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angelonasher · 4 days ago

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Hello! I hope you guys are having a good day :) [Smiley face]

I'm writing a story and one of the main characters has CPTSD, and I had a few questions about it. I think I might have CPTSD but I'm not able to get evaluated right now.

I know you say we can do whatever we want when writing about our own conditions, but since I'm not actually diagnosed I wanted to double check things.

Relevent character info: She's been in therapy on-and-off for about 5 years (she had a therapist, stopped seeing him because she moved, and then started seeing a new one) and her trauma revolves around being abused/neglected as a child, witnessing violence, and having assassins sent after her.

Question 1

If she's been in therapy for a years and has a very good therapist, would it make sense that she's able to better deal with stressful/traumatic situations when they come up? Like, being more "resiliant" to being triggered I guess?

For example, she ends up having to work with a group of people, and initially she worries that they might be assassins that were sent after her, but she later realizes that they're not.

Would it make sense for her to not be as hypervigilant/wary around them after realizing this, and more willing to get to know them, and slowly sharing more information about herself as time goes on? Especially if they're also telling her about their past and showing her that she can trust them?

I know that trauma and triggers aren't exactly "logical" sometimes (like being scared of something even though you know it's harmless) so I don't want it to come off as "Well she was scared but then she realized she was being silly so now she's fine lol!"

Should I maybe have her mention to one of them something like "Yeah if I met you guys years ago I would have refused to trust any of you, but therapy really helped me with my issues"?

Question 2

This is sort of related to question one.

I've read that one big thing that determines whether or not someone is traumatized by something/develops PTSD is whether or not they recieve adequate support after the traumatizing event.

So for example, if someone is in a car accident and then they recieve a lot of support from friends/family/therapists, they'll be less likely to develop PTSD VS someone who is in a car accident and then given no support.

In the story, there's a lot of bad things going on. But this time, instead of only having one or two friends to help comfort her, she has a very good therapist and large support network who are there for her.

Would this help prevent her from being further traumatized or making her symptoms worse?

Question 4

Is there a specific order in which symptoms get "fixed"? Like for example, if someone has nightmares, flashbacks, and hypervigilance, would it be possible that their nightmares and flashbacks are less of a problem after treatment, but they're still hypervigilant?

She generally doesn't have issues with nightmares or flashbacks unless extremely stressed or triggered by something specific, but she still has emotional regulation issues (quick to fly off the handle and get mad) and she's quite wary and hypervigilant, especially around people she's doesn't know.

I just wanted to make sure that that behavior makes sense.

She used to be very quiet and people please-y but after therapy she started standing up for herself more, and now she sort of went in the other direction. So instead of just taking everything quietly, she's quick to speak her mind and she's not afraid to defend herself.

Question 5

During the story, she ends up falling in love with one of the people she had to work with, and they start dating about a month after meeting.

I don't want to fall into the "The power of love cures mental illness and now they're all better" trope, so I want to make sure that I show her having occasional symptoms even though she's been doing really well in therapy.

I know it's kind of hard to say since healing doesn't really work on a scale of "0% healed, having a bad time" to "100% healed, no symptoms" but for someone who's been in therapy for years, how often would she still experience symptoms, and what would they be?

I was thinking of showing that she's mostly okay, but still having the occasional nightmare, intrusive thought, flashback, etc.

Hello!

Before I get into the specific questions you have, I just want to give a general disclaimer about PTSD/C-PTSD.

Trauma and trauma disorders are very complex and vary greatly from person to person. The diagnoses for both PTSD and C-PTSD are fairly new (PTSD was only added to the DSM in 1980 and C-PTSD has not yet been added) and the effect that trauma has on the brain is still yet to be fully understood.

I'm speaking from both my own experiences and my own knowledge on the topic as well as some additional research to ensure my information is up-to-date.

Throughout the post, I do mostly refer to PTSD instead of C-PTSD. This is because C-PTSD is generally considered to be a sub-type of PTSD so what I'm describing will generally apply to both. Though there are differences between C-PTSD and PTSD, there isn't exactly a single, commonly agreed upon list of them.

In general, C-PTSD is believed to stem from long-term, repeated/chronic trauma (especially when the brain is still developing) while PTSD comes from a singular event or several separate events. Of course, because C-PTSD isn't in the DSM yet, there are many people who have been diagnosed with PTSD but may better fit the label of C-PTSD.

Personally, I was diagnosed with PTSD as well as a several other trauma-based/trauma-related disorders. My psychologist believes that C-PTSD would be more fitting for what I'm experiencing but, because it's not commonly used in my area, deferred to PTSD.

