CPTSD—The Pain of A Million Paper Cuts
Episode Notes
Today's podcast episode is packed. Phew! You wanted to talk CPTSD (or complex trauma) so that's where we're going, with a side note on trauma & faith communities and some thoughts on what it *really* means to find safety in other people.
Here's what we cover:
1. What is CPTSD?
2. What are the symptoms of CPTSD?
3. How does it impact healthy self-trust & an experience of safety in other people?
4. Why I don't believe you are a label
5. My thoughts on trauma and faith communities
6. 4 key ways to heal from CPTSD
Resources
- Complex PTSD: From Surviving to Thriving by Pete Walker
- Try Softer, by Aundi Kolber
- The Best of You: Break Free From Painful Patterns, Mend Your Past, and Discover Your True Self in God, by Dr. Alison Cook
- Episode 4: What do I need to know about trauma?
- Resources for support
Key Quotes:
We're not only spiritual beings, our bodies are affected by trauma. Our thought life is affected by trauma. Our emotions are affected by trauma. And, so, we need spiritual solutions and we also need psychological solutions. We need physiological solutions. We need emotional solutions. We need a whole toolkit of solutions.
A safe person doesn't say, I'll rescue you. A safe person says, I see you and I love you, and guess what I'm going to bring some of my own wounds to the table. So let's honor each other, let's hold space for each other's wounds.
Thanks to our sponsor Organifi -Go to www.organifi.com/bestofyou and use code BESTOFYOU for 20% off your order
While Dr. Cook is a counselor, the content of this podcast and any of the products provided by Dr. Cook are not specific counseling advice nor are they a substitute for individual counseling. The content and products provided on this podcast are for informational purposes only.
Transcript
Alison: Hey everyone. Welcome back to this series on Psychology Buzzwords, Listeners' Choice Edition. These are the words you chose. I put out a poll and you voted, you let me know the topics that you're the most interested in.
Today's topic is CPTSD, Complex PTSD, and you're seeing this word a lot on social media, in articles. It's really kind of a newer concept. It really originated in the early 1990s, we'll get into that. And one of you, really, wisely and astutely, pointed out to me, "These aren't really buzzwords in the sense that-" A buzzword implies something like jargon, that's trendy, that might be passing. These are very real terms.
In fact, all of these terms, in both of these series, are not really buzzwords in the sense that they're very real, substantive, meaty terms. In fact, you guys wanted me to go into the deep end on this series, which I'm really excited about. But what I mean by that is simply that they are trending.
These are words that we're hearing more and more, and more. And, so, it's all the more important to understand them correctly. Because these are words that are describing really important, powerful, psychological concepts that a lot of people face.
Now, these are not new concepts. People have dealt with trauma, toxicity, all these things we've been talking about since the dawn of time. But we've developed, out of the field of psychology, this new vernacular for describing a lot of these things. And I think we've gotten more accurate in how we describe these things. So it's so important to pause for a minute, which is why I'm so glad you want me to talk about these, and say, "What are we really talking about here?"
Now, before we dive in, just a quick reminder, please sign up for my August webinar series. It's Five Toxic Behaviors and How to Protect Yourself. I talk a lot in this episode about the importance of learning skills, when there's been an absence of healthy parenting, or when you've dealt with some painful events in your life.
You need to learn skills, that's one aspect of healing. And that's one of the things I'm going to teach you in this webinar, is I'm going to really focus on skills, scripts, communication strategies, practical ways to learn these new skills. To sign up for it, it's free when you pre-order my new book, The Best of You, which is also chock-full of healing and skills.
So preorder to the book, and then as my thank you to you for your early support. You get entered into this two-part webinar series in August. If you can't attend live, I will be sending out the recordings. So preorder the book and then go to my website. It's dralisoncook.com/book to sign up for the webinars. You'll get everything emailed to you, including the recordings, if you can't attend live.
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All right, so let's go ahead and dive into what is CPTSD, or I may call it Complex Trauma for short. Because CPTSD is a lot of letters to say, and I will probably fumble over them if I keep trying to say them a lot.
So we have to start this discussion with this idea of if there's a C, which is for Complex, before PTSD and we touched on PTSD. What is PTSD? We touched on that in episode four on Trauma, healing from trauma.
