How Victims are Affected by Abuse
Complex Post-Traumatic Stress Disorder (C-PTSD)
By: Dr. Sam Vaknin
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(I use "she" throughout this article but it applies to male victims as well)
Contrary to popular misconceptions, Post-Traumatic Stress Disorder (PTSD) and Acute Stress Disorder (or Reaction) are not typical responses to prolonged abuse. They are the outcomes of sudden exposure to severe or extreme stressors (stressful events). Yet, some victims whose life or body have been directly and unequivocally threatened by an abuser react by developing these syndromes. PTSD is, therefore, typically associated with the aftermath of physical and sexual abuse in both children and adults.
This is why another mental health diagnosis,
C-PTSD (Complex PTSD) has been proposed by Dr. Judith Herman of Harvard
University to account for the impact of extended periods of trauma and abuse. It is described here:
One's (or someone else's) looming death, violation, personal injury, or powerful pain are sufficient to provoke the behaviours, cognitions, and emotions that together are known as PTSD. Even learning about such mishaps may be enough to trigger massive anxiety responses.
The first phase of PTSD involves incapacitating and overwhelming fear. The victim feels like she has been thrust into a nightmare or a horror movie. She is rendered helpless by her own terror. She keeps re-living the experience through recurrent and intrusive visual and auditory hallucinations ("flashbacks") or dreams. In some flashbacks, the victim completely lapses into a dissociative state and physically re-enacts the event while being thoroughly oblivious to her whereabouts.
In an attempt to suppress this constant playback and the attendant exaggerated startle response (jumpiness), the victim tries to avoid all stimuli associated, however indirectly, with the traumatic event. Many develop full-scale phobias (agoraphobia, claustrophobia, fear of heights, aversion to specific animals, objects, modes of transportation, neighbourhoods, buildings, occupations, weather, and so on).
Most PTSD victims are especially vulnerable on the anniversaries of their abuse. They try to avoid thoughts, feelings, conversations, activities, situations, or people who remind them of the traumatic occurrence ("triggers").
This constant hypervigilance and arousal, sleep disorders (mainly insomnia), the irritability ("short fuse"), and the inability to concentrate and complete even relatively simple tasks erode the victim's resilience. Utterly fatigued, most patients manifest protracted periods of numbness, automatism, and, in radical cases, near-catatonic posture. Response times to verbal cues increase dramatically. Awareness of the environment decreases, sometimes dangerously so. The victims are described by their nearest and dearest as "zombies", "machines", or "automata".
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The victims appear to be sleepwalking, depressed, dysphoric, anhedonic (not interested in anything and find pleasure in nothing). They report feeling detached, emotionally absent, estranged, and alienated. Many victims say that their "life is over" and expect to have no career, family, or otherwise meaningful future.
The victim's family and friends complain that she is no longer capable of showing intimacy, tenderness, compassion, empathy, and of having sex (due to her post-traumatic "frigidity"). Many victims become paranoid, impulsive, reckless, and self-destructive. Others somatise their mental problems and complain of numerous physical ailments. They all feel guilty, shameful, humiliated, desperate, hopeless, and hostile.
PTSD need not appear immediately after the harrowing experience. It can – and often is – delayed by days or even months. It lasts more than one month (usually much longer). Sufferers of PTSD report subjective distress (the manifestations of PTSD are ego-dystonic). Their functioning in various settings – job performance, grades at school, sociability – deteriorates markedly.
The DSM-IV-TR (Diagnostic and Statistical Manual) criteria for diagnosing PTSD are far too restrictive. PTSD seems to also develop in the wake of verbal and emotional abuse and in the aftermath of drawn out traumatic situations (such a nasty divorce). Hopefully, the text will be adapted to reflect this sad reality.
We tackle recovery and healing from trauma and abuse in our next article.
Trauma bonding (Stockholm Syndrome) is poorly understood. The intimate partner in a trauma bond constitutes a "safe (or secure) base". In child psychology a safe or secure base is typically the infant's mother. The child experiments with his new boundaries as a separate individual (separation-individuation) knowing that it can always return to the safe base.
In a trauma bonded dyad (couple), the parties feel free to experiment with the most reckless misbehaviors and indulge in the most outlandish fantasies, knowing that the safe (or secure) base partner will always be there for them.
The safe base partner shapes the other's sense of identity and many of her beliefs and cognitions (thoughts). The two members of the bond are merged and fused. It is not easy to let go of the partner's voice, representation, imago, or avatar in one's head (introject). Unconsciously, it is perceived as who one is.
In a trauma bond, the introject is negative and sadistic but it is a part of one's self-perception of who one is, one's demarcated identity (as a "bad, worthless, malicious, crazy object".) This is why any change to the status quo is treated as a threat and the relationship is remarkably stable despite the copious amounts of mind altering abuse.
Women who are traumatized by past abusive relationships (CPTSD), or suffer from emotional dysregulation owing to personality or mood disorders have very low tolerance for situations & circumstances which are ambiguous, vague, uncertain, or unpredictable.
The abuser's intermittent reinforcement (hot-cold, approach-avoidance) & rejection create exactly such an ambient environment.
Broken and wounded women cannot cope with ambivalence (love-hate relationships), cognitive dissonance (simultaneously holding two conflicting thoughts or beliefs), or frustration, or boredom & inner emptiness.
They react to all the above with overwhelming anxiety & panic & ultimately, with debilitating depression.
