By Tracy Guy, BNurs, GradDipCounsel & Alison Rose-Hughes, BNurs.

Complex Post-Traumatic Stress Disorder (CPTSD) is often associated with chronic, repeated trauma. Unlike PTSD, which can stem from a single incident, CPTSD develops through prolonged exposure to traumatic events, often in environments where escape feels impossible. While this diagnosis is frequently linked to abuse or war, a lesser recognised but equally devastating source is the prolonged trauma of progressive illnesses like cancer, especially when it recurs over the years, across multiple loved ones.

Progressive illness doesn’t just affect the body; it erodes the emotional, mental, and relational foundations of both the patient and those around them. In cases where remission is followed by relapse, and where multiple family members battle life-limiting conditions over decades, the psychological toll can be profound, leaving deep, complex trauma in its wake.

The Patient’s Perspective: Grieving While Still Alive

Living with a progressive illness such as cancer is not a single traumatic event; it is a series of events often spanning months, if not years. Patients and their loved ones suffer the initial shock of diagnosis. Then there’s treatment, uncertainty, side effects, remission, hope, relapse, and the ultimate decline to the end of life. Each stage demands a reprocessing of reality. Patients grieve their autonomy, their future, and their identity. As one nurse described: “I see them grieving the life they thought they’d have. I try to give them space to talk about it, to cry, to ask ‘why me?’” This grieving isn’t linear; it reactivates with every scan, every return of symptoms, every new round of treatment, and every appointment. CPTSD symptoms like hypervigilance, emotional numbness, avoidance, and deep despair are often present but are misinterpreted as mere depression or anxiety. Yet, what they’re experiencing is trauma in real time. Patients like Brian, who was gradually debilitated by Motor Neurone Disease (MND), illustrate this clearly. His haunting words, “It’s like I only matter when I’m dying, not while I’m still living,” reflect not only physical decline but emotional invisibility, a key driver of complex trauma.

The Family’s Trauma: Secondary Victims, Primary Sufferers

Family members, especially long-term caregivers, face their own psychological war. Watching a loved one repeatedly fight, improve, relapse, and then ultimately decline induces what could be called “trauma fatigue.” Each remission is a breath of hope; each recurrence is a suffocating blow, together forming a relentless, re-traumatising cycle that dismantles the self and leaves behind irreversible psychic wounds. Over time, family members may develop CPTSD themselves, carrying unresolved grief, guilt, helplessness, and anticipatory loss. As one nurse reflected, “Families suffer just as much as the patient. They look for answers, guidance, and sometimes even comfort. I often find myself balancing the clinical aspects of care with simply being someone who listens to everyone.” For spouses or adult children who assume caregiving roles, the trauma compounds. Their roles shift: the partner becomes a nurse, the daughter becomes an advocate, and the son becomes a carer. And when the medical system fails to provide coordinated support, as it did for Lisa, who cared for her gravely ill husband with no training or dedicated point of contact, the weight of caregiving becomes not just physical, but deeply traumatic.

A Legacy of Illness: Generational Trauma

Now imagine this experience not as a one-time tragedy, but as a family legacy. When several relatives face life-limiting illnesses over decades, each illness unfolding slowly and painfully, the trauma is no longer contained. It becomes embedded in the family’s psyche. Children raised in households where cancer or other progressive illnesses are a recurring presence may develop anxiety, severe depression, and emotional dysregulation. Adult family members may avoid medical care for themselves out of fear or denial, and some may live with chronic hypervigilance, bracing for the next call, the next biopsy result, the next loss. This prolonged exposure to death and dying, especially in close quarters, can mirror the type of chronic trauma characteristic of CPTSD. The debilitating nature of CPTSD can manifest in the surviving family members as persistent emotional numbness, difficulty trusting others, intense grief reactions, and an ongoing sense of threat, even long after their loved one has passed. Triggers may include healthcare and clinical settings, billboards for cancer research and donations, and movies of terminal illness (many of which do not provide trigger warnings), among others. And yet, support systems and the medical community rarely acknowledge the impact on the wider family network.

