Thursday, August 29, 2013


Case Study – 30 Amazing Years Of Struggling With Complex Post-Traumatic Stress Disorder (C-PTSD)

Sally was around 23 years old when she developed C-PTSD. She was traumatized and re-traumatized by at least 10 major events in her life to date. Though she had to endure countless minor traumatization by her husband, of the 10 major events, at least five from her husband were contributing factors exacerbating her C-PTSD. She survived her C-PTSD without any medication through her own determination as she struggled for her own survival. This case study maps her C-PTSD starting from one of the earliest trauma she suffered to date while being with her husband.

It all began when she was driven home by her husband after having his usual weekly dinner sessions with his sister’s family. On this particular weekend around midnight, he decided to meet his friends at a pub for a drink and supper but Sally refused to join him. A quarrel ensued between them and she was forcefully abandoned by him in the middle of the night along a quiet and desolate part of the housing estate in Petaling Jaya while he went off to enjoy drinking with his friends. As this was in the early 80s, there were no such devices as mobile phones or portable communicate devices and being sparsely populated, it was hard for her to get help. After she was abandoned, she had to walk around the area that she was totally unfamiliar to. While being subjected to the fears of being accosted by strange and unsavoury characters roaming around at night, she eventually managed to find help from a couple and made her way back home. The incident traumatized her deeply but unknown to Sally, she developed C-PTSD. She started to have recurring nightmares and flashbacks of being trapped and unable to find her way home. 

Sally could deal with her husband’s bad temperament but her C-PTSD made her very temperamental. She gets upsets very easily and displays a lot of anger, fear and frustration. As far as the incident is concerned, she tried to blot out anything associated with the place and situation as much as she can. Initially, she couldn’t step out from the house because outside, her fears of the dark, being alone or seeing strangers approaching make her prone to panic attacks as any of the encounters will trigger her C-PTSD reminding her of the night she was dumped. Reports of criminal activities like rape, abuse, snatch thieves or robbery in the newspaper or television around her area can trigger her phobia to step out from the house. She is so badly incapacitate by such news as it invokes her feelings being unsafe outside. This feeling of insecurity prevents her from visiting a popular shopping complex that is just a stone’s throw away from her home.

Before this incident, Sally was an outgoing, warm, cheerful and generous person. She travels a lot and loves shopping whenever she has the time. As good as she is to those around her, she is equally enterprising and excelled in doing business. To relax, she loves to take long walks in the park or out in the nature. But now as she is overtaken by her C-PTSD, she becomes very seriously handicapped by her emotions. She has developed psychomotor (it has 3 stages of development: 1st or cognitive stage – action marked by awkward slow and choppy movement; 2nd or associative stage – action becomes more fluid, spending less time thinking; 3rd or autonomic stage – action performed skilfully, movements refined through practice) impairment or retardation, causing a visible slowing of physical and emotional reactions, including speech and communication with others. The impairment reduced much of her psychomotor function down to the cognitive stage. When she is traumatized, her actions become jerky and lacks refine control even when she had repeated the same action many times over. This impairment of hers is her inability to step out of her home, due to having the persistent feeling that outdoors is very unsafe. So much so that she will hide herself at home than to go to the office or anywhere else. 

Situations and incidences that are seemingly trivial or minor to a normal person are capable of traumatizing Sally. It does not take much effort or complications to spark off her trauma. When traumatized, she displays speech and language impairment, making it hard for her to express herself coherently or stringing her thoughts together fluently. It can affect her in other ways like when she is driving, she will lose some of her spatial perspective making it hard for her to drive properly, especially in the confines of the car park and in trying to park her car. The hardest is probably her loss of ability to navigate her way around, not just to some destination in her car but the place can be as small as inside a large shopping complex. 

The C-PTSD can cause her at times to deepen her fears to levels of paranoia, generating a lot of aggression in her. As the closest person to her is her husband, most of this aggression is directed at him because in her mind, he is the one that not only abandoned her but betrayed her as well. Her husband vehemently denies that he is the cause of her C-PTSD, insisting that she doesn’t have C-PTSD or the impact ought to be extremely mild. He insists that by now she should have fully recovered. Complaining, he blames her for trying to take revenge on him, torturing and burdening him to be a scapegoat to her whims and fancies like chauffeuring her around, controlling his freedom and making his life very inconvenient. Sally’s gets traumatized even more when she sees him going out to have fun and meals with his friends, for it reminds her of the reason that she was not protected but abandoned instead and her own memories of her younger self as a charming and outgoing person that she cannot be at all. She is at his mercy for simple things like her meals for when he is happy and obliging, he will provide but when he is unhappy, he would not provide for her but abuse and challenge her to go out on her own.

