Latest / Psyched For Sanity / Episode 39 - Trauma, PTSD, and CPTSD

Transcript

Episode 39 - Trauma, PTSD, and CPTSD · Psyched For Sanity

• 0:12
  SPEAKER_00: Hello and welcome to Psych for Sanity.
• 0:14
  SPEAKER_00: I'm one of your hosts, Dr.
• 0:15
  SPEAKER_00: Brendell Doss.
• 0:16
  SPEAKER_00: I'm a licensed psychologist specializing in trauma treatment, geriatric psychology, forensic psychology, and assessment.
• 0:23
  SPEAKER_02: I'm Dr.
• 0:23
  SPEAKER_02: Tara McKelvey Parker.
• 0:25
  SPEAKER_02: I am also a licensed psychologist.
• 0:27
  SPEAKER_02: I work in private practice and I specialize in assessing and treating complex trauma and attachment wounds from childhood.
• 0:34
  SPEAKER_02: And speaking of complex trauma.
• 0:37
  SPEAKER_02: Speaking of complex trauma, today we're going to be talking about the difference between post-traumatic stress disorder, or PTSD, and complex post-traumatic stress disorder, or CPTSD.
• 0:49
  SPEAKER_02: We've talked about trauma.
• 0:51
  SPEAKER_02: Right, yeah, we have.
• 0:52
  SPEAKER_02: You know, here and there, I think across lots of episodes.
• 0:55
  SPEAKER_02: In our attachment episodes, for sure.
• 0:56
  SPEAKER_02: Yep, yep.
• 0:57
  SPEAKER_00: Maybe even in boundary episodes too.
• 0:59
  SPEAKER_02: I think it's probably come up in a lot of, yeah, over the course of our episodes.
• 1:04
  SPEAKER_02: And so we wanted to just be specific and define these terms and talk a little bit more about what they mean.
• 1:09
  SPEAKER_00: Yeah, and I think unfortunately it affects a lot of people, um, both in our practices that we see and in and across, you know, across the country and the globe.
• 1:20
  SPEAKER_00: And so I think it's helpful to understand the difference between these two experiences and to understand like what the path towards recovery would look like.
• 1:29
  SPEAKER_02: Yes.
• 1:30
  SPEAKER_02: So when we're talking about PTSD versus complex PTSD, the type of trauma matters.
• 1:38
  SPEAKER_02: Yeah.
• 1:39
  SPEAKER_00: The type of trauma m definitely matters.
• 1:41
  SPEAKER_00: I think when you think about uh PTSD, post-traumatic stress disorder, you generally think of a single incident or um a single event.
• 1:50
  SPEAKER_00: Um a car accident, car accident, sexual assault.
• 1:53
  SPEAKER_02: Sexual assault, um some kind of war or combat trauma.
• 1:57
  SPEAKER_02: Yes.
• 1:58
  SPEAKER_00: Uh something like that.
• 1:59
  SPEAKER_00: Robbery, even.
• 2:01
  SPEAKER_00: Lots of different things can be experienced as a a trauma.
• 2:04
  SPEAKER_00: And what I think is always important to highlight is post-traumatic stress disorder is is an interesting disorder that not everyone that goes through a traumatic event develops it.
• 2:12
  SPEAKER_00: Yeah, that's there's the idea.
• 2:13
  SPEAKER_00: Uh-huh.
• 2:14
  SPEAKER_00: There might be the idea that if you have a traumatic thing happen to you that you develop it automatically, I guess, is what I've run across.
• 2:19
  SPEAKER_02: Yeah, I think that with trauma, both for PTSD and CPTSD, when we've experienced something that is really scary, overwhelming, threatening, um, if we haven't made sense of the experience, we haven't grieved or really felt through the emotions, you know, that are really normal to feel when ex when going through something like that, when we haven't regained trust in others or ourselves or safety after the traumatic event or events, it's more likely to get stuck.
• 2:50
  SPEAKER_02: Right.
• 2:51
  SPEAKER_02: Um, and our brain and our bodies still feel as though we are in that scary, overwhelming, dangerous, threatening situation.
• 2:58
  SPEAKER_00: So PTSD really develops from a failure of the brain and body to recover.
• 3:04
  SPEAKER_02: To recover and for CPTSD.
• 3:07
  SPEAKER_02: Exactly.
• 3:08
  SPEAKER_02: Um but CPTSD, um, and just to add on about the the PTSD, you can have repeated and chronic um events, right, in this in a PTSD kind of way, and still develop classic PTSD and not necessarily complex PTSD.
• 3:27
  SPEAKER_02: Because for complex PTSD, really it's it's interpersonal.
• 3:31
  SPEAKER_02: The interpersonal piece matters a lot.
• 3:33
  SPEAKER_01: Yes.
• 3:34
  SPEAKER_02: So for someone who develops PTSD, it would be more common for them to experience like combat trauma or some kind of scary, threatening event that activated the nervous system.
• 3:44
  SPEAKER_02: CPTSD is usually parent-child or relational.
• 3:49
  SPEAKER_02: Relational in some kind of way, caregiver.
• 3:53
  SPEAKER_02: Um, and so that's really important.
• 3:55
  SPEAKER_02: Also, CPTSD is usually developmental.
• 3:59
  SPEAKER_02: A lot of folks call CPTSD childhood PTSD or developmental trauma because this trauma is happening as you're growing up.
• 4:11
  SPEAKER_02: And so we have talked about in our child development episodes, right, that self-esteem is developing.
