10 Things To Say To Someone With CPTSD (And Not Say)
10 Things To Say To Someone With CPTSD
I hear you. I’m listening.
It’s not your fault what happened to you.
Your feelings matter to me. You are important to me.
What would help you right now as you feel overwhelmed and anxious? Making a list? Brainstorming what we can do together if something happens? Slowing down and breathing? Taking a break?
I’m not sure what to say right now, can I sit next to you and just be here for you?
Would you like to tell me more? No pressure. I’m here to listen.
I’m here for you. You’re not alone.
Your reactions and symptoms make sense based on what you’ve been through.
There is nothing wrong with you. You are not crazy.
You’ve been through a lot. I know it’s not my fault, but I’m sorry.
The goal is to:
Validate (hearing some kernel of truth in what they are saying, not necessarily agreeing)
Actively listening (listening to understand not interrupt)
Foster connection (to let them know they are not alone)
Be authentic
Be present and attuned
10 Things Not To Say To Someone With CPTSD
It wasn’t that bad, was it?
That happened in the past, why are you still upset?
Calm down.
You’re overreacting. It’s been years now. Get over it.
You’re too much right now.
What’s wrong with you?
I don’t believe anything you’re saying.
You are crazy. You are dramatic.
Stop crying.
Other people have gone through worse things. Are you serious?
The goal is not to:
Minimize their experiences
Invalidate or dismiss their experiences
Compare their experiences
Blame them
Shame them
Ways To Support Someone With CPTSD
Be curious (rather than judgmental)
Validate their feelings and thoughts (rather than minimizing and invalidating)
Emphasize strengths (rather than deficits)
Practice consistency and structure (rather than constant changes)
Anticipate distressing events and problem solve/brainstorm possible solutions
Use direct assertive communication (mean what you say and say it as directly as possible vs. passive, passive aggressive, aggressive forms of communication)
Let them know that perfection doesn’t exist, they don’t need to be perfect, and mistakes aren’t bad (and that mistakes/ruptures/tensions/conflicts are to be expected and that you can work through them together)
Taking Care Of Yourself While Supporting Someone With CPTSD
Take good care of yourself
Rest, relax, sleep, eat well, drink water, exercise, spend time with other friends/family
Take a break
Let them know you need space and/or time to take care of yourself and you’ll be in touch when you’re ready to engage again
Assert your boundaries directly
Let them know what you need and want
Accept you cannot help them with everything nor should that be your responsibility/role
Having boundaries is healthy
Let them know your boundaries if/when they cross/violate them
Just because someone has a history of trauma does not excuse abusive or manipulative behavior
Understand your own trauma and triggers
Separate what is yours and what is not yours to bear/is responsible for
Be curious and ask yourself questions like
What attracted me to this person in the first place?
What do I appreciate and value about this person?
What makes it hard (barriers) or challenging to be with this person?
What are their triggers?
What are my triggers?
What in my past might be replicating itself right now in this relationship?
What are their boundaries? Do they have healthy boundaries? Where and who did they learn boundaries from? How do they say no? Is it easy or hard? How do they accept others’ boundaries? Do they?
What are my boundaries? Do I have healthy boundaries? Where and who did I learn boundaries from? How do I say no? Is it easy or hard? How do I accept others’ boundaries? Do I?
Seek professional help
Therapy and/or support group who has training in CPTSD and can offer you a third ear/perspective on what may be going on
Consider ending the relationship or friendship or taking a break/pause
The decision to end a relationship is personal and entirely up to you (not anyone else)
Our choices come with responsibility and consequences
If you find that you’re stuck in these cycles of conflict over and over, it might be time to seriously reflect on what might be happening underneath and what keeps you in this cycle with this person
Go seek professional help from someone who can help you process these dynamics
Journal about these thoughts and feelings
Feel and process your feelings related to these issues and conflicts
You have the right to assert your boundaries and say what you need/want and they also have the right to assert their boundaries and say what they want and need
Boundaries shift and change: there’s always the possibility of taking a break and coming back to the relationship when you have more space/energy to devote to it (again, the other person may or may not accept your boundaries. And that’s okay)
What is Complex PTSD?
