For my 90th article I am writing a series of articles on complex post-traumatic stress disorder (CPTSD).
I am a full time Transformative Life Coach (TLC). But it wasn’t always that way. I was a reconstructive trauma and cancer surgeon for over 20 years. 36 percent of UK surgeons have trauma symptoms, and 12 percent of UK surgeons have post traumatic stress disorder (PTSD). There is one suicide every 40 seconds. What made me change professions? I realised that the only true goal in life is to find peace, love, joy, and serenity. We chase accolades, ‘imitation love’, and external validation as if they were oxygen. They are not: They are poison. My role now, as a deep coach, is to guide you, very gently yet powerfully, to total wellbeing and abundant success, in line with your true Self and purpose.
Post-traumatic stress disorder (PTSD)
Disclaimer: I am a doctor and an academic scientist. If you need therapy, you need to get in touch with a psychotherapist. These notes and musings are summaries of what I have learned in the last four years on my own journey to wellbeing as an academic doctor. I am not a therapist. But I can share my learnings during the last four years about how to get well from my personal perspective. I am not giving this advice as a medical doctor, but as a fellow journeyman. I have been where you are. I am delighted to help men recover from their spiritual dis-ease - from what they don’t even know that they are ill with. Do get in touch if you want to continue this conversation at hello@transformativelifecoach.co.uk
I am an adult survivor of childhood trauma and emotional abuse, having grown up in a severely dysfunctional family, dominated by my mother. I grew up in a variety of houses that were never homes, in a family that was as loveless as an old-school orphanage. I felt unwanted, unloved, unworthy, rejected, and hated by my own mother. Trauma gets engrained in your mind, body and soul. These notes are from the amazing book by Pete Walker ‘Complex PTSD: From Surviving to Thriving.’ It is a veritable and self-declared comprehensive self-help guide for working through the toxic legacy of the past on the individualised journey to achieving a rich and fulfilling life. It holds pride of place on my 'Suggested Reading List':
An overview of recovering
I have Complex Post Traumatic Stress Disorder (CPTSD) and am writing this from the perspective of someone who has experienced a great reduction of symptoms over the last four years through my reading and inner work. I also wrote these articles from the viewpoint of someone who has discovered many silver linings in the long, windy, bumpy road of recovering from CPTSD. We are all on a Hero’s journey: We just don’t always know that we are. If you felt unwanted, unliked, rejected, hated and/or despised for a lengthy portion of your childhood, trauma may be deeply engrained in your mind, soul and body (as a dysregulated nervous system.
Key concepts of these articles include managing emotional flashbacks, understanding the four different types of trauma survivors, differentiating the outer critic from the inner critic, healing the abandonment depression that comes from emotional abandonment and self-abandonment, self-reparenting and reparenting by committee, and deconstructing the hierarchy of self-injuring responses that childhood trauma forces survivors to adopt.
The book also functions as a map to help you understand the somewhat linear progression of recovery, to help you identify what you have already accomplished, and to help you figure out what is best to work on and prioritise now. This in turn also serves to help you identify the signs of your recovery and to develop reasonable expectations about the rate of your recovery.
I hope this map will guide you to heal in a way that helps you to become an unflinching source of kindness and self-compassion, and that out of that journey you will find at least one other human being who will reciprocally love you unconditionally in that way.
I also strongly recommend the book ‘The Body Keeps the Score: Mind Brain and Body in the Transformation of Trauma’ by Bessel van der Kolk.
So here we go…
The journey of recovering from CPTSD
There are many silver linings to CPTSD. The good news about CTPSD is that it is a learned set of responses and a failure to complete numerous developmental tasks. This means that it is environmentally, not genetically, caused. But there are many silver linings. Unlike many of the diagnoses it is confused with, it is not inborn. It is learned. It is not inscribed in your DNA. This is good news. It is caused by nurture, or rather the lack of it. What is learned can be unlearned. And vice versa. What was not provided by your parents, can now be provided by your Self and others.
Recovery from CPTSD has important self-help and relational components. The relational piece can come from authors, friends, partners, teachers, outreach contacts, recovery groups, therapists, therapeutic groups or any combination of these. This may be called “Reparenting by committee”. One must emphasise, 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 traumatising abuse and abandonment. Traumatising abuse and abandonment can occur on verbal, emotional, spiritual, and or physical levels. The author believes that we have an epidemic of traumatising 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. This is likely to be an massive under-estimate of the prevalence.
