c-PTSD and Relationships

PTSD vs c-PTSD: what’s the difference?

Both Post-traumatic stress disorder (PTSD) and Complex PTSD (c-PTSD) occur in response to trauma. 

 PTSD and c-PTSD share the following symptoms:

• Intrusive memories, flashbacks and/or nightmares related to the trauma.

• Frequent changes in mood and thinking, including feeling distant from other people and having overwhelming negative emotions . Distorted thoughts and beliefs.

• Avoidance of people, places, situations, or thoughts related to the trauma.

• Hyperarousal -this can look like  sleeplessness, hypervigilance, angry outbursts, and difficulty concentrating.

While the two have various overlapping symptoms, the main difference between the disorders is that PTSD is caused by a single traumatic event, whereas c-PTSD is caused by long-lasting trauma that  continues repeatedly.

Events causing PTSD include: isolated acts of violence, near death experience, sudden death of a loved one, a natural disaster, and war.

Events causing c-PTSD include: ongoing childhood abuse or neglect, domestic violence, verbal abuse, and sexual abuse.

Symptoms of c-PTSD include:

Cognitive distortions - inaccurate and irrational perception of situations that manifest in intense and distorted thoughts. Examples include emotional reasoning, magical thinking, black and white thinking, catastrophizing, etc.

Frequent emotional dysregulation - difficulty controlling emotions. This looks like explosive anger, persistent sadness, depression, and suicidal thoughts.

Negative self-view - increased feelings of shame and guilt, which can lead to feeling alien from others.

Interpersonal difficulties- a tendency to distrust others and/or gravitate toward unhealthy relationships.

Detachment from the trauma - disconnecting from oneself (depersonalization) and the world around them (derealization), or suppressing and forgetting the trauma entirely.

Identity disturbance -losing one's core beliefs, values, and experiencing a shaky foundational sense of self.

c-PTSD and Intimacy

If you live with c-PTSD symptoms, you likely find it challenging to experience intimacy within your relationships. The psychological distress caused by c-PTSD can be a tough barrier to overcome. It can feel like the closer you are to someone, the greater the perceived threat. Your symptoms may manifest as emotional or relational avoidance, lack of trust, and/or a cycle of toxic relationships that resemble the past trauma at its roots.

One way to heal from your trauma and build trust in your relationships is to establish healthier coping mechanisms. The following is a chain link analysis exercise that will help you become more cognizant of not only your triggers and trauma responses, but also how they impact your relationship.

Identifying Triggers

Trigger Chain Link Analysis 

Follow each step to map out your specific triggers, emotional states, behaviors, symptoms, and new behavior patterns. Let this exercise serve as a launching pad for new and improved habits that can eventually replace your trauma responses.

Step 1: Write down at least one trigger you experience in your relationship. Here are a few examples to get you going.

Examples: 

→Not receiving a text within two hours of sending a text

→Receiving negative feedback

→Going on a first date

Step 2: Connect the trigger to an emotional state + behavior pattern. Think back to previous conflicts regarding this trigger. What thoughts did you have? How did you feel? How did you react?

Examples:

When not receiving a text within 2 hours of sending a text → you felt abandoned and rejected (emotional state), which led to avoiding and giving the silent treatment (behavior).

When receiving negative feedback → you  dissociated from your body (emotional state), which led to suppressing your feelings and lashing out (behavior).

When going on a first date → you felt anxious and paranoid (emotional state), which led to  performing and mirroring the other person’s beliefs, interests, and lifestyle in order to avoid rejection (behavior).

Step 3: Connect the emotional state + behavior pattern → to the c-PTSD symptom(s) that fits.

Examples: 

You felt abandoned and rejected (emotional state), which led to avoidance/silent treatment (behavior) → You experienced cognitive distortion + interpersonal difficulty (symptoms).

You felt  dissociated from your body (emotional state), which led to suppressing your emotions and lashing out (behavior). → You experienced  detachment from the trauma + emotional dysregulation (symptoms).

You felt anxious and paranoid (emotional state), which led to  performing/mirroring  (behavior). → You experienced identity disturbance (symptom).

Step 4: Write out new behavioral patterns in place of your usual trauma response. Don’t pressure yourself to implement the new behavior right away. Remember this exercise is a launching pad meant to map out alternative and healthy habits to practice in the future.

