PDF Summary:Complex PTSD, by Pete Walker

Complex PTSD is a guide to recognizing Complex Post-Traumatic Stress Disorder and beginning to recover from it. Pete Walker—a psychotherapist with decades of experience, and a childhood trauma survivor—provides detailed explanations of the disorder’s causes and symptoms, as well as numerous tips and tools to help people recover from their past traumas.

Our guide will begin by explaining what Complex PTSD is—why and how it happens, as well as some of the most common symptoms. Next, we’ll go into detail about the various aspects of recovering from complex PTSD: physical, psychological, emotional, and social healing. Finally, we’ll discuss one crucial tip that Walker gives to help people on their recovery journey.

Our commentary will provide additional information about psychology and trauma, as well as actionable advice for people who want to start their recovery journey or help a loved one with theirs. We’ll also compare and contrast Walker’s ideas with those from other psychology self-help books such as Why Does He Do That?.

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The first category is intimidation, where the abuser frightens their victim into submission by hurting them or threatening to hurt them. Physical violence (or the threat of it) is one form of intimidation, but this category also includes acts such as damaging the victim’s reputation, taking control of their finances, and making threats against their family or other loved ones.

The second category is manipulation, where an abuser convinces the victim to doubt their own thoughts, feelings, and beliefs in favor of whatever the abuser wants them to think, feel, and believe. One example of this is repeatedly telling someone that they’re too stupid to know what they want, or insisting on what’s morally right in a given situation; eventually, the victim becomes dependent on the abuser to tell them what to do.

Cultivating Mindfulness

Walker adds that developing a healthy sense of self eventually leads to mindfulness: the capacity to understand and accept yourself as you currently are. Phrased differently, mindfulness is the combination of comprehension and compassion. Practicing mindfulness helps people to observe their moment-to-moment thoughts and impulses, identify them, and rationally decide how to respond to them.

(Shortform note: Walker’s explanation of mindfulness is a bit different from its usual meaning, which involves awareness but not necessarily compassion. In Radical Acceptance, psychologist Tara Brach defines mindfulness as recognizing and understanding one’s moment-to-moment thoughts, emotions, and physical sensations without feeling compelled to act on them. For instance, a mindful person might recognize that they feel uncomfortable in a social situation, but not feel like they need to escape from that situation immediately—they can first consider why they feel uncomfortable, then make a rational choice about whether to stay or go. Note that Brach does consider self-compassion to be part of a healthy mindset, she just doesn’t include it as part of mindfulness.)

Additionally, Walker says that mindfulness is a crucial skill for people with CPTSD to develop. This is because mindfulness will allow them to recognize which thoughts come from their overactive self-judgment and which are actually appropriate for the current situation. Mindfulness will also allow them to make rational, healthy decisions about what to do, instead of impulsively reacting to their fears of punishment or abandonment.

For example, someone who’s being treated unfairly at work might experience the feeling of shame and the belief that it’s their own fault. By practicing mindfulness, they could recognize that those are trauma-induced thought patterns and that anger would be a justified, healthy response to such unfair treatment. They could then make the rational decision to report the situation to HR.

Mindfulness Meditation

The traditional way to develop mindfulness is by practicing meditation. Mindfulness meditation trains practitioners to calmly observe their own internal processes; to recognize what they’re thinking and experiencing without impulsively reacting to it. This practice helps them to take calm, rational action in any situation, instead of blindly following their impulses.

As Buddhist monk Bhante Gunaratana writes in Mindfulness in Plain English, mindfulness meditation involves sitting quietly and focusing completely on one thing, such as breathing. Distractions are bound to arise, like extraneous thoughts or sounds from outside, but each time the practitioner gets distracted they gently guide their focus back to their breath. Importantly, they should recover their focus without criticizing themselves for getting distracted, and without getting upset at whatever distracted them. For example, if someone hears a car horn while meditating, they should simply acknowledge what they heard and go back to meditating—they shouldn’t pass judgment on themselves or on the car, nor should they get up and close the window to block out the sound.