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. When abuse and neglect is multidimensional, the severity of the CPTSD worsens accordingly.
Definition of complex CPTSD
CPTSD is a more severe form of post-traumatic stress disorder (PTSD). It is delineated from this better known trauma syndrome by five of its most common and troublesome features:
1. Emotional flashbacks
2. Toxic shame
3. Self-abandonment
4. A vicious inner critic
5. Social anxiety
Emotional flashbacks are perhaps the most notable and characteristic feature of CPTSD. Survivors of traumatising abandonment are extremely susceptible 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 unlike most things in life are not all or none - flashbacks can range in intensity from subtle to truly horrific. They can also vary in duration ranging from moments to weeks on end where they devolve into what many therapists call regression.
Toxic shame, explored enlighteningly by John Bradshaw in ‘Healing the Shame that Binds’ obliterates a CPTSD survivors 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 traumatising parent. Toxic shame can also be created by constant parental neglect and rejection.
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 an intensely painful alienation of the abandonment mélange. A ruling morass of shame, fear and oppression. The abandonment mélange is the fear and toxic shame that surrounds and interacts with the abandonment depression. The abandonment depression itself is the deadened, dissociated feeling of helplessness and hopelessness that afflicts traumatised children. Toxic shame also inhibits us from seeking comfort and support. In a re-enactment of the childhood abandonment we're flashing back to, we often isolate ourselves and helplessly surrender to an overwhelming feeling of humiliation. If you were stuck viewing yourself as worthless, defective, or despicable you are probably in an emotional flashback. This is typically also true when you were lost in self-hate and virulent self-criticism.
List of common CPTSD symptoms
Survivors may not experience all of these. Varying combinations or common factors affecting this are your 4F type (see below) and your childhood abuse neglect pattern.
· Emotional flashbacks
· Tyrannical inner and or outer critic
· Toxic shame
· Self-abandonment
· Social anxiety
· Abject feelings of loneliness and abandonment
· Fragile self-esteem
· Attachment disorder
· Developmental arrests
· Relationship difficulties
· Radical mood vacillations, for example pseudo-cyclothymia
· Dissociation via distracting activities or mental processes
· Triggered fight-flight response
· Over sensitivity to stressful situations
· Suicidal ideation
Suicidal ideation
Surgeons have a six times higher suicide rate than the general population despite our resilience. Suicidal ideations is a common phenomenon in CPTSD particularly during intense or prolonged flashbacks. Suicidal ideations is depressed thinking or fantasising about wanting to die. It can range from active suicidality to passive suicidality. Passive suicidality is far more common and it ranges from wishing you were dead to fantasising about ways to end your life. When lost in suicidal ideation the survivor may even pray to be delivered from this life. He may fantasise about being taken by some calamitous act of fate he may even think or obsess, without being serious, of stepping in front of a car or jumping off a building. Fantasy typically ends however without a serious intent to kill yourself. This is as opposed to active suicidality where the person is actively proceeding in the direction of taking their life. Passive suicidality does not result in the same kind of alarm as active suicidality. Passive suicidality is typically a flashback to early childhood where our abandonment was so profound that it was natural for us to wish that God or somebody or something would just to put an end to it all. When the survivor caches himself in a suicidal reverie he will benefit from seeing it both as an emblem of how much pain he is in and is a sign of a particularly intense flashback.
If flashback management does not help and suicidality becomes increasingly active please call the national suicide hotline on: https://www.nhs.uk/mental-health/feelings-symptoms-behaviours/behaviours/help-for-suicidal-thoughts/
The Samaritans: https://www.samaritans.org/how-we-can-help/contact-samaritan/talk-us-phone/
Or contact the Listening Place on: https://listeningplace.org.uk
Skilled therapists and caregivers learn to discriminate between active and passive suicidal ideations and do not panic and catastrophise when encountering the latter. Instead the counsellor invites the survivor to explore his suicidal thoughts and feelings knowing that in most cases verbal ventilation of the flashback pain underneath it will deconstruct the suicidality. In the much less common scenario of active suicidality encouraging verbal ventilation will also help the therapist or helper discern if there is indeed a real risk and if action needs to be taken to protect the survivor.
What you may have been misdiagnosed with
If CPTSD were ever given its due the DSM, the diagnostic and statistical manual of mental disorders, used by all mental health professionals, would shrink from its dictionary like size to the size of a thin pamphlet.