Example:

You used to avoid and give the silent treatment (behavior) → because you experienced cognitive distortion + interpersonal difficulty  (symptoms). →Now you will choose to  cool off before reaching out again -listen to a podcast, exercise, play video games, text a friend, etc. (new behavior pattern).

You used to suppress your emotions and lash out (behavior) →because you experienced  detachment from the trauma and emotional dysregulation  (symptoms). → Now you will choose to step away and return to the conversation when grounded (new behavior pattern).

You used to perform and mirror in order to avoid rejection (behavior) → because you experienced identity disturbance (symptom). →Now you will choose to determine 5 core values and journal about it before meeting someone in person (new behavior pattern).

View the full chain link analysis below for an example of how to map out triggers, unwanted behavior patterns, and the new habits you’ll form in the future.

By labeling your trauma responses and linking them to past unwanted behavior, you increase your ability to catch yourself before behaving in a rash (and potentially regretful) way when these triggers inevitably pop up again.

While the trigger chain link analysis is not a replacement for sessions with a licensed professional, the exercise can heighten your awareness so that you have a shot at changing the course of events and in turn mend your relationship in spite of your c-PTSD.

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c-PTSD resource list:

Articles/sites:
Relational Healing and Complex PTSD
Emotional Flashbacks

Books:
Complex PTSD: From Surviving to Thriving
The Body Keeps the Score

BPD & Relationship Maintenance Skill

GIVE (for the relationships you want to keep)

G- gentle. Be mindful of your facial expressions/harshness in your voice. Inflections. Tone. Even in disagreement, state your claim respectfully and learn to tolerate a “no”. 

I-[act] interested. be mindful of your body language. Are you looking away or at your phone? Are you furiously tapping  your shoe, waiting to counter their argument? Even if you want to do all these things, give them your undivided attention. Act as you’d want them to act if you were expressing yourself.

V-validate. As much as you crave validation right now, you need to give it to get it. Avoid words such as “but” as it will negate the validation.

For instance, “I know that I messed up, but I had a bad day and you had no right to point that out to me”. 

Try “I know that I messed up and it upsets you because ______. I want you to know I had a bad day and wasn’t thinking clearly.” Big difference, right.

E-easy manner. Soften your approach. You’re angry enough to clench your teeth and scream or sad enough to close down and relapse. Ok, that’s valid. Now be objective. You feel that way, but it isn’t necessarily the reality of the situation. Save face a little bit. This isn’t about wearing a facade, it’s about not allowing the intensity of your emotions control the nature of the conversation.

Grief and Quiet BPD

It’s been four months since I put my dog down. I think about Lucky everyday. The funny way he’d cock his head and flop onto the bed, his way of saying it was time to cuddle. His little under bite, constant neediness, and stinky dog breath. I miss it all. I made the decision to put him down after multiple visits to the emergency vet. He had severe heart disease and was eventually dependent on the hospital’s oxygen crate. I knew it was time. 

We said our goodbyes in a small tent just outside the hospital and because of his condition we didn’t have a lot of time. I held my boy, crying out loud, surprising myself. My untamed emotions don’t  normally present themselves with so many people around. “So many people” being my family who are not so emotionally available. Vulnerability and openness are met with discomfort and awkward silences. I shouldn’t have been surprised when my dad talked about the stimulus package and COVID while waiting for Lucky to be brought out.

Because of my upbringing, I rarely cry at funerals and in front of people, afraid that I’ll make the people around me feel uncomfortable. Afraid that my untamed emotions would be too much. It feels more  fitting to be an observer of grief rather than a participant. At funerals I find myself people watching, silently empathizing from afar.  I was never great at accessing my own  emotions unless alone. Granted, losing your pet is different from losing someone for whom you cared for, but was not in your care, I still found the distinction between the two processes of grief worth exploring. 

I remember when one of my best friends passed away. I was 23. This happened during a period of  ignoring her calls, texts, and soft blocking her efforts to hang out. Was I splitting?  (Hint: absolutely). My anger stemmed from the sting of rejection (real or imagined, I can’t tell now). I  thought she preferred a mutual friend over me and became resentful of their closeness (hello, insecure attachment), she made jokes about my suicidal ideation, and was just all around rude (or appeared that way when the idealization phase wore off), at one point humiliating me at a party about not having real friends. At her funeral, I watched her mom kiss and caress her cheek. I was sad for her mom, but still splitting and couldn’t feel my own feelings of loss until well after the funeral.