With time and experience the practitioner will find that they get distracted much less frequently, and if they do get distracted, it’s much easier to regain their focus. This is a sign that they’ve gotten better at understanding themselves and have begun to separate experiencing something from reacting to it.

Emotionally Recovering From CPTSD

Healing from the psychological impacts of trauma is a large part of recovery. However, for a survivor to fully develop or regain their sense of self, they must also reconnect with the emotions that their abusers forced them to repress.

Walker says that abusers often punish and shame their victims for expressing negative emotions like sadness or anger. As a result, trauma survivors tend to repress those feelings, which can cause two serious problems:

First, trying to avoid unpleasant or “forbidden” emotions makes people unable to process those feelings and move on from them. Therefore, paradoxically, people who try to avoid feeling negative emotions often get stuck in negative emotional states for a much longer time. To illustrate this idea, picture negative feelings like a so-called Chinese finger trap: The harder someone struggles to escape, the more tightly the negative feelings hold them.

(Shortform note: The effects of repressing emotions can be much more severe than just feeling worse for a longer time—those unprocessed feelings keep accumulating, eventually becoming a source of intense stress and even psychiatric disorders like anxiety and depression. Emotionally repressed people also tend to have a hard time forming meaningful relationships; they’re not able to be open and honest about their own feelings, and they’re often uncomfortable when people express strong emotions. As a result, they form only shallow and distant connections with others, rather than creating meaningful and supportive relationships.)

Second, repressing some emotions often leads to repressing all emotions. In other words, in trying to avoid feeling sad or angry, the survivor becomes unable to feel anything. This leaves them unable to enjoy the good things in life, and often makes it difficult for them to make even simple decisions; without emotions guiding them, they don’t know what they want.

This emotional deadening is also a safety concern because negative emotions are clues that something’s wrong. Therefore, without feelings like fear and anger to warn them of potential problems, the survivor may not be able to recognize when they’re in danger or are being treated unfairly.

(Shortform note: The emotional deadening that Walker describes—also known as emotional numbness or emotional blunting—can cause a person to lose interest in everything from hobbies to friends, and even their significant other. Scientists aren’t sure why blocking out negative feelings can dull a person’s entire emotional spectrum in this way, but some research suggests that it’s because the brain’s methods for suppressing emotions can’t distinguish between “good” and “bad” feelings. For instance, one hypothesis is that people subconsciously avoid noticing what’s around them, thereby shutting out things that would spark both positive and negative emotions.)

Walker adds that society reinforces this type of emotional trauma. In many places, it’s not culturally acceptable to show negative emotions. Also, media constantly bombards people with messages that they should be happy and cheerful all the time. Much like an abusive parent or partner, these cultural influences condition people to repress their feelings and only express the “right” emotions—which makes it even harder for people with CPTSD to recover emotionally.

(Shortform note: Encouraging people to be happy at all times is known as toxic positivity. It’s called toxic because, even when well-intentioned, such forced positivity dismisses people’s real feelings and glosses over genuine problems. Also, with the growth of social media, toxic positivity has become much more common. For instance, people will share posts with simplistic advice like “Choose happiness,” as though people aren’t happy just because they’ve decided not to be. In short, toxic positivity insists that everyone should always feel good but ignores the reasons why people are unhappy in the first place. Even worse, it often sends the message that people’s unhappiness is their own fault; for someone with CPTSD, such messages could echo their abuser’s victim-blaming tactics.)

The end goal of emotional recovery is for the survivor to develop emotional intelligence: the ability to recognize emotions in themselves and others, accept those emotions for what they are, and respond to them in a healthy way. In this section, we’ll explain why Walker believes that grief is the most effective way to develop these skills, and we’ll describe what the grieving process looks like for a trauma survivor.

(Shortform note: In addition to helping trauma survivors reconnect with their feelings, emotional intelligence is also useful in the workplace, especially for people in leadership positions. Therefore, developing emotional intelligence can also help people with CPTSD to advance in their careers and thus build better lives for themselves. It’s useful for leaders because when people understand how their own emotions can affect their judgment, it helps them make more objective, rational decisions. People with high emotional intelligence also tend to be more proficient at communication, teamwork, and conflict resolution—all crucial skills for someone in a leadership position.)

