What is Complex PTSD? CPTSD definition (healing from emotional abuse or toxic shame) (reference for therapists, coaches and clients) (CPTS-R)

Updated Trauma Flowchart Somatic PT Nina Goradia with Debbie JBLThis blog post continually receives a large number of views, so I felt compelled to add this update on Jan 18, 2020.

I have been on a search for you to refer you to someone who can support you in healing CPTSR/ CPTSD – someone who knows their stuff, is friendly and professional, and is competent and caring. As soon as I saw her “Trauma Flowchart”, I had a good feeling. Then I connected with her and couldn’t wait to share her with you. Her name is Nina Goradia. You can download her flowchart and link to her video here.

What is Complex PTSD? CPTSD definition (healing from emotional abuse or toxic shame) (reference for therapists, coaches and clients) (CPTS-R)


Now that I’m moving the CPTSD conversation from “an aside” to a main topic in this here blog, I figured it’s time for a good ole definition.  Or Three.

But first, a metaphor

Race horses wear cheek pieces called blinders or blinkers that keep their vision focused forward and protect their eyes from dirt and mud. This is a great metaphor for Complex Post Traumatic Stress Disorder, or CPTSD.

But, unlike the horses, people who should have a choice about taking the blinders off frequently don’t even realize they’re there. Living through high levels of psychological stress, the blinders were strategically put on by either a) the abuser who was in power (for purposes of coercion) OR by b) the targeted person, in order to survive the environment.

For example, a young child who grows up with an unhappy parent will most likely tell himself or herself: “It must be my fault”. To the child, that feels like ABSOLUTE TRUTH. And it can last a lifetime. This is a blinder which can be extremely difficult to take off later on, especially if it’s woven with toxic shame and / or toxic loyalty (Stockholm syndrome / trauma bond).

Since explaining that seems to be extremely nebulous and difficult, especially trying to help someone understand who hasn’t been through it – or someone who’s in denial (a common symptom) – I’m going to call for backup. Richard Grannon, Christine Louis de Canonville and Pete Walker, please come to the front desk. You have a phone call.

Richard Grannon (English accent), psychology student / NLP practitioner / self-defense instructor

Here’s a very short video from Richard Grannon which offers the best explanation I have heard. It’s not perfect. But it makes perfect sense to me, so hopefully it will shed some light on your path, too. It’s 2 minutes. Listen till the end.

I have noticed that people who are recovering from CPTSD seem to frequently always have blind sides that get in the way of gaining traction in living and thriving. Protecting oneself from predatory personalities can be poignantly absent and intimacy can be challenging.

(Note to therapists and coaches: When I co-author a new future with/for someone, I ask permission to speak truth as I see it. This is important, as it puts us on more equal footing as we go forward. This is imperative because it increases their sense of agency in the transformation process. It places the power back where it belongs, in their hands.)

When I name one of their blind sides, they usually feel an immediate sense of relief as their perceptions open and expand. HOWEVER… I’ve also noticed that their BLIND SIDE IS VERY LIKELY TO REAPPEAR if their NEW perception and NEW underlying belief, backed up by a NEW healthy behavior, is not given a good, strong dose of “repetition.” This can be extremely frustrating if you’re the one who sees the blind side and they don’t. You might find yourself repeating yourself. This is normal.

It helps when the courageous-person-in-recovery-of-CPTSD understands:

  1. They have homework: to face the toxic shame so that it can be released. Over and over again. There is no known shortcut or bypassing this as far as I know. I wish there was!
  2. Validation of their experience (memories, perceptions, needs, feelings, desires) is key, core and central to healing.
  3. Growing up means popping oneself out of denial as frequently as possible as kindly (yet firmly) as possible.
  4. There are methods that can make #1, 2 and 3 easier, such as a “Tell Me More” process I created to help myself face – and feel – and embody – all of my feelings.  This is the key to setting them free. My clients love this process. You can experience us walking through worksheet together here: Bring it ON, Exchange Toxic Shame for Healthy Self Connection.
  5. Knowledge and understanding of CPTSD is essential.
  6. Critical thinking skills and discernment are keys to thriving.
  7. This wasn’t their fault.
  8. Having a healthy support system REALLY HELPS heal the relational trauma which is the basis of CPTSD.
  9. Repetition is absolutely required in order for the blinders of old brainwashing / survival strategies to stay OFF.

