By guest writer Becki Malpass
“We live an increasingly conscious world when it comes to mental health, so it’s always surprising when we come across a diagnosis that we’ve never heard of before. In 2017, as I sat across from a psychiatrist in my GP’s office, I learnt about a diagnosis I had no idea existed; Complex Post Traumatic Stress Disorder (CPTSD).
Differing from PTSD, which usually develops as a result of one-off trauma, CPTSD develops as a result of sustained trauma or multiple traumatic events, among others. As well as the full spectrum of PTSD symptoms, it comes with the addition of long-term difficulties in maintaining relationships, managing emotions, experiencing strong feelings of guilt and worthlessness, physical symptoms and suicidal thoughts.
Struggling to manage my emotions was the symptom that finally drove me to my GP for help. I had spent the majority of my life until that point in and out of depressive episodes, but as I got older I realised that the volatility of my emotions was something more than depression. I felt everything in extremes. My highs were off the charts, but always fleeting, while my lows were so low and sustained that my mind was permanently in a dark place.
I also suffered – and often still do suffer – with feelings of worthlessness, and by this I don’t mean feeling like I don’t deserve nice things. I mean full self-loathing to the point that at my lowest I feel like I don’t deserve to have a drink of water when I am thirsty.
Most of these things come from deep-rooted traumas suffered at a young age. For me it was growing up a violent and abusive household that was the root of my CPTSD, accompanied by a handful of significant life events and a lot of bullying at school. A severe lack of ability to trust people makes having relationships hard, and when you combine that with erratic highs and lows which develop when no space is given as a child to learn how to handle big emotions, it makes it quite difficult to keep relationships going. I found myself in long periods of isolation, struggling to accept friendship. So loneliness became a big feature in my life.
When I did find friendships that stuck, they were usually toxic. I have discovered as I’ve gone through life that people who suffer tend to find each other. Misery does love company and when you find someone who has similar behaviours to yours and feels misunderstood in the same way, it creates a bond. This can often mean that volatile behaviours meet, resulting in equally volatile relationships. CPTSD left me permanently in flight or fight mode, where everything felt life threatening and there was no sanctuary from it. I carried it everywhere with me and it affected everything I did, including how I behaved in relationships.
After the doctor explained to me what CPTSD was, she looked at me regretfully and told me that she couldn’t formally give it as a diagnosis. While CPTSD was coined in the 1980s, in 2017 it still wasn’t officially recognised in the Diagnostic and Statistical Manual of Mental Disorders – the medical manual used to diagnose mental illnesses. Instead, she told me to research the disorder to find out more about it in lieu of any literature she could give me and that she was going to refer me for something called Psychodynamic Psychotherapy.
I did as she told me to and hit up google immediately after my appointment. I spent hours trawling through sites finding out as much as I possibly could, feeling a deep sense of relief with every article I read. It was like reading a disturbingly intimate biography of my mind, but it meant it was real. I sat ticking off my symptoms and experiences with everything listed on each of the sites. Once I was confident that my “diagnosis” was right, I started googling the therapy I was about to start.
Psychodynamic Psychotherapy, I learned, was about to take me into a deep dive into my past to find all the underlying issues and reasons why I had developed CTPSD. As it turns out, this kind of therapy is hard. I spent 18 months (broken into two chunks so I could take a break while I had my first baby), diving into my traumas, reliving them, re-feeling them and learning why they affect me the way they do. My therapist used the Free Association method which essentially enabled me to lead my therapy. I attended each of my weekly sessions and would be free to discuss anything that I felt I needed to. More often than not it would start with my discussing whatever had happened during the previous week, and by the end of it I would be making connections between what I was feeling an why I felt that way.
I also learnt how to recognise my triggers, see my warning signs and, most importantly, understand that the reason I behaved the way I did was not my fault. One of my biggest triggers is the feeling of being gaslighted – it is a common trait of abusers to try and undermine a lived experience – amongst others. When you’re living in a world where you are second guessing even your own basic needs, being gaslighted is deeply triggering. Finding out that the trauma I had suffered had affected the way my brain had developed, having a place to put my blame and vindicating my feelings were the biggest game changers for me.
In 2019, while I was in the midst of my therapy, a breakthrough came for CPTSD in the UK when it was recognised by World Health Organisation member, the British Psychological Society, who then began to endorse it as a diagnosis. Unfortunately, it still has a long way to go and is not yet officially recognised by the American Psychiatric Association.
As for my breakthrough, I finished my therapy in 2021 and I couldn’t be more grateful for being referred for it. For all of the incredibly hard work it was it was worth it. I’m stronger, much more balanced and I now understand why I react the way I do to things. My relationships are stronger and healthier too, I have learnt what it is to put healthy boundaries in place and things are feeling much more manageable. I would argue that there aren’t really coping mechanisms in place for CPTSD, like grief it just becomes something that you learn to live with, but I have learnt that with childhood trauma there comes a lack of knowing who you are. So for me, a coping mechanism is knowing that I’m not done getting to know myself yet. When something triggers me, I have a step now where I ask the question “how do I want to respond to this, really?” It genuinely helps.
CPTSD doesn’t go away, I will live it for the rest of my life, and as life goes on I might come across more triggers that I didn’t manage to explore in my therapy, but I now have the tools in place to help recognise it and get the help that I need when I need it. . It helps to talk about it. Like most other non-mainstream mental illnesses or disorders, there is a stigma around CPTSD that needs to break, especially as it’s still making tracks through the scientific world. But my advice is this; your CPTSD diagnosis is unique to you. Your circumstance is unique to you. Remember that your experience is 100% valid, so ask for help. Go to your GP and ask for assessment, when you are referred to therapy make sure you allow yourself time to decide whether the therapist you’ve been assigned to works for you. You need to feel comfortable with them as they are likely to be standing beside you and holding your hand as you walk down the shadowy roads of your past experiences, feeling safe with that relationship is paramount. Give yourself time and space to work through it all. It is hard, it is scary but I can say with absolute honesty that it is worth every effort it takes.”
If you would like to talk to Becki about CPTSD, you can find her on Instagram @RebeccaExploring.