Complex PTSD / episode 52 show notes

Put yourself first. I keep every episode as safe as I can, but just by the nature of the topics, you may experience some stuff come up. Take a break if you need to.

And these are my personal conceptualizations about how the PVT connects to the DSM. I’m not suggesting you think the same way. This is how I am viewing them in general. As a starting point.

This information is NOT meant to diagnose. If you feel like you may be experiencing symptoms of CPTSD, consult with a mental health or medical professional. I am speaking in generalities. Your specific situation, diagnosis, treatment and medication are entirely between you and your provider.

COMPLEX PTSD

Polyvagal Ladder review

CPTSD was initially proposed by Judith Herman (1992), who stated that “In contrast to the circumscribed traumatic event, prolonged, repeated trauma can occur only when the victim is in a state of captivity, unable to flee, and under control of the perpetrators” (p. 337).

Shutdown = can’t run or fight

• Neuroception of life threat

Herman is describing childhood - prolonged, repeated trauma where they cannot escape and under the control of the perpetrators due to childhood dependence on others

CPTSD is typically begun during childhood when major developments are happening and when self-regulation is supposed to be happening

• But self-regulation is entirely dependent on co-regulation early on in life

• Need co-regulation from safe others, especially parents and people in the home

• Without self-regulation, life becomes a lot more difficult as the individual is always in a stuck state

The diagnostic criteria for C-PTSD include:

1. Experiencing anxiety-producing visual or emotional flashbacks, and vivid memories of trauma in response to triggering events

Same with PTSD

Triggering events are a neuroception of danger, passing through any sort of conscious processing and subjective to that individual

Triggering the stuck freeze energy or going from safe to flight/fight that are accompanied by the visualizations of the event and the emotions of it

Emotions and visualization are connected to the polyvagal state, which is probably connected to the traumatic event

• Those details of the event get imprinted to the person as cues of danger for the future

2. Going to extreme lengths to avoid environments or situations that are believed likely to provoke flashbacks or unpleasant memories

Same with PTSD

Going to extreme lengths in and of itself is using some sympathetic energy

Behavioral adaptation to avoiding the sympathetic energy

Sympathetic energy without the safety system is too much

Obviously not just the memory, but what is tied to it; and the memory is a reflection of the state, a visualization of the danger cues

3. Chronic feelings of being unsafe or vulnerable to threats, even when external circumstances show no obvious signs of danger

Potentially different than PTSD due to a chronic unsafe feeling

Could be any of the stuck defensive states

This is outside of being triggered by a vague thing; it’s chronic, it’s always there

Due to lack of self-regulation, which is due to lack of co-regulation and betrayal of trusted caregivers, not just a lack of co-regulation

• Lack of safety in this person’s life

• Lack of trust

• Lack of vulnerability

• If anything, other dysregulated people are the norm for this individual

Sounds like a pretty unsafe existence

4. A pattern of participating in unstable, dysfunctional, and unsustainable relationships

Like I said in 3, dysregulated others become the norm

• Like attracts like

• People in their safety state will keep their distance from unsafe others

• Dysregulated people will keep their distance from safe individuals because it feels uncomfortable or they feel like they don’t deserve it or they lack the skills necessary for these safer relationships

In more detail...

Polyvagal theory explains that neuroception is healthy or unhealthy

When we exist more down the ladder, we perceive danger everywhere and miss the cues of safety; our autonomic nervous system is prepared for danger, not social engagement

This person has great difficulty in detecting safety or risk in others due to #3, the chronic feelings of not being safe, which is the stuck defensive state

You’re left with dysregulated states attracting each other to get basic needs met, to seek protection, to seek companionship, but finding other dysregulated nervous systems that might compliment or exploit that

The social engagement system of this individual is underdeveloped due to their chronic traumatic life, leaving this type of external relationship pattern. But this lack of safety also reflects on their internal relationship pattern...

5. Negative self-concept defined by feelings of deep shame, guilt, and unworthiness

Very limited access to the social engagement system, where feelings of positivity woud live

Remember, CPTSD is a reaction to “prolonged, repeated trauma… in a state of captivity, unable to flee, and under control of perpetrators.”

If you can’t run, if you can’t fight, you shutdown

These #5 feelings are all feelings of being in a shutdown state - the impulse to become smaller, to curl up; this is the bodily impulse of shutdown and the emotions that come along with it

Per Peter Levine, shame is a biosocial thing, it serves a purpose on the social level and is felt in the biology; not just a state of mind

• Like with registries for sexual offenders - it’s for public safety, but also serves a function of public shaming

• Or being de-friended due to cheating

• The community can use shame as a way of stopping behavior

• But for the shame to be effective, it needs to be repaired

• The shaming of children through abuse is obviously a misuse of shame and is inflicted upon the child from the abuser’s own shame

Shame needs safety to be undone, but the cptsd individual potentially did not have actual safety, so the shame persists along with the shutdown from the traumas

If one were to listen to the bodily feelings under the shame, it might lead them toward completing the bodily impulse of becoming smaller, then coming out of that posture with the sympathetic energy as they climb the polyvagal ladder

• Wanting to disappear - becoming physically smaller, tucking head in, curling shoulders inward, a hunched look

• Feeling inferior, worthless, self-loathing, loneliness, emptiness

• Posture of collapse, aversion of gaze, wanting to hide and being smaller, lowered capacity to think, problems orienting to the moment and environmental safety

Story follows state as well - these are thoughts that are directed toward the self and reinforcing of the state; we focus on the thoughts and not what is underneath them

6. Poor emotional control that leaves sufferers vulnerable to fits of rage and frustration and bouts of paralyzing anxiety

Sounds like stuck freeze energy to me - rage, paralyzing anxiety;

• paralysis is the stiff muscles along with immobilization

• Rage is the uncontrolled sympathetic fight energy that gets triggered

Weaker vagal brake, which is entirely dependent on the strength of the social engagement system

• Influence on the heart

• Makes sense since the lack of co-regulation in early childhood would have left with with a very underdeveloped social engagement system

This dx is kind of all over the place, representing a very dysregulated body

Stuck freeze energy and a severe shutdown state possibly at the same time

All six symptoms must be detected before a complex PTSD diagnosis can be made. Because C-PTSD is often complicated by depression, anxiety disorders, borderline personality disorder, and substance abuse (all common co-occurring conditions with C-PTSD), mental health professionals will screen for such conditions once the symptoms of complex PTSD have been identified.

We can see how this dx can end up looking many different ways when one adapts their behavior to the defensive state

This has a lot in common with borderline personality disorder, which might be a behavioral adaptation to the cptsd; i can also see narcissistic being an adaptation to the cptsd

But where is the dissociative sx?

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ANNOUNCEMENTS -

• This completes the first year’s worth of weekly episodes. There’s actually more than that.

• Polyvagal Patrons! 2 mini episodes per week for the next couple weeks at least. Listen to them right after this in the same podcast player.

• Double check your subscriptions, Narcissistic Personality episode didn’t upload correctly

HOMEWORK -

• Remind yourself that you’re safe

• Maybe now, maybe when you’re at home, maybe when you’re on a walk, look around and remind yourself you’re safe

Peter Levine and Shame Interview - https://www.youtube.com/watch?v=i2CN5nhmfxk

Intro/Outro music & Transition Sounds by Benjo Beats - https://soundcloud.com/benjobeats