Reconnecting With Emotions Through Grief

Walker says that overcoming the emotional damage of CPTSD requires the survivor to reconnect with their feelings through grief. Grieving is a powerful experience that involves the full range of emotions—negative feelings like sorrow, as well as positive feelings like acceptance and hope for the future—and therefore it’s ideal for helping people break through emotional barriers.

(Shortform note: Although safe and long-term recovery from CPTSD requires therapy, there are other ways for people to try reconnecting with their feelings. For instance, some mental health professionals suggest using books and movies to spark feelings of joy or grief. Fiction has the added benefit of being a relatively safe emotional outlet for survivors who aren’t ready to confront their own experiences yet.)

Grieving is also an important part of working through traumatic experiences and, eventually, recovering from them. Walker explains that complex trauma survivors often need to grieve for the lost parts of their lives: for example, the love and safety they should have experienced, the feelings they should have been allowed to express, or the self-esteem they should have been encouraged to develop.

(Shortform note: It’s a common misconception that people only grieve after losing a loved one, but there are many different kinds of loss, and all of them can trigger feelings of grief. However, someone who’s mourning something besides a death—in this case, grieving for the life they should have had—often struggles because the people around them don’t think it’s a valid reason to grieve. As a result, instead of getting the understanding and emotional support they need during the grieving process, the survivor hears that they “shouldn’t” be mourning; having their feelings dismissed in this way only amplifies the pain of loss.)

The Grieving Process

Walker says that there are four aspects of the grieving process when recovering from emotional trauma:

1. Sorrow: The survivor recognizes feelings of sadness along with their anger, and they vent those feelings by crying. Walker explains that crying is a powerful emotional release, as well as a self-soothing tool; it helps people let go of fear and shame so they can reach a healthier emotional state such as anger.

2. Anger: The survivor complains or rages about the abuse they endured and the parts of their life they lost. Doing so connects them with their feelings of anger and resentment; these are normal, healthy responses to unfair treatment. It also helps the survivor fight back against feelings of shame by placing blame where it belongs—on their abuser—and gets them accustomed to standing up for themselves.

3. Verbalizing: The survivor talks or writes about whatever they’re feeling at the moment, without judging themselves or censoring their words. The more emotional their language is, the more this technique helps them to connect with and express the feelings that they’ve been repressing. Walker adds that for survivors who are too disconnected from their emotions to verbalize them, talking about physical sensations (muscle tension, nausea, headaches, and so on) is also effective.

4. Experiencing: The other three aspects of grieving have been about actively expressing emotions—this final aspect means feeling those emotions without expressing them. In other words, the survivor is fully aware and accepting of their emotions and is able to experience those feelings while remaining in control of themselves. This is not to be confused with the emotional repression that’s common in CPTSD, where the survivor tries to stay in control by not feeling their negative emotions.

How Does Walker’s Grieving Process Compare With the Five Stages of Grief?

Walker’s description of the grieving process has some similarities to—and some notable differences from—the more common model of the five stages of grief, which was developed by psychiatrist Elisabeth Kübler-Ross:

Denial: The first stage in Kübler-Ross’s model is denial. Denial is an instinctive response to something shocking or upsetting, such as the death of a loved one; people try to cope with overwhelming emotions by pretending that they’re not feeling those emotions in the first place, or that there’s no reason to feel that way. While Walker’s model of grief doesn’t specifically mention denial, this is what trauma victims are doing when they disconnect from their emotions or pretend to be happy, as if the traumatic experiences never happened to them.

Anger: Anger is the second stage in both Kübler-Ross’s and Walker’s models of grief. Anger is often the first emotion that people express when coming to terms with something upsetting or traumatizing, because getting angry allows them to release their feelings without leaving themselves emotionally vulnerable. In other words, anger is a “safe” emotion to express during a difficult time.

Bargaining: Grieving people will often bargain with a higher power to take away their pain or to fix the situation that’s causing them grief; for example, they might promise never to drink again if their loved one recovers from a deadly illness. Although Walker’s model of grief doesn’t mention bargaining, it’s important to note that people turn to bargaining because they feel helpless to fix the situation themselves—much like how people with CPTSD feel when emotional memories of trauma pop up.