PTSD is a diagnosis. It's in the DSM, the Diagnostic and Statistical Manual that psychiatrists and psychologists use to diagnose folks. The PTSD diagnosis arose out of a lot of soldiers who were returning from war, which is a traumatic environment, a traumatic situation. These soldiers were returning home and experiencing night terrors, flashbacks, hypervigilance, which means your alert system is on high alert, on all the time. Muscles are tense.
You might be reacting really quickly and with a certain amount of intensity to maybe minor things, but that's because your body is still in that fight/flight state, as a result of the trauma. We went through a lot of that in episode four on Trauma. So you can go back to that episode and learn more about what we mean by PTSD. But the thing is PTSD tends to be tied to a specific event.
There's exposure to a death, or a violence, or maybe an injury. Something happens that's traumatic and your body responds to that. And if you don't get the care that you need in that moment, we always talk about this on here. Trauma isn't just the result of being exposed to something awful. Trauma is the result of not getting the care you need after that exposure.
Because your body can heal. But if you don't get the care that you need, after that exposure to a traumatic event. Those chemicals that course through, that give you that fight/flight response. That give you that adrenalized response that you need in the moment, stay in your body.
And, so, you don't return, as we discussed last week, you don't return to that calm centered place. You may not even know what that feels like. And, so, that's what happens with PTSD. You're exposed to a trauma. You come home, all of a sudden, you're just supposed to be this normal person, but your body is like, "Something terrible happened."
And, so, your body is still responding in the current situation that maybe isn't traumatic, based on how it was conditioned by this traumatic event in the past. That never really got healed.
So what does it mean to bring the complex into PTSD?
What does it mean to move into CPTSD?
Well, think about it this way. Maybe you're somebody who wasn't exposed to a one-time traumatic event. Maybe you were exposed to constant neglect as a child. Maybe you weren't cared for emotionally or physically. Maybe you were exposed to constant patterns of bullying or manipulation. Maybe you were raised by a caregiver who was addicted or mentally ill.
And, so, there was just, kind of, a constant environment around you of what I like to call a million tiny paper cuts. Maybe it wasn't one big event. Maybe it was a million tiny events that began to have an impact on your soul, on your body. And that's how I like to explain CPTSD, complex trauma, to the people I work with.
Is it like a million tiny paper cuts that create these wounds, as opposed to one big gash. It's a chronic exposure, a pervasive exposure, over time to pain, to being mistreated, to toxicity. And these traumatic events, when it comes to complex trauma, tend to happen in the context of interpersonal relationships.
They tend to happen with our primary caregivers. But not only with our primary caregivers, they can happen throughout the course of our lives, in our communities, in our neighborhoods with our peers. Where we're exposed to just constant, sort of, paper cuts to the soul. And these early injuries affect the way that we develop. They affect our core sense of self, especially, when no one comes in and guides us through them appropriately.
Because this physical and emotional pain of neglect, or of being mistreated. These are often inflicted by our primary caregivers, by siblings, by teachers, by our school or church environments. Where we're misunderstood consistently, or labeled, or marginalized consistently.
And, so, we start to take ourselves to be less than. We start to take ourselves to be not good enough. We start to develop an identity around this experience of constantly being mistreated, or unseen, or shoved aside, and this is what we mean by complex trauma. It's complex because it's woven into a lot of the different fibers of our being. Maybe even every fiber of our being. Depending on how much care we got apart from these painful experiences.
Now, CPTSD is not an official diagnosis in the DSM, yet, in the Diagnostic and Statistical Manual. It, sort of, builds on and expands on this idea of PTSD. On this idea of interpersonal, relational trauma. To say that, "Man, repeated exposure to pain, and to wounds, and to trauma during childhood leads to symptoms." And these symptoms are different than the symptoms we've categorized as PTSD, it's a different thing. And, so, here are some of those symptoms of what we're calling complex trauma.
Number one, your emotions are affected. You may experience overwhelming emotions. In fact, you may find yourself almost regressing is a word that psychologists use, or you'll have an emotion that feels like that 10-year-old inside of you.
That you might even be aware of. Like, "I think I'm overreacting here, but all I know is I feel like that helpless, stuck, child that I felt like in fifth grade." And, so, you feel like you have these big emotions and you don't know what to do with them.