The Nurse’s Insight: Bearing Witness to Unseen Wounds

Nurses are often the silent observers of this slow, emotional unravelling. They see patients’ physical decline, but also their spiritual and emotional pain. They are present when the diagnosis is given, when the world splits into “before” and “after.” They support patients in their grief, help them maintain dignity, and bear witness when the family begins to fracture under the emotional strain. One nurse shared: “Nursing goes beyond administering meds or checking vitals. It’s sitting at the bedside holding a hand or simply being there in silence when there are no more words.” But even the most compassionate nurse cannot fill the systemic gaps in care. From diagnosis, through progression, and on to death, there is often no coordinated emotional support for patients or families. This failure leaves everyone, patients, caregivers, and nurses, facing immense psychological burdens with minimal resources.

Closing the Gap: A Call for Systemic Change

The emotional trauma of progressive illness does not wait for palliative care to begin. It starts at diagnosis and builds with each remission, each relapse, and each unmet need. To address this, we must:

• Recognise CPTSD as a legitimate consequence of prolonged illness and caregiving.

• Integrate psychological support from the moment of diagnosis, not just at end-of-life.

• Provide structured care plans that include emotional, financial, and practical support for end-of-life planning, a source of major anxiety.

• Offer consistent points of contact for families, case managers, social workers, and counsellors.

• Support nurses through reflective practice, mental health services, and manageable workloads.

As the nurse said of Brian and Lisa: “Their story is a reminder that progressive illness doesn’t just need end-of-life care, it needs in-life care.”

Progressive illness is not a single trauma; it is a sustained emotional siege. Its psychological effects ripple outward, often leaving behind CPTSD in both patients and families. In witnessing these long battles, we must stop pretending that the emotional wounds are secondary. They are central. They are real. And they deserve treatment too.

A Call for Systemic Change

The emotional trauma of progressive illness does not wait for palliative care to begin. It starts at diagnosis and builds with each remission, each relapse, and each unmet need. Yet, the current healthcare model tends to focus support at the final stages when it’s often too late to address the psychological damage that has already taken root. To change this, we must shift from a reactive to a proactive model of care. That means embedding emotional and psychological support into the entire illness trajectory, not as an optional extra, but as a core part of treatment. Support must begin at diagnosis, evolve with the illness, and extend beyond death to include grief and family recovery. Patients and families should never feel abandoned during the long stretches between treatments or outside hospice care.

Key systemic improvements include:

• Early psychological intervention: Trauma-informed counselling should be offered soon after diagnosis and revisited regularly throughout the progression of illness. Patients and caregivers alike need access to trained professionals who can help them process fear, loss, and compassion fatigue.

• Dedicated care coordination: A single point of contact- a case manager, nurse navigator, or palliative care coordinator should be assigned early to each patient to manage continuity of care. This professional could guide families through treatment plans, referrals, home care logistics, and support services.

• Integrated caregiver support: Carers are at high risk for burnout and trauma. Structured respite options, emotional support services, and financial guidance and assistance need to be made available not just at crisis points, but throughout the caregiving journey.

• Long-term monitoring for CPTSD symptoms: Many patients and families show signs of complex trauma without understanding what’s happening. Regular screenings for psychological distress should become standard practice in oncology and progressive illness settings. Referral pathways to trauma specialists must be clear and accessible.

• Expansion of in-life care services: Rather than overloading the final weeks with care, resources should be spread throughout the disease progression. This means consistent home visits, proactive symptom management, and emotional support long before a terminal prognosis is declared.

• Support for frontline workers: Nurses, who often become de facto counsellors, require their own systems of emotional care. Regular debriefs, mental health days, and reflective supervision should be standard, not a luxury. Compassion fatigue is real, and if left unaddressed, it can compromise the quality of care delivered and the well-being of caregivers themselves.

The bottom line: progressive illness is not linear, clean, or predictable. It is chaotic, cruel, and emotionally relentless. The trauma it causes is often unseen, misdiagnosed, or entirely ignored, especially in families and caregivers. Recognising CPTSD as a legitimate outcome of prolonged medical trauma is not just clinically appropriate, it’s humane.