Depression: According to Kübler-Ross’s model, depression happens when the grieving person starts coming to terms with the fact that they’re facing a great loss and there’s nothing they can do about it. People in this stage of grief tend to become withdrawn, avoiding their friends and loved ones during a time when they might need those connections the most. Walker’s model of grieving doesn’t mention depression, but recall that isolation and depression are common symptoms of CPTSD. Walker’s third step, verbalizing, is an important tool for people trying to overcome those symptoms.

Acceptance: The final stage of Kübler-Ross’s model is acceptance, when the grieving person moves past depression and acknowledges that their loss is what it is. The person may still feel deep sadness, but they’re no longer fighting to change the situation through denial, anger, or bargaining. Though Walker doesn’t use the term acceptance, this closely mirrors the final stage of his model of the grieving process, when the survivor learns to understand and accept their own emotions.

Although the two models of grief don’t directly line up with each other, this is because grieving is never a step-by-step process. Grieving people often bounce between the “stages” in no particular order—they might also keep circling back to a particular stage of grief or skip some of the stages entirely.

Socially Recovering From CPTSD

The previous sections have focused on trauma survivors as individuals, but Walker says that another crucial part of recovering from CPTSD is learning how to form healthy relationships. This is necessary because people have deep-seated needs to feel safe and loved, and the only way to meet those needs is through meaningful connections with other people. He adds that “safe” in this context doesn’t just mean physically safe, but also safe to be fully themselves: to freely express their thoughts and feelings without the fear of ridicule or punishment.

Remember that CPTSD occurs when the most important people in someone’s life—such as family members or romantic partners—habitually abuse and neglect that person. This conditions the survivor to believe that all people are dangerous: If they couldn’t trust the people they were closest to, who could they possibly trust now?

Neuroplasticity: How the Brain Changes in Both Trauma and Recovery

The conditioning that Walker describes here doesn’t just change a person’s thought patterns, it physically changes how their brain works. This is possible because of neuroplasticity, which means the brain’s ability to change and adapt. In Behave, neurologist Robert Sapolsky explains that the brain works like a muscle: The parts that a person uses a lot grow bigger and stronger, while the parts that they don’t use as much shrink and become weaker. In short, the brain gets better at doing what it habitually does.

Unfortunately, for someone with CPTSD, neuroplasticity means that their brain has become very good at protecting them from other people, but very bad at determining who’s actually dangerous and who isn’t. This also means that they can’t just decide to stop being afraid—they have to recondition themselves and rewire their brains to stop assuming that other people are a threat.

To illustrate this point, in The Body Keeps the Score, psychiatrist Bessel van der Kolk cites a study that compared brain functions in people with PTSD and those without. The participants were hooked up to a brain scanner and shown images of a cartoon character making eye contact with them. In people with PTSD, the areas of their brains associated with defensive and protective behaviors were immediately activated. In people without PTSD, areas of the brain associated with social skills were activated instead; this suggests that they were interpreting the character’s expression and intentions, rather than immediately considering it to be a threat.

Finding Meaningful Connections

The importance of strong social bonds is well documented and widely accepted, but how can someone who believes people are dangerous start to form deep, meaningful, supportive relationships with others?

Walker says that, in many cases, a survivor’s first meaningful connection is with their therapist. When someone’s conditioned to be afraid of others, sharing personal details and leaving themselves emotionally vulnerable feels much too dangerous to risk. Therefore, therapy may be the first time they’re able to talk honestly about their thoughts, feelings, and past experiences.

Trauma support groups or online forums about recovery are also good places for someone with CPTSD to begin looking for healthy connections with other people. For survivors who aren’t ready to join new social groups, a pet can also be an excellent source of love, acceptance, and connection.

(Shortform note: It’s notoriously hard for adults to make new friends—one study found that in 2004, the average American had zero close friends—and it’s even more difficult for people with CPTSD. One reliable way for adults to make new friends is to join a group that interests them, where they’ll naturally meet other people who share that interest and interact with them regularly. Also, making new friends sometimes takes a certain amount of boldness: To make friends they wouldn’t make otherwise, people may have to accept invitations they’d normally turn down or try making the first move to start a new friendship. For reasons that we’ve discussed, all of these things are exceptionally hard for people recovering from complex trauma.)