And this is, again, I want to reiterate, we talk about this a lot on this podcast, this isn't your fault. These emotions need your attention. They're cues, they're trailheads, that maybe in the moment, someone actually gave you a real paper cut. Meaning maybe someone said something that wasn't super nice, but they really didn't mean major harm.
Maybe your spouse was short with you, or maybe your spouse just didn't even have the perfect response to a need that you had in a moment. And you have this big emotional response as if that person just cut you to the core. And they're confused because they're like, "I get it. I'm sorry that I didn't give you the exact, right response, but you know I love you. You know I'm here for you."
And you're confused because you're like, "I know. I mean, I know that. I don't know why I just exploded in that moment." That's an example. That's a symptom that there might be some complex trauma there. That there's big emotions inside of you from all the way back, a long tail back to the past. And they're coming out in this moment of a small infraction.
Where just a normal human is being a normal human, and not really trying to hurt you. But it did hurt. But maybe it was little hurt not major hurt. But you're exploding or reacting as if it was a major hurt. Because your body doesn't experience it as one little paper cut, one little hurt.
Your body experiences it as a million and one paper cuts. And that one paper cut is building on a million over the course of your lifetime, and you just don't have any reserves. You don't have any tolerance. You don't have any reserves for it. And, in fact, this person might even be safe. And, so, those emotions, that backlog of emotions, feels like it can come out. So that's one example.
Number two, a lot of shame comes with that. And the reason is you know. You're like, "Why are my emotions so big?"
"Why do I react in such a big way?"
"What's wrong with me? I feel like there's something wrong with me." So that shame comes into it, and shame can just be toxic, and devastating, and big, when you've survived a lot of these micro traumas. A lot of these million paper cuts, this complex trauma. You feel a lot of shame because you feel like there's something wrong with you.
And I want to say to you right now that shame it's there. It came in as a result of your unhealed wounds. But the first thing you got to do is recognize shame for what it is, it's just shame. It doesn't have the real story that you're beloved. That you've been through something really hard, that it's not your fault.
So you've got to learn to identify that voice of shame and learn to not let it lead you, or guide you, or drive you. And we'll get more into that in episodes to come.
Another example of something you might experience. If you've been through this kind of complex trauma is deficits in attention or your self-awareness even. And then, also, in your self-perception, your self-esteem, how you take yourself to be.
And, again, this gets at that idea of shame. You lose connection with that core sense of self. Of, you know, "I blew it in the moment, but I'm okay. I can reset. I can come back to home base. I fundamentally trust myself, and, yes, I can get off kilter." We all do.
But there's that fundamental sense of self. Well, that's really hard if you've had this pervasive pattern of a million tiny paper cuts, of CPTSD. It's really hard to connect to that core sense of self. And, so, there's a lot of shame. There is a lack of a healthy or even the way God sees you, and I'll get into that more in this episode. That there's a misguided sense of yourself.
That, "There's something wrong with me."
"Why can't I just be like other people."
Instead of saying, "Oh, man, I've been through a lot. I respond in this way for a reason. There is a subtle shift there between, "What's wrong with me?" Which is beating yourself up. And, "Wow, this is a cue. There's some way in which I respond to people that I need to get curious about."
And then, lastly, you may notice significant distress in how you show up in your relationships with other people. You might notice a lot of anxiety. You may notice fear of people leaving you. You may distrust yourself and your ability to be loved. Your ability to love and receive love. You may have ideas about relationships that are idealized. Like, "I just need that one safe person who will make everything okay?"
Because you don't know how to trust yourself, or you may avoid people altogether.
"Nobody is trustworthy."
"I can't let people in."
As opposed to this healthy dependence. Which is, "Nobody is completely trustworthy. But I trust myself enough to know that I'll advocate for myself when I need to."
That, "I can go into a relationship and I can notice when someone else isn't treating me right. And I know how to take care of myself. I know how to advocate for myself."
There is that sense of self. Again, we're coming back to that sense of self, that empowers you, and equips you, and gives you that confidence. To know how to discern safety in other people and how to protect yourself when you bump up against toxicity. There's a self-trust there that is lacking because no one ever taught you how.
