I recently discovered that my often-puzzling cluster of symptoms seems to precisely fit the definition of “complex PTSD” (CPTSD), which is sometimes called developmental trauma as its origin is often traced to repeated or prolonged toxic stress (such as due to physical or emotional abuse and neglect) experienced during the formative years. A frequent stress response during the critical period of brain development can fundamentally alter the architecture of the developing brain, which in turn can make the child particularly vulnerable to future stress, and potential lifelong struggles may ensue. CPTSD is, therefore, as much neurological as psychological.
This diagnosis seems to explain why my brain and body tend to immediately kick into survival mode and go into overdrive when I experience stressful life events. Other trademark symptoms include, but are not limited to: an inability to relax and switch off the fight-flight-freeze-fawn response even long after stressful events have passed; negative automatic thinking and cognitive distortions such as all-or-nothing thinking and catastrophizing; toxic shame and guilt; a vicious inner critic; and a sense of unworthiness and powerlessness.
Armed with this new understanding, I began the last session with my psychiatrist in May 2022, shortly before her retirement. When I began seeing her in January 2016, I’d been experiencing multiple distressing events and was feeling at the end of my rope. She diagnosed me with generalized anxiety disorder (GAD) back then. Although I became more stable and my symptoms were in remission over the past few years, I still kept up quarterly meetings as she needed to monitor my progress and to make sure I keep taking my meds. She told me that I have “PTSDish” symptoms from childhood trauma, and that I should stay on medication until retiring to my grave. She'd been a great psychiatrist and I really liked working with her; but I also started to wonder why she'd never once mentioned the term “complex PTSD” (CPTSD), so I brought it up towards the end of our session.
"You diagnosed me with GAD several years ago. But after writing my memoir and learning from the internet, I'm beginning to think my symptoms might be more in line with complex PTSD. Would you agree with that?" I asked.
She paused for a moment and said, "I think you are right," as if it were an afterthought.
That was my lightbulb moment. If even a seasoned psychiatrist like her could overlook this, I thought it is a sign that the mainstream American mental health professionals haven’t yet fully embraced the entity of CPTSD. It is in fact not included in DSM-5 even though it’s been recognized by the UK and the World Health Organization as a diagnosable disorder.
The concept (and term) of “complex PTSD” was first introduced in 1988 by Dr. Judith Herman, a Harvard psychiatrist. The Adverse Childhood Experiences (ACE) study–the seminal collaborative research conducted on 17,000 participants by the CDC and Kaiser Permanante from 1995 to 1997–further cemented Dr. Herman’s argument and helped raise wider awareness of the strong association between childhood adversity and its long-term impact on physical and mental health in adult years. (CDC has a website dedicated to prevention of ACEs.)
The Covid pandemic has exacerbated the mental health crisis globally, and the data from the 2020 Household Pulse Survey by the U.S. Census Bureau have revealed that one-third of Americans now show signs of clinical anxiety and/or depression, with young adults, women and the poor hit the hardest. In Japan, more people (women in particular) died from suicide in the month of October alone than the total number of Corvid-related deaths in 2020. But both countries are woefully unprepared to meet the skyrocketing demand for mental health services. And when it comes to CPTSD, most people, even doctors, don’t seem to have even heard of it.
Like many other disorders, CPTSD is a stress-related spectrum disorder, and symptoms vary widely depending on how the individual’s nature interacts with different environmental factors. All these symptoms, from mild to severe, if undetected and untreated, deprive those complex PTSD sufferers of years (even decades) of joy and happiness in life. With awareness and help, however, these symptoms can lessen considerably. There are many treatment options such as Dialectical Behavior Therapy (DBT), Cognitive Behavioral Therapy (CBT), Eye Movement Desensitization and Reprocessing (EMDR) and NeuroAffective Relational Model (NARM) therapy. But no one-size-fits-all approach would work for everyone, because complex PTSD is, well, very complex. And all these established approaches appear to be in their inception stage when it comes to determining effectiveness to treat CPTSD.
There are also many potential obstacles to finding appropriate help. First, there is simply a dearth of well-qualified, trauma-informed therapists who know how to treat developmental trauma. And trying to find a good match with one that ticks all the boxes is like searching for a needle in a haystack. Affordability is another obstacle.
Fortunately, there's much information available on the internet including YouTube videos by mental health professionals and laypeople alike. The ever-growing YouTube channels on this topic seem to indicate that there's a clear movement trying to fill the gap, educate the public, and offer advice and support to those who suffer from CPTSD. I've found some of them quite informative and helpful in understanding this mental health condition and what’s been ailing me for all these years. This is a powerful positive step in the right direction. On a side note, however, it doesn’t feel quite right to see an unlicensed layperson offering a series of workshops or one-on-one coaching sessions (based largely on his/her own experiences) with inordinate fees and turning it into a big business. It seems like capitalizing on the vulnerable population desperately in search of help.
Still, we have much to hope for as science is learning that our brains remain plastic throughout our lifetimes, and that rewiring of our brains is quite possible at any age. I believe each sufferer is on a unique healing journey to discover what would work best to heal, and that will require commitment, patience and perseverance, likely involving some trial and error. But I believe the efforts will be well worth it and eventually be rewarded with deeper self-knowledge and greater self-awareness and acceptance.
Besides basic self-care (such as a healthy diet, exercise and good sleep), yoga, meditation, mindfulness practices, and engaging in creative activities are said to be beneficial. What I've personally found helpful more than anything else is writing. When I started writing my memoir many years ago, I did know I had something important to share (e.g., intergenerational trauma and how childhood emotional adversity can cause lifelong repercussions), but knew absolutely nothing about complex PTSD. It was the byproduct to discover that the process of putting my thoughts on paper and giving voice to my innermost feelings was actually helping me reprocess and reorganize chaotic memories of the past experiences. And that, in turn, has enabled me to develop new perspectives and relate to the past in ways that are more constructive and conducive to healing. Although my habits and maladaptive coping strategies learned in childhood may never go away entirely, I’m hopeful that I can stave off the debilitating influence of complex PTSD symptoms and better handle life’s stressors by continuing to practice self-care, gratitude and self-compassion through mindfulness and finding humor in daily life.
In my next blog post, I will muse on how my overadapting to certain sociocultural values and expectations while growing up in Japan might have reinforced and perpetuated some of my CPTSD symptoms.