To extricate themselves from this relationship morass, to put an end to their increasing misery, such women act out recklessly. In most cases, they end up cheating on their men ostentatiously & flagrantly.
The message to their abusive intimate partners implicit or explicit in their egregious misbehavior is: "I cannot leave you because I do not have the courage & the heart to hurt the needy & tortured child that I see in you. But, can't you see that I am damaged goods & you should dump me?"
By behaving dissolutely & cruelly, the injured woman also convinces herself that breaking up with her partner is for his own good: she is so corrupt and hopelessly shattered that she would be doing him a service by exiting his life or a disservice by staying in it. Her misbehavior legitimizes initiating the breakup & strengthens her resolve: "I am doing it for his sake, because I love him and want him to be happy with a good woman which he deserves!"
It is easy to lose sight of the chain of events as we engage in a morally righteous judgment of the infidelity. It is the abusive partner who triggers such women & causes them to disintegrate, decompensate, and bed a stranger in a desperate attempt to flee what had become a torture chamber, a prison cell, and a madhouse combined.
His rejection and denigration drive his weak & disordered partner to suspend her values, boundaries, rules of conduct, & commitments to herself - indeed, her very identity - and reduce herself to behaviors that shock even her.
She is fighting for her survival and self-preservation, attempting to square the circle: flee without guilt, abandon without hurt, cheat without shame, do the right thing.
She ends up deceiving and breaking hearts and minds all around.
What can we learn by
observing people in extreme or traumatic circumstances - for example when they
are exceedingly drunk or immediately after a natural disaster or when they have
just received horrible news?
Very little, it turns out.
By definition the personality is comprised of traits, cognitions, emotions, beliefs, inhibitions, and behaviors under NORMAL circumstances. One's personality consists of the TYPICAL and the RECURRENT, not the one-off and the aberrant.
There is very little useful to learn from observing people in extreme conditions - so we rarely do.
This is why we ignore experiments in psychology which simulate extremely stressful circumstances. We even castigate them as unethical partly because of the paucity of useful information that they produce.
And this is why there is no official diagnosis of "psychopath" in the DSM: psychopaths have been observed and tested almost exclusively in outlier settings such as prisons or corporate boards. The diagnosis is promoted mainly by self-interested and media savvy psychologists like Hare, Dutton, and Babiak: they sell diagnostic tests, seminars, and consulting time.
Broken and wounded, fresh out
of a union with a narcissist or a psychopath, it is a bad idea to self-medicate
with a new, rebound relationship.
A break of at least one or two years may be needed in order to regain one's balance and restore a modicum of self-knowledge free of the abusive partner's brainwashing and shared psychosis.
But is unhealthy to choose distrust of others and self-isolation as one's new way of life. At a certain point the transition from victim to survivor requires new intimate partners.
Distance relationships provide an optimal mix of intimacy, reversibility, and personal space.
Face to face, in the flesh, and live-in relationships can be demanding and sometimes degenerate into a replay of injurious conflicts and abusive, traumatizing misconduct. They are also logistically harder and more heartbreaking to terminate.
Distance relationships are far more manageable and flexible: timing is controlled and negotiated, the depth of any single interaction can be fine tuned, geography makes sure that the repertory of reactions is restricted: the partners can hang up or break up at will - or escalate from distance relationship to a more committed and complex liaison.
In some important respects, distance relationships are like simulations or movies: they provide all the thrills and few of the costs. That is why they are the best way to test the waters.
with the same structure or emotional content resonate with and either amplify
or ameliorate each other ("trauma resonance"). This is even more
pronounced if the traumas involve the same person and are proximate in time
Typically, the traumatized person reacts with "trauma displacement": she reprocesses the more inactive or less recent experience (via flashbacks, nightmares, obsessive or intrusive thoughts, various emotions, anger, sadness, rumination, and so on). This way, she represses or reframes the new trauma, especially of there is no other effective way to cope with it.
Avoiding triggers is very counterproductive. On the contrary: healing is predicated on obtaining desensitization and closure via repeated exposure to the the people or circumstances who caused the trauma, even to the point if controlled retraumatization (a technique in Cold Therapy).
broken women develop low self-esteem. They are afraid to be judged by potential
mates as wanting, dysfunctional, and defective. They are sure that they are
bound to disappoint and frustrate otherwise eligible partners. The "nice
guy" is a constant hurtful and infuriating reminder of their inadequacies
and broken dreams.
It is a self-fulfilling prophecy, of course. The woman's anxiety, emotional dysregulation, and catastrophizing translate into despair, aggression, and acting out.
She may preemptively abandon her loving, kind, and generous partner and elope with a "bad guy" that she both deserves and knows how to handle. She may trash herself and engage in reckless behaviors. Or she may act passive-aggressively and undermine any incipient intimacy and budding relationship, precipitating the very rejection that she so dreads (approach-avoidance repetition compulsion)
I thought if I have a good and beautiful wife and nice kids and a comfortable house, I will be at peace ... But I've got too much damage, and too many needs. Putting a picket fence around me won't make me into a whole person."
("Magic Hour" by Susan Isaacs)
"Trauma Bonding" and the Psychology of Torture
Case Studies on the Psychopath and Narcissist Survivors Support Group
Ask Sam on the Psychopath and Narcissist Survivors Support Group
Ask Sam on the Narcissistic Abuse Recovery Forum
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