Relationships are hard, period. But for people who've experienced chronic trauma, it can be a real process to relearn what makes a relationship healthy and sustainable. For people living with Complex PTSD, or C-PTSD, this process can take up a lot of extra emotional energy.
According to the American Psychiatric Association, PTSD “can occur in people who have experienced or witnessed a traumatic event.” That’s not to say that people can’t have post-traumatic reactions to many events: women soldiers, for example, can develop PTSD from both the violence of war, and the threat of sexual assault within the military.
But C-PTSD is somewhat different: rather than one traumatic experience, C-PTSD is caused by chronically traumatic situations that don’t have a discrete ending and beginning. Living through childhood neglect, domestic violence, sex trafficking, being a prisoner of war, and living in a war-affected region can all cause C-PTSD.
While C-PTSD is not recognized by the DSM as its own unique diagnosis, a 2012 study in the journal Borderline Personality Disorder and Emotional Disregulation has recognized the connections between chronic trauma, affective disorders, and diagnoses like borderline personality disorder (BPD). And research has found that, just like its cousin PTSD, C-PTSD dramatically impacts an individual’s ability to navigate emotional terrain and relationships.
According to Dr. Robert Carter III, an expert in emergency medicine who is also a Lieutenant Colonel in the U.S. Army, C-PTSD, like PTSD, is often characterized by a “sense of threat, avoidance, and re-experiencing.” He tells Bustle that people with C-PTSD also “will likely experience characteristics such as negative self-concept or self-view, emotional dysregulation, detachment from trauma, and interpersonal disturbances.” These negative self-concepts can create obstacles in intimate relationships, leaving people with C-PTSD particularly vulnerable to feeling “helpless, guilty, or ashamed about the traumatic experience.”
C-PTSD impacts all kinds of relationships in all kinds of ways. It can make trust especially hard to build when you're first dating a new person, or expose you to inadvertent re-traumatization each time you and your partner of five years get into a fight. It even includes being able to handle constructive critique from supervisors, because those are relationships, too! Living with C-PTSD may mean you find yourself having strong and seemingly unprovoked emotional responses to otherwise neutral events. You might be having a conversation with a person in front of you right now, but actually reacting to a conversation you had all the time growing up.
For example, if your partner or friend tells you that they actually wanted cherry instead of apple turnovers, you might react as though they’ve told you that you’re a horrible person, a failure, and inconsiderate. Dr. Carter explains that this is because "people who develop C-PTSD may communicate their care needs, coping, and healing mechanisms in different ways," including having high-stress responses to low-stress situations.
Someone with C-PTSD might react as though they’re attacking you and the very fundamentals of who you are. Or, if someone gives you a gift for seemingly no reason, you might panic: you might wonder what it is they want from you, or what they expect in exchange for their kindness. You might push them away because it’s safer than being in their emotional debt. When these types of reactions occur, Dr. Carter tells Bustle that "it is very important for loved ones to respect [your] personal space and let [you] share [your] experiences at a low stress and comfortable pace." Asserting that you may need this kind of space is therefore essential for a healthy relationship.
So what’s a human living with C-PTSD to do? How do you navigate your relationships when it feels like an impossibly Herculean task to navigate your own emotions?
Dialectical Behavioral Therapy (DBT) is a treatment for people living with BPD (who, as mentioned earlier, often experience C-PTSD) that focuses on navigating life skills in the midst of overwhelming emotional onslaughts often related to a history of chronic trauma. One of the DBT skills that has helped me most in relationships is the shockingly difficult art of recognizing what you’re feeling before you let that feeling take over your reactions.
It’s about shaping responses to the person in front of you, rather than replaying the reactions you’ve had that kept you alive in the past, but are sabotaging your relationships now. For example, you might have felt that you had to never express what you wanted to survive an abusive household in the past, but you need to express your wants in order to have a healthy relationship with someone now.
DBT teaches you to pause and identify exactly what you’re feeling: “I’m feeling extreme anger because I don’t feel cared for,” you might write down. “Why do you feel uncared for?” DBT trains you to ask yourself. “Because my partner brought home to wrong kind of milk which means she didn’t listen to me well enough which means she doesn’t care what I want which means she doesn’t care about me.”
Well, when you say it like that? The emotional logic can break itself down, and you might even let humor into the conversation: “Hey, I’m angry because you bringing the wrong milk home makes me think you hate me. But, uh, I know you don’t hate me. So let’s go back and get the right milk as a team?” Here, it can be helpful to ask your partner listen to you carefully. As Dr. Carter says, "listening to [your] stories and experiences and avoiding interrupting [you] will help with addressing C-PTSD." This listening can help you and your partner honor the fact that people with C-PTSD need to be listened to, even when we "tend to have difficulties trusting and interacting."
It sounds a lot simpler than it is. But preserving your healthy relationships are well worth the effort, especially when C-PTSD has spent so long trying to convince you that you can’t have healthy relationships. You can: you might just have to take the long way around. The good news? There are a lot of people on the C-PTSD community road with you: one of them might even be your partner! Taking the journey together can be difficult, but it is also so much more powerful than thinking you have to do it alone.
If you or someone you know is seeking help for mental health concerns, visit the National Alliance on Mental Health (NAMI) website, or call 1-800-950-NAMI(6264). For confidential treatment referrals, visit the Substance Abuse and Mental Health Services Administration (SAMHSA) website, or call the National Helpline at 1-800-662-HELP(4357). In an emergency, contact the National Suicide Prevention Lifeline at 1-800-273-TALK(8255) or call 911.