So there's a lot to this CPTSD that we're not going to get to all of this in this episode. In fact, next week, spoiler alert, we're going to go into attachment. Which was another one of your top-most requested topics because this all does relate very much into attachment. This is all interconnected.
And you start to get a picture of this idea of what does it mean to be a healthy self? And that a healthy self means starting to heal from either these million tiny paper cuts, or these big, deep gashes, or both. It could be both, and start to learn to heal that sense of self. Because that sense of self is what also allows you to heal your relationships.
Now, paradoxically, healthy relationships, bumping up against safety in other people helps you heal yourself. The two go hand in hand, and we're going to get into that. But all of this does get back into attachment. We'll go more into attachment next week.
I want to just pause here and give a note about labels. So, in so many ways, what we're doing here with these words, these diagnostic categories, these labels like PTSD, CPTSD, Trauma, Attachment Wounds. What we're doing is just trying to give names for pain, for wounds, for human suffering.
And, so, maybe we used to say things like, "Oh, someone is sick." In biblical times there's so much about this person was sick. Well, were they physically ill?
Were they mentally ill?
Were they someone who had been wounded, and abused, and hurt by others? There were just different categories. Different ways of labeling that some much more stigmatizing than others.
So, right now, what we're trying to do in psychology is get more clarity around these categories of behaviors. There's a reason that you're like this, and we can put this word around it such as CPTSD. That says, "Listen, maybe you didn't have this major traumatic event."
Maybe you had a halfway normal family, on the surface. Maybe other people looking inside of your family would be like, "Look, there's a mom, there's a dad, there's a sibling." You had your needs met. You had dinner every night. It looks, quote-unquote, "Normal" on the outside. Who would describe that as quote-unquote "Trauma"?
But on the inside of that family there was this million tiny paper cuts. That could be criticism. It could be manipulation. It could be neglect. There could be so many different things. And I go into a lot of this, again, in my new book. My new book, The Best of You, really takes you through a lot of some of the key ways that these million tiny paper cuts occur.
But the point is you didn't get the nourishment. The care that you needed, and, so, your sense of self isn't quite formed in the way, that parts of you know, it could be.
I want to recommend a book. There's a wonderful book called Complex PTSD: From Surviving to Thriving by Pete Walker. It’s a beautiful book, a roadmap really, to how to find your way through complex trauma. And it is such a helpful resource.
But returning, again, about labels is that no label is perfect. And you want to be careful about putting yourself in a box. We don't want other people to put us in boxes. Nobody wants someone else to say pigeonhole you, or put you in a box.
We also want to be careful about putting ourselves in boxes. Because any of these labels, we're hopefully improving. The labels, I think, it's healthier to say to somebody, "You know what you're showing signs of complex trauma."
I think that's healthier to help someone understand themselves. Than saying some of these stigmatizing things from their past. Such as calling people mentally ill or disturbed. When, no, in fact, your body is responding in an appropriate way to a lot of pain, to a lot of suffering.
So I think these labels are improving. I still think we want to just be careful because they're not all of who we are. These are descriptions of your experience of pain. Of your experience of suffering, and they're important to get right.
But you are more than a diagnostic label. You are. These descriptions are important. And, also, you are still a beautiful soul made in God's image. Your soul can heal. It may take a lifetime, depending on the level and severity of the trauma you've been through.
But your soul is beautiful. And even this story of trauma that you're learning to understand about yourself. And if this diagnostic category is helpful for you to go, "Oh, I think that fits me. I think my trauma was complex. It was a, an exposure to a whole lot of different things over a period of time. That's still describing your experience. It's not the sum total of who you are.
You're still a beautiful soul made in the image of God. That's who you are. You're a child of God. You're a beautiful soul. And this diagnostic category, this label can help you understand why you show up in the world in certain ways.
Why you show up in relationships in certain ways.
Why certain emotions seem to take you over.
Why you struggle so much with shame.
Why it's hard for you to trust a spouse that is in fact trustworthy.
Why it is hard for you.
Why you want to run away, when you know what you really need to do is have that hard conversation.
These help us understand the WHY of those things, but they don't ultimately define your core self.