At the heart of progressive illness lies an unrelenting confrontation with mortality. For patients, every recurrence or decline is a reminder that time is finite. Even in remission, there’s often no true peace, only a waiting period shadowed by uncertainty. Living under this constant threat reshapes a person’s identity, priorities, and ability to feel safe in their own body. For families, watching a loved one slowly fade becomes a prolonged mourning of the living, where hope and dread coexist. The psychological weight of this battle, with no clear endpoint, can fracture one’s sense of purpose and safety in the world. The trauma is not just in the decline or death, but in the daily reckoning with what it means to lose control, to say goodbye in stages, and to face the inevitability of loss over and over again.

As professionals who walk this path daily, nurses see what often goes unseen by systems and policies. They hold space for grief, fear, and resilience in ways few others can. But without broader, structural change, their ability to protect patients and families from the deepest wounds of this journey remains limited. It’s time we acknowledged that progressive illness isn’t just a medical condition; it’s an emotional battleground, and both patients and caregivers deserve to be supported in their fight with the unknown.

Photo by Harry cao on Unsplash

Guest Post Disclaimer: Any and all information shared in this guest blog post is intended for educational and informational purposes only. Nothing in this blog post, nor any content on CPTSDfoundation.org, is a supplement for or supersedes the relationship and direction of your medical or mental health providers. Thoughts, ideas, or opinions expressed by the writer of this guest blog post do not necessarily reflect those of CPTSD Foundation. For more information, see our Privacy Policy and Full Disclaimer.

Tracy Guy

Tracy Guy is a published author and a proud guest writer for the C-PTSD Foundation. Professionally, Tracy has experience in mental health and muti-trauma nursing and is now a full-time registered counsellor working with people struggling with complex trauma, anxiety, and grief. Her passion for writing, unwavering instinct to help others, and professional and lived experience drives Tracy to support and advocate for those suffering from debilitating traumatic experiences and C-PTSD. Tracy hopes to raise understanding and awareness of C-PTSD, more specifically, the association of C-PTSD with abusive relationships.

Understanding CPTSD and FND

CPTSD arises from prolonged exposure to traumatic events, such as chronic abuse or captivity, leading to a constellation of symptoms, including emotional dysregulation, negative self-perception, and difficulties in relationships. The prevalence of CPTSD in the general population ranges from approximately 2.6% to 7.7%, with higher rates observed in at-risk groups.

Medical Perception of Functional Neurological Disorder (FND)

Functional Neurological Disorder (FND) occupies a unique space within the medical field, as it lies at the intersection of neurology and psychiatry. FND sufferers are often dismissed by the medical profession due to the absence of structural abnormalities in diagnostic tests, leading to misconceptions that their symptoms are psychological or “not real.” Although historically misunderstood and often stigmatized, the perception of FND has evolved significantly in recent years, thanks to advances in research and a deeper understanding of its underlying mechanisms.

FND, previously known as conversion disorder, manifests as neurological symptoms—such as functional seizures, paralysis, or sensory disturbances—that lack a clear medical cause. Research indicates that individuals with FND report an approximately threefold increase in adverse life experiences compared to healthy controls, highlighting the significant role of trauma in its development.

The Interplay Between CPTSD and FND

The relationship between CPTSD and FND is multifaceted, with trauma serving as a common denominator. Traumatic experiences can disrupt neural networks and alter brain function, leading to both psychological and neurological symptoms. Studies have shown that individuals with FND often have a history of complex trauma, suggesting a potential trauma subtype of FND.

Shared Mechanisms

Several mechanisms may underlie the connection between CPTSD and FND:

• Dissociation: Both conditions frequently involve dissociative symptoms, where individuals experience a disconnection between thoughts, identity, consciousness, and memory.
• Emotional Dysregulation: CPTSD is characterized by difficulties in managing emotions, which can exacerbate or trigger FND symptoms.
• Altered Brain Connectivity: Research suggests that trauma can disrupt resting-state functional connectivity in the brain, affecting areas involved in emotion regulation and motor control.

Implications for Treatment

Recognizing the overlap between CPTSD and FND has significant implications for treatment approaches. A trauma-informed, multidisciplinary strategy that addresses both psychological and neurological aspects is crucial. This may include psychotherapy to process traumatic experiences, physical therapy to manage functional symptoms, and interventions aimed at improving emotional regulation and reducing dissociation.

