which is the um international diagnostic system, but it's not in the DSM V, which is what we use here in the United States. And I think that's another piece where we have so many gaps in people who are living with CPTSD but don't know they're living with CPTSD.

SPEAKER_00 40:03

Before you go on, what's the significance of it not being in the DSM five?

SPEAKER_02 40:06

Um, it means that if a provider is using certain assessments, that it may not be caught on those. So um there's all sorts of checklists and questionnaires for different diagnoses. So we've got one, the PCL5 for PTSD, but not all clinicians are as well versed in CPTSD because it's not necessarily something that you're taught a lot in school because it's not in the DSM. So it's kind of significant that it's not included. Some providers may be looking for those very specific, really big single event life traumas. And if that didn't happen, there they may not start to use that trauma language with someone. So diagnosis really requires someone who is gonna sit down and look at more than just trauma history, that's a part of it, but is also looking so fully at like the full impact of someone's history and impairment.

SPEAKER_00 41:06

So does it mean it's not covered by insurance treatment if it's not in the DSM?

SPEAKER_02 41:11

That is what that would mean. Yeah, which is uh a huge gap in um in the treatment of CPT SD.

SPEAKER_00 41:19

I'm assuming as a therapist, there's always another way. There's always something else that's going on that is in it.

SPEAKER_02 41:26

There is always another way. It it not being in the DSM does not mean that you can't access care. Um, there are so many different ways that care and there are ways to to navigate and to work within the systems that we have to still get the treatment that you need. It's again, why I can't say enough, it's important to find a therapist who's really well versed in that, who's gonna be able to help meet you where you're at.

SPEAKER_00 41:50

It sounds like you'd almost have to know yourself about it before you went to a therapist or your doctor. I mean, who who how is somebody gonna hear CPTSD if they haven't before when they might have been living with it for decades?

SPEAKER_02 42:03

Maybe as simple as it comes across their feed, maybe they see this this very podcast and they start to relate and wonder. And there there certainly are lots of providers who are aware of and understanding of CPTSD. I just know with a lot of my clients, when I use that language with them, it's the first time they're hearing it. And most of my clients have done a lot of therapy before. Um, and so it it's kind of surprising and and unfortunate. But I think it's growing in being understood and being talked about and in in importance. Um, so I think more and more providers are going to be catching that.

SPEAKER_00 42:42

If a therapist treats PTSD, wouldn't they know enough about it to know that this is a variation of it if someone comes to them?

SPEAKER_02 42:50

Yeah, oftentimes, oftentimes any therapist who's working in this space of PTSD, um, and I really think as therapists, we we're all working with trauma, whether we realize it or not. Um but it it really is that element of fully realizing and kind of educating on just how complex trauma is and all the different ways it can look and and can be impactful. Uh, but oftentimes someone working with PTSD has some understanding um of CPTSD as well.

SPEAKER_00 43:19

I would hope so. Yeah. Can CPTSD be healed?

SPEAKER_02 43:24

Yeah, I think absolutely. Um, I I so wholeheartedly believe that and I see it in my office all the time. Um at the same time, I think I have to add that doesn't always look like a total absence of symptoms of CPTSD. Oftentimes it really means learning to live with the CPTSD, but also learning that so much more is possible and not feeling so trapped, so stuck in certain patterns. So healing, absolutely possible. But I like to be really honest when I say, like, for everyone, that doesn't mean no symptoms ever again. Again. Like these wounds happened really early. They're so relational. So, so triggers may happen, different seasons of life may happen that that bring up new things. I'm a new mom myself. And so in in that process, I think it it brings up a lot, a lot of stuff that maybe I wasn't taking a look at before. Um so different seasons can can bring up uh triggers. Even if you've been aware of your CPT SD diagnosis, working with it, uh, there's still it can look so different over time.

SPEAKER_00 44:35

I would think the the the way you live after you are diagnosed and have received some treatment, the very act of feeling safer, of, of allowing more in, of understanding that you can have a boundary, all the things we've been discussing would lessen the symptoms. Is that did I make was that clear?

SPEAKER_02 44:55

It certainly can. Um, it certainly can. And at the same time, when it comes to working with CPTSD, I think the work is not just, we've talked a lot about like decreasing the activation, like addressing uh the symptoms, helping the nervous system regulate. But there's sometimes just as much, if not even more, work in learning to really build a tolerance for things being safe and connected. That old programming is in there. And so sometimes when you're you're doing something that is safe and connected, um, that that old network can show up that says, don't trust it. It's not safe, or don't enjoy it for too long because something bad's gonna happen. It's just around the corner. There can be this pull back into that familiar place. So there, there's really important work in um learning to savor or like bask in positive experiences and let yourself really feel them, know that you deserve them, that you are safe, that you are connected. So I think over time, as as you build that muscle almost, it gets easier and easier to do. But it it's it can be hard at first. I I really like we referenced Pete Walker's book earlier in his title is From Surviving to Thriving. And I think that really is what so much of the work is about. Learning we don't have to live in survival all the time. We we truly are safe enough to thrive and enjoy life.