So I wanted to just briefly touch on how we understand this idea of complex trauma, biblically. Well, here's the thing, we are holistic people. We're mind, body, heart, soul. We're complex people to use that word, again, complex.
And, so, there's not a one-size-fits-all to becoming the people that God made us to be. And, oftentimes, in faith communities we focus in on the spiritual, and that makes sense. Because these are faith communities. These are spiritual communities, and there's nothing wrong with focusing in on the spiritual in a faith community.
But I think what's happening, and I'm going to do a whole another episode on this, because you guys asked this great questions. So many of you, and it's worthy of a whole series, not just a bullet point in an episode. But this idea of what is the difference between trauma over here, and what I keep hearing it about as like sin. Sin nature over here in my faith community.
And I'm going to do a whole thing on that because it's just such a important question. But, for today's purposes, what I want to say is this is in our faith communities. In the best of a faith community, there's toxic faith communities, for sure. But in the best of a faith community, you're going to hear spiritual solutions.
We can go to God to know that we're loved. We can pray. These are spiritual solutions and there's nothing wrong with that. They're real. Research shows that prayer, that being part of faith communities, that understanding a loving God is helpful to our mental health.
Here's the problem, we're not only spiritual beings, our bodies are affected by trauma. Our thought life is affected by trauma. Our emotions are affected by trauma. And, so, we need spiritual solutions and we also need psychological solutions.
We need physiological solutions. We need emotional solutions. We need a whole toolkit of solutions. So that's not to say that spiritual solutions don't have some corner on what we need as humans to heal, they do. But they're only one part of the story.
And, so, just to give you a teaser where I land on that, when it comes to being a trauma informed, faith communities. I don't know that faith communities have to become therapists.
But I do think it's confusing for folks because we're starting to understand all this from psychology. Where we're starting to understand, "Wait a minute, there's a reason I lash out. And I don't want to lash out. And I know it's not how God wants me to be, but there's a reason I do it, and it's because of this trauma. It's because I have this fight/flight response that I can't control. It doesn't necessarily let me off the hook, but there's also a reason for it. So I can have compassion for myself."
So what we need to begin to do is help faith communities understand, "Let's approach things spiritually. Let's also leave room for the psychology, for the physiology of human behavior." They're not incompatible they go hand in hand. But I will say this the root of all healing, whether it's spiritual, physiological, psychological, emotional is compassion.
We don't heal in the context of shame and judgment. We heal in the context of compassion. We change in the context of compassion. So this idea of sin, and missing the mark, and trauma, I'm going to circle back to that.
But I do want to just pause and say understanding the reasons why you act the way that you do. Understanding those reasons why you might have developed a substance abuse issue, or why you have an anger management issue, or why you avoid relationships, or why, as we discussed last week, you constantly people please, you fawn. Understanding why helps you show compassion for yourself, and it's how, I believe, God shows up with us.
It's not that God says, "That's great that you do that, keep doing it." That's not it. But it's that God comes alongside you and says, "Yes, I get it. Of course you do this thing. Of course, there's a reason."
There's no shame in the way God puts His finger, on those areas of our lives that need healing. There's compassion. So we name it without shame. And it doesn't mean we get to say, "Well, I'll just always be this way."
It means, we say, "Oh, I've got to go on a journey of healing, and that healing may take a long time." And we start to talk about it differently. We might say, "Yes, I do, I struggle with anger. And I may lash out at you and I'm sorry, when I do. Here's why I do that. It doesn't make it, okay, and I want you to know that I'm working on it. But I just also want you to understand where I'm coming from and my story." We have these stories to tell, and these stories are a big part of who we are.
All right, just to wind up here. I want to touch on a few ways that we heal from CPTSD. Number one, we have to establish a sense of safety, both in ourselves. And this starts with self-compassion.
This starts with naming— "I've been through a lot in my life. I've got to stop beating myself up. I've got to stop blaming myself. I have to start getting curious about all these paper cuts that have become my soul. About the pain of what sometimes feels like I shredded soul. And I've got to stop minimizing that. And I've got to start saying, 'Lord this is what I see, help me take that first step.'"
And then we got to find safety with God because God doesn't shame us. I already said that, but I'm going to say it again. God says, "I know. I know what you've been through. I've seen it. I was there with you, even though you, maybe, didn't feel me there with you. It's okay. It's not too much for Me, I'm with you."