In other words the role of traumatised childhoods in most adult psychological disorders is enormous. Many clients with CPTSD are misdiagnosed with various anxiety and depressive disorders. Moreover many are also unfairly and accurately labelled with bipolar, Narcissistic, codependent, autistic spectrum, and borderline disorders. This is not to say that CPTSD does not sometimes co-occur with these disorders. Further confusion also arises in the case of ADHD (attention deficit hyperactive disorder) as well as OCD (obsessive compulsive disorder), both of which are sometimes more accurately described as ‘fixated flight responses to trauma’. This is also true of ADD (attention deficit disorder) and some depressive and associated disorders, which similarly can more accurately be described as fixated freeze responses to trauma. Furthermore, this is not to say that those so misdiagnosed do not have issues that are similar or correlative with these disorders. The key point is that these labels are incomplete and unnecessarily shaming descriptions of what the survivor is actually afflicted with. Reducing CPTSD to panic disorder is like calling food allergies chronically itchy eyes. Over focusing treatment on the symptoms of panic in the former case and eye health in the latter does little to get at root causes. Feelings of panic or itchiness in the eyes can be masked with medication but all the associated problems that cause these symptoms will remain untreated. Moreover, most of the diagnoses mentioned before are typically treated as innate characterological defects rather than as learned maladaptions to stress: Adaptations that survivors were forced to learn as traumatised children. And most importantly because these adaptations were learned they can often be extinguished or significantly diminished and replaced with more functional adaptations to stress. In this vein the author believes that many substance and process addictions also begin as misguided maladaptations to parental abuse and abandonment. They are early adaptations that are attempts to soothe and distract from the mental, emotional, and physical pain of CPTSD.
Origins of CPTSD
How do radically abused and or abandoned children develop CPTSD? While the origin of CPTSD is most often associated with extended periods of physical and or sexual abuse in, ongoing verbal and emotional abuse also causes it. Many dysfunctional parents react contemptuously to a baby or toddlers plaintive call for connection and attachment. Contempt is extremely traumatising to a child, and at best extremely noxious to an adult. Contempt is a toxic cocktail of verbal and emotional abuse: A deadly amalgam of denigration, rage and disgust. Rage creates fear and disgust creates shame in the child in a way that soon teaches her to refrain from crying out from ever asking for attention. Before long the child gives up on seeking any kind of help or connection at all. The child's bid for bonding and acceptance is thwarted and she is left to suffer in the frightened despair of abandonment.
Particularly abusive parents deepen the abandonment trauma by linking corporal punishment with contempt. Slaveholders and prison guards typically use contempt and scorn to destroy their victim’s self-esteem. Slaves, prisoners, and children who are made to feel worthless and powerless devolve into learned helplessness and can be controlled with far less energy and attention. Furthermore, CPTSD can also be caused by emotional neglect alone. Emotional neglect also typically underlies most traumatisations that are more glaringly evident. Parents who routinely ignore or turn their backs on a child's call for attention, connection, or help abandon their child to unmanageable amounts of fear and the child eventually gives up and succumbs to depressed death-like feelings of helplessness and hopelessness. These types of rejection simultaneously magnify the child's fear and eventually add a coating of shame to it over time this fear and shame begets a toxic inner critic that holds the child, and later the adult, totally responsible for his parents abandonment until he becomes his own worst enemy and descends into the bowels of CPTSD.
More about trauma
Trauma occurs when attack or abandonment triggers a fight-flight response so intensely that the person cannot turn it off once the threat is over. He becomes stuck in an adrenalised state and his sympathetic nervous system is locked on: He cannot toggle into the relaxation function of the parasympathetic nervous system. One common instance of this occurs when a child is attacked and hurt by a bully after school. He may remain in a hypervigilant fearful state until someone takes action to ensure him that he will not be re-victimised and release the hyperactivation in his nervous system. This is a child who's learned through experience that he can come to at least one of his parents when he is hurting, frightened or needing help: He will tell mom or dad about it with them - he will grieve the temporary death of his sense of safety in the world by verbally ventilating crying and angering about it. Moreover his parent will report the bully and take steps to assure that it will not happen again and the child will typically be released from the trauma it will naturally relax back into the safety of parasympathetic nervous system functioning. In this instance traumas can often be resolved relatively easily if CPTSD is not already present.
If however, the bullying happens on numerous occasions and the child does not seek help or if the child lives in an environment so dangerous that the parent is powerless to ensure a modicum of safety it may take more than parental comforting to release the trauma. If the trauma is not too continuous over too long a time a short course of therapy may be all that is needed to resolve the trauma. Provided of course that the danger in the environment can effectively be remediated.