Interestingly enough, C-PTSD is often mistakenly called "childhood PTSD" because it's most frequently seen in victims of childhood abuse/trauma.

Question 1

Although it doesn't work for everyone, having a good therapist and attending therapy sessions regularly can certainly have a positive effect on trauma and PTSD in general.

Some of the main things that therapists can do include:

Helping your character to recognize when they are becoming triggered.

Helping your character to pinpoint some of the situations that may trigger them.

Working with your character to develop strategies for dealing with their triggers and the feelings that they bring up.

Working with your character to open up about and process their trauma.

Being a safe person to vent to.

Helping your character to navigate difficult situations that arise and helping them to separate their rational thoughts/beliefs on the situation from their initial, trauma-based responses*.

*As an example: A character with trauma from an abusive relationship has a big fight with their new partner. Their first instinct might be to pack their things and leave before their partner gets the chance to hurt them. A therapist can help them recognize that their current partner has never behaved aggressively towards them and identify the ways that this situation is different from their past relationship (They have a stronger support system, they're in therapy, they live in a place with different views on abuse, etc.). With trauma, the past and present often end up blurred -- especially when the present starts to mirror the past -- and it can be difficult to separate the two without help. A therapist can provide this help.

While these things may not make your character immune or even more resilient to being triggered, they can help your character manage it and navigate the situation when it does happen.

Considering the example you gave, I think it could work but there are some other things to consider here:

Why does she originally suspect them of being assassins? Is this something that she suspects all new people of or did they do something specific to trigger the belief? For example, maybe the assassins she encountered tried to poison her and the new people keep offering her food.

How long does it take her to realize that they aren't assassins? What kind of thought process does she go through during this time? Did she speak with her therapist during this time? What does her therapist have to say about it?

What made her realize they aren't assassins? Was it something logical (For example: She uncovers information that proves they aren't assassins) or is it more emotional in nature (For example: She makes a connection with them/bonds with them and starts to trust them)? Are her doubts completely assuaged with this or is she still a bit suspicious in the back of her mind -- even sub-consciously?

It would make sense for her to grow more trusting and open with them as time goes on but, from a PTSD standpoint, trust alone doesn't really have much of an effect on hypervigilance.

Being wary and being hypervigilant are two very different things. The way I usually describe it to people is that wariness is more conscious -- hypervigilance isn't. Even when I'm with somebody I trust, I'll still flinch when they come up behind me unexpectedly -- even if I know it's them. It's a physical response, not something that I can necessarily turn off.

Although your character's wariness may be assuaged, their hypervigilance wouldn't necessarily be something that is eased by trust.

While I do think that having her mention her therapy journey is a good idea (especially considering the fact that there's still a stigma around therapy), I wouldn't rely on it to get your point across about her trauma and trust issues not being an immediate fix.

Instead, I'd encourage you to show how it's a longer process:

Maybe she still has some lingering suspicions/doubts about them on a sub-conscious level and has to mentally talk herself out of them ("You've known these people a long time. They're making coffee for everyone, not just you so the likelihood that they're trying to poison you specifically is low."). While trauma isn't necessarily logical, using logic against these kinds of thoughts can be helpful.

Maybe she still has a physical reaction to something that triggers her. For example, she goes into the kitchen and one of her new coworkers turns around with a knife in their hand from where they'd been cutting food and she stumbles back/gasps because she isn't prepared for it. Not every trigger has to result in a major flashback -- being triggered can just look like your body going "wait a second, I've been in this situation before and it's not safe. Let's take a few steps back until we know it's safe".

If the story is in first person, I'd encourage you to explore her thoughts on the new people, both at the beginning when she distrusts them and later on when she begins to trust them more.

You could also show how she uses some of the tools she's learned in therapy such as self-regulation techniques like grounding exercises or controlled breathing or even just recognizing when she's getting triggered and doing something about it. Depending on what kind of person she is, this could look like her making an excuse to be alone for a moment ("I'm just going to run to the washroom quickly.") or speaking up about her situation ("Just... give me a minute, okay?" or "Wait. I need a second.").

I'd advise against having her explicitly state what is happening ("I'm getting triggered right now." or "I'm starting to have a panic attack.") for a few reasons:

The first being that -- for the most part -- people don't naturally speak like that, especially not when they're already stressed out. A lot of the time, it's not always evident what exactly is happening. The beginning of a panic attack can feel a lot like a spike of anxiety or an increase in hypervigilance.

The other big thing is that words like "triggered", "panic attack", and other mental health-related terms have a history of misuse behind them (Ex: People using "triggered" to mean offended, people using "OCD" to mean neat/organized, etc.). As a result, you run the risk of giving your readers the wrong impression when using them in this context -- especially in dialogue.

