Attachment and C-PTSD: How Complex Trauma Gets in the Way

Close-up photo of loving couple holding hands while walking at sunsetComplex trauma is what happens when someone experiences multiple incidences of cruelty and abuse in the context of an unequal power relationship. This is most commonly found in people who grew up with abusive or neglectful parents, but also happens to kidnapping victims, prisoners of war, and people in abusive sexual or “romantic” relationships. The result of this complex trauma is C-PTSD (complex PTSD), which has similar effects to the posttraumatic stress (PTSD) experienced by people who have been in car accidents or similar traumatic events but involves deeper disturbances of the personality. Many people diagnosed with bipolar and other personality conditions are, in fact, survivors of complex trauma. This requires delving into the individual’s personal history and life story, rather than only analyzing their present symptoms.

Another way of looking at complex trauma and C-PTSD is the concept of attachment trauma. Attachment—the bonds that exist between one human being and another—sounds like a rather vague or abstract concept. Like all emotional states, however, such as happiness, fear, or anger, it is rooted in our biochemistry and is essential for human flourishing.

While our level of intelligence distinguishes humans from other animals, it is only through working together that we were able to survive and thrive. There is simply no way an individual human could take down a woolly mammoth. Human beings evolved to cooperate and work together in groups. One aspect of this is our unique capacity for language acquisition. For true social cooperation, however, bare communication of information is not enough. In the modern world, one may be able to go about many items of daily business (shopping, for example) without any emotional bond, but the cohesive groups in which humans evolved required a much deeper level of connection.

Even today, we can observe that an office where there is no camaraderie between employees will not function well no matter how highly they are paid. Family life, friendship groups, and romantic relationships are, of course, quite difficult to maintain without attachment. As a result of our evolution, all, or almost all, human beings feel a deep need to be attached to others regardless of whether it is strictly necessary for their survival or material prosperity. People who do not form relationships are often plagued by feelings of depression and sadness, no matter how successful they may be in other areas of life.

Attachment, however, is hard. Forming a relationship with another human being involves both verbal and nonverbal communication, as well as an intricate dance of appropriate behavior. Express too little empathy in a relationship and you may be considered cold or distant. Express too much or too early and you may be considered overbearing. High-functioning people on the autism spectrum (commonly known as Asperger’s, though this has largely fallen out of academic usage) typically lack many of the native instincts for successful relationship formation that other people have, making their lives difficult in ways that those in the general population find hard to appreciate or understand.

However, like all human traits, the ability to form attachment bonds is not purely innate; it is learned behavior. And as with most human learning, attachment is learned by doing. From the moment they exit the womb, babies are learning attachment. This, and not only the need to materially provide for the child, is the basis of the family, a universal component of human society. Even utopian social experiments which aimed to replace the family had to fall back on structures that essentially mirrored mother- and fatherhood, with mixed success.

In treating people with C-PTSD who seek therapy, building up their ability to experience attachment and to feel safe, secure, appreciated, and loved in relationships is a high priority.

It follows, therefore, that when the relationship between parents, or a replacement primary caregiver, and the child is seriously distorted by abuse or neglect, this has far wider implications than the parent-child relationship alone. Survivors of complex trauma typically emerge with gaps in their ability to form attachment bonds with others. This is not to say their desire for attachment is any less—far from it. The unfulfilled desire for connection and pervasive feeling of loneliness in survivors of complex trauma is a major contributing factor to the symptoms they experience, including depression, inability to regulate emotion, and engagement in risky or self-destructive behaviors.

In treating people with C-PTSD who seek therapy, building up their ability to experience attachment and to feel safe, secure, appreciated, and loved in relationships is a high priority. It is also an extremely difficult process. As I have discussed in previous articles, C-PTSD is best conceptualized less as a process of damage than as a learning process in highly unfortunate circumstances. Like all children, people who grow up in an environment of persistent abuse are born with potential, which they develop in their own way under adverse circumstances.

In short, survivors of complex trauma in childhood learn to live in a world turned upside down because that was the only world they ever knew. Therapy for people with C-PTSD is a delicate undertaking, involving revisiting this initial learning process and initiating a new one that allows them to grow and develop in healthier and more fulfilling ways.

