With the winter season quickly approaching, it is natural to anticipate the stresses that come along with the endless festivities celebrating holiday cheer. If you are a survivor of trauma, this time of year can bring up even more complex emotions as you contemplate spending time with family who may have been a source of your trauma, witnesses to it, or lacking in understanding of its symptoms. While you may recognize others looking forward to the ‘most wonderful time of the year’ it is often a very different experience for someone with complex PTSD.
What Is Complex PTSD?
It is likely by now you have become familiar with the term post-traumatic stress disorder (PTSD). While it is normal to have upsetting memories, feel on edge, or have difficulty sleeping following a traumatic event, most people may recover from initial symptoms naturally. However, a PTSD diagnosis is typically given if symptoms last for more than one month and continue to impact the ability to tend to daily activities (e.g., work, school, social activities).
It has been suggested that the current PTSD diagnosis does not fully capture the complete psychological impact that can occur with prolonged, repeated exposure to trauma as compared to a singular traumatic event (Herman, 1992). You might be thinking, trauma is trauma, how could it make such a difference? Psychiatrist, Judith Herman was the first to propose a new perspective on the complicated symptoms observed in survivors of prolonged, repeated trauma. In her book, Trauma and Recovery (1992), she coined the term “complex PTSD”. While complex PTSD is not currently recognized as a diagnosis in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), it is now included as a distinct diagnosis in the ICD-11 (WHO’s International Classification of Diseases 11th Revision).
Complex PTSD has been associated with specific types of traumas that encompass more severe characteristics as compared to single traumatic stress events. Some of these characteristics involve 1) relational betrayal; 2) repetitive, prolonged, or pervasive trauma; 3) harm or neglect by individuals who are in the role of a caregiver or adult in charge of protecting and caring for a child; 4) occur at a vulnerable time in the victim’s life, such as when the victim if of young age; 5) and have the potential to significantly compromise the child’s psychological development (Ford, et al., 2005).
How Is It Different Than PTSD?
A diagnosis of complex PTSD shares similar criteria with PTSD including:
- Re-experiencing the traumatic event(s) (e.g., nightmares, unwanted memories, flashbacks)
- Avoidance of traumatic reminders (e.g., thoughts, objects, memories, people, places, activities)
- A persistent sense of current threat (i.e., hypervigilance, feeling on edge, irritability)
In addition to PTSD, chronic trauma or complex PTSD can be associated with other comorbidities including substance use, mood disorders, and personality disorders. For those who endure prolonged periods of victimization (e.g., long term sexual, emotional, physical abuse) can also develop difficulties in the following areas:
- Emotion regulation (e.g., anger outbursts, inhibited anger, chronic sadness, suicidal thoughts)
- Dissociation (i.e., forgetting traumatic events, periods of feeling detached from one’s body, emotions, thoughts, etc.)
- Self-perception (e.g., helplessness, shame, guilt, feeling different from others)
- Distorted perceptions of the perpetrator (e.g., becoming preoccupied with the relationship to the perpetrator or preoccupied with revenge)
- Relationships with others (e.g., isolation, distrust, seeking a ‘rescuer’)
- Sense of meaning (i.e., can include loss of sustaining faith, sense of hopelessness or despair)
5 Tips For Surviving the Holidays With Complex PTSD
Even if your complex trauma does not originate in your family, the holidays can be difficult due to feelings of isolation, triggers in the environment, and difficulties navigating social situations. However, it is especially challenging when, as a complex trauma survivor, you are expected to spend time with people who trigger difficult feelings and memories, leaving you with having to deal with the negative impact on your mind, body, and relationships. However, the following strategies may help you cope with and manage the challenges of the holiday season, particularly for those with a complex PTSD history:
- Set boundaries and limits on how you will spend your time with family members. Identifying boundaries that you need to feel safe and effectively communicating these boundaries with family members. For example, if you have a parent who might drink and become aggressive which is a trigger for you, you can clearly let them know you will have to leave if they are unable to refrain from these behaviors.
- Don’t over-commit yourself to obligations or events. Despite the holiday season often entailing a multitude of events that you may feel pulled to attend, be sure to check in with yourself before committing to events. Remind yourself you have the right to say no, and that over-committing to plans can lead you to feeling overwhelmed or burnt out. When tackling the challenging emotions of the holiday season in general, these compounded stressors can make managing your complex PTSD more difficult.
- Practice self-compassion or giving yourself a break and using a nonjudgmental approach with yourself. Perhaps your usual coping strategies aren’t working as well, and you find yourself engaging in less helpful behaviors. Maybe you have an extra glass of wine at dinner, or you indulge a little more than usual on your comfort foods. Remind yourself, the negative emotions are temporary and sometimes it is okay to just survive. You may experience feelings of guilt or shame that the holidays do not bring you the feelings of joy that is often promoted in society. Nonetheless, give yourself permission to feel any emotions that arise without judgement.
- Grieve the loss of years past where you were left feeling unfulfilled by the ‘holiday joy.’ It can be painful to process and accept that your family is the source of your greatest trauma. In addition, it may bring discomfort when working to let go of the hope that things might change. Allow the space for the challenging emotions and be kind to yourself while honoring that inner child who had to endure that loss without having the support you deserved.
- Use your social support and make efforts to spend time with those who help you feel safe. Make a point to connect with family and friends that support you during this time, even if it is only for just 5 or 10 minutes. Touching base with friends and family may help you feel less stranded or alone during this difficult time. This can also be an opportunity to create new, positive memories and traditions to incorporate for you and your family moving forward.
The holidays are tough. They can be particularly straining on those with complex PTSD due to the triggering reminders and emotions that tend to surface during this time of year. It is important to be kind and patient with yourself as you navigate these challenging next few weeks. You might have some bad days, be a little short with someone you love, or just not be your best self sometimes, and that is okay. Remind yourself you are human, and you deserve that compassion and support that may not have been given to you during the times you most needed it. But you can now, one step at a time.
If you find yourself feeling chronically triggered, anxious, or depressed, it is okay to reach out for help. By speaking with a trauma-informed specialist you can learn more about how complex PTSD might be affecting your life and develop skills to cope with its impact. Our team at STEPS is always available to help. To make an appointment with a trauma treatment specialist, please contact us at 631-301-4888.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596
Ford, J.D., Courtois, C.A., Steele, K., Hart, O., & Nijenhuis, E.R. (2005). Treatment of complex posttraumatic self-dysregulation. Journal of Traumatic Stress, 18(5), 437-447. https://doi.org/10.1002/jts.20051
Herman, J. L. (1992a). Complex PTSD: A syndrome in survivors of prolonged and repeated trauma. Journal of Traumatic Stress, 5, 377–391. https://doi.org/10.1002/(ISSN)1573-6598
National Institute of Mental Health (2022). Post-traumatic stress disorder. Retrieved November 18, 2022, from https://www.nimh.nih.gov/health/topics/post-traumatic-stress-disorder-ptsd
The National Child Traumatic Stress Network (2022). Complex Trauma. Retrieved November 18, 2022, from https://www.nctsn.org/what-is-child-trauma/trauma-types/complex-trauma
U.S. Department of Veteran Affairs (2022). PTSD: National Center for PTSD: Complex PTSD. Retrieved November 18, 2022, from https://www.ptsd.va.gov/professional/treat/essentials/complex_ptsd.asp
World Health Organization. (2018). International classification of diseases for mortality and morbidity statistics (11th Revision). Retrieved from https://icd.who.int/browse11/l-m/en