After painful or life-threatening events, we may experience ongoing stress related to that trauma. If this stress continues, it may develop into Post-Traumatic Stress Disorder (PTSD), which has been steadily receiving more and more media attention in the last several years. There is a lesser-known related condition called Complex Post-Traumatic Stress Disorder (C-PTSD), which arises from repetitive or chronic trauma. This complex trauma often results from relationship-based trauma, such as attachment trauma or developmental trauma in childhood.
What’s the difference between PTSD and C-PTSD?
PTSD and Complex-PTSD share symptom clusters, or groups of related symptoms. However, C-PTSD includes three additional symptoms: difficulty regulating emotions, a lack of continuity in identity and self-worth, and challenges maintaining long-term relationships. Since C-PTSD often results from relational trauma, its symptoms are primarily interpersonal and intrapersonal. While these symptoms are often seen as problems to be solved, it can be helpful to reframe them as coping mechanisms. Just as our bodies develop a fever to fight infections, our minds develop these responses and tendencies as ways to cope with traumatic experiences. By framing these symptoms as our minds’ (misguided) efforts to help us, it can allow us to show ourselves more compassion if we’re struggling to manage these symptoms.
What do these symptoms look like in daily life?
When your body’s stress response and your mind’s maladaptive coping persist, this can lead to Complex-PTSD. One of the key aspects affected by complex trauma is a person’s ability to mentalize. Mentalization involves understanding one’s and others’ intentional mental states, and recognizing the differences in perspectives. In other words, mentalization allows you to (literally) think about walking in your shoes and walking in someone else’s. It’s essential for empathy development, but complex trauma can impair your capacity to incorporate other social influences into these mental thought processes.
Another aspect influenced by complex trauma is a person’s ability to regulate their emotions. As children are growing up, they rely on their caregivers and other adults around them to help them understand emotions that they may not be able to grasp yet. This practice of being responsive in moments to a distressed person’s emotions and then helping them soothe and understand those emotions is called “marked mirroring.” When a child doesn’t experience enough marked mirroring from their caregivers, they may struggle to learn how to soothe and understand their difficult emotions, ultimately leading to poor emotional regulation or emotional dysregulation. This can then result in further maladaptive coping behaviors, such as unsafe sex, self-harm, or substance misuse, which are ultimately attempts at self-regulation (even if they are not actually helpful or sustainable).
An overactive amygdala can send fear into overdrive
The amygdala, the fear center of our brain, plays a vital role in how we code memories associated with emotions. For those who have experienced complex trauma, their amygdala can be overly “protective,” leading to an “amygdala hijack.” In other words, our amygdala is always on alert and takes charge of responding to moments or experiences that seem stressful. Even minor perceived threats in relationships may trigger extreme flight, fight, or freeze responses, leading to strained connections. These heightened responses can also lead to distorted perceptions of oneself and others, intensifying feelings of being misunderstood and creating an overwhelming sense of injustice.
A tendency to think only in heroes and villains, and nothing in-between
People with C-PTSD may also experience a thought and behavioral pattern known as “splitting,” where they view the world, themselves, and others in only black-and-white terms. For example, they may be able to see themselves only as a ‘good’ or ‘evil’ person, or relationships with others as only ‘healthy’ or ‘unhealthy.’ This lack of tolerance for ambiguity or the middle-ground can make it challenging to maintain relationships and form a coherent sense of self, as people are complicated and do not exist in only the good or the bad. To cope with this internal chaos, they might base their identity on external markers like achievements, personality test results, or other markers that feel more tangible.
A fear of intimacy
While desiring closeness and connection is innate, those with relational trauma might fear intimacy due to past experiences of hurt and abandonment. Being vulnerable with another person can trigger emotional memories of pain, making it challenging to engage in genuinely intimate relationships. This can become a self-reinforcing loop too. If you are afraid to be vulnerable with someone, you might pull away from relationships, and in doing so, the other person pulling away as well can make it even scarier to try to be vulnerable next time.
Other considerations
Research suggests that trauma, particularly complex trauma, increases vulnerability to other conditions such as borderline personality disorder (or borderline-like features). While symptoms of C-PTSD and BPD may appear similar, there are significant differences between the two, and it is important to work with a mental health professional who can help distinguish any potentially similar symptoms.
What does C-PTSD look like in the context of Asian and Asian American culture?
In Asian and Asian American culture, the concept of trauma often encompasses more than just external events. Trauma can encompass a complex interplay of cultural values, family dynamics, societal expectations, and other subtle yet impactful experiences that people encounter throughout their lives. Many Asian cultures are collectivist and emphasize family honor, respect for authority, and conformity to societal norms. These cultural norms and familial and community expectations can create a unique backdrop for the development of complex trauma. For example, the pressure to excel academically, professionally, and socially can place significant burdens on children, especially young ones.
The fear of disappointing family members or failing to live up to perceived ideals can give rise to a constant sense of inadequacy and self-doubt. As a result, children may suppress their emotions and personal needs, prioritizing the expectations of others over their own well-being. This emotional suppression can become an ingrained coping mechanism, leading to an erosion of self-awareness and a difficulty in expressing emotions openly as an adult.