Conclusion

The intricate connection between CPTSD and FND underscores the profound impact of trauma on both mind and body. While statistics are limited, it’s recognized that some physicians may not fully acknowledge trauma as a precursor to the development of Functional Neurological Disorder (FND). This gap in recognition can lead to challenges in providing comprehensive, trauma-informed care for individuals with FND. By deepening our understanding of the interplay between CPTSD and FND, we can develop more effective, holistic treatment strategies that address the full spectrum of symptoms experienced by individuals affected by these complex disorders.

Guest Post Disclaimer: Any and all information shared in this guest blog post is intended for educational and informational purposes only. Nothing in this blog post, nor any content on CPTSDfoundation.org, is a supplement for or supersedes the relationship and direction of your medical or mental health providers. Thoughts, ideas, or opinions expressed by the writer of this guest blog post do not necessarily reflect those of CPTSD Foundation. For more information, see our Privacy Policy and Full Disclaimer.

Tracy Guy

Tracy Guy is a published author and a proud guest writer for the C-PTSD Foundation. Professionally, Tracy has experience in mental health and muti-trauma nursing and is now a full-time registered counsellor working with people struggling with complex trauma, anxiety, and grief. Her passion for writing, unwavering instinct to help others, and professional and lived experience drives Tracy to support and advocate for those suffering from debilitating traumatic experiences and C-PTSD. Tracy hopes to raise understanding and awareness of C-PTSD, more specifically, the association of C-PTSD with abusive relationships.

Understanding the Impact of CPTSD on Personality

Trauma fundamentally changes how individuals view themselves, others, and the world around them. In CPTSD, the effects are often pervasive, shaping emotions, beliefs, and behaviours. Common personality changes may include hypervigilance, where individuals are constantly alert to potential danger, and persistent low self-worth, driven by feelings of guilt or shame. Many people with CPTSD also experience emotional dysregulation, where they struggle to manage intense emotions, often cycling through anger, sadness, or anxiety. These changes are survival mechanisms developed during periods of trauma but tend to persist, disrupting relationships and everyday life even when danger has passed.

How CPTSD Impacts Trust

Trust is one of the most significant casualties of prolonged trauma. The very essence of CPTSD involves a betrayal of safety, which creates deep-seated mistrust in people, systems, and even oneself.

For individuals with CPTSD, trusting others often feels unsafe or even dangerous. Relationships may be approached with suspicion, skepticism, or outright avoidance, as they constantly anticipate betrayal. Conversely, some survivors may overextend trust to gain approval or prevent rejection, leaving them vulnerable to exploitation or re-traumatisation.

Trust issues also extend inward. Many survivors struggle with self-doubt, questioning their own perceptions, decisions, or worth. This internalised mistrust can feel paralysing, preventing individuals from confidently navigating relationships or decisions. Furthermore, fear of intimacy often develops, as the vulnerability required for deep connections triggers reminders of past betrayals, leading to emotional walls and isolation.

Personality Changes Over Time

The cumulative impact of trust issues and trauma responses often leads to significant long-term personality changes. While not universal, many people with CPTSD experience heightened sensitivity to rejection. This can cause intense emotional reactions to perceived slights, even if unintentional.

Defensive behaviours are also common, such as isolating from others or relying on perfectionism as a means of control and protection. These coping mechanisms, while initially protective, can prevent individuals from forming meaningful connections or embracing growth.

Chronic guilt or shame also becomes a dominant trait for many. Survivors of prolonged trauma often internalise their experiences, believing they are fundamentally flawed or to blame for their suffering. These beliefs shape identity and self-esteem, making it difficult to engage confidently with the world.

Lastly, relationships may oscillate between extremes of closeness and distancing as survivors struggle to balance the fear of abandonment with the need for connection. This dynamic can lead to cycles of idealisation and devaluation, further complicating personal and social interactions.

The Path to Healing and Growth

While CPTSD creates significant challenges, healing and growth are attainable with the right tools and support. Rebuilding trust and addressing personality changes involves small, intentional steps and a willingness to confront past wounds.