My delayed emotional reactions came like a phantom. A flurry of mixed emotions came through first thing in the morning-anger and guilt about not making amends. Regardless of how bitchy she was being to me, I still should have confronted her or at least ended the friendship. Then  came the spikes of sadness. A year later I finally grew to miss her.  A bitter pill to swallow is that I’ll never see her again to resolve any of this.

I wish that my relationships with people were like my relationships with animals: free of pesky BPD triggers, like splitting and premeditated grief. Comparing this to my relationship with my dog, the grief I feel about his passing is so straightforward. Your animal is in your care; you know to just love them unconditionally, flaws and all. You also don’t exchange words that run the risk of being miscommunicated, words filtered by the “BPD lens”.  With Lucky, I don’t have to worry about being rejected or humiliated. I don’t have those BPD defenses to  interfere with my love for him. I’m just this raw nerve when it comes to loving Lucky, which is nice but also cuts deep now that he is gone. 

This raw nerve feeling  may be why I keep friends at an arm’s length. I don’t want to experience the sting of grief when people inevitably leave; sometimes I think it would be easier for me to split rather than ever miss anyone. At my worst, I perceive closeness in relationships as a high risk, low reward venture. I’m ashamed of my emotional immaturity, but tired enough to crave change.

Steps to Change:

Detect premeditated grief as an expression of a fear of intimacy.

First thing I want to do is accept the logic behind the borderline’s intrinsic fear of intimacy.  I’m reminded of  how often I’ve experienced grief (premeditated or real) in relationships.  Borderlines experience loss in the anticipation that our loved ones will leave or reject us, just like I experienced loss when splitting on my friend (before she passed). I was angry, but I was also projecting.  My mindset at the time was “if I could be having these hateful thoughts about her, she’s probably having them about me. Time to split!”. I was afraid of her no longer thinking the world of me, grew jealous of the time spent with our mutual friend, and convinced myself to leave. The logic behind premeditated grief is “leave them before they can leave you”. In my relationships when I feel those “leave them before they leave you” vibes, I will now associate them with my fear of intimacy acting up again. 

Self-compassion, always.

Second, I want to validate my fears. The fear of abandonment is so severe that I don’t know how to experience intimacy, at least not completely. This is what makes it so hard for me to express my love to anyone. Because I know down the line the harder I love someone, the harder I will anticipate them leaving me. I’m afraid to love because I’m afraid to lose, but I know this fear stems from a zero sum mentality, which is nothing more than a cognitive distortion that prevents me from experiencing intimacy completely. I understand how this fear came to exist and will no longer shame myself for it by processing the feelings with sustainable coping skills, like venting to a loved one, journaling, and absorbing more content that will help me understand the fear of abandonment.

Learn from my mistake.

Third, I want to pinpoint the error in my ways. I remember feeling relieved when my friend passed away because while I was splitting on her, I felt like she was dead to me anyway. This isn’t a sentiment I can share with someone who isn’t familiar with BPD. Our mutual friends would have looked at me like I was a monster, and at times I felt like one . I shouldn’t have ignored her. I should have at least told her how I felt.  Deep down I know she was important to me, otherwise I wouldn’t be splitting on her in the first place. Sad that my only indication of having cared is the vitriol I feel once a bridge is burned, but at least I have the awareness of precisely what I will do differently the next time I’m splitting on a loved one. Talk to them, and if that isn’t an option -find the gray in between those gradients of black and white.

Find the Gray.

Ask myself: what was the incident that bothered me? What parts of this person am I not liking or finding compatible to me and why? Are there any aspects of their character that I appreciate? What are my values? Does keeping them in my life align with those values? What do I want out of this relationship and where do I see it in the long run?

What grief taught me:

It took losing my dog to reflect and see that I needed to change. My love for Lucky shines a light on a better version of me. One that will weather the inevitable BPD storms, accompanying relationships, for a fraction of sunlight experienced when I choose to love with my whole heart. In conclusion, I’ve learned the hard way that while it may be complicated to have relationships with people, I can’t live without them.  I might as well make the best of my time with my loved ones while we’re still here.  Even if it means I’ll be a sniveling mess when they leave. 

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