Complex PTSD is a guide to recognizing Complex Post-Traumatic Stress Disorder—which is more common than many people think—and beginning to recover from it. In this book, psychotherapist Pete Walker provides detailed explanations of the disorder’s causes and symptoms, as well as numerous tips and tools to help people overcome their past traumas. Complex PTSD is written for people who suffer from it personally, but it’s also helpful for anyone who wants to understand the condition better.
Walker is a practicing psychotherapist with degrees in psychology and social work. In addition to his decades of practical experience, he’s worked as a writer and educator for more than 30 years, and as a therapists’ consultant for 20 years....
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Complex PTSD is short for Complex Post-Traumatic Stress Disorder; for brevity’s sake, we’ll refer to it as CPTSD from here on.
Walker explains that CPTSD is a psychological condition that comes from prolonged, repeated abuse or neglect, usually in childhood. He adds that while many people associate this condition with physical or sexual abuse, people can also develop CPTSD from verbal and emotional abuse, or even emotional neglect. He adds that CPTSD resulting from a long-term pattern of mistreatment separates it from the more commonly known form of PTSD, which can happen after a single traumatic experience.
(Shortform note: The Diagnostic and Statistical Manual of Mental Disorders 5th Edition (DSM-5)—the standard that US healthcare professionals use to diagnose mental disorders—currently doesn’t recognize CPTSD as a separate condition from PTSD. Some US doctors are still fighting to get CPTSD recognized as its own condition, while others don’t think it’s necessary to create a new diagnosis for...
Walker says that when dealing with complex trauma, recovery is also complex; it must address the physical, psychological, emotional, and social harm that long-term abuse or neglect causes. We’ll begin by discussing the physical aspects of recovery.
In addition to any long-term injuries a survivor might have from physical abuse, chronic stress from CPTSD can cause severe ongoing damage to their body. For instance, constantly being tense can injure their muscles, or insomnia can weaken their immune systems and make them heal more slowly; in many cases, survivors also harm themselves even more by self-medicating with alcohol or other drugs.
(Shortform note: The physical effects of long-term stress can be even more serious than Walker says here. According to Mayo Clinic, severe cases of...
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Healing from the physical damage of trauma is an important step toward feeling better, but most of the effects of CPTSD are mental and emotional. Therefore, it’s equally important to learn the psychological symptoms of trauma and how to start recovering from them.
Walker explains that complex trauma often leaves survivors with a distorted sense of self; they internalize the hurtful things their abusers said and come to believe them. For instance, someone who grew up being told that they’re stupid likely still believes it, even if there’s plenty of evidence to the contrary in their accomplishments.
(Shortform note: According to many psychologists, self-underestimation—undervaluing one’s own worth, as Walker describes here—is a common result of childhood neglect or abuse. Some parents actively harm their children’s self-esteem by insulting and belittling them (abuse). However, neglect can lead to the same result; young children often believe their parents are infallible, and therefore a neglected child will conclude that they (the child) must not deserve to be loved, rather than recognizing that...
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...
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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...
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...
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Now that you’ve read Walker’s description of CPTSD and how to recover from it, take some time to think about how this condition affects people’s lives. Consider how some of Walker’s recovery techniques might be helpful for you, regardless of whether or not you personally struggle with CPTSD.
Were any aspects of CPTSD especially surprising to you? Which symptom (or symptoms) surprised you the most? For instance, maybe you never considered the physical damage that constant stress could cause, or you didn’t realize that avoiding people could be a symptom of past traumas.