One other thing I'll mention is to keep in mind that changing therapists can be very stressful and set your character back a few steps, especially since they have to build that relationship with their therapist again. Keep that in mind when you consider the timeline for these events. If she has just changed therapists, she may not be comfortable enough approaching them about this yet.

Question 2

We don't yet know what specifically causes somebody to develop PTSD. In a broad sense, it's a traumatic event but there are so many different factors at play that can determine whether or not somebody is traumatized, develops PTSD, or develops another trauma-based disorder.

You are right that the level of support somebody gets after a traumatic incident can have an impact -- but there are so many other factors too such as:

The event itself including the duration, the type of incident, their involvement in it (as a witness, a victim, a rescuer, etc.), etc.

Their age and brain development. A child who witnessed somebody's death but was too young to really understand what was happening would have a vastly different experience than an adult who was fully aware of it. Something to keep in mind, however, is that while children were generally considered to be more resilient to trauma than adults, that isn't necessarily true*.

The specific individual -- including their personality, resilience, past experiences/history, pre-existing disabilities and other conditions, etc.

Their experiences during the trauma. There's a common misconception that people develop PTSD only when they don't believe help is coming (for example, being stuck in a car accident in the middle of nowhere). This isn't exactly true but it can have an effect.

Now, on to your actual question: That depends.

Along with the factors mentioned above, their current situation should also be considered. If they're on a series of busy missions and don't have the time to actually process their trauma, they'll have a harder time with healing than they would if they were able to take it easy and process things at their own pace.

While her therapist and support system can absolutely help her manage the more recent trauma, her past experiences in therapy and the skills/tools she's learned can also benefit her -- both in the traumatic moment and after the fact.

In short: Yes, it could make sense that she's more resilient to this new experience than she was to her original trauma.

*There's a great book by Bruce Perry (the child psychologist) that talks about this. It's called The Boy Who Was Raised as a Dog and it's a heavy read but a good one.

Question 4

Something that's important to remember about PTSD and C-PTSD is that the trauma can never be fully "fixed" or healed.

Trauma -- especially complex and long-term trauma -- has lasting effects on a person's brain. It changes the way we think, the way we approach new situations, the way we deal with stress. Some types of trauma can even have an impact on the way our kid's brains develop [Link].

While therapies, medication, and support can make a difference and cause symptoms to lessen (or disappear entirely), the trauma will still have lasting effects.

In terms of the order that symptoms get resolved, this is something that varies so greatly from person-to-person that I can't give you an actual answer.

The other thing is that healing from anything (especially something as messy and complex as trauma) isn't as straightforward as it seems. Even with the proper treatment, symptoms don't just decrease steadily or in order.

You may have heard the phrase "progress isn't linear" before. This is very applicable to PTSD and C-PTSD. There will always be setbacks or stumbles or relapses. You can go for years without having a flashback or nightmare and then one day be triggered enough for it to happen. You're still healing, it's just not a straight path.

In your character's case, it could absolutely make sense for her symptoms to lessen at different rates. That said, I'd be wary about portraying it as a straightforward path.

Although recovery is complicated and it's normal to relapse/stumble/have a setback, it's frequently portrayed as a straightforward path and characters rarely experience these setbacks -- which is very discouraging when you're actually recovering from trauma.

Question 5

You might be getting sick of me saying this by now but: ✨it depends!✨

The experience you described (with her occasional nightmares/flashbacks/etc.) is one possibility but it's definitely not the only one.

Somebody can be in therapy for just as long and still experience the same amount of symptoms they did when they first started. Likewise, somebody can have that same experience (with the occasional nightmares/flashbacks/etc.) after only being in therapy for a couple months.

It is important to remember that therapy doesn't get rid of symptoms -- it just helps you process them and teaches you how to cope with them. In some cases, this can cause a decrease in symptoms (for example, talking about an experience can help you process it and decrease the amount of nightmares you have about it) but it doesn't directly get rid of symptoms.

Also worth noting is that therapy doesn't work for everybody and that there are so many other ways of managing PTSD and trauma in general. Some people benefit more from medication (usually anti-anxiety meds or antidepressants) or other types of therapy (such as eye-movement or narrative therapies).

Of course, there are also people that cope with their trauma in ways that aren't generally considered "healthy" such as substance use, risk-taking behaviours, self-harm, etc.

Although therapy is becoming more popular and more openly talked about, I think it's important to acknowledge that there's not just one "right" way to healing from, coping with, and processing trauma.

Cheers,

~ Mod Icarus

#not mine #writing reference #reference #ptsd #c-ptsd #long post

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