Although it remains explicitly absent from the Diagnostic and Statistical Manual of Mental Disorders, complex posttraumatic stress (C-PTSD) is a condition that has gained broad acceptance in the mental health community. The symptoms and features of C-PTSD may be similar to borderline personality and posttraumatic stress (PTSD) and are most commonly associated with experiences of chronic child abuse or neglect, though any uneven power dynamic exploited over a prolonged period—such as kidnapping/hostage situations, indentured servitude, cults, or even intimate partner violence—can be the basis for complex trauma.
Complex trauma’s chief distinction is its prolonged nature. It’s not that your caregiver assaulted you that one time; it’s that your experience as a child was filled with recurring maltreatment, resulting in symptoms that are often diagnosed as attention-deficit hyperactivity (ADHD), depression, and anxiety. While these diagnoses may be accurate, they do not address the origination of the problem.
How a parent interacts with their child can have a huge impact on the child’s emotional development. If a child is not properly attuned, attended to, or acknowledged as an infant or in early childhood, a lifetime of damage may result. Generally, no visible scars or marks offer clues that anything damaging has occurred. When the person becomes an adult, they may experience serious relationship problems or struggle with addictions and other issues without understanding why. This, too, is complex trauma.
In fact, when someone has been chronically maltreated during any portion of life as a result of any type of abuse or emotional neglect, they may develop an inner propensity to manifest a variety of external symptoms. These tend to include but are not limited to “airheadedness,” anxiety, somatic symptoms (migraines, stomachaches, etc.), dissociation, and depression.
People who experience trauma from an early age must protect themselves in some way in order to cope. One means of protection is to “split off” the part of themselves that is experiencing the trauma. This results in the traumatized person having a fragmented psyche. Fragmentation is really a protective strategy. It serves a person well during traumatic experiences, but tends to be problematic once no longer needed for survival.
This splitting cannot be seen under a microscope or in a brain scan. Rather, it is as if the person develops different, developmentally stunted personas that are frozen in time deep within one’s unconscious memory. Each “persona” or “mode” is rigidly committed to a lack of growth and causes a level of stunted emotional development.
Schemas and Modes
During a child’s upbringing, various inner working models about life are developed. These can result in internalized “schemas.” Schemas develop in all people at an early age; some are adaptive and some are maladaptive. They are comprised of emotions and deeply ingrained beliefs about self, others, and relationships. Schemas are neurologically held as experiential or implicit memories, and are experienced viscerally. For example, one type of schema could leave an internal felt message of, “I know I am not worthy of love; I just know it. I feel it in my being.”
Modes are developed internally in response to schemas and are comprised of the personas created during traumatic or otherwise emotionally dysregulating experiences. Modes are compensatory and are created mainly as protectors. Some protectors are over-compensatory, such as in the case of narcissistic and antisocial personalities. Others are in the form of avoidance, denial, being overly friendly, etc.
Modes are akin to personalities. The necessary personality shows up as needed in response to the trigger at hand.
Everyone operates in modes. Some people with minimal traumatic experiences in childhood have relatively “normal” modes, where triggers aren’t as devastating as in the case of those who come from extremely emotionally deprived childhoods. When particularly strong modes of relating are present, personality conditions may develop.
Dissociative identity (DID) is the clinical term for a person with distinct and separate personas developed as a result of childhood trauma.
Triggers usually have a connotation of something negative, but can also occur when a person has been conditioned to experience something positive. For the purposes of this article, I am referring to those triggers that cause a person to maladaptively regress emotionally to an earlier time in life.
Triggering occurs when a person experiences something that reminds them unconsciously of a past traumatic or emotionally upsetting experience. A schema is what is triggered, and a mode is what comes into play to protect the underlying, unbearable emotional pain.
When threatened by a negative emotional experience, subconsciously a schema is triggered and a mode comes to the rescue to protect the individual from the underlying emotional discomfort. The threatened unbearable emotions may include anger, shame, humiliation, desperation, fear, and emptiness.
Challenging the underlying maladaptive beliefs helps a person who experienced complex trauma begin to assess the damage caused during their childhood. The goal of therapy is integration of the different personas into a cohesive, adaptive, pro-social whole.
For people with personality conditions, a common threat is the potential for warmth, nurturance, or closeness. Such individuals may display personas to stop healthy interpersonal connection from happening.
Why is this? The hope for love may be threatening to a person with a personality condition. The “protector” shows up to stop this threat from becoming a reality. For a person with a personality condition, the hope for attachment may bring up the emotions of vulnerability, neediness, helplessness, powerlessness, and subjugation. These feelings may be too threatening to experience consciously.
If, as a child, a person did not experience consistent nurturance and reassurance when feeling helpless, needy, or vulnerable, but instead experienced abandonment and abuse, then dissociation and over-compensatory measures may have been created. Over-compensatory measures may occur in the form of another personality, such as The Entitled, The Superior One, The Rager, or The Detached Observer. These modes are protective.
Think of the concept of a person having part of their personality stuck in an early developmental stage, such as age 3. Now, think of a person with narcissism having a “rage attack.” The image you conjure may resemble the temper tantrum of a 3-year-old.
This is an example of a trigger leading to an emotional regression. The rage attack is akin to the “protection” for the person. While it may be maladaptive, it is effective in protecting the person from feelings of vulnerability and helplessness.
Treating Complex Trauma
One of the most helpful first steps in treating complex trauma is to identify the various modes within a person’s psyche. Some people have a few distinct personas, such as the ones mentioned above. Others include personas with attributes fitting titles such as The Rebel, The Fighter, The Victim, The Seducer, The Liar, The Party Girl, and so on. These labels are self-descriptive; the corresponding personas may show up when particular schemas are triggered as a result of threats being sensed in the environment.
Some of these personas act “normal” and can be masterful at concealing dysfunction. Protective in nature, these modes are usually the ones that present to the world and can be likened to a mask. For healing to occur, it is helpful to identify all modes—the “normal” ones as well as the socially maladaptive ones.
A good therapist can help a person struggling with complex trauma identify their schemas, modes, triggers, and personas, and can help the person learn to integrate these parts into a cohesive whole. Keep in mind it is not the goal of therapy to eliminate a person’s protectors, but to embrace them and incorporate them into the person’s sense of oneness.
Integration succeeds differentiation. Once the different parts are identified, the therapist can help the person ascertain the primary underlying threatening schemas residing in their psyche. Once these underlying schemas are pinpointed, the triggers make sense. Challenging the underlying maladaptive beliefs helps a person who experienced complex trauma begin to assess the damage caused during their childhood. The goal of therapy is integration of the different personas into a cohesive, adaptive, pro-social whole.
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