In some cases, Asian and Asian American parents or caregivers may adopt a parenting style that relies heavily on discipline and strict adherence to rules. While done with the intention of nurturing success, these parenting practices may lack emotional attunement and validation, and may inadvertently lead to emotional neglect. Additionally, intense punishments (or abuse) for perceived mistakes or failures can create lasting wounds and contribute to feelings of abandonment and rejection. The lack of emotional validation in combination with harsh or severe discipline can result in not only poor emotional regulation but also a distorted sense of self-worth and a poor sense of self-esteem.
Note: It is essential to recognize that Asian and Asian American cultures are diverse and multifaceted, with varying beliefs, practices, and experiences. Individuals within these communities may not have the same encounters with complex trauma, and cultural factors may also serve as protective resources and sources of resilience.
Are there any strengths related to C-PTSD?
While it can be difficult to see the strengths in a condition like C-PTSD, it can be helpful to think about the skills that have developed in order to help you survive these traumatic experiences. Children who did not receive support from their caregivers and were forced to learn responsibilities beyond their age grow into adults who are independent, persistent, and reliable. They are often very capable and competent, and can face and solve challenging situations that may be overwhelmingly stressful for their same-age peers (who did not experience similar trauma).
Children who experienced abuse or domestic violence in the home also become observant and skilled at picking up subtle cues, which can ultimately help them become empathetic adults. Additionally, because they may not have had the best relationships in their childhood, these adults often care a lot about their relationships and try their best to be considerate of all their connections.
Treating C-PTSD in Therapy: A Journey of Strength and Healing
If you recognize or suspect C-PTSD in yourself, there’s hope for healing. C-PTSD doesn’t define you or determine your future – it’s a group of symptoms that can be addressed through therapy. The foundational goal of therapy is to establish a supportive and honest therapeutic relationship, fostering trust, mentalization, mindfulness, and emotional regulation skills. The short-term goal involves reducing maladaptive coping behaviors, while the long-term goal focuses on processing early relational trauma.
This process can be challenging, but it leads to emotional resilience and meaningful growth. By creating new neural pathways, processing allows us to remember the past in empowering ways. Remember, healing doesn’t erase the past; it transforms it into hope for the future. Together, we can embrace the strength within us to overcome the effects of complex trauma and embark on a journey of healing and growth.
Forgiving does not erase the bitter past. A healed memory is not a deleted memory. Instead, forgiving what we cannot forget creates a new way to remember. We change the memory of our past into a hope for our future.
Lewis B. Smedes
Begin Working with An Asian American Therapist in Los Angeles, CA, and New York, NY
At our Los Angeles, CA, and New York City, NY-based therapy practice, we have many trauma-informed, culturally sensitive therapists who can help you navigate complex trauma in the context of your cultural upbringing. For your added convenience and simplicity, we offer online therapy for anyone in the state of California or New York. We know that your mental health is important, and we want to help you work through whatever’s holding you back. Follow the steps below to begin.
- Fill out the contact form to get connected with us.
- Get matched with a skilled therapist.
- Start processing the ways that complex trauma may be impacting you.
Other Services at Yellow Chair Collective
There are many options for treatment using online therapy in California and New York, it just depends on what you’re needing. And while we certainly service Asian American folks, we also work with individuals from other cultures, too. So, whether you’re needing support in overcoming anxiety, burnout, trauma, or PTSD, we can help. Likewise, we serve teens and couples in need of support, too. So when you start online therapy with us, you can bring your whole self, including past struggles, cultural impacts, and more.
References:
- Jordan, J. V. (2017). Relational–Cultural Therapy (Theories of Psychotherapy Series) (Second ed.). American Psychological Association.
- Luyten, P., Campbell, C., & Fonagy, P. (2019). Borderline personality disorder, complex trauma, and problems with self and identity: A social‐communicative approach. Journal of Personality, 88(1), 88–105. https://doi.org/10.1111/jopy.12483
- Lanfredi, M., Macis, A., Ferrari, C., Meloni, S., Pedrini, L., Ridolfi, M. E., Zonca, V., Cattane, N., Cattaneo, A., & Rossi, R. (2021). Maladaptive behaviors in adolescence and their associations with personality trait, emotional dysregulation and other clinical features in a sample of Italian students: a cross-sectional study. Borderline Personality Disorder and Emotional Dysregulation, 8(14). https://doi.org/10.1186/s40479-021-00154-w
- Montgomery-Graham, S. (2016). DBT and schema therapy for borderline personality disorder: Mentalization as a common factor. Journal of Contemporary Psychotherapy: On the Cutting Edge of Modern Developments in Psychotherapy, 46(1), 53–60. https://doi.org/10.1007/s10879-015-9309-0
- Symptoms of PTSD – Page 7 – PTSD UK. (n.d.). https://www.ptsduk.org/what-is-ptsd/symptoms-of-ptsd/7/
- Tanasugarn, A. (2020, June 5). Is it borderline personality disorder or is it really complex PTSD? Psychology Today. https://www.psychologytoday.com/gb/blog/understanding-ptsd/202006/is-it-borderline-personality-disorder-or-is-it-really-complex-ptsd