References:

  1. Cloitre, M., Garvert, D. W., Weiss, B., Carlson, E. B., & Bryant, R. A. (2014). Distinguishing PTSD, complex PTSD, and borderline personality disorder: A latent class analysis. European Journal of Psychotraumatology, 5, 10.3402/ejpt.v5.25097. Retrieved from http://doi.org/10.3402/ejpt.v5.25097
  2. Lawson, D.M. Treating adults with complex trauma: An evidence-based case study. (2017) Journal of Counseling and Development, 95(3), 288-298. Retrieved from http://doi.org/10.1002/jcad.12143
  3. Sar, V. (2011). Developmental trauma, complex PTSD, and the current proposal of DSM-5. European Journal of Psychotraumatology, 2, 10.3402/ejpt.v2i0.5622. Retrieved from http://doi.org/10.3402/ejpt.v2i0.5622
  4. Sullivan, R. M. (2012). The neurobiology of attachment to nurturing and abusive caregivers. The Hastings Law Journal, 63(6), 1553–1570.
  5. Tarocchi, A., Aschieri, F., Fantini, F., & Smith, J. D. (2013). Therapeutic assessment of complex trauma: A single-case time-series study. Clinical Case Studies, 12(3), 228–245. Retrieved from http://doi.org/10.1177/1534650113479442

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  • Aliya R.

    March 5th, 2019 at 9:47 PM

    Thank you so much for your insightful and sensitive description of this difficult but treatable condition.

  • Robin

    June 20th, 2019 at 3:14 PM

    I think many providers miss the mark on this: “treating people with C-PTSD who seek therapy, building up their ability to experience attachment and to feel safe, secure, appreciated, and loved in relationships is a high priority.” Often the focus seems to be on personal healing but not in the context of family or relationships. Partners and family members of people with C-PTSD are not included enough in the therapeutic process, and while the survivor may do well in some treatment programs they often are unprepared to return to their families, and their families haven’t been provided with tools or support. I am in a partners of survivors group, and we talk about this frequently. We need more family-centered therapists and interventions. The original trauma didn’t happen in isolation; the healing cannot either.

  • Claudia

    June 21st, 2019 at 3:42 AM

    I worked in treatment centers for addiction and felt the same need; a way to treat the whole family for the addict to thrive.

  • FERDINAND

    June 29th, 2019 at 7:41 AM

    Please provide me with more details on how best to treat complex trauma in children.

  • The GoodTherapy Team

    June 29th, 2019 at 8:54 AM

    Hi Ferdinand,

    Thanks for your comment. If you would like to consult with a mental health professional, please feel free to return to our homepage, http://www.goodtherapy.org/, and enter your postal/zip code into the search field to find therapists in your area. If you’re looking for a counselor that practices a specific type of therapy, or who deals with specific concerns, you can make an advanced search by clicking here: http://www.goodtherapy.org/advanced-search.html

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  • Bryan

    November 18th, 2019 at 11:10 AM

    I’m really struggling with this and not sure how to handle it. I’ve been isolated and alone all my life. No family. No friends. No relationships. Just me, myself, I, and my therapist.
    At 48, I’m now starting to try to figure out how to make friends. But I don’t seem to have the social skills necessary to do it. As any friendships I do make only last for a short period of time and then they just “disappear”. I get that one reason is, I may be considered “too negative” or “toxic”, but then I’m in the grieving process of long-term childhood trauma that has shatter my entire life in to millions of pieces. Of course I’m negative. Of course I can be overwhelming to other people. And I am good at making acquaintances, but not friends. I have no clue how people learned to do this. I was never taught social skills. The only skill I learned growing up was to detach, for self-protection. Now as an adult, how the hell am I supposed to learn these social skills and learn how to make friends, at the same time risk coming off too “negative” and yet still authentically grieve the loss of my childhood, my young adulthood, and the last 40 years of my life that has been numbness, isolation, and trauma? I think being open is scaring people off. I’m not sure. But I cannot seem to figure out how to make friends. I don’t get how others learned this. Where the hell, at 48, am I supposed to learn how to make friends?

  • Dr. Memo

    March 24th, 2020 at 10:21 AM

    Thank you very much for your lovely insights which give me considerable amount of better understanding of wife problems.