• 4:17
  SPEAKER_02: Yes.
• 4:17
  SPEAKER_02: Our ability to regulate emotions are developing, our relationship skills are developing, and our caregivers, it's it's kind of their responsibility and duty to help their kids through those experiences and develop healthy skills.
• 4:32
  SPEAKER_00: That's what I was just saying.
• 4:39
  SPEAKER_02: Right.
• 4:39
  SPEAKER_02: So when you have CPTSD, you generally grow up in homes that are chaotic, unpredictable, scary, chronically neglectful, and then you don't really have, you're not developing skills the way that you really need to be.
• 4:53
  SPEAKER_02: And so a lot of folks in CPTSD CPTSD literature talk about these folks as having developmental stunts.
• 5:02
  SPEAKER_02: They're developmentally arrested in some of these areas.
• 5:05
  SPEAKER_00: Right.
• 5:06
  SPEAKER_00: Can you talk about for our viewers and listeners what the term arrested in this context means?
• 5:10
  SPEAKER_02: Means that you're kind of stuck in a younger space.
• 5:13
  SPEAKER_02: Like stopped.
• 5:14
  SPEAKER_02: Yeah.
• 5:15
  SPEAKER_02: You kind of stopped at a particular place in your development.
• 5:18
  SPEAKER_02: You didn't quite achieve a healthy ability to regulate your emotions.
• 5:23
  SPEAKER_00: I actually like for instance.
• 5:24
  SPEAKER_00: For my work um in geriatric psychology, I it's very interesting and fascinating in that when I come across, when I get a new patient, I will go in and there'll be some quality or characteristic or aspect of a person that I'm talking to.
• 5:38
  SPEAKER_00: And I screen all of my folks for traumatic events as part of the required batteries for the organizations I work for.
• 5:45
  SPEAKER_00: However, I'll ask them, I kind of have this interestingly a gut, a clinical gut feeling.
• 5:50
  SPEAKER_00: There's been some type of event.
• 5:52
  SPEAKER_00: And what I often will tell people to do that work with these folks or that are maybe they're behaviorally disorganized and causing challenges in my facilities, I'll do this.
• 6:00
  SPEAKER_00: I said, okay, take a moment, you can close your eyes or or not, but if you were to guess this person's age that's not chronological, how old do they seem?
• 6:09
  SPEAKER_00: And that is uncannily the age at which potentially CPT CPTST experiences or the relational traumas started occurring.
• 6:18
  SPEAKER_02: Exactly.
• 6:19
  SPEAKER_02: Like almost to the year.
• 6:20
  SPEAKER_02: Exactly.
• 6:21
  SPEAKER_02: So this term, like this is fragmentation.
• 6:23
  SPEAKER_02: Like people who have experienced complex trauma, they have um uh lots of different parts.
• 6:31
  SPEAKER_02: Yes.
• 6:31
  SPEAKER_02: We all have parts to an extent, right?
• 6:33
  SPEAKER_02: We have a scared part, we have a, you know, an assertive part, we have a bold part.
• 6:37
  SPEAKER_02: We can talk about lots of people in terms of parts, but people with trauma are quite fragmented.
• 6:42
  SPEAKER_02: And they have younger, developmentally arrested parts inside of them, right, you know, that still need tending to, still need healing, and still need development because it's their caregivers, you know, it the trauma is really b in in in that developmental really key part.
• 6:58
  SPEAKER_02: And it's usually, you know, caregivers are an interpersonal in nature.
• 7:02
  SPEAKER_02: Um, and then be because a lot of it is um much of it is childhood, then there's also this sense of being unable to escape, right?
• 7:12
  SPEAKER_02: Because the person or people that really need to feel safe are are very scary, and you but you can't leave because you depend on them for your survival, so you're kind of trapped or stuck.
• 7:24
  SPEAKER_02: Sure, you know, in in a way that's not quite the same for PTSD.
• 7:29
  SPEAKER_00: And I think I um I'd be curious about your perspective on this.
• 7:32
  SPEAKER_00: Have you ever come across a patient, obviously in the in adulthood, that claims to have a relatively typical or typical developmental course and then develops CPTSD later in life.
• 7:45
  SPEAKER_00: Um or like in the early courses of their adulthood, like early twenties.
• 7:49
  SPEAKER_02: Yes, too, because it's developmental, right?
• 7:51
  SPEAKER_02: So we are we are still developing through young adulthood.
• 7:55
  SPEAKER_02: So you can absolutely develop CPTSD from repeated interpersonal traumas in adolescence and early adulthood.
• 8:03
  SPEAKER_02: Yes.
• 8:04
  SPEAKER_02: Definitely.
• 8:05
  SPEAKER_02: Um it is just more typically Under 18.
• 8:08
  SPEAKER_02: Under Yeah.
• 8:09
  SPEAKER_02: Well childhood, yes, I guess so.
• 8:11
  SPEAKER_00: I mean it's an arbitrary age assignment.
• 8:13
  SPEAKER_00: And or Yes.
• 8:15
  SPEAKER_00: But I've I work with several patients that have identified and experienced CPS CPSC symptoms.
• 8:20
  SPEAKER_00: Yes.
• 8:21
  SPEAKER_00: And they started over the age of 20.
• 8:23
  SPEAKER_02: And it doesn't, and in this particular age range, it doesn't necessarily have to be parent-child or caregiver child.
• 8:30
  SPEAKER_02: Yep.