• Seek Trauma-Informed Therapy: Approaches like EMDR (Eye Movement Desensitisation and Reprocessing), Cognitive Behavioural Therapy (CBT), or Dialectical Behaviour Therapy (DBT) are highly effective in addressing trauma’s root causes and teaching new coping mechanisms.
• Rebuild Trust Gradually: Begin by trusting yourself through small commitments and achievable goals. Surround yourself with safe individuals who demonstrate reliability and respect.
• Practice Self-Compassion: Healing guilt and shame starts with kindness toward yourself. Techniques like mindfulness, journaling, and affirmations can challenge negative beliefs and reinforce your worth.
• Develop Healthy Boundaries: Learn to set and maintain boundaries in relationships, protecting your emotional and mental space while fostering mutual respect.

Engage in Support Networks: Whether through support groups, friends, or community resources, connecting with others who understand your journey can provide strength and validation.

A Journey of Transformation

The effects of CPTSD on trust and personality are deeply ingrained but not insurmountable. Healing requires patience, persistence, and support from trusted professionals and networks. Through intentional effort, survivors can begin to rebuild their sense of self, reclaim their resilience, and foster healthier, more fulfilling relationships.

While the road to recovery may be challenging, it also offers opportunities for profound transformation. By addressing the wounds of the past, individuals with CPTSD can step into a future defined not by their trauma but by their strength, growth, and renewed ability to trust.

If you have been impacted by betrayal, you might like to check out my blog, Betrayal Trauma & CPTSD. https://cptsdfoundation.org/2022/09/22/betrayal-trauma-cptsd/

Photo from Unsplash: timo-stern-EvcUtLF12XQ-unsplash.jpg

Guest Post Disclaimer: Any and all information shared in this guest blog post is intended for educational and informational purposes only. Nothing in this blog post, nor any content on CPTSDfoundation.org, is a supplement for or supersedes the relationship and direction of your medical or mental health providers. Thoughts, ideas, or opinions expressed by the writer of this guest blog post do not necessarily reflect those of CPTSD Foundation. For more information, see our Privacy Policy and Full Disclaimer.

Tracy Guy

Tracy Guy is a published author and a proud guest writer for the C-PTSD Foundation. Professionally, Tracy has experience in mental health and muti-trauma nursing and is now a full-time registered counsellor working with people struggling with complex trauma, anxiety, and grief. Her passion for writing, unwavering instinct to help others, and professional and lived experience drives Tracy to support and advocate for those suffering from debilitating traumatic experiences and C-PTSD. Tracy hopes to raise understanding and awareness of C-PTSD, more specifically, the association of C-PTSD with abusive relationships.

Credit: Karla Ruiz

What is Betrayal Trauma?

• How do you begin to heal when you discover that your partner has been unfaithful?
• How do you learn to trust again when a family member has betrayed you?
• How do you move forward when your boss abused their position of power and sexually harassed you?

In the wake of a betrayal, many people feel their world has been shattered. Some are left wondering whether they even have a future at all. Betrayal and the ensuing sense of despondence can leave victims with chronic distrust problems and crippling self-doubt. Being betrayed by a trusted person can have a long-lasting impact on physical and mental well-being and compromises the ability to form lasting relationships with others.

In her article ‘Understanding Complex Trauma, Complex Reactions, and Treatment Approaches’  Dr. Christine Courtois highlights the interconnectedness of betrayal trauma and Complex Post-Traumatic Stress Disorder (CPTSD), stating that “complex trauma generally refers to traumatic stressors that are interpersonal, that is, they are premeditated, planned, and caused by other humans, such as violating and/or exploitation of another person” (Courtois, 2019). Betrayal causes immense emotional pain and has far-reaching physical and psychological consequences, which are not easily overcome in a day, a week, a month, or even a year. Some people never get over the impact of betrayal. Healing from betrayal requires intense reflection and work on personal growth to rebuild a sense of worthiness, self-confidence, and belonging. Learning to trust others is one of the most difficult hurdles to overcome. Recovery from betrayal is isolating and painfully difficult and often leads to a transformation of the self.

Types of Betrayal

The most common types of betrayal include the disclosing of confidential information, disloyalty, infidelity, and dishonesty. At the least, betrayal causes shock, loss, anger, and grief; at worst, it can cause anxiety disorders and PTSD (Rachman, 2010).