The CPTSD Response – (F###, it’s not a disorder, it’s an intelligent, strategic response of someone who lived through a psychological warzone, a horror movie – see the movie Gaslight, 1960’s version with Ingrid Bergman and Angela Lansbury) – this RESPONSE was designed to protect the person at all costs. This is why the recovering person has to do their homework quite diligently in order to regain their peripheral vision. Their identity. Their life.

Christine Louis de Canonville, psychologist / criminologist / theologist (Irish accent)

Here’s an excerpt from her poignant ebook, When Shame Begets Shame:

New perspectives on psychological trauma and post-traumatic growth:

Many victims of narcissistic abuse develop post-traumatic stress. So, when working with victims of narcissistic abuse, the clinician is working with the client to alleviate problems associated with their post-traumatic stress, whether it is Post Traumatic Stress Disorder (PTSD), or the more virulent form of trauma, which is called Complex Post Traumatic Stress Disorder (cPTSD). Without doubt,working with the co-narcissist’s toxic shame is key to overcoming the effects of PTSD when it is rooted in  childhood abuse. Apart from physical and emotional abuse, the narcissist can impart shame onto a child through meta-communication (i.e. their body language and voice tones). In this way they can effectually transmit their disgust, contempt, abandonment, and rejection onto the child, wounding and shaming them terribly. The therapist must engage the client in intellectual and cognitive processing so that they can observe the way their shame armouring defences (behaviours and thoughts) from the past are still affecting them in the present. There may also be a need to encourage the client to reframe their old perceptions and behaviours in a more constructive way, rather than constantly reinforcing the old negative messages that were fed to them in the past. Many clinicians fear to work with clients suffering from PTSD, let alone cPTSD. To those clinicians, I would like to assure you that PTSD is not a sign that your client has a disorder, on the contrary. Post-traumatic stress symptoms are a loud signal to you that your client is going through a perfectly normal and natural process (to regain equilibrium) following an overwhelming experience.

If you are wondering what the difference is between these two forms of stress, I would say, it is “a matter of degree”. Where PTSD can be the effects of just one extreme experience (i.e. a car accident, an aggressive assault, illness, bereavement or divorce, etc.). Complex PTSD warns you that your client has been dealing with a repetitive and prolonged trauma while in an interpersonal relationship where there was an uneven power dynamic (i.e. being a hostage, or possibly living under the tyranny of a pathological narcissist for years, etc.). What both kinds of clients are experiencing is their nervous system trying to gain its equilibrium, and thus, it wants to repair and rebuild itself. Therapy is a process that can assist the nervous system to heal itself, but sometimes it heals itself without any clinician’s intervention. These survivors who did not feel the need to enter the therapeutic process generally have had good social support, and they probably did not suffer other major life events after getting out of the relationship. Whether it is with the help of a clinician or not, part of the process includes that the co-narcissistic victim makes sense of whatever has befallen them in their past. That means taking stock and accept what has happened to them. Acknowledge their subsequent pain and the lasting effects that had upon their identity and personality. Learn from it, discharging the residual negative energies associated with the trauma, deal with the shame, and make the necessary changes for moving on with their much-improved lives.

Pete Walker, psychotherapist (MA, MFT) / author of Complex-PTSD, From Surviving to Thriving (Berkely, CA accent, whatever that means :-))

My commentary about his book:

I feel encouraged and enlivened by this topic of C-PTSD recovery because the cure seems like a strong bridge made of solid bricks. As we are moving forward with this topic, I wanted a good definition. Here is Pete Walker’s definition of C-PTSD from his book by the same name. Reading this excerpt from Pete’s book feels extremely normalizing to me about the entire topic. Thanks for growing with me, alongside each other… doing it together is so much better!!!!!