PTSD is a singular event such as being in a car accident, sexual assault, experiencing an earthquake or natural disaster, or witnessing violence.
Complex PTSD is repeated, chronic, and ongoing traumatic experiences usually from early childhood to adolescent to adulthood, but can be any prolonged period of time ranging from months or years at a time.
These repeated experiences indelibly shaped individual’s thoughts, feelings, behaviors and ultimately identity and relationships with themselves and others.
From the International Classification of Diseases (ICD): Complex post traumatic stress disorder (Complex PTSD) is a disorder that may develop following exposure to an event or series of events of an extremely threatening or horrific nature, most commonly prolonged or repetitive events from which escape is difficult or impossible (e.g. torture, slavery, genocide campaigns, prolonged domestic violence, repeated childhood sexual or physical abuse). All diagnostic requirements for PTSD are met.
In addition, Complex PTSD is characterized by severe and persistent:
Problems in affect regulation;
Beliefs about oneself as diminished, defeated or worthless, accompanied by feelings of shame, guilt or failure related to the traumatic event; and
Difficulties in sustaining relationships and in feeling close to others.
These symptoms cause significant impairment in personal, family, social, educational, occupational or other important areas of functioning.
Who Coined Complex PTSD or CPTSD?
In 1988, Dr. Judith Herman (author of Trauma & Recovery) suggested that a new diagnosis, complex PTSD, was needed to describe the symptoms of long-term trauma.
Such symptoms include, according to her formulation:
Behavioral difficulties (e.g. impulsivity, aggressiveness, sexual acting out, alcohol/drug misuse and self-destructive behavior)
Emotional difficulties (e.g. affect lability, rage, depression and panic)
Cognitive difficulties (e.g. dissociation and pathological changes in personal identity)
Interpersonal difficulties (e.g. chaotic personal relationships)
Somatization (resulting in many visits to medical practitioners)
Examples of What Can Cause CPTSD
Childhood trauma (including abuse, sexual violence, incest, harsh punishments, forced to watch pornography, being intentionally hit)
Childhood neglect (parent/caregiver failed to take care of you emotionally and physically, failed to get you proper medical care, did not give you clothing or shelter, didn’t give you enough food to eat, didn’t make sure you were safe, left you alone for long periods of time without supervision)
Attachment disruption (parent/caregiver left you through death, incarceration, deportation, migration, or other reasons)
Foster care youth who moved often and were housing unstable/lacking consistency growing up
Witnessing violence
Growing up in poverty
Community violence (growing up in an area with violence (hearing gunshots, people fighting, people getting jumped), not feeling safe to leave your home, living in an area with a lot of gang violence)
Homelessness and/or housing instability
Sexual assault and violence
Bullying (being cursed at, insulted, being put down, humiliation, being teased, being physically intimidated, threats, people turning agains you, lies and rumors being spread)
Racism (anti-black racism, death, hyperviligance, gaslighting, macroaggressions, microaggressions, stereotype threat, internalized oppression)
Homophobia
Transphobia
Ableism
Religious abuse
Survivors of cults
Refugees
Asylum seekers
Survivors of torture
Survivors of war
Survivors of terrorism
Survivors of genocide (Holocast, Khmer Rouge, Armenian genocide, Rwandan genocide)
Survivors of enslavement
Concentration camp survivors
Domestic violence survivors
Survivors of trafficking
And more
Common Effects of CPTSD Include The Following Dimensions
Thoughts/Beliefs About Self & The Future
Feelings/Emotions
Relationships
Body/Soma Effects
Consciousness
Thoughts/Beliefs About Self & The Future
Altered self perception. May include helplessness, shame, guilt, stigma, and a sense of being completely different from other human beings. May also include a loss of sustaining faith or a sense of hopelessness and despair.