• 8:30
  SPEAKER_02: There can be repeated interpersonal trauma in romantic relationships or in friendships, too.
• 8:36
  SPEAKER_02: So it's not always parent-child.
• 8:38
  SPEAKER_02: It's talked about that way, and it more often is caregiver, child, whoever, you know, but certainly interpersonal, repeated, prolonged, um, and it occurs at some developmental period in your life where you get kind of stuck.
• 8:53
  SPEAKER_02: Yep.
• 8:54
  SPEAKER_02: Um, and so then so the trauma type of trauma matters, and then also the symptom presentation when we're talking about PTSD, CPTSD.
• 9:05
  SPEAKER_02: Um I just wanted to make that a little illustration.
• 9:07
  SPEAKER_02: No, that was great.
• 9:08
  SPEAKER_02: I think a lot of people, including myself, tend to kind of forget about that part because mine was largely, you know, my own trauma was largely parent-child.
• 9:18
  SPEAKER_00: So Yeah, I think but but kind of capturing the whole picture is part of explaining the difference between the two.
• 9:23
  SPEAKER_00: Yes.
• 9:24
  SPEAKER_00: Um so let's talk about some of the symptoms that PTSD has and CPTSD have, and sometimes they're similar, but otherwise there's differences as well.
• 9:32
  SPEAKER_02: Yeah.
• 9:33
  SPEAKER_02: So there's sort of three core symptoms that are common in PTSD and complex PTSD.
• 9:40
  SPEAKER_02: Um, one is re-experiencing the trauma in some kind of way.
• 9:45
  SPEAKER_02: Another is avoiding the trauma in some kind of way.
• 9:49
  SPEAKER_00: Avoiding stimulus or or things that might remind you of, yeah.
• 9:52
  SPEAKER_02: And then another one is this persistent sense of threat even when you are objectively safe.
• 9:59
  SPEAKER_02: Right.
• 10:00
  SPEAKER_02: So with re-experiencing the trauma, what do you tend to think of?
• 10:04
  SPEAKER_02: I th I tend to think of flashbacks.
• 10:05
  SPEAKER_00: Yeah, flashbacks.
• 10:07
  SPEAKER_00: It's sort of a classic, more like prototypical.
• 10:10
  SPEAKER_00: Um re-experiencing can also um I guess intake a sense of of of of nightmares in a sense.
• 10:16
  SPEAKER_00: Mm-hmm.
• 10:17
  SPEAKER_00: Nightmares is one.
• 10:18
  SPEAKER_01: Yeah.
• 10:18
  SPEAKER_01: Mm-hmm.
• 10:19
  SPEAKER_02: Um, intrusive thoughts, right, memories.
• 10:22
  SPEAKER_02: Unwanted.
• 10:23
  SPEAKER_02: Unwanted.
• 10:24
  SPEAKER_02: They kind of, you know, you may randomly think about the scary thing that happened to you.
• 10:28
  SPEAKER_00: Without any kind of stimulus being in the environment.
• 10:30
  SPEAKER_02: A lot of times there's some kind of external trigger, but there doesn't always have to be.
• 10:35
  SPEAKER_02: Right.
• 10:35
  SPEAKER_02: Um, or just having really intense feelings of helplessness, fear, anger when you're reminded of the trauma.
• 10:43
  SPEAKER_02: Right.
• 10:44
  SPEAKER_02: Um, I find that'll uh people come into treatment either in sort of chronic overactivation and re-experiencing or in chronic avoidance and shutdown.
• 10:57
  SPEAKER_02: Right.
• 10:58
  SPEAKER_02: So um I think one important thing to point out here is that with PTSD, a flashback looks very different than it does for CPTSD, okay, generally speaking.
• 11:13
  SPEAKER_02: Um with PTSD, a flashback, I think about like a war veteran, right, who hears a car backfire and they are immediately or fireworks.
• 11:23
  SPEAKER_02: Or fireworks and immediately feeling as though they are back on the battlefield.
• 11:27
  SPEAKER_02: Yeah.
• 11:28
  SPEAKER_02: Like actually experiencing that.
• 11:31
  SPEAKER_02: Yeah, like their brain and body is transported back there.
• 11:34
  SPEAKER_02: It's kind of transported back there.
• 11:36
  SPEAKER_02: Okay.
• 11:36
  SPEAKER_02: Um, and usually there's some kind of memory, there's something associated with the flashback.
• 11:42
  SPEAKER_02: So we can kind of say, oh, okay, that makes sense, right?
• 11:45
  SPEAKER_02: I had that experience and that's why I'm terrified, and it reminds me of that because I heard that thing.
• 11:50
  SPEAKER_01: Yeah.
• 11:50
  SPEAKER_02: Um, but for CPTSD, we usually don't have memories or thoughts attached to the flashback.
• 11:57
  SPEAKER_02: They're called emotional flashbacks.
• 12:00
  SPEAKER_02: So we may be triggered, usually in an inner personal situation that feels similar to what we experienced in childhood.
• 12:08
  SPEAKER_02: So we just feel intensely scared or desperate or overwhelmed or angry or sad, and we don't really know why.
• 12:17
  SPEAKER_01: Yeah.
• 12:17
  SPEAKER_02: It's really intense, and you, you know, people with CPTSD may even realize that the reaction is super intense and disproportionate to the event.
• 12:28
  SPEAKER_02: And that's usually because your brain and body are remembering something that happened to you before you had language, perhaps, right?
• 12:37
  SPEAKER_02: Or before you had ability to encode long-term memory.