  • Rachel

    July 10th, 2020 at 9:52 PM

    I have seen therapists and psychologists in the past, but they have been hesitant to give me a clear diagnosis. After prolonged research, I believe that I am suffering from c-ptsd. My symptoms are consistent with this diagnosis without falter. However, I have a lingering concern about BPD. I initially sought a doctor because I thought this was my problem, but it was only determined that I have ADHD and non specified anxiety disorder. She felt that many of my symptoms resulted from developmental trauma and that I would benefit more from therapy. I had signs of borderline, but it was unclear. Years following that visit I found myself in controlling relationship with a physical abusive partner. I had to spend months planning my escape because I had no support system to fall back on. I was diagnosed with PTSD, but I avoided therapy for years following out of shame and fear of being misunderstood. I thought I could push through the symptoms and move forward. I had made a lot of progress, but I also avoided intimacy and relationships. For years I would isolate, so no one would judge me for what I was going through. The last couple years, however, I have been seeking more informed help and learning about c-ptsd. Through online research, I’ve found grounding techniques and tools to identify my symptoms and triggers. It’s been incredibly healing. I’ve been in my first serious relationship in 6 years this year. Things were rocky at first, but we had finally moved to a place of support and trust, but then COVID happened. I spent the first 6 weeks locked up in bliss with my boyfriend, but then I started to feel scared and cagey. I noticed myself dissociating and then came the nightmares and panic attacks. I’m 30 years old and I have not relived those memories in years. It put an incredible strain on my relationship despite trying to explain trauma to my partner. I was the one that ultimately broke up with him, but it was mostly out of fear of abandonment. He had suggested we take a break. I’ve been over texting and wavering between wanting him completely out of my life and sheepishly hoping we can slowly build back trust and security. He wants to get back together eventually, but I have a hard time trusting him now. I truly think my abandonment fears are based on the current climate and my fear of finding work/supporting myself when I have no family to rely on. I can see where I am being needy, but it’s not typical for me in a relationship. I also genuinely fear abandonment at this point. I’m just still unclear about the difference between c-ptsd and bpd. I have a clear idea about who I am at the core, but I’ve struggled finding my true calling or a definite career path. I would say that my personality and general interests are consistent, I just feel a little lost. I’m finally looking for a therapist, but I’m trying to keep within a limited budget. I can’t afford to see a doctor right now. The abandonment thing is just concerning me. I would like to talk to a trauma counselor, but I’m afraid that I actually may have BPD. Does that effect therapy choice significantly? I still feel like c-ptsd makes the most sense for my symptoms, but please be real with me about that. Is there anyone on here that might have a few insights?

  • SSK

    April 11th, 2021 at 1:22 PM

    Hi Bryan. To make friends, you have to show that you are friendly. You have to show you are interested in others and are concerned for how things are going in their life. Ask them questions about themselves and be prepared to listen. Show you are interested in them. When a person feels safe that you can be trusted with their feelings they will allow you to enter in closer and deeper in the friendship. But if you talk about your own problems and dwell on them exclusively and continue to focus on them, those conversations will cause a wall to go up. Talking about ‘poor, poor me’ wears out the best of friends. Your attitude is your choice. Those who feel entitled to pollute the conversation with self-centredness will be taught that such conversation is not a bond-maker. The other person who feels that you are ‘damaged’ and the budding acquaintance/friendship will suffer. Another barrier will go up as the friend backs off. Who wants to be around doom and gloom? We have enough of our own worries and stresses. Just because you were abused as a child doesn’t entitle you to insist that others shower you with pity and give you the love that you deserved as a child but didn’t get. Why are you wanting to share your sad childhood with strangers and acquaintances? That is for sharing with a counsellor or with very close friends. Continuing to stay in the abused mindset will not bring you any joy either. It is truly a choice – a choice to get counselling, to heal, to let go of your ‘right’ to hold on to anger and hard feelings and to get revenge on your abusers. You can read some excellent material such as the autobiography written by POW Corrie Ten Boom. She was dreadfully abused in a Nazi war camp and her sister died in the same camp. After the war, she couldn’t forgive the SS guard who had been so cruel to her when he attended one of her meetings. She was to shake his hand as he lined up to speak to her at the door, but she had to pray, “Father please let your love flow through me to this man because I don’t have any love for him.” (Or words to that effect). Then Corrie said she felt the love of God go through her and she no longer felt any hatred to her abuser but was truly able to feel concern and empathy for him. There is a higher power than evil in this world and you can tap into that power of Love. You need to give up thinking your are entitled to hand on to your anger and stop feeling you are justified doing so. You will never be happy that way. Love heals but love also forgives – not forgets, not pretends you weren’t badly abused, not fakes being happy when you’re really not happy. Real happiness comes from accepting you are loved, you are of incredible value and no one can take that value away from you. You don’t need others to tell you that they think you are valuable either. If you want friends it is so you can give to them and make them happy. A true friend will be delighted to give back to you. Friendship is a give and take of care that is expressed by both sides. If you feel that you have been ‘hard done by’ and focus on that aspect of your life, you will be mainly depressed, angry and not inviting to others. You can accept that you have been undervalued. You can also pity the parents who missed out on the love and trust of a beautiful child. You can be like Jesus taught – Love your enemies and do something good to those who don’t deserve it. You might make a friend out of them. Your behaviour and mental attitude should not be based on your past. As a child you had no protection or choice but to endure the abuse. Now you are an adult you can choose to forgo your ‘need/right’ to cherish anger against those who abused you. Instead you can focus on how you can spread the love that you never received to others who might have also had such a difficult childhood. We give emotional warmth to others and very often we receive something positive back. Not always, but enough to feel that it’s a better way. Life will be what you make of it. If a man wants to have friends, he has to show that he is friendly to others. I like to study the words of Jesus – not so much what anyone else writes or says, because Jesus faced the hardest questions and hardest circumstances and abuse in life. Despite giving so much to others, everyone deserted Jesus and they abandoned and rejected him to the point of murdering him. And he was the nicest person ever who never hurt or abused anyone. Jesus certainly didn’t have a cushy life. He could have moped about his unfaithful friends for his whole 33 years of age, but he didn’t need to do that. He knew he had incredible value and Jesus always said that his value was grounded in the fact that his father in heaven loved him. If you can understand that your father in heaven also loves you so very much then you can feel empathy for your abusers as Jesus did (and does). Jesus said to those who were murdering him, “Father forgive them because they don’t know what they are doing.” Your abusers didn’t know what they were doing in the sense that they didn’t recognise your value either. You can choose to forgive them for being unloving and you can forgo your right to get revenge through angry feelings. It would be a helpful choice for you to focus on spreading love to others. Think about how you can help someone else who might be struggling. Be the giver to others, of the happiness you want in your life. But most of all, study what Jesus said and did because it makes so much sense and it works. I hope this helps you.