SPEAKER_00 46:22

What types of therapies or treatments are most effective for CPTSD?

SPEAKER_02 46:27

So I think therapy that addresses the mind and the body is really important when it comes to the treatment of CPTSD. I think there's all sorts of different types of somatic therapies that can be really effective. Body-related body-related therapies. Yeah, absolutely. Um, still means we're working with the mind. Our brain, our brain is part of our body. So there's definitely going to be um elements of that as well. But often talk therapy alone, insight alone, even cognitive behavioral therapy alone may not be quite enough. We really need to take a look at all the ways that that as your body, your nervous system have been impacted and be able to work with that. So, like um, I'm a brain spotting practitioner. I find brain spotting to be really effective with CPTSD. I also um use sensory motor psychotherapy, which addresses CPTSD really well. And those are just two of many um EMDR, somatic experiencing. When I think of this question, I also think there really are a lot of modalities that are effective. What the research says is that one of the most important determining factors of therapy being effective is the relationship. So it's before you get too bogged down and like which modality do I need to use or which which modality is gonna work best for me. Find someone who works with trauma, who works with CPTSD, and someone that that you start to get that felt sense of. I think I could feel safe enough with this person. I feel like they hear me. I feel like they understand me. Um, and maybe not perfectly. Repair sometimes is an important part, even of the therapeutic relationship, but let yourself find someone you feel good about before you worry too much about how are they working and is that working for me?

SPEAKER_00 48:20

Okay. I just want to say for anybody who doesn't know what EMDR or brain spotting are, we did just do an episode on each. So look it up. Yeah. Uh so for listeners who can't afford therapy, are there actionable, self-directed things that work that they can do themselves to start to heal?

SPEAKER_02 48:39

I really like Pete Walker's book since we've talked about it a couple of times now. That can be a really interesting starting place. Uh it feels um clinical without being too clinical and very relatable. So um grabbing that book can be a great starting place. I often recommend it to the partners of my clients as well to help with that understanding of the person you love who's living with CPTSD. So I would definitely recommend that as a starting place.

SPEAKER_00 49:07

So if I have CPTSD, I go to a therapist I can trust who is trauma-informed and go through whatever that therapeutic process is at the end of that, or I realize there's no like finish line, but what does recovery from CPTSD look like on a daily basis?

SPEAKER_02 49:27

I think recovery looks like um this sense of feeling more expansive. So you feel like you have more access to choice and agency and possibility. It feels like um an ongoing, likely noticing of triggers or things that could be triggers, but being able to slow down enough to respond instead of react. Um, I think it also again looks like repair, we're not gonna get it right every time, but recognizing with that curiosity again of ah, like there's there's that familiar place I go. I wonder what's going on that may have led to that. Like maybe I'm just really tired or I'm hungry, or I've I'm just like not at capacity. Uh, the more stressed we are, the more likely we are to kind of revert back to that really old programming. So it's just kind of this ongoing process of noticing, noticing and naming where you're at.

SPEAKER_00 50:25

So, in in noticing and naming, what are some of the signs that healing is taking place?

SPEAKER_02 50:31

Yeah, I think people really start to feel that expansiveness, that transformation, that possibility. Relationships are feeling a little bit easier. You're able to feel closer to people around you. Um, you're able to engage in hard conversations without like shutting down or needing to flee the conversation. Um, that inner critic is getting a little quieter. A lot of my clients start to notice the first place they went with self-compassion instead of self-criticism, which is really beautiful. You're maybe putting yourself out there. You're trying something new and different, something you you never thought was possible. Um, when you start to notice some of those things, we we probably have some healing taking root. It can be really subtle, just like we said, some of the triggers are it's not always this huge transformation and this moment of, oh my gosh, I'm a different person, but it's these these little subtle shifts of I was just nice to myself. I just didn't assume the worst in myself or the people around me. Those moments really matter.

SPEAKER_00 51:34

Those moments really matter.

SPEAKER_02 51:36

Yeah.

SPEAKER_00 51:36

So, what is a hopeful message in closing for someone who may have complex PTSD and has spent years, decades, their whole life thinking this is just who I am. This is just how I am.

SPEAKER_02 51:49

Yeah, I think the message really is this is a part of how you learned to be. This kept you safe. This worked in some ways in the past, and it it's not working now. And your system is so resilient and capable of learning something different. I think we're talking so much about trauma, even the generational pieces, but like equally important is post-traumatic growth and transformation and intergenerational growth and transformation. So all of that is really possible. Your system can learn something different.

SPEAKER_00 52:24

And you see it in your practice. Absolutely. Every day. Wonderful. Thank you so much for your time and for explaining all this. It's a complex topic.

SPEAKER_02 52:32

It is. You're so welcome. Thank you so much for having me.

SPEAKER_00 52:35

And we will be back next week with another dive into another behavioral health topic. Thanks for joining us.