• 12:41
  SPEAKER_00: Yeah.
• 12:42
  SPEAKER_02: Or you were dissociated or disconnected from your childhood, and you could not consciously store the information to survive and move on.
• 12:51
  SPEAKER_02: Sure.
• 12:51
  SPEAKER_02: So your brain and body react like, oh, I am being rejected right now, and that is unsafe and terrible, and toxic shame may just like come up, and you're like, wait a second, the person didn't text me back.
• 13:03
  SPEAKER_02: It's not that why am I right.
• 13:06
  SPEAKER_02: So emotional flashbacks are much more common.
• 13:09
  SPEAKER_00: And I, you know, speaking on that disassociation element, I mean some of my patients don't have memories.
• 13:14
  SPEAKER_00: Like they have no, they have certain ages with their they have no memories prior or before certain points.
• 13:19
  SPEAKER_00: So I think like it can be a real like a real blank space that can be distressing as well.
• 13:23
  SPEAKER_02: It's super distressing, and I can relate to that.
• 13:25
  SPEAKER_02: And so, you know, I often will work really hard to validate the experience and emotion and provide a lot of psychoeducation about, you know, our brains protect us by not by not encoding scary information.
• 13:39
  SPEAKER_00: Yeah, I like to use you know how I love a metaphor.
• 13:41
  SPEAKER_00: You do love a metaphor.
• 13:42
  SPEAKER_00: And I'm sure our audience knows that by this point, too.
• 13:45
  SPEAKER_00: I always describe it to my patients that I work with in terms of trauma, that it's like the brain is watching a television, probably more likely nowadays in old-timey television, and something scary is on the TV.
• 13:57
  SPEAKER_00: And so the brain is seeing this coming on the TV and is scared and unplugs the television, but that doesn't mean the event is not occurring.
• 14:05
  SPEAKER_01: Mm-hmm.
• 14:06
  SPEAKER_00: And it's still like somehow being processed or being recorded and encoded.
• 14:10
  SPEAKER_00: Yes.
• 14:10
  SPEAKER_00: But just not where the brain can conscientiously or consciously, I should say, yeah, connect to it.
• 14:15
  SPEAKER_02: It's stored in the unconscious or segregated, we like to say, in trauma world.
• 14:19
  SPEAKER_02: It's sort of split off from conscious knowing, but we continue to act and feel as though right, we're still experiencing the trauma.
• 14:27
  SPEAKER_02: So it's wild.
• 14:29
  SPEAKER_02: And for people with CPTSD, it it incurs a lot of shame.
• 14:33
  SPEAKER_02: You know, that there are such strong reactions without really being able to know.
• 14:37
  SPEAKER_02: And it just it just takes time and practice kind of digging in right to childhood and starting to make those connections, but it can be challenging.
• 14:45
  SPEAKER_02: So re-experiencing is common for PTSD and CPTSD, just in different ways.
• 14:50
  SPEAKER_02: Right.
• 14:51
  SPEAKER_02: Um, and then we have avoiding the trauma.
• 14:54
  SPEAKER_02: Okay.
• 14:55
  SPEAKER_02: So I think for people with complex trauma, it would be really challenging to just be aware of the trauma a hundred percent of the time, right?
• 15:06
  SPEAKER_02: So overwhelming.
• 15:07
  SPEAKER_02: Yeah, there are various ways that we we tr we try to avoid really thinking about or feeling the tr the trauma.
• 15:15
  SPEAKER_00: I think for some folks that might be like avoiding like certain let's let's let's say there was traumatic events that occurred to you in a certain city or region, or maybe um for other patients I've had it's might been a person with a certain hair color.
• 15:28
  SPEAKER_00: Yeah, yeah, for sure.
• 15:29
  SPEAKER_00: And they just have really strong reactions that they vaguely understand is traumatic and and and stressful, so therefore they avoid hardcore anyone with characteristics or features or areas places, anything that reminds them of the trauma.
• 15:45
  SPEAKER_02: That's that's external avoidance, and then I think many of us do a lot of internal avoidance where we may um you know purposefully try to push thoughts or memories out of our mind or stay very distracted or busy, um, you know, or minimize.
• 16:02
  SPEAKER_02: Right.
• 16:02
  SPEAKER_02: Would that also look like avoiding emotions?
• 16:05
  SPEAKER_02: Uh yeah, I think, yeah, yeah, I definit definitely.
• 16:08
  SPEAKER_02: I think there are certain emotions that are that can be really challenging in the present day because there was not a ability to express or you know, really experience safely experience safely as a kid.
• 16:22
  SPEAKER_02: So we don't want to experience them as an adult.
• 16:25
  SPEAKER_02: Anger is a really common one, right?
• 16:27
  SPEAKER_02: I think for for us.
• 16:28
  SPEAKER_02: Absolutely, you know.
• 16:29
  SPEAKER_02: Um so yeah, avoidance either externally or internally.
• 16:34
  SPEAKER_02: More broadly with CPTSD, there may be a general avoidance of vulnerability, right?
• 16:41
  SPEAKER_02: Um area of weakness, relationship.
• 16:44
  SPEAKER_02: Any perceived area of weakness.
• 16:46
  SPEAKER_02: Um there may be a total avoidance of conflict.
• 16:52
  SPEAKER_02: Right.
• 16:52
  SPEAKER_02: So there's like it really, you know, with with PTSD, it's it's it's more discreet because it's more about this sort of specific kind of trauma or single event.