And then we also need to reestablish safety in relationships, and that doesn't mean finding this safe mythical unicorn, that just magically makes us feel better. Which we get duped by because sometimes that person shows up and we're like, "Oh, they are wonderful." But no one human being can be that safe, they're going to let us down.
So what I mean by finding safety in another person is another person who's honest. Is another person who can hold space for you, as you say, "I need you to know that my soul is feeling, kind of, shredded. I've been through a lot. And I'm doing my best to heal but every once in a while, these things will happen. You'll see me fold into a shame spiral. You might see me run away. You might see me doubt you when you haven't done anything that's untrustworthy. And I just need you to know that."
And then here's what a safe person does. A safe person says, "I see you and that's okay. I'll hold space for you. And guess what? Here's the wounds I bring to the table." They don't offer to be your rescuer. A safe person doesn't say, "I'll rescue you."
A safe person says, "I see you and I love you. And guess what? I'm going to bring some of my own wounds to the table. And, so, together let's honor each other. Let's hold space for each other. Because as we do that we will heal together."
Because as the old adage, and it's a cliché but it's so true, says "Shared sorrow is half the sorrow." When you could share your pain with someone else who sees you, and they don't set themselves up as your rescuer, as you're healer. But, instead, they come alongside you and say, "I know. I get it. I see you. I'm not afraid. I honor those parts of you. And guess what? I've got some of my own and we can honor each other in this."
That is how you begin to establish safety and relationships. Continuing through here, as far as healing, you have to begin to pay attention to painful thoughts and emotions. And this is the topic of my book Boundaries for Your Soul, where we walk you through a process. It's based on an evidence-based model of therapy IFS. You can find an IFS therapist.
But you walk through a process of really learning to connect to big emotions. Connect to overwhelming thoughts or thoughts that may not be serving you. May not be telling you the truth. And there's a method for this, this is a process. This isn't happening in a one-time zap of the wand. And, so, this is a process, depending on how much you struggle with overwhelming emotions and with painful thoughts. Get a therapist to help you with that.
Another model of therapy, I've talked about on here, that is really helpful with this is EMDR. EMDR gets at a lot of the body component of this. Learning how to find safety in your nervous system. Again, another part of healing from CPTSD is grief work. There's grief in recognizing what was lost. There's grief in realizing that you didn't get the care that you needed, and that had an impact on you, there's grief in that.
Sometimes we don't want to face that. We'd rather minimize because it's too painful to face the grief that, "Man, if I'd had the care that I needed, I wouldn't have to be going through this." And there can be anger in that too. So get help get support for that portion of this. But there is some grief work in healing.
Next there's skills that you have to build. There are some skills you can learn. Skills about like how to communicate on behalf of your experience. How to identify emotions and communicate on behalf of them?
How to set healthy boundaries as opposed to fighting or fleeing?
How to have healthy and courageous conversations with other people?
How to establish trust with yourself. There's some skills you can learn?
Again, a lot of those skills are what I go through in my book, The Best of You. But all of this establishing safety, reconnecting to thoughts and feelings, grieving, and then learning new skills. Guess what? It's hard work. It's a journey but you begin to become this amazing person. And it's so exciting and so life-giving as you begin to see progress. And you start to see this new life that you are creating because it's never too late.
I mean, listen, as people of faith, we believe the soul lives forever. So we've got forever to live as these new, healed, and healing people. So it's never, ever too late to start healing. Because we've got forever to continue that process, and to become the whole people that God made us to become.
So, listen, we've got so much more to go into and I look at next week's episode on attachment, really a, sort of, part two of this conversation. And we'll continue on with deeper and deeper layers of this, especially, this piece about how we deal with this idea of sin coming from faith communities and trauma coming from psychology in future episodes.
But for now, please just remember that you are not your diagnosis. You are not your worst day. You are not your pain. You are a beautiful soul doing the hard, brave work of healing, and that's the best of you. That is the best of you for today.
The best of you says, "One more step that's all I've got to take, and I'm so proud of myself for just that tiny step that I took today."
Thank you for being here. I look forward to seeing you next week.