When the trauma however is repetitive and ongoing and no help is available the child may become so frozen in trauma that the symptoms of simple PTSD began to set in this can also occur during the prolonged trauma of or a domestic violence situation. If however, a person is also afflicted by ongoing family abuse or profound emotional abandonment the trauma will manifest as a particularly severe emotional flashback. Because he already has CPTSD - this is particularly true when his parent is also a bully.
Carl Jung wrote that "The greatest burden a child must bear is the unlived life of the parents."
The 4Fs: Fight; flight; freeze; and fawn
The fight-flight response that is an innate automatic response to danger in all human beings. A more complete and accurate description of this instinct is the fight, flight, freeze, fawn response. The complex nervous system wiring of this response allows a person in danger to react in four different ways. A fight response is triggered when a person suddenly responds aggressively to something threatening. A flight response is triggered when a person responds to a perceived threat by fleeing or symbolically by launching into hyper-activity. A freeze response is triggered when a person, realising resistance is futile, gives up, numbs out into dissociation and/or collapses as if accepting the inevitability of being hurt. A fawn response is triggered when a person responds to threat by trying to be pleasing or helpful in order to appease and forestall an attacker. This fourfold response potential will heretofore be referred to as the 4Fs traumatised children often over gravitate to one of these response patterns to survive and as time passes these four modes become elaborated into entrenched defensive structures that are similar to narcissistic fight, obsessive compulsive flight, dissociative freeze or codependent fawn. These structures help children survive their horrific childhoods but leave them very limited and narrow and how they respond to life. Even worse they remain locked in these patterns and bolted into them when they no longer need to rely so heavily on one primary response pattern. It is important to understand that variances in the childhood abuse neglect patterns ,birth order. and genetic predispositions result in people polarising to their particular 4F type.
Always remember that: That which makes you fall is that which makes you rise. You can't rise without falling.
Poor parenting creates pathological sibling rivalry
Many children in CPTSD engendering families cannot turn to their siblings for comfort because her parents unconsciously practised the divide and conquer principle. Parents model and encourage sarcasm and constant fault-finding among the children. Moreover, interactions of cooperation or warmth are routinely ridiculed. Sibling rivalry is further reinforced in families by the fact that all the children are subsisting on minimal nurturance and are therefore without resources to give to each other. Moreover, competition for the little their parents have to give creates even fiercer rivalries.
If one child falls into the role of ‘gifted child’ as described by Alice Miller in ‘The Drama of the Gifted Child’, for example coming into this life with infinite compassion and a sense that if one studies one’s mother enough and figure out what she needed one could provide for her needs, this would sometimes calm her down and make her less dangerous, bitter, and sarcastic. Over the years one can hone this adaptive skill and clairvoyantly anticipate sore spots, moods, and preferences so that sometimes it seems that one can come to know what the mother needs before she does and with practise one can become adept at diffusing her anger and sometimes even gaining morsels of her approval. These are the titbits that keep us going. I was that child, having to parent my mother, in the absence of her parenting me. Parents like my mother exploit our compassionate nature and prime us for domestic servitude as long as she would need it, which meant until her next affair. We are only released from emotional captivity when this happens or when a parent dies. This is codependent enslavement. An observer who knows all the siblings as adults may marvel that it seemed as if each had different parents.
Finally, a scapegoat role does not fall exclusively on the flight type. It can be bestowed on any one of the 4F types depending on the given family. The scapegoating role can also shift over time from one person to another and each parent or sibling may choose a different scapegoat.
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Olly Alexander Branford MBBS, MA(Cantab), PhD
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I have a Bachelor's degree in Natural Sciences from Trinity College, Cambridge; a Master's Degree in Philosophy from Trinity College, Cambridge; a PhD Doctorate in Scientific Research from University College London (UCL); a Medical Degree (MD/MBBS) from The Royal Free Hospital School of Medicine, London and have been a doctor and reconstructive trauma and cancer surgeon in London for 20 years. I have published over 50 peer reviewed scientific journal articles, have been an associate editor and frequent scientific faculty member, and am the author of several scientific books. I have been awarded my Diploma in Transformative Life Coaching in London, which has International Coaching Federation (ICF) Accreditation, as well as the UK Association for Coaching (AC), and the European Mentoring and Coaching Council (EMCC). I have been on my own transformative journey full time for four years and I am ready to be your guide to you finding out who you really are and how the world works.