This is my tentative theory of how CPTSD works and why it is so complex.
The boundary between emotions and physiological processes is gradual. We can describe emotions and mental states in terms of neurology, and we can describe physical phenomena like muscle tension, blood pressure and gastrointestinal complaints in emotional terms like having butterflies in your stomach, feeling faint, gritting your teeth and so on.
What happens in cases of CPTSD is that repeated and prolonged exposure to traumatic events causes strong emotional and physical reactions that then become the focus of further traumatising events.
For example, if an adult screams at a child the child will have strong emotional and physical responses of fear. What happens if, instead of being soothed or allowed to recover, the child is then subjected to additional abuse, ie. The adult then forcefully demands that the child “snap out” of their emotional and physical fear response and “act normal” to comply with the adult’s instructions?
In such cases the child is still in a state of fight-or-flight, but is being placed under a new set of threats and demands that specifically require the suppression of the fight-or-flight response. Yet these new threats and demands are likewise causing strong emotional and physical responses themselves!
This is how CPTSD becomes “complex”. It is complex because the child is learning and growing and developing within layers of traumatic experience that are themselves impinging on the natural emotional and physical responses to trauma.
Unpacking and untangling these interwoven layers of trauma is not easy. Along the way it may prove transformative to recognise that what you are experiencing as “anxiety” or other persistent trauma-related symptom is not actually emotion, but the physical aspect of the fight-or-flight response to trauma.
It is possible to have butterflies in your stomach, a lump in your throat, a tightness in your chest, and yet otherwise feel fine on an emotional level. If these sensations can be viewed as the physical components of old trauma responses, rather than real-time emotional responses to the present moment, their power is immediately diminished.
If you’ve ever had something in your eye you’ll know that even when the object is gone your eye can still feel scratchy and sore, and you will make it worse by continuing to rub it.
In the picture of CPTSD I have described above, the child’s initial trauma of being yelled at by the adult triggers an emotional and physical response that is then further targeted by the adult as a pretext for abuse. For that child, the mere fact of having a fight-or-flight response puts them in danger and therefore becomes the trigger for an additional or exacerbated fight-or-flight response.
The child with CPTSD not only lives in fearful anticipation and expectation of future trauma, but additionally lives in fear and vigilance against their own natural reaction to that trauma, because those reactions were the apparent cause of further punishment and abuse.
This is by no means the sum total of what is going on psychologically or neurologically in cases of CPTSD but it is, I believe, a key component of the messy feedback loop that makes this condition so complex.
Because no matter how many first-order traumas and responses you might process and clear, this preoccupation with controlling the fight-or-flight response can persist, hiding away on a meta level and overarching the other more concrete episodes of trauma such a child might have experienced.
My hypothesis is that we can unpack this meta-trauma by first identifying it, and second by making peace with the physiological expressions of the fight-or-flight response. The trauma is kept alive by the belief that fight-or-flight symptoms are dangerous, unacceptable, and need to be controlled or suppressed. But this is not true. A fight-or-flight response is a normal, healthy, and highly evolved response to dangerous situations. For people with CPTSD the condition is not an indictment of them but of the traumatic circumstances, environments and people that once surrounded them.
Finally, by learning to recognise and discern the faint but responsive flow of actual emotions in real time, distinct from the old pattern of fight-or-flight symptoms, we are reassured that our genuine emotional responsiveness is still active, still on track, and very very different from the physiological residue of old trauma.