• 17:02
  SPEAKER_02: Whereas for perceived PTSD, we avoid certain relationship patterns or expressions of particular emotions or kind of erase or wipe out, you know, total that the certain like like you said, the conflict avoidance, things like that.
• 17:14
  SPEAKER_02: Yeah, exactly.
• 17:15
  SPEAKER_02: Yeah.
• 17:16
  SPEAKER_02: So yeah, and then there's the persistent Yeah, persistent, persistent negative self-evaluation.
• 17:23
  SPEAKER_01: Mm-hmm.
• 17:24
  SPEAKER_02: That's with CPTSD for sure.
• 17:26
  SPEAKER_02: Right.
• 17:26
  SPEAKER_02: Um, but for both CPTSD and PTSD, there is also the persistent threat, the for persistent fear, right?
• 17:34
  SPEAKER_02: As like the third kind of symptom for both.
• 17:37
  SPEAKER_00: The hypervigilance, yes, the hyperarousal.
• 17:41
  SPEAKER_00: Yes that can be really hard and physiologically and physically exhausting.
• 17:46
  SPEAKER_00: Mm-hmm.
• 17:46
  SPEAKER_00: Because your body is constantly, literally on alert.
• 17:51
  SPEAKER_02: Yes.
• 17:51
  SPEAKER_02: So hypervigilance, definitely, um again, the exaggerated startle response.
• 17:58
  SPEAKER_00: Yeah, someone shutting a door, um, not in a loud manner.
• 18:01
  SPEAKER_00: Um someone even walking up behind you and touching you from behind.
• 18:04
  SPEAKER_00: Mm-hmm.
• 18:05
  SPEAKER_02: Yeah, so that being really s you know, s really scary and you're kind of easily startled.
• 18:10
  SPEAKER_02: Um difficulty with sleep.
• 18:12
  SPEAKER_02: Yes.
• 18:13
  SPEAKER_02: Right?
• 18:13
  SPEAKER_02: And nightmares.
• 18:15
  SPEAKER_00: Because if you're hyper if you're hyper uh vigilant or uh you have hyperarousal, but to get into restful sleep or really sleep in general, your body has to be in a relaxed state, which is the antithesis or opposite of hypervigilance.
• 18:29
  SPEAKER_00: So sleep is really, really hard for these folks.
• 18:32
  SPEAKER_02: Yeah.
• 18:33
  SPEAKER_02: Um and also I think one that's uh more common with CPTSD is this um developing this really uncanny ability to scan people's moods and facial expressions and tone of voice.
• 18:50
  SPEAKER_02: People with CPTSD are usually incredibly sensitive to changes in tone of voice, um, you know, facial expressions, mood.
• 19:01
  SPEAKER_02: Um, it was particularly handy if you had to manage a parent's moods growing up or needed to know if something was going to upset or anger your parent or just any person you're in a relationship with, it's protective.
• 19:17
  SPEAKER_02: Um but because of that, there's extreme sensitivity um to these kinds of changes.
• 19:24
  SPEAKER_02: Sure.
• 19:24
  SPEAKER_02: And and and often there is a misinterpretation of those changes in mood and in, you know, posture, body language, all that stuff.
• 19:33
  SPEAKER_00: And for example, if you have CPT PTSD and you know, your partner comes home in a negative place and maybe it's completely and totally unrelated to you or anything about you, right?
• 19:44
  SPEAKER_00: But you might automatically assume some level of relational discord or discomfort.
• 19:49
  SPEAKER_00: Yes.
• 19:49
  SPEAKER_00: And personalize something that is not connected to the dynamic.
• 19:53
  SPEAKER_02: Right, right, right, right.
• 19:54
  SPEAKER_02: Because disconnection or or conflict or some kind of you know, or rejection or abandonment, all that stuff comes up um really automatically for someone with unhealed CPTSD.
• 20:08
  SPEAKER_02: So um, you know, it's it's we're we're real good at scanning and seeing the shift.
• 20:15
  SPEAKER_02: Usually correct.
• 20:16
  SPEAKER_02: But the interpretation is not necessarily correct.
• 20:20
  SPEAKER_02: Yeah.
• 20:20
  SPEAKER_02: Um, so in your example.
• 20:22
  SPEAKER_00: Well, and I think about my past work with children in foster care, that kind of scanning ability um is adaptive in one environment, and adaptive in an environment that is um chaotic or dangerous or unsafe, and that same ability is not adaptive in a relatively safe, stable home.
• 20:42
  SPEAKER_00: It becomes problematic.
• 20:44
  SPEAKER_02: Right, yeah, r yes, yes, exactly, which is you know why PTSD and CPTSD um can cause lots of problems in our in our relationships or just in our functioning if we're in a safe place now, but we're still reacting as though the trauma is occurring.
• 21:01
  SPEAKER_00: I think we also should mention, and this might be sort of a an aside, um, people can have index traumas and have CPSD symptoms.
• 21:11
  SPEAKER_00: Like so they're not it's not always a clear divide.
• 21:13
  SPEAKER_00: Sometimes it is.
• 21:14
  SPEAKER_00: What do you mean index traumas?
• 21:16
  SPEAKER_00: So an index trauma would be like we've talked about like a sexual assault or a severe car accident or maybe being robbed or a military experience, and also still have the relational element that comes from developmental trauma.
• 21:28
  SPEAKER_02: Yeah, that's true.
• 21:29
  SPEAKER_02: Yes, you could have PTSD and CPTSD both.