I wrote this book from the perspective of someone who has Complex Post-Traumatic Stress Disorder [Cptsd], and who has experienced a great reduction of symptoms over the years. I also wrote it from the viewpoint of someone who has discovered many silver linings in the long, windy, bumpy road of recovering from Cptsd. I have also seen this type of recovering in a number of my friends and many long term clients.

First, the good news about Cptsd. It is a learned set of responses, and a failure to complete numerous important developmental tasks. This means that it is environmentally, not genetically, caused. In other words, unlike most of the diagnoses it is confused with, it is neither inborn nor characterological. As such, it is learned. It is not inscribed in your DNA. It is a disorder caused by nurture [or rather the lack of it] not nature. This is especially good news because what is learned can be unlearned and vice versa. What was not provided by your parents can now be provided by yourself and others.

Recovery from Cptsd typically has important self-help and relational components. The relational piece can come from authors, friends, partners, teachers, therapists, therapeutic groups or any combination of these. I like to call this reparenting by committee. I must emphasize, however, that some survivors of Cptsd engendering families were so thoroughly betrayed by their parents, that it may be a long time, if ever, before they can trust another human being enough to engage in relational healing work. When this is the case, pets, books and online therapeutic websites can provide significant relational healing.

This book describes a multimodal treatment approach to Cptsd. It is oriented toward the most prevalent kind of Cptsd, the kind that comes from growing up in a severely abusive and/or neglectful family. In this vein, the book describes a journey of healing the damage that occurs when you suffer traumatizing abuse and abandonment. Traumatizing abuse and abandonment can occur on verbal, emotional, spiritual, and/or physical levels. Moreover, sexual abuse is especially traumatizing. I believe that we have an epidemic of traumatizing families. Current estimates posit that one in three girls and one in five boys are sexually abused before they enter adulthood, and recent statistics from The Kim Foundation report that 26% of Americans over 18 have been diagnosed with a mental disorder. When abuse or neglect is severe enough, any one category of it can cause the child to develop Cptsd. This is true even in the case of emotional neglect if both parents collude in it, as we will see in chapter 5. When abuse and neglect is multidimensional, the severity of the Cptsd worsens accordingly.

Definition Of Complex PTSD 
Cptsd is a more severe form of Post-traumatic stress disorder. It is delineated from this better known trauma syndrome by five of its most common and troublesome features: emotional flashbacks, toxic shame, self-abandonment, a vicious inner critic and social anxiety.

Emotional flashbacks are perhaps the most noticeable and characteristic feature of Cptsd. Survivors of traumatizing abandonment are extremely susceptibility to painful emotional flashbacks, which unlike ptsd do not typically have a visual component.

Emotional flashbacks are sudden and often prolonged regressions to the overwhelming feeling-states of being an abused/abandoned child. These feeling states can include overwhelming fear, shame, alienation, rage, grief and depression. They also include unnecessary triggering of our fight/flight instincts.

It is important to state here that emotional flashbacks, like most things in life, are not all-or-none. Flashbacks can range in intensity from subtle to horrific. They can also vary in duration ranging from moments to weeks on end where they devolve into what many therapists call a regression. Finally, a more clinical and extensive definition of Cptsd can be found on p. 121 of Judith Herman’s seminal book, Trauma and Recovery.

An Example Of An Emotional Flashback 
As I write this I recall the first emotional flashback I was ever able to identify, although I did not identify it until about ten years after it occurred. At the time of the event, I was living with my first serious partner. The honeymoon phase of our relationship came to a screeching halt when she unexpectedly started yelling at me for something I no longer recall. What I do most vividly recall was how the yelling felt. It felt like a fierce hot wind.

I felt like I was being blown away – like my insides were being blown out, as a flame on a candle is blown out. Later, when I first heard about auras, I flashed back to this and felt like my aura had been completely stripped from me. At the time itself, I also felt completely disoriented, unable to speak, respond or even think. I felt terrified, shaky and very little. Somehow, I finally managed to totter to the door and get out of the house where I eventually slowly pulled myself together.

