- [Kyle] CPTSD pervades all
areas of a sufferer's life. There are key cognitive,
behavioral, physiological, and emotional signs of the disorder that patients and supporters
alike can look out for. Dr. Ramani walks through those
symptoms in this session. - Can someone develop CPTSD while the abuse is still occurring? - So while the abuse is
still occurring, absolutely, you're gonna see very likely many of the patterns you'd
see an ongoing CPTSD, that there'll be emotional numbing, that there'll be a fear and a confusion about close relationships. There'll be shifts in
their self-perception, viewing themselves as bad,
negative, damaged, and helpless. There also are shifts in their perception of the perpetrator. They sometimes view the perpetrator as all powerful and all knowing. There are times they'll have fantasies about revenge against a perpetrator. All of that can be happening in real time. However, what you gotta keep in mind is, if the perpetration stops,
those patterns don't stop. You know what I'm saying? That the two, so yes, they
absolutely can develop at the same time. And I must say, I've worked with clients who will share with me that
while it was happening, their sense of valuation
just kept deteriorating. A very common theme I'd hear, particularly in women and girls who were sexually abused as girls for years and years and years, it really impacted their
sense of body image. They had a very distorted
sense of themselves, of their bodies, as their
bodies sexualized more and more, they'd cover it up, they
would develop eating disorders or distorted body image. So, you'd see again, all these plates sort of
shifting developmentally 'cause these are children being affected. - Well, when it comes
to spotting the signs, we break them up into a few categories, the cognitive, physiological,
emotional, behavioral. Let's start with cognitive, what are some of those warning signs? - So when we talk about any
kind of a cognitive symptom or cognitive sign, it's an alteration in how a person is thinking and perceiving
and even believing, okay? When we look at a cognitive symptom, it's a problem or a disorder on thinking, it's a distortion more often than not. So the kinds of cognitive
distortions we can see in CPTSD are often about the self, viewing themselves as bad, as damaged, sometimes even blaming themselves. That's not an uncommon theme that somehow they were
complicit in their own abuse, maybe I shouldn't have said that, well, I didn't try to run away is one. They'll blame themselves for
something happening to them against their will. They'll view themselves
as helpless and powerless, and they'll take that perception of powerlessness and helplessness into other areas of their
lives and almost feel crushed when they can't, for example,
in school or in a job, because that sense of helplessness, that sense of powerlessness tends to dog them in other areas. So these are incorrect perceptions. So when we see those
and they're so distorted and they're so consistent, that's not an uncommon
pattern at all in CPTSD. - What about things like
flashbacks and suicidal ideation? - Absolutely. Those would definitely fall
under the cognitive symptoms, not just of CPTSD, but also of PTSD. So it's this re-experiencing. When a person experiences a trauma, one of the hardest things
that happens for them is the re-experiencing. And if you talk to someone
who's experienced trauma, what's so heartbreaking is
things in their environment can set it off. It could be anything,
a time of day, a sound, and they re-experience that's it. - The re-experience though is them not actually experiencing
it, but to them, it is. - Well, they're thinking about it. They're in it, they can't break out of it. In fact, people who are with them might even feel that in the moment, they become mildly dissociated, like they're in that space
and they're far away. Many, many, many clients over the years where we're doing the traumatic work and I start to lose them,
I can see they're slipping, and I'm like, come back
in, I need you here because what I wanna do, any of us who work in trauma is, we don't want their
thinking about the trauma to become so dissociated
'cause then they're back in it. I want 'em in the room. In fact, I'll almost make noise, like you're here, look it,
we were talking about this, Right here, we're talking about it, it's not happening right now. And so it's really
keeping them in the room. It's okay, I'm here, you're
safe, no one can come in, but you're keeping them in the room. But that re-experiencing,
it's a mental re-experiencing, but some people will literally describe, like, they feel like
their body is in it again, they feel like they're being held back and I'll even see that in
their posture, like their back, like they're being held, you know, what was done to
them is being done to them and so it's devastating,
it's absolutely devastating. - And this isn't a conscious choice, this is a subconscious way to cope. - I mean, trauma chops up
the brain a bit, right? The brain is amazing and how
it tries to protect itself, but there's more and more
interesting work on how the brain isn't the only
place that holds memory, our bodies hold memory too. And a lot of this, you know, interesting work that's
coming out on trauma is really understanding how
our bodies hold this, too. People feel this physically,
all over their body, and so we can't underestimate
that it's very easy. I mean, listen, I'm all about
the penthouse suite here, but it's all happening around the body. One pattern we do observe in CPTSD is disruptions in attention
and concentration, that there will be times
that it almost will feel, at times almost dissociative, that they just won't be present, and a person with CPTSD
just won't be present. And there will also be times when they themselves will acknowledge, like, could you say that again? I didn't get that, right? And so, we do know that
trauma in all its forms disrupts attentional processes, and the research, the
neuro-psychological research on attentional performance
and concentration in people who've endured trauma, there's clearly
disruptions there for sure. And that can make life
a lot more difficult. It makes school very difficult,
it makes work difficult 'cause you're not tracking as well, it can even make conversation difficult. Like I said, even in therapy, I'll have clients say,
could you repeat that? And I can see what that is. It's sort of that frank,
attentional impairment they have. Now remember, attention,
concentration, memory, these are all linked central
nervous system processes. So, it would make sense,
but it can be frustrating 'cause sometimes people think that they're almost being arrogant, why don't you listen to me? You know, and again, it's,
this almost as though there's always this distracting pull that people with CPTSD will
acknowledge experiencing. So, I think that's an important
part of the pattern to note, because it can be
misunderstood by some people, some people might even see it
as something like ADD or ADHD. It can look like that as well, but it is very frustrating for people who are experiencing CPTSD on top of the many other
disruptive, uncomfortable symptoms that they're experiencing. - So how common is amnesia
for someone who has CPTSD? - Well, in stress disorders as a whole, and certainly in
post-traumatic stress disorder, it's not unusual to see
dissociative symptoms, and dissociation is when a
person almost breaks away. It's as though that they break
away from their own reality or break away from themselves. They're not present in
the situation anymore, they've gone someplace else. Dissociation is known to be a mechanism that people who've
experienced trauma manifest. And so, in its most extreme manifestation, we see dissociative identity disorder where a person actually breaks off into a separate and distinct personalities that dissociate from sort
of the host personality. In the case of the kind of dissociation we see in post-traumatic stress,
the person may dissociate when they're reminded of the trauma and when they're talking about the trauma. And that's a pretty classical
traumatic presentation. You can see some
dissociative symptomatology. Obviously in complex PTSD,
this person has endured trauma so they may dissociate in that moment, and that becomes almost
a regulation issue. - So is amnesia just a
form of dissociation then? - Amnesia is a blockage of memory, typically we'll see around trauma. So the person cannot recall
events right around the trauma. - Understood. - You see what I'm saying?
- Yes, yes. - It's a memory function
that gets disrupted at the time of trauma
against something we do see. But there's actually something
called dissociative amnesia that happens during the time of a trauma, the person just simply cannot recall it, which is actually quite horrible because sometimes people
who've been through a trauma and can't accurately recall it, people doubt that they
even experienced the trauma because they can't remember it because that's what happens
to the brain during trauma, quite frankly. So that's a misnomer
and a misunderstanding many, many people hold. So you can see that form
of dissociative amnesia in people with PTSD. Here's the trick with complex PTSD. They've had repeated
exposures to the trauma. Some they'll remember, some they won't. And some of that not remembering may be a by-product of a
dissociative amnestic episode.