• 21:32
  SPEAKER_02: Right.
• 21:33
  SPEAKER_02: Um that's very true.
• 21:35
  SPEAKER_02: And I I I don't know the research on this, but there may be you know, I I think there could totally be a link between childhood trauma and eventually there is you know, some kinds of of jobs that re where there is trauma.
• 21:50
  SPEAKER_00: Yeah, no, I I actually have a little bit of awareness of this literature that, you know, when you have traumatic events in childhood, there's a lot of negative outcomes possible, unfortunately.
• 21:59
  SPEAKER_00: Um And the reality is that it can help push you towards helping professions and helping areas and also sort of like propel you towards sort of healing yourself by healing others or helping others.
• 22:13
  SPEAKER_00: Oh my gosh, there's a reason why I'm in this field.
• 22:15
  SPEAKER_02: I mean, there's a lot of things.
• 22:17
  SPEAKER_02: I'm in this field.
• 22:18
  SPEAKER_02: It makes so much sense and I love it.
• 22:21
  SPEAKER_02: But it has been a journey for me to tease apart some of the secondhand trauma and how that impacts my nervous system because of my developmental trauma.
• 22:30
  SPEAKER_02: Right.
• 22:30
  SPEAKER_02: Yeah.
• 22:31
  SPEAKER_02: Yeah.
• 22:31
  SPEAKER_02: Yeah, for sure.
• 22:33
  SPEAKER_02: So yes, you could have all the you could have all of it.
• 22:36
  SPEAKER_02: Um and and yes, certainly having developmental trauma predisposes you to having other kinds of trauma in your life later, unfortunately.
• 22:44
  SPEAKER_00: Yeah, any type of traumatic event, unfortunately, increases the likelihood of risk.
• 22:49
  SPEAKER_02: Right, right, right.
• 22:50
  SPEAKER_02: Um okay, so those are the three overlapping symptoms between PTSD and CPTSD.
• 22:56
  SPEAKER_02: Re-experiencing the trauma, avoiding the trauma in some kind of way, and then feeling still like there's a threat, even when there's even when you're really objectively safe.
• 23:08
  SPEAKER_02: Um for CPTSD, there are a few additional symptoms.
• 23:13
  SPEAKER_02: Um and so one is difficulty regulating emotions.
• 23:19
  SPEAKER_02: Okay.
• 23:20
  SPEAKER_02: If you have listened to our previous episodes on child development, I think we have hammered home.
• 23:26
  SPEAKER_02: Have we hammered enough?
• 23:27
  SPEAKER_02: In a million episodes, how important you know, like co-regulation is.
• 23:32
  SPEAKER_02: Right.
• 23:33
  SPEAKER_02: And how children develop their ability to regulate emotions at least partially from their caregivers, their caregivers' nervous systems and their own ability to regulate their own and and co-regulate with their kids.
• 23:46
  SPEAKER_02: So as you can imagine, if you grow up in a home where it is chaotic or unpredictable or neglectful or abusive, um, these parents are going to be having a much harder time with co-regulation and and helping teach.
• 24:03
  SPEAKER_00: Yeah, and and for unfortunately for some of them, it's that's not even on the radar.
• 24:08
  SPEAKER_02: They did, you know, of course, because we, you know, it this is all intergenerational.
• 24:12
  SPEAKER_02: Of course, these parents probably grew up with parents who who who had a hard time themselves.
• 24:18
  SPEAKER_02: And so this stuff not only gets passed down behaviorally, it gets passed down genetically.
• 24:23
  SPEAKER_02: Correct.
• 24:23
  SPEAKER_02: Epigenetics, it literally like gets coded into our genetics, and and and so it's very it's challenging.
• 24:30
  SPEAKER_02: Um, but difficulty with emotion regulation is really um ke key for CPTSD.
• 24:38
  SPEAKER_00: Um there's a lot of extreme extreme emotional responses, not understanding your emotions, and then that might be where the emotional avoidance would come in for some folks because they don't know how to manage that experience.
• 24:53
  SPEAKER_00: Oh, yeah.
• 24:55
  SPEAKER_02: Yeah, so then you can see you could see the opposite extreme where there is a lot of numbing and avoidance um for sure.
• 25:02
  SPEAKER_00: Just cut it from your body.
• 25:03
  SPEAKER_02: Yeah, there's there's usually some kind of either overactivation, like flooding of the nervous system, extreme panic or irritability.
• 25:13
  SPEAKER_02: Um, and this looks like mood swings.
• 25:15
  SPEAKER_02: So a lot of times these folks get misdiagnosed bipolar or or borderline personality disorder.
• 25:21
  SPEAKER_02: And of course you can have right, you could you could you could have multiple, you know, diagnoses, but um, you get the really rapidly shifting mood swings with CPTSD.
• 25:32
  SPEAKER_02: Um and then um there is also the um persistent negative self-concept, right?
• 25:42
  SPEAKER_02: Right.
• 25:43
  SPEAKER_00: Yeah, the negative self-concept um is something that's really interesting and I talk a lot about with folks because I think it's so important to understand because it's literally it how I describe it and and view it pro professionally is it's the lens from which you view everything.
• 25:56
  SPEAKER_00: It's how you view yourself, um, your interactions, your ability, mm-hmm and the situation at large.
• 26:04
  SPEAKER_00: So I think that's yeah, pretty pervasive.
• 26:08
  SPEAKER_02: Yeah.
• 26:08
  SPEAKER_02: I mean self-esteem is developing throughout childhood.
