—
Learning about C-PTSD is not easy because it doesn’t officially exist. The name “complex PTSD” is somewhat new, coined in the ’90s by psychiatrist Judith Herman. And it doesn’t exist because it isn’t officially in the Diagnostic and Statistical Manual of Mental Disorders (DSM), which is essentially the bible of mental health: If it’s not in there, it ain’t real. There was an effort by a group of mental health experts to include it in the DSM-5, which was published in 2013, but the faceless arbiters of mental health behind the DSM—a group of psychiatrists I envision as a society of hooded figures chanting around a sacrificial child star—decided that it was too similar to PTSD. There was no reason to add a “C,” no need for a distinction between the two. It’s worth mentioning, however, that the U.S. Department for Veterans Affairs and the United Kingdom National Health Service both recognize C-PTSD as a legitimate diagnosis.
Because of this, there isn’t much literature on C-PTSD. What does exist is often dry, dull, and written with all the kindness and emotional intelligence of a tech bro. But still, I was desperate to learn, so I bought a small stack of books, each with a vague impressionist painting on the cover coupled with uninviting font. And I made my way through them, one painful page at a time.
The books taught me that when we live through traumatic experiences, our brains take in the things around us that are causing the greatest threat, and they encode these things deep into our subconscious as sources of danger.
Let’s say, for example, that you are hit by a car. Your brain registers the noise of the car screeching to a halt, the grille speeding toward you. It shoots out an onslaught of stress chemicals like adrenaline and cortisol that elevate your heart rate and blood pressure, narrowing your focus to the thump of the impact and the pain and the sound of an ambulance. But at the same time, your brain is subconsciously taking in thousands of other pieces of stimuli: the foggy weather, the Krispy Kreme at the intersection, the color and make and model of the car, the Midwestern accent of the guy who hit you, his blue Wolverines T-shirt. And your brain imprints deep inside itself the powerful connections between these stimuli and this pain.
These associations are stored in your brain along with the corresponding emotions from that day. And they often do not come with full stories. Therefore, your brain might not encode the logical connection between the Krispy Kreme and the car crash. It might simply encode: KRISPY KREME. DANGER.
The result is that when you see a glazed doughnut or a blue Wolverines T-shirt, you might become uneasy without understanding why. Your brain is recognizing a pattern that it has flagged with life-or-death importance, and it reflexively shoots out what it believes to be the appropriate emotional response. This reflex might manifest in a big way, like a panic attack. Or it might manifest in a smaller way, like suddenly feeling very grumpy. You might decide that you’re irritated at your girlfriend for a mildly stupid thing she said that morning and text her to say so. None of this, of course, is reasonable or rational. But your brain is not trying to be reasonable. It’s trying to save your life.
If someone pulls out a gun near us, we shouldn’t need to ponder for a few minutes about the make and model of the gun and how guns work and what caliber the bullets might be and the amount of damage they might do. If we see a gun, we need to know one thing, and we need to know it fast: GET DOWN. MOVE. RUN.
What we might think of as emotional outbursts—anxiety, depression, lashing out in anger—aren’t always just petty, emotional failings. They may be reflexes designed to protect us from things our brain has encoded as threats. And these threatening inputs are what many people call triggers.
No, having triggers doesn’t make you a fragile little snowflake. It makes you human. Everyone has them, or will have them eventually, because everyone will experience some form of trauma. That annoying blank stare your ex used to give you. The sound of the ventilator your grandmother was hooked up to in the weeks before she died. Having an emotional response to a trigger is perfectly healthy. Those triggers are only considered PTSD when an event is so traumatic that its triggers cause symptoms like panic attacks, nightmares, blackouts, and flashbacks—when the emotional response becomes debilitating.
And here’s what makes complex PTSD uniquely miserable in the world of trauma diagnoses: It occurs when someone is exposed to a traumatic event over and over and over again—hundreds, even thousands of times—over the course of years. When you are traumatized that many times, the number of conscious and subconscious triggers bloats, becomes infinite and inexplicable. If you are beaten for hundreds of mistakes, then every mistake becomes dangerous. If dozens of people let you down, all people become untrustworthy. The world itself becomes a threat.
* * *
—
I put down the books and stared at the wall for hours after reading these sentences, trying to figure out what they meant for me specifically. I started counting some of my obvious triggers. Whenever I saw an angry man, I’d get intensely pissed at them—my boss, my boyfriend, Joey, a random guy in the street. Whenever Joey chewed the inside of his cheek or set his jaw a certain way, the exact way my father used to clench his, it enraged me. I’d snap, “What? What’s wrong? What’s your problem?” Often, he would look at me in surprise and confusion.
“You’re mad,” I’d insist.
“I’m not mad,” he said, mad. “Why do you think I’m mad?”
“I’m intuitive! I’m good at reading people,” I said.
Then I read a section in one of the books that featured a long line of photos of a woman making various expressions—transitioning slowly from a sad face to an angry one. A study at the University of Wisconsin showed these pictures to children who had not experienced abuse, then to children who had.[1] The abused kids thought that more of these photos presented an angry threat than the children from normal homes. They were hyperalert to even the smallest twinges in facial expressions.
Was Joey actually mad? Or was I interpreting the tiny knots in his forehead as anger because I was a paranoid crazy person? What was real?