Still unknown to Sally is her C-PTSD condition so the recurring onset of her trauma is without a doubt debilitating and tiresome. She tries to deal with her issue as best as she can but as her condition drags on, she becomes withdrawn and numbing emotionally. She begins to develop a sense of shame, guilt and learned helplessness. In fact, her rejection rate is very high because of her learned helplessness. Her panic attack is also preventing her from focussing or concentrating properly, causing her to act clumsily or display irritability towards others. When she tries to force herself out of the home, she has a constant nagging feeling that there is danger lurking around the corner, forming an invisible barrier preventing her from stepping out. Even though the only place she can go to is her office, when the trauma takes its toll on her, she simply stays holed up in her home. But as the business is hers, for the sake of her business and her sickly child’s medical bills, she has to live with the constant recurring fear associated with going to the office, parking her car and taking her car home. 

Eventually the C-PTSD takes a toll on her relationship with her child. As the child was growing up, it seems not to matter because she could provide the best for her child. But her negative thoughts of something will happen to her child like being kidnapped or the child could have run away, got lost or had an accident, kept the child in tight reins. As the child was coming of age to be a young adult, her husband used her condition to estranged the child from her, by insinuating that “freedom to be with friends is of utmost importance and without it, one should rather die”. Her child followed in the footsteps the father and openly avoided and rebelled against her. This double dose traumatized her quite badly, now not just by her husband’s irresponsible attitude but that of her child too. After the loss of her child, Sally pretty much stayed at home, making visits her office casually. 

As years went by, the constant traumatizing and re-traumatizing of her C-PTSD took a toll on her body. She developed high blood pressure, mild diabetes, increased pulse rate, aches and pains caused by excessive muscular tension. Her behaviour changed drastically, so did her lifestyle. It is of late that Sally began to understand her condition she is suffering from. Medication is used to treat conditions of insomnia and panic attacks or depression is found to be quite effective for PTSD sufferers. There is no medication designed specifically to treat symptoms of PTSD.  In fact, anti-depressants or SSRI (selective serotonin reuptake inhibitors) medication commonly issued to PTSD sufferers can help them to improve their mood by improving numbing and hyper arousal symptoms. Medication can also act as tranquilizers incapacitating the user for the duration of the dosage. It does not prevent the re-experiencing symptoms of PTSD. For Sally, it is her “re-experiencing” symptom that is the bottom line of her problem, that is why no medication to cure her. 

It is of late that Sally began to understand the condition she is suffering. Her understanding of C-PTSD can reduce its effects but damaged done to her cognitive abilities remains to be seen if it can be healed totally. Again, whether her fears and anxieties can be managed is being managed. It is still very easy for her to be re-traumatized by her husband giving her recurring flashbacks and nightmares, trapping her in her past memories, which has created some sort of virtual prison within her mind. Even when she constantly yearns for freedom, wanting the feeling of being safe, it is invalidated by her fears for her personal safety and loss of coherence of her sense of self. Complex Post-traumatic stress disorder is preventing Sally from living a full and useful life.

Treatment Plan

Sally does not need medication because she does not have sleeping problems nor is she suffering from depression. And as there is no medication to prevent Sally from re-experiencing her traumas, she has to find alternatives to help herself. Though psychotherapy may help her, she didn’t know and therefore, unable to find a psychologist for help. By the time she understood what she is undergoing is called C-PTSD, she was expanding her knowledge, reading widely and forcing herself to attend courses to find ways to help herself.  

Sally had much guilt and self-blame for her own condition thus she went to learn to reconstruct herself and her family again, without knowing that it was her C-PTSD to be fault. So, her constant re-traumatization by her husband and later in life her child, led her find other means of support to help her tide over her panic attacks.

Apart from learning to manage her stress level, eat healthily and takes up physical exercises like yoga and brisk walks at the park.  She had to relearn most of her basic skills like language and driving, even basic computing skills. She even took up non-verbal therapy, music therapy and expressive art therapy to help herself.

Meditation taught in accordance to original Buddha's teaching (Mahasatipatthana sutta from Digha Nikaya and suttas from Majjhima Nikaya)  is also another important tool that she used to counter her panic attack strikes.The technique taught must incorporate the transformation of negative thoughts, reconstruction by positive thoughts, development of self awareness, self acceptance and self confidence.

Most importantly, Sally is a survivor, needing to survive alone and fighting constantly with her condition. She has to learn to accept C-PTSD as part of her life and to live with it.


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