Examples of betrayal:

• Discovering that your husband/wife/partner had a physical, emotional or online affair.
• Finding out that your husband/wife/partner has engaged in addictive behaviour, e.g. drug-taking, gambling, porn.
• Experiencing sexual, physical and emotional abuse at the hands of a family member or by a key relationship.
• Discovering that your friend told someone a secret that you entrusted them with.
• Finding out that your co-worker used your work as their own to elevate their status.
• When your family justifies your partner’s abusive behaviour.
• When a boss abuses their position of power and takes advantage of you.
• Failure to offer or provide support and assistance during times of physical or emotional need.

Types of Betrayal Trauma

• Institutional
• Parental
• Partner
• Interpersonal, e.g. friends.

Additionally, any of these types of betrayal trauma may be accompanied by ‘betrayal blindness’,  an unawareness or forgetting of the act of betrayal. (Freyd, 1999).  This adaptive response may be associated with betrayals not traditionally recognised as trauma, such as adultery, inequities in the workplace and society, etc. Victims may unwittingly manifest symptoms of betrayal blindness to preserve the relationships and social systems upon which they depend. (Freyd, 2021). 

Symptoms of Betrayal Trauma 

• Chronic mistrust
• Commitment issues
• Flashbacks
• Nightmares
• Hopelessness
• Dissociation
• OCD
• Emotional dysregulation
• Confusion & self-doubt
• Panic, anxiety & depression
• Irritability and rage
• Fear
• Toxic shame and guilt
• Low self-esteem
• Loss of confidence & self-worth
• Extreme exhaustion
• Withdrawal from social interactions
• Difficulty maintaining relationships

Childhood trauma and the associated betrayal can elicit symptoms that continue through adulthood and often prevent the formation of deep, intimate relationships due to past experiences. The severity of betrayal trauma is complex because it concerns not only the experience of the act of abuse but also the experience of being betrayed by a trusted person or someone the victim relies on for support and survival. Symptoms of betrayal trauma do not meet the Diagnostic and Statistical Manual of Mental Disorders 5 (DSM-5) diagnostic criteria for PTSD. However, symptoms of betrayal trauma are closely related to those of CPTSD which occurs as a result of abuse and ongoing trauma. (Diagnostic and statistical manual of mental disorders: DSM-5-TR 2022)

Feelings and effects of betrayal such as degradation, rejection, and humiliation can be catastrophic and life-changing. Betrayal on any level causes immense emotional pain and can be incredibly isolating, but with professional help, therapy, and support, many trauma victims go on to live fulfilling lives. Trauma-informed therapy, such as that offered by the C-PTSD Foundation, helps individuals move forward in their personal and professional lives with ongoing support that promotes healing and recovery. Some individuals with extensive trauma histories may remain in therapy for years; however, recovery is possible with a trauma-informed approach and lots of determination and support.

References

• Courtois, C. A. (2019). Understanding Complex Trauma, Complex Reactions, and Treatment Approaches. Understanding complex trauma, complex reactions, and treatment approaches – Gift From Within. Retrieved from
• American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders: Dsm-5-Tr. 
• Freyd, J. J. (1999, June). Blind to Betrayal: New Perspectives on Memory for Trauma. Retrieved from https://dynamic.uoregon.edu/jjf/articles/freyd99.pdf
• Freyd, J. J. (2021). What is a Betrayal Trauma? What is Betrayal Trauma Theory? Definition of Betrayal Trauma Theory. Retrieved from https://dynamic.uoregon.edu/jjf/defineBT.html
• Rachman, S. (2010). Betrayal: A psychological analysis. Behaviour Research and Therapy, 48(4), 304–311. https://doi.org/10.1016/j.brat.2009.12.002

Guest Post Disclaimer: Any and all information shared in this guest blog post is intended for educational and informational purposes only. Nothing in this blog post, nor any content on CPTSDfoundation.org, is a supplement for or supersedes the relationship and direction of your medical or mental health providers. Thoughts, ideas, or opinions expressed by the writer of this guest blog do not necessarily reflect those of CPTSD Foundation. For more information, see our Privacy Policy and Full Disclaimer.