  • Shilah

    June 8th, 2021 at 10:02 AM

    I get it. and I’m writing this about 3 years after you sent it, so I dunno but I hope that by now you have found a friend…. I get it; some of us are more easily unbalanced than others & a real friend can make such a difference. ….I don’t have all the answers, by any means.
    ……to me, a friend is someone who will reach out to me once in a while, they don’t always wait for me to initiate contact. So, by that standard, I have 3 friends, all of whom are far away. :-( And my best friend is probly my brother… who is a lot like me, poor guy. Family does help… if you’re lucky in that area….
    One thing I have had to come to terms with is, that people change… or circumstances change… so even though they don’t intend it, the friendship might fade just because of changes. Maybe they had a hard stretch and can’t bear up right now under my normal tendency to be a bit of an Eeyore…. maybe they are preoccupied with a situation… maybe their duties (work, family whatever) are making it hard to reach out… maybe it’s a time difference so phone calls are hard to manage. Many a time I have wished my mom lived in the same time zone as me. Gotta cut people a LOT of slack. Cut yourself some slack too…. and remember, animals are “people” too. They can be there for you when no one else is.
    I sleep a lot more now, due to covid-induced stresses; so when people complain about the folsk who sit around collecting unemployment, I refuse to receive that as being valid for me The dang goverment decided my business, my skill set, is non-essential, so they can darn well support me till they get off their high horse and value my skills again. Sometimes what it takes to survive is to convert one’s sadness into anger. It’s not pleasant, but sadness is a drain on energy while anger gives its own kind of energy, and it takes energy to stand up for oneself.
    I get it though… being open isn;t for everyone. I have to even ration the amount of “me” that I share with my husband, and we’ve been together almost 40 years. His job keeps him running and weary; I know things will improve once he retires but that’s another ten years from now.
    Not everythign that helps me wil help you, but please know I get it. I also wonder how does one make a friend… how does one hang on to a friend without scaring them away…. how do I know when it’s THEM being weak or selfish or whatever, instead of me being the problem (& how do I convince myself)… mostly, how to take care of myself when human friends are just not in the picture. I think I need to remember: having friends does not validate me. Being ME is valid – whether anyone else likes it or not.