• 26:11
  SPEAKER_02: So kids don't have the ability to make sense of why their parents are treating them, their caregivers or treating them the way that they are.
• 26:20
  SPEAKER_02: Um so they assume it's because they're bad.
• 26:23
  SPEAKER_02: Um, they're broken, defective, there's something inherently wrong.
• 26:28
  SPEAKER_02: Um, and so that is what we you know, I've mentioned it before is toxic shame.
• 26:32
  SPEAKER_02: It's pervasive.
• 26:33
  SPEAKER_02: Right.
• 26:34
  SPEAKER_02: And it's not just about the traumatic event with PTSD.
• 26:37
  SPEAKER_02: You know, you may conclude because you, you know, were assaulted potentially, it's because you're bad or there's something wrong with you.
• 26:45
  unknown: Right.
• 26:45
  SPEAKER_02: But for CPTSD, the shame is just ever present.
• 26:49
  SPEAKER_02: Colors everything.
• 26:50
  SPEAKER_02: Very harsh inner critic, sort of all of the time.
• 26:53
  SPEAKER_02: Yeah.
• 26:54
  SPEAKER_02: Um, and then difficulty with relationships.
• 26:57
  SPEAKER_00: Yeah.
• 26:58
  SPEAKER_00: Uh I think it's when you feel really horrendous about yourself in every context, it's hard to be an engaged, supportive, open partner.
• 27:08
  SPEAKER_00: Sure, yeah.
• 27:09
  SPEAKER_00: Um, because you're kind of so consumed with that all that all-encompassing feeling of shame, unfortunately.
• 27:14
  SPEAKER_02: Yeah, and I do I will say that for you people who are more in the avoidance, they're they're more in the avoidant part of CPTSD, they may not be super aware of that inherent shame.
• 27:26
  SPEAKER_02: Right.
• 27:27
  SPEAKER_02: Um, I would say that through a series of really activating events in my life, I moved from someone who was much more in avoidance about my complex trauma to someone who is more activated.
• 27:40
  SPEAKER_02: Um, and so then that shame becomes more obvious.
• 27:43
  SPEAKER_02: But for for many people with CPTSD, they might not actually recognize many of these symptoms until they get in there and really start doing work.
• 27:51
  SPEAKER_02: Um, but people with CPTSD and relationship troubles are extremely sensitive to rejection, criticism.
• 27:58
  SPEAKER_02: Yeah, um, any feedback is personalized.
• 28:02
  SPEAKER_02: It it more often than the time can be personalized.
• 28:04
  SPEAKER_02: It triggers that toxic shame.
• 28:07
  SPEAKER_02: Um a lot of hyper-vigilance in relationships, push pull.
• 28:12
  SPEAKER_02: I really want to get close, but that terrifies me.
• 28:15
  SPEAKER_02: Right.
• 28:16
  SPEAKER_02: Because we've learned that closeness equals danger.
• 28:19
  SPEAKER_02: So there's a lot of like, I want to get close and then I'm gonna pull away.
• 28:22
  SPEAKER_02: Or I really want support, but I'm gonna push you away.
• 28:26
  SPEAKER_02: Um it's very confusing for others.
• 28:28
  SPEAKER_02: And then extreme fear of rejection and abandonment, usually with complex trauma.
• 28:34
  SPEAKER_02: Right.
• 28:34
  SPEAKER_00: Okay.
• 28:35
  SPEAKER_00: So what other elements would you say that CPTSD has that are distinct from post-traumatic stress disorder?
• 28:44
  SPEAKER_02: Um, usually with CPTSD, so we've talked about perfectionism on this show.
• 28:49
  SPEAKER_02: We have people with CPTSD are a lot more likely to develop perfectionism.
• 28:54
  SPEAKER_02: Um, if I can do everything perfectly, nobody will reject me, no one will hate me, and no one will leave me, and nothing will bad will happen.
• 29:01
  SPEAKER_02: Right.
• 29:02
  SPEAKER_02: Um there's also emotional flashbacks, which we've already talked about.
• 29:06
  SPEAKER_02: Um, the younger regress states.
• 29:08
  SPEAKER_02: So people with CPTSD intellectually know that they are an adult.
• 29:13
  SPEAKER_02: They know usually what the appropriate response is.
• 29:17
  SPEAKER_02: They know that their reactions are disproportionate.
• 29:19
  SPEAKER_02: They understand they have problems and relationships, but when those younger, wounded, unhealed parts emerge, they they start driving that bus, and there's nothing you can do to stop it until you develop right the the ability to, right?
• 29:37
  SPEAKER_02: Um you have to learn how to sort of wrangle those parts and really kind of like approach situations in an integrated adult self.
• 29:46
  SPEAKER_02: Um which is is really hard work.
• 29:48
  SPEAKER_00: Um it's it's incredibly hard work, yeah.
• 29:51
  SPEAKER_00: And and important.
• 29:53
  SPEAKER_00: And I think especially when you look at that, I think those parts are still kind of kind of trapped in a in a system of believing that they're at a different age and they're still under under threat.
• 30:02
  SPEAKER_00: And so helping them know that you're safe today in your in your body and that nothing scary or dangerous is happening.
• 30:08
  SPEAKER_02: Mm-hmm.
• 30:08
  SPEAKER_00: It takes a while to I think we should connect.
• 30:11
  SPEAKER_02: I think it would be helpful to have an episode on reparenting, um, and to talk a bit more intentionally about healing.