Tracy Guy

Tracy Guy is a published author and a proud guest writer for the C-PTSD Foundation. Professionally, Tracy has experience in mental health and muti-trauma nursing and is now a full-time registered counsellor working with people struggling with complex trauma, anxiety, and grief. Her passion for writing, unwavering instinct to help others, and professional and lived experience drives Tracy to support and advocate for those suffering from debilitating traumatic experiences and C-PTSD. Tracy hopes to raise understanding and awareness of C-PTSD, more specifically, the association of C-PTSD with abusive relationships.

Credit: Lilartsy.

Although not formally recognised by the DSM, the International Classification of Diseases 11th Revision (ICD-11) describes C-PTSD as a disorder that can develop after witnessing an event, or series of events of an extremely threatening nature. These events may have been repetitive or ongoing and particularly horrific. Repetitive or ongoing events that could cause severe psychological wounds to include those from which escape is difficult or impossible, such as slavery, torture, prolonged intimate partner violence, child sexual abuse, and physical abuse. Individuals who present with C-PTSD meet all the diagnostic requirements for PTSD; they also demonstrate difficulty maintaining a positive outlook, have problems regulating anxiety levels, have poor self-worth, experience feelings of guilt and shame, and have difficulties maintaining relationships. A diagnosis of C-PTSD significantly impacts personal, family, social, educational, and professional functioning.

Intimate partner violence includes, but is not limited to:

• physical violence—grabbing, pushing, slapping, shaking, biting, choking, hitting, kicking
• sexual violence—unwanted attempted or actual sexual contact
• physical or sexual abuse threats—instilling fear with the use of words, looks, or actions
• psychological or emotional abuse—name-calling, bullying, intimidation, controlling behaviour
• stalking—harassment, following, and unwanted contact
• financial abuse—full control over economic resources, drip-feeding money, controlling access to money and property.

People who have experienced such trauma become highly anxious and live in a perpetual hyper-arousal state. This anxiety occurs as a physiological response to what happened in the past. Our brain remembers the event and what it felt like and refuses to believe that it could not happen again. Therefore, triggers send us into ‘fight or flight’. We literally live in dread every day and fear the future because our past, as well as memories of the event, and our physiological responses, hold us hostage. Trauma that precedes a diagnosis of PTSD or C-PTSD will stay with the victim long after the event. Memories of the trauma reside in a place in your mind and soul that is dark and impenetrable. Triggers bring these memories to life, making your flashbacks and nightmares feel as real and scary as they did when they first occurred.

Triggers

A trigger is a psychological stimulus that activates an emotional flashback or a recall of a past traumatic event. Triggers can be external or internal stimuli that provoke and elicit an emotional flashback. In narcissistic relationships, your triggers will haunt you. The longer you maintain contact with the narcissist post-separation, the more likely you are to experience flashbacks and high anxiety. Yet, if you cut off all contact, you may experience severe anxiety for years. Unfortunately, the temptation to reconnect with a narcissistic ex-partner is very powerful, and victims often self-sabotage efforts to distance themselves, increasing the chance of re-traumatisation. The intense trauma bonds that develop as a result of shared toxic emotional experiences are what make separation and leaving so difficult. The biochemical reaction to toxic love is extremely addictive, and the only way to detox from a narcissist is to go ‘no contact’. Trauma bonding occurs as a result of the intermittent reinforcement of ‘reward and punishment’ that occurs as part of the abuse cycle. This type of bonding can occur due to physical, psychological, emotional, or sexual abuse and is very difficult to break. Breaking these bonds and the act of leaving a partner where there are well-established trauma bonds is very difficult. Victims often feel painfully empty while trying to break these bonds, much like an addict does during withdrawal. Besides fear, the reward and punishment cycle is just one of the reasons victims of domestic violence keep returning for more. It is also one of the primary reasons many victims develop C-PTSD over time.