I am a bad person
I am not good enough
I am broken
I am weak
There is something wrong with me
I like having control
I like having answers
I like certainty
Feelings/Emotions
May include persistent sadness, suicidal thoughts, explosive anger, or inhibited anger.
I feel sad
I feel angry
I feel irritable
I feel ashamed
I feel scared/afraid/fearful
I feel helpless
I feel hopeless
I feel insecure
I feel lost
I feel apathetic
Impacts On Relationships
Examples include isolation, distrust, or a repeated search for a rescuer.
I can’t trust anyone
I trust the wrong people
I want to be alone
I can’t make friends
I can’t keep friends
Relationships are hard
Relationships are not worth the effort
People eventually die
People eventually leave me
Body/Soma Effects
The body keeps the score. Your body learns to constantly be on guard, to protect itself, and is in a state of arousal, nervousness, and anticipation of the worst and danger. Eventually, your emotional symptoms become somatic and gets lodged/stuck in your body.
My shoulders are tense
I feel jumpy
I don’t feel anything in my body
I feel like I’m out of my body and floating
My stomach hurts
My head hurts
My body aches and hurts
I fidget a lot
I’m exhausted no matter how much I sleep
I don’t like looking people in the eyes
I don’t like to be touched
I don’t like be to close to others physically and emotionally
Impacts On Consciousness
Includes forgetting traumatic events, reliving traumatic events, or having episodes in which one feels detached from one's mental processes or body (dissociation).
Disassociating when under stress, panic, or worry
When I am having a fight with my partner, I leave my body and go away
Feeling like I’m just floating through life
Feeling like I’m separate from my body
Feeling like this isn’t my body and I’m disconnected
Lack of ability to recall early memories (or only remembering “bad” experiences)
Constant reliving of the traumatic events
Nightmares
Constantly on edge
Hyper vigilance
Always on the look out for something bad to happen
Anticipating the worst
What Types Of Therapy Help People With CPTSD?
Most of the research on trauma has been traditionally focused on PTSD, or single incident trauma. Current research is being done on CPTSD and what treatment models might be helpful, though it is still inconclusive.
Current evidenced based treatment models for PTSD include:
EMDR (Eye Movement Desensitization Reprocessing)
TF-CBT (Trauma Focused-Cognitive Behavioral Therapy)
CBT (Cognitive Behavioral Therapy)
CPT (Cognitive Processing Therapy)
PE (Prolonged Exposure)
Lesser known and researched trauma specific treatment models for PTSD include:
Somatic Experiencing
Sensorimotor Therapy
Somatic Therapy
Progressive Counting
Brainspotting
Because CPTSD is an issue caused in relationships, a relationship based therapy will be most helpful.
The goal is to learn to trust your therapist (or have your therapist earn your trust), feel safe enough to tell them more about the impacts of trauma on your life, learn to assert your boundaries (asking for what you need rather than assuming), have a healthier relationship with your emotions, and learn to challenge your thoughts and beliefs.
How Do I Select A Therapist For CPTSD?
The most important thing is to feeling like you like and can learn to trust your therapist. Trust your gut or instinct.
A good trauma therapist will have a great understanding of trauma, be trained in a few trauma modalities, hold firm boundaries, engage in self-care outside of their work, hold hope for healing, are strength-based, and flexible to adapt treatment to your needs.
Schedule a consultation and see how you feel speaking to the therapist.
What is your first reaction?
Do you feel like you can talk more with this person?
Do you like this person?
Find someone with training and experience with trauma, PTSD, and specifically PTSD.
Look for a therapist who focuses on the following areas:
Complex trauma
Relational trauma
Childhood trauma
Developmental trauma
Attachment theory
Neuroscience
Disassociation
Relational therapy
Interpersonal neurobiology
Trauma Resources
Looking for more trauma resources? Click here for a list of evidenced based trauma therapies, books, and workbooks.
References & Further Reading