• 30:18
  SPEAKER_00: Yes.
• 30:18
  SPEAKER_02: Trauma and CPTSD.
• 30:20
  SPEAKER_02: Um there's lots of different ways and models, but Yeah, that definitely sounds like something to explore together.
• 30:25
  SPEAKER_00: Yeah.
• 30:26
  SPEAKER_00: Um we both have experience on that, different sides of that, and I think that would be really, really tremendous.
• 30:30
  SPEAKER_02: Yeah, I think it would be really helpful.
• 30:32
  SPEAKER_02: So those are some other kind of thing, you know, sort of syndromes or s or symptoms that are common with CPTSD that are not necessarily in the um in in the diagnosis or or whatever kind of speaking of the diagnosis, I think it also bears um um stating that CPTSD is not a formal diagnosis recognized.
• 30:53
  SPEAKER_02: The labels are a bit different.
• 30:54
  SPEAKER_02: So it's the it's the ICD 11 I think so.
• 30:57
  SPEAKER_02: Is that what it is?
• 30:58
  SPEAKER_02: It's the m it's a European version, right?
• 31:01
  SPEAKER_02: Of the DSM.
• 31:03
  SPEAKER_02: I'm probably getting that incorrect.
• 31:05
  SPEAKER_02: But essentially CPTSD is a label not used in the United States.
• 31:09
  SPEAKER_02: Right.
• 31:09
  SPEAKER_02: Um in the DSM, which we use in the United States, it would be coded PTSD but chronic.
• 31:14
  SPEAKER_02: Correct.
• 31:15
  SPEAKER_02: Um so different labels but similar.
• 31:18
  SPEAKER_00: Slight nuance in the language, but important.
• 31:21
  SPEAKER_00: Right.
• 31:22
  SPEAKER_00: Okay.
• 31:23
  SPEAKER_00: Well, uh what are you taking away from today's conversation about these two um somewhat overlapping but also distinct experiences and diagnosis?
• 31:33
  SPEAKER_02: Um yeah, for I don't know, for whatever reason, I'm having a lot of right now, a lot of gratitude for my patients with CPTSD and in various traumas.
• 31:43
  SPEAKER_02: I really I really love working with trauma.
• 31:46
  SPEAKER_02: Um it's something that I'm really passionate about and have unfortunately, you know, had a history of myself.
• 31:52
  SPEAKER_02: So it it I do often feel it's really nice to be able to connect with with my patients and um for them to feel understood.
• 32:02
  SPEAKER_02: And it's it's helpful for me too as I see their progress and what I need to be doing for myself.
• 32:06
  SPEAKER_02: And yeah, so it's like we're growing up together almost a little bit with my patients.
• 32:12
  SPEAKER_00: I think it reminds me of something, and I feel very similar.
• 32:15
  SPEAKER_00: It's like I developed this after working at the the one of the VAs um in Texas here, is that I I really experience like it's a real honor to walk with someone towards mental health.
• 32:25
  SPEAKER_00: Yeah.
• 32:26
  SPEAKER_00: Like it's a privilege, you know?
• 32:27
  SPEAKER_00: Yeah, I agree.
• 32:28
  SPEAKER_00: To aid in that recovery.
• 32:30
  SPEAKER_00: So well, I really appreciate your thoughtful, like you are so knowledgeable and thorough, and so I love listening to you, pontificate.
• 32:37
  SPEAKER_02: Thank you so much.
• 32:39
  SPEAKER_02: She's over there like wrap it up.
• 32:41
  SPEAKER_02: Yeah, she like actually she was.
• 32:43
  SPEAKER_00: She was other reasons.
• 32:45
  SPEAKER_00: Other reasons.
• 32:46
  SPEAKER_00: Um, but I really do think this has been a really helpful conversation.
• 32:51
  SPEAKER_00: Just derailing us right at the end.
• 32:53
  SPEAKER_00: Sorry, this is my vulnerability push-ball.
• 32:56
  SPEAKER_02: I'm like, ugh.
• 32:57
  SPEAKER_02: You didn't do anything.
• 32:59
  SPEAKER_02: Let me be funny and create some distance.
• 33:01
  SPEAKER_00: No, I'm gonna chase you.
• 33:02
  SPEAKER_00: I'm gonna emotionally chase you so you emotionally hold me back.
• 33:06
  SPEAKER_00: That's our relationship literally in a nutshell.
• 33:10
  SPEAKER_00: Well, guys, um ending this session on a moment of brevity is really part of our dynamic and our friendship.
• 33:16
  SPEAKER_00: We love this work.
• 33:17
  SPEAKER_00: We love um treatment of trauma, and so we hope you guys can find something beneficial about this episode, and we'll catch you in the next one.
• 33:37
  SPEAKER_00: This podcast is intended for informational and educational purposes only, and is not a substitute for therapy, diagnosis, or any kind of professional mental health treatment.
• 33:47
  SPEAKER_00: We hope that we can share with you our experience authentically and genuinely, and we hope that occasionally we'll make you laugh.
• 33:53
  SPEAKER_00: Maybe you can relate to our quest and how we're psyched for sanity.
• 33:57
  SPEAKER_00: The content we share is um our personal opinions and insights.
• 34:00
  SPEAKER_00: They are not clinical insights to anyone, and they don't represent or reflect any entity that we work in or have worked for in the past.
• 34:07
  SPEAKER_00: But if listening to this podcast has made you think, we really encourage you to seek out a mental health professional in your area.