Please remember that triggers serve a purpose! They illuminate the wounds that need healing. Triggers come along to shine a light on the festering wounds that are lying in the depths of your mind. These wounds continue to fester until you take the necessary steps that are required to heal them. Triggers may be people, places, objects, news reports, and noises such as the sound of a car backfiring, a text message, a song, a phone or doorbell ringing, or maybe even the sound of someone’s voice. Nevertheless, these wounds require attention. Some wounds are so traumatic and buried so deep that they require years of therapy to recover from, and the first step is diagnosis. If you think you may have C-PTSD, please seek professional help as soon as possible to start your path back to wellness. Unfortunately, despite the prevalence and increasing evidence of domestic violence, many public servants and healthcare professionals lack sufficient understanding of PTSD or C-PTSD with regard to domestic violence situations. 

Survivors require ongoing support where they are validated and encouraged to heal at their own pace. The CPTSD Foundation offers a Daily Recovery Support service where certified coaches, licensed clinicians, and mental health advocates offer support and tips to trauma survivors to help them navigate their healing journey with expert knowledge.

 The Consequences of Abuse

The cycle of abuse is insidious. This pattern of events is usually well established before we even realise we are in a toxic, abusive relationship. Many abuse victims, especially those who experience chronic traumatisation, go on to develop mental health disorders and other health conditions that develop secondary to their abuse. Post-abuse issues vary in severity, and the consequences of abuse may include: 

• PTSD
• C-PTSD
• depression and other stress-related illnesses
• suicidal tendencies
• long-term disabilities
• eating disorders
• drug and alcohol addiction
• low self-esteem
• sexual dysfunction or sexual intimacy problems
• physical illnesses such as chronic pain, heart problems, digestive problems, sleep disorders, headaches, and migraines.

Credit: Pixabay

The long-term consequences of abuse are far-reaching and affect not only those involved but also their children, extended family members, and society. Now recognised as a human rights issue, domestic violence impacts the financial future of those involved due to loss of earnings, legal issues, and unemployment, and, in some cases leads to homelessness. As discussed in Dr Ilsa Evans’ report, ‘Battle-Scars: Long-Term Effects of Prior Domestic Violence’, many victims delay seeking legal advice due to stigma and a lack of faith in the justice system, especially in the family court. Intimate partner violence has devastating consequences and sends out shock waves that continue to reverberate throughout the lives of survivors and their communities well into the future.

 REFERENCES

1. American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders: Dsm-5-Tr. 
2. World Health Organization. (n.d.). 6B41 Complex post-traumatic stress disorder. International Classification of Diseases 11th Revision. Retrieved from https://icd.who.int/browse11/l-m/en#/http%253a%252f%252fid.who.int%252ficd%252fentity%252f585833559
3.  World Health Organization, 6B41 Complex post-traumatic stress disorder, 2022, The International Classification of Diseases 11th Revision. Available at: https://icd.who.int/browse11/l-m/en#/http://id.who.int/icd/entity/585833559.
4. Iverson, K.M, Addressing the Stress and Trauma of Experiencing Intimate Partner Violence. PTSD: National Center for PTSD, 2015. Available at: https://www.ptsd.va.gov/professional/treat/type/intimate_partner_violence.asp.
5. Evans I, Battle-scars: Long-term effects of prior domestic violence. Centre for Women’s Studies and Gender Research Monash University, 2007. http://www.chilliwebsites.com/sitefiles/553/File/Battlescars.pdf

Guest Post Disclaimer: Any and all information shared in this guest blog post is intended for educational and informational purposes only. Nothing in this blog post, nor any content on CPTSDfoundation.org, is a supplement for or supersedes the relationship and direction of your medical or mental health providers. Thoughts, ideas, or opinions expressed by the writer of this guest blog do not necessarily reflect those of CPTSD Foundation. For more information, see our Privacy Policy and Full Disclaimer.

Tracy Guy

Tracy Guy is a published author and a proud guest writer for the C-PTSD Foundation. Professionally, Tracy has experience in mental health and muti-trauma nursing and is now a full-time registered counsellor working with people struggling with complex trauma, anxiety, and grief. Her passion for writing, unwavering instinct to help others, and professional and lived experience drives Tracy to support and advocate for those suffering from debilitating traumatic experiences and C-PTSD. Tracy hopes to raise understanding and awareness of C-PTSD, more specifically, the association of C-PTSD with abusive relationships.