Note: This article was originally published in the CuttingEdge Spring/Summer 2009 Newsletter
By Debra L. Kaplan, MA, LAC, LISAC
Not too long ago, a client who I was treating for prescription drug abuse, looked at me and said, "It's my desperate need to silence my feelings that drives me to want to use." She went on to describe what it felt like to live in her skin. "It's as if the people in my life are at the controls of this rollercoaster called my life and I'm trapped and I can't get off. I like or hate the ride based on how I feel about them at that moment; in my mind you're either with me or against me. But I can't fire them from the controls!"
Unbeknownst to this woman, she was verbalizing her underlying issue: Complex Post-Traumatic Stress Disorder (CPTSD). For the uninitiated, CPTSD is classified as a long-term traumatic stress disorder that may impact a healthy person's self-concept and adaptation. Exhibited symptoms include mood disorders (depression, manic-depression, anxiety); fear of real or imagined rejection or abandonment; and addictive, self-defeating behaviors including bulimia, anorexia, compulsive spending, sexual compulsivity, and perhaps self-injury.
In an effort to differentiate between psychosis and neurosis, the condition first was branded Borderline Personality Disorder (BPD). New research and advances in studying chronic trauma’s effects on self-concept and psychological organization have yielded a more accurate approach to characterize exhibited symptoms.
Recurring bouts of emotional instability wreak havoc on the life of an individual struggling with this issue. Along with the ups and downs of the emotional roller coaster comes confusion about one's identity. An individual with CPTSD often wrestles with a persistently unstable self-image; like in a house of mirrors, one's identity is rendered illusive and distorted.
Those who are familiar with CPTSD know all too well the chaos and havoc brought to bear upon relationships. In working with trauma complicated by emotional dysregulation, I have often likened the displays of impulsive rage to a cluster bomb. From one furious mass come multiple smaller submunitions. These emotional explosions neutralize any threat of real or imagined relational rejection, abandonment or disapproval. Loved ones who are idealized one day are devalued and rejected the next, relegated to the role of enemy - perhaps simply because an act of parting was interpreted as an act of betrayal. Some who struggle with CPTSD have co-occurring mood disorders that exacerbate internal stressors to the point of brief psychotic episodes.
Individuals with CPTSD often verbalize feeling wronged, misunderstood and empty. As is often the case, the trigger - be it internal or external - prompts attempts to self-medicate overwhelming emotions with alcohol or chemical dependence, acts of self- mutilation (cutting, burning, wrist-slashing), and even suicide attempts.
Historically speaking, the prognosis for CPTSD has been poor. Within the therapeutic community, clients who present with these symptoms have been branded unmotivated, hard to treat or, worse, noncompliant. The current belief - and one that I genuinely embrace - posits that a consistently supportive therapeutic relationship can become a healthy foundation that allows a client to begin to experience trust and safety. Much is still unknown about the post-traumatic condition, but continued advances in neurobiological, genetic, and social research have led to new treatments and psychopharmacological interventions that have proven successful in generating enduring, positive change.
The path out of the CPTSD maze begins with a gradual acknowledgement of the problem and a willingness to accept oneself. But what happens when one does not acknowledge the presence of a problem? Clearly, such denial undermines progress toward positive change. An individual's need to shield himself from unacknowledged and overwhelming feelings exists until he is psychologically ready to see himself as he really is - and not who he wants to be.
Support for an individual's attempts to break through denial is necessary for enduring progress to be made. The presence of a psychological struggle does not designate a bad or defective person. He's done nothing to deserve it, much like a child does nothing to deserve the onset of juvenile diabetes. However, the individual is now living a reality of roller coaster emotions, unstable relationships, addictions, and feelings of emptiness. The cold, harsh fact is that the self-defeating behaviors and unstable self-worth are not likely to change until the person changes.
As with all physical and emotional distresses, there comes a moment when the status quo is no longer acceptable. The chaos or unmanageability of a situation necessitates asking for help and taking action. Perhaps the adage "being brought to one's knees" applies here. An ensuing adjustment period, in which one comes to terms with a new reality, may not be immediate. However, a new perspective might arrive with a sobering blow to the denial - or with the quiet realization that life is eroding beyond one’s grasp. Self-acceptance can be attained perhaps only through small, sometimes imperceptible steps. In recovery speak, it is progress rather than perfection that guides us: "I am not a problem, but my behavior has become problematic!" I ask my clients, "Which would you prefer to be: resolutely right or resolutely happy?"
When one is living a life that, despite great efforts, no longer results in satisfying outcomes, it is time to look inward and ask the hard questions: "What am I doing that is no longer working? Harder yet, what am I prepared to do about it?"
Until that moment of introspection and committed motivation, little if any enduring change will occur. But the path out of the house of mirrors, and away from the emotional roller coaster, is the path to a new life.