  • Jeff

    July 21st, 2021 at 9:11 AM

    I think you’re kind of missing the whole point here. As the result of extreme infantilization/enmeshment, I’m “stuck in dorsal vagal” or frozen, and when I try to get therapy like EMDR it’s pointless because my body refuses to have anything to do with my mind, so my “inner child” therapy options are severely limited. And I guess you either don’t know or aren’t using polyvagal theory here because if you can’t get into ventral vagal state you just can’t interact socially with anyone, the ONLY times I’ve ever had any success with anyone was when I met them on the phone FIRST because if I try meeting them for the first time in person they “don’t seem to see anyone there who’s interested” and leave. And please don’t tell me to “try harder”, if you say that you’re just compounding the obvious fact that you don’t know what you’re talking about!! Yes we’re a tiny contingent but I’ve met others online just like me, don’t you have any responsibility if you’re going to give advice on a subject like this that it ought to at least be useful rather than increase one’s frustration? I’m looking forward to trying KAP (ketamine-assisted psychotherapy) sometime in the future when I can afford it, I’m not “preferring” a pharma-based solution but believe me I’ve tried almost EVERYTHING else, and my current therapist (who doesn’t offer it herself) concurs. I mean really, you didn’t mention polyvagal theory or its equivalent even once here.

  • Christi An.

    September 30th, 2021 at 7:39 AM

    Bryan,

    I’ll be a friend to you. With you. I, too, have suffered at the unwanted unfortunate parental abuses we once used to regard as no big deal. I, too, chose a path of giving back to and helping those in need by weeding my way through various social working positions. I, too, struggle to decompress all that I tend to absorb by connecting to) those I have helped throughout the day or week or month. I, too, feel like I’m on the inside of the proverbial fishbowl of life and totally struggle to connect and relate to seemingly superficial small talk when I internally hold the weight of my day, including some poor child’s trauma that is too unfathomable to repeat (especially to a casual friend over lunch) that I just can’t detach completely from to discuss the price of toilet paper with her.. (seriously, I’ve got bigger waaaaaay bigger burdens to bear. Things that would make this person have nightmares that would send her butt running for the comfort of moving back in with her parents and leaving the night light on in the hallway just to avoid the repeat nightmares from the horrific story I wanted to scream at her about. Only…I didn’t really want to scream at her or cause her nightmares. I just couldn’t talk about a laundry list of crap I was seemingly supposed to be easily able to engage talking about while we sipped our water over this lively lunch.. I was so not into it. But I wanted to be. Sound familiar? Its ok. Its not you against the world, I promise. There are others like you that you need a bit more of to help those seemingly impossible casual instances of interaction, seem a bit more palatable. Why? Because maybe it would help to have a sprinkling of friends who you could actually relate to in a deeper level. People who understood your depth because they walk it too, most everyday. And they get lonely too…even amongst the busy crowd of people making small talk around them. So, hopefully this was mildly helpful. Or, maybe you got a good laugh at me. Which is perfectly fine with me. Who knows? Maybe I provided some reassurance that there are nutter peeps out there than you (you’re welcome, if so). But, maybe…just maybe…you just made a friend today. Im Christi, by the way. I happen to be on a mission to find integrity and kindness and goodness in the world…and I’m on a life mission to not only find it…but to help those happiness I discover, become completely contagious and I’m hopeful it will spark a new pandemic. One that will pass from human to animal to nature to human and back again. Thats right, my Fairweathered friend (<—see that there?!) I am the one and only proud member of team kindness..and thoughtfulness..and being good and decent to those people and animals and nature around us (because in doing so, it in turn takes care of us back). I'm one member strong-but hey, what's one more passanger? Or captain…you can totally be the captain, if you prefer.. I have no need to hog the best seat in the house.:) OK, all kidding aside. I'm definitely in a position of understanding of your experience with holding relationships with others when you feel like you can't relate or understand them. I am not a whack job. I look at the world through whatever lens I feel I can tolerate at the time, which my imagination usually runs wild with by suggesting a giant microscope lens that I can quietly analyze the world with, one person and situation at a time. ("OK, pipe down." I find myself telling my own imagination to chill out on the suggestion box entries for this one, lol. Yeah. Its totally annoying to mentally open up 690 "entries in the suggestion box from "that guy" (<—my imagination) each night. Its exhausting, hehe. Ok..so, anyway… Bryan with a y…Ill be your friend. If you are interested in adding a bit of laughter and a boat load of understanding and wit to your friend-list. (Or if you just want to laugh at me, thats ok too :) And how those who applied, would be debt-free after using their program.
    Its this very kind of email address that has people lining up to get my autograph for. No, I’m kidding. It was a totally impulsive move and well…its mine now. So, have fun with it while you type it out. Hehe.
    Hopefully, I hear from you soon. Or if I never do, I hope you find a better perspective on relationships in general and relating to those around you either way. The offer still stands. Have a satisfying day, Bryan-with -a-y. Y:)

    Thanks,
    Christi

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