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.
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:
- 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.
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.
- American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders: Dsm-5-Tr.
- 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
- 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.
- 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.
- 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