As I said earlier, it took me ten years to figure out that this confusing and disturbing phenomenon was an intense emotional flashback. Some years later, I came to understand the nature of this type of regression. I realized it was a flashback to the hundreds of times my mother, in full homicidal visage, blasted me with her rage into terror, shame, dissociation and helplessness.

Emotional flashbacks are also accompanied by intense arousals of the fight/flight instinct, along with hyperarousal of the sympathetic nervous system, the half of the nervous system that controls arousal and activation. When fear is the dominant emotion in a flashback the person feels extremely anxious, panicky or even suicidal. When despair predominates, a sense of profound numbness, paralysis and desperation to hide may occur. A sense of feeling small, young, fragile, powerless and helpless is also commonly experienced in an emotional flashback, and all symptoms are typically overlaid with humiliating and crushing toxic shame.

Toxic Shame: The Veneer Of An Emotional Flashback 
Toxic shame, explored enlighteningly by John Bradshaw in Healing The Shame That Binds, obliterates a Cptsd survivor’s self-esteem with an overwhelming sense that he is loathsome, ugly, stupid, or fatally flawed. Overwhelming self-disdain is typically a flashback to the way he felt when suffering the contempt and visual skewering of his traumatizing parent.

Toxic shame can also be created by constant parental neglect and rejection. Early in my career I worked with David, a handsome, intelligent man who was a professional actor. One day David came to see me after an unsuccessful audition. Beside himself, he burst out: “I never let on to anyone, but I know that I’m really very ugly. It is so stupid that I’m trying to be an actor when I’m so painful to look at.” I will never forget how shocked and disbelieving I felt at first, that such a handsome person could feel ugly, but further exploration brought me understanding. David’s childhood was characterized by broad spectrum abuse and neglect. He was the last and unwanted child of a large family, and his alcoholic father repeatedly attacked and looked at him with disgust. To make matters worse, his family imitated his father and frequently humiliated him with heavy doses of contempt. His older brother’s favorite gibe, accompanied by a nauseated grimace, was “I can’t stand sight of you. You make me want to vomit!” Toxic shame can obliterate your self-esteem in the blink of an eye. In an emotional flashback you can regress instantly into feeling and thinking that you are as worthless and contemptible as your family perceived you. When you are stranded in a flashback, toxic shame devolves into the intensely painful alienation of the abandonment mélange – a roiling morass of shame, fear and depression.

The abandonment mélange is the fear and toxic shame that surrounds and interacts with the abandonment depression. The abandonment depression itself is the deadened feeling of helplessness and hopelessness that afflicts traumatized children.

Toxic shame also inhibits us from seeking comfort and support. In a reenactment of the childhood abandonment we are flashing back to, we often isolate ourselves and helplessly surrender to an overwhelming feeling of humiliation. If you are stuck viewing yourself as worthless, defective, or despicable, you are probably in an emotional flashback. This is typically also true when you are lost in self-hate and virulent self-criticism. Immediate help for managing emotional flashbacks can be found at the beginning of chapter 8 which lists 13 practical steps for resolving flashbacks.

Walker, Pete. Complex PTSD: From Surviving to Thriving: A GUIDE AND MAP FOR RECOVERING FROM CHILDHOOD TRAUMA (pp. 4-6).

That’s all for now.

Big love and happy trails to you!

Happy D!

For more info about CPTSR/ CPTSD/ codependency/ co-narcissism, just enter any of those terms in the search bar (in the website footer) at https://joybasedliving.com/

Debbie Happy Cohen is a master coach with a graduate degree in counseling. She’s the founder of Joy-Based Living, an online global conversation where people develop the skills to create (internal and external) environments so that JOY can thrive in their lives.

Many people who are committed to having joy in their lives are people who have known its exact opposite. Therefore, we explore many aspects of joy, including its shadows. Awareness, acceptance and action are keys to opening the doors to greater joy; and courage is strengthened when people experience connection.

The Joy-Based Living E-book offers 12 foundational practices to help you get in touch with your feelings, make a deeper commitment to yourself, and step up into becoming who you really are. It’s a great supplement any holistic practice, including therapy and coaching. https://joybasedliving.com/ebook/




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