Walker adds that social recovery is the last stage of recovering from CPTSD, since it requires a certain degree of self-esteem and self-confidence—things that complex trauma conditions out of people. In fact, trying to form social bonds too soon can cause further harm, as rejection or humiliation might confirm the survivor’s beliefs that they’re unworthy of love and that other people are unsafe.

(Shortform note: It might seem strange that a simple rejection could cause further trauma, but doctors say that people respond psychologically to rejection in the same way they respond to physical pain. In fact, the responses are so similar that over-the-counter painkillers have been shown to reduce the pain of hurt feelings. This suggests that—especially for people with CPTSD, who already see others as threatening—walking into a social situation could feel as risky as putting themselves in physical danger.)

Tip for Healing: Embrace the Adequate

Walker provides numerous tips and tools to help survivors with their CPTSD, but the one he emphasizes most is embracing the adequate: accepting and appreciating things that are “good enough,” instead of throwing them away to look for something perfect. For example, breaking contact with a friend just because they have an annoying habit often does more harm than good. Similarly, leaving a good doctor over a single mistake might leave someone scrambling to find another provider whom they trust.

Therapists commonly encourage embracing the adequate to preserve important and beneficial relationships, even if they’re not perfect, as in the above examples. However, Walker believes that people should try to apply that mindset to every aspect of their lives: an adequate home, an adequate career, an adequate meal, an adequate vacation, and so on.

Gratitude Versus the Search for ‘More’

Embracing the adequate really means practicing gratitude, but unfortunately, gratitude doesn’t come naturally to most people. To paraphrase Drs. Lieberman and Long (The Molecule of More): We haven’t evolved for gratitude, we’ve evolved for survival. Early humans had to constantly search for food, shelter, and other necessities—taking time to relax and appreciate what they already had wasn’t a good survival strategy. For people with CPTSD, who are stuck in “survival mode” due to their past traumas, it can be even harder to remember and appreciate the good things in their lives.

Lieberman and Long say that finding the right career or hobby can be crucial in counteracting that instinct to constantly look for “more.” They suggest that people look for something that demands their full attention in the present (so they’re not worrying about the future), but also gives them goals to work toward; having milestones to look forward to helps satisfy the urge to get “more.”

Painting is an excellent example of this. Each brushstroke demands the artist’s full attention, yet the artist also needs to have an idea of what the painting will look like when it’s finished—that final product is the goal they’re working toward.

Why Embracing the Adequate Helps

Walker says that embracing the adequate is especially helpful for people with CPTSD, because acceptance and gratitude support every aspect of recovery.

Psychologically, acceptance and gratitude are a direct counter to the perfectionism and virulent shame that are hallmarks of CPTSD. Each time a survivor embraces the adequate is a time that they don’t give in to the urge to blame and shame themselves for imperfection.

Emotionally, embracing the adequate helps survivors recognize that their feelings (whatever those feelings are at the moment) are acceptable—that, in turn, helps survivors understand that there’s no need to suppress their emotions or pretend to feel better than they do.

Socially, understanding that people can make mistakes and still be “good enough” helps survivors build healthy and realistic relationships.

Physically, embracing the adequate helps CPTSD survivors to stay calm and relaxed, which in turn helps their bodies heal.

Embracing the Adequate Can Help Everyone

While practicing gratitude may be especially helpful for people with CPTSD, it has numerous health benefits that anyone can take advantage of. To give just a couple of examples, various studies over the last 20 years have shown that:

Practicing gratitude improves mental and physical health. People who regularly take time to think about the things they’re grateful for have lower rates of depression and anxiety, higher average self-esteem and life satisfaction, and even lower blood pressure compared to their peers.

Expressing gratitude builds stronger relationships. People who feel gratitude toward others, and express their gratitude to those people, deepen and strengthen their emotional bonds with them. Doing this regularly helps to create a strong sense of warmth and closeness between friends and loved ones.