What’s so complicated about Complex PTSD?

(when safety gets in our way)

Complex PTSD is one of those things that can hide in plain sight. While most therapists know CPTSD has been around for a long time, it’s not even listed in the DSM, the big book of diagnoses that mental health professionals use. Whether the APA considers CPTSD a “real” diagnosis or not, it’s real and we can see it in the brains and nervous systems of so many people who have spent their lives adapting to chronic, relational harm.

It’s usually not one identifiable event, but rather an environment that never felt quite safe enough to be a whole person. An environment that maybe didn’t say directly but implied: don’t need too much, don’t feel too much, don’t take up space, don’t cause a problem, don’t make a mistake.

When people think about trauma, they often imagine something big and acute - oftentimes, we think of war veterans who return with PTSD. But complex PTSD isn’t usually like that. It’s more pervasive but quieter and less obvious, building from the patterns of over and over again experiencing rupture without repair in the very relationships that were supposed to model safety. Emotionally immature parents. Unpredictable caregivers. Repeated misattunement. Constant pressure to perform or please or disappear. CPTSD isn’t just about what happened but also about what didn’t happen. All the moments you never got to feel connection, protection, presence, delight, play.

The brain and the nervous system learn from this, organizing around what keeps you the safest, what causes the least amount of problems for others, and what creates the least stress and activation for you. Yes, even as a child, our brain is able to assess what is happening and make choices about how to keep the peace.

Once those patterns are in place, your brain keeps following those familiar roadways. Those neural pathways are awash in survival emotions; they’re what your brain thinks it needs to do to prevent you from being eaten by tigers. Long after you’ve left the environment, built a life for yourself, and are an adult who can make choices for themselves, the protective patterns remain because that’s how our brain is wired to work. They may not be efficient, they may get in the way of you building connection or getting excited or moving toward what you want for yourselves, but they ARE adaptive and protective based on your early environments.

This is why CPTSD can be so hard to spot, both from the outside and from the inside - we may not even recognize it in ourselves. Think of the fish who doesn’t know they’re swimming in water - if this is how it’s been our whole lives and we’ve been conditioned to believe that any emotions or needs we experience are difficult or annoying or problematic, then how would we realize that we want something different?

If you collapse in public, if you scream, if you dissociate mid-sentence, someone might take notice. But if your trauma response looks like being calm, capable, articulate, and endlessly available to everyone around you? You’ll probably get praised for that. You’ll get promoted. You’ll be the friend everyone counts on. And you’ll continue to believe that your over-functioning is who you are, your identity, not a strategy you learned to survive.

That’s the thing about CPTSD. It doesn’t always show up as symptoms we hate. It can show up as the very traits we’ve been applauded for. The high-achieving student, the thoughtful partner, the selfless friend, the intellectual friend, the empath, the expert. The one who never needs anything, but can always hold space for everyone else.

Sound familiar? None of those traits are bad, but oftentimes they are part of a freeze shutdown response that is cloaked in competence. When things in your earlier (or adult environments) are so overwhelming all of the time, or not enough all of the time, or emotionally cold all of the time, you adapt. You do so because you are resilient. Because you need to maintain connections with your caregivers and attachment figures, you’re biologically wired to do so. And we, as humans, are extremely good at adapting, and adapting so well that we don’t look like someone in pain.

You have it all together. You’re good. You’re not overly emotional. You tell yourself that long enough, you shut the sadness, anger, shame down long enough that you start to believe it yourself. And that usually works until it doesn’t. Until your body starts to revolt. Until you feel empty, lost, stuck. Until everything feels so intolerable that even going to a dinner with friends makes you want to scream because you’re so tired of keeping it all inside, listening to everyone else’s problems but no one listening to yours (not that you’d let them know you have any issues!). Panic attacks, unexplained fatigue, irritability that feels out of proportion, a growing sense of disconnection. Like you’re watching your life from just a few inches outside of it.

It’s not just friends, therapy can miss it too. For people whose adaptive strategies mean they show up as hyper competent, hyper “self-aware", hyper achieving, then therapists who are trained to track symptoms like low mood, difficulty getting things done, difficulty moving towards goals, are going to think, “huh, I wonder why this person is here? They’re so self-aware, they’re doing great!” Especially if the work stays surface-level, and especially if you’re good at telling the story but staying out of the feelings.

So many people with complex trauma show up in therapy with a polished version of themselves. They talk about their week, reflect on their relationships, and make sense of things quickly. They sound like someone who’s doing the work. And they are, but only from the neck up. From the protective tower in their castle, surrounded by a moat of alligators that says thinking = safe, feeling, moving toward goals, connecting, sharing, being seen = very, very dangerous. The body and brain are still holding what hasn’t been safe to feel. The nervous system is still on high alert, even while the mind is narrating a coherent, emotionally distant version of events.

If this is you, I want you to know that you’re not failing at healing (it’s all one being experiment). You’re not avoidant. You’re not too intellectual for therapy. You’re just trying to protect yourselves in the only way you knew how. Of course you would stay up in your tower. Of course you learn that presenting as smart, perfect, having no needs would make people like you. Of course you would keep yourself going at all costs because slowing down meant feeling all the overwhelming feelings.

Your system has done an extraordinary job keeping you safe. It’s just that the strategies that worked then are now keeping you from accessing what you actually want: rest, closeness, ease, aliveness.

And here’s the hard part: the closer you get to wanting something different, the louder the old strategies tend to get. The moment you try to move toward more connection, more visibility, more authenticity is the very moment your brain and nervous system might slam the brakes. The freeze may tighten and push into making yet another list, buying another self-help book, getting a new planner. The fawn may step in to keep the peace, convincing you that your needs are silly or a waste of time. That doesn’t mean something is wrong, but rather it’s a clue that some old, emotional learning is playing out when you start to move toward having needs.

This is why healing from CPTSD requires more than insight. It requires remapping. A reorganization of the neural pathways (bundles of thoughts, emotions, body sensations, and behaviors) that tell your brain and body what’s safe, what’s allowed, and what will happen if you stop performing your old roles. None of this can be forced. None of it can be done through analyzing (I’m so sorry to my fellow intellectualizers). None of it can be done by trying harder or taking on more (sorry, fellow perfectionists). None of it can be done by having fewer needs and doing more for others (sorry, fellow people pleasers).

It happens slowly, with repetition, co-regulation, curiosity, and neutral observation. It happens by building up a felt sense of safety. It happens by learning to notice the old patterns and finding what’s true in the present versus what was taught to you in the past.

If you recognize some of these patterns in yourself and feel like in therapy you’re stuck, just skimming the top, I’d invite you to try on naming that. What would it be like to say “I really appreciate our time together, but I notice it feels like I’m just telling you about my week or analyzing things, but not making any changes. I think there might be more happening, but I’m not sure how to get to the deeper layers. Can we explore that together?” A good therapist will be able to hear that and meet you there, getting curious with you about what you’re really wanting.

Complex PTSD is complicated because it teaches you to become someone likable, admirable, helpful, even successful. It hides in the roles that protected you.

The work now is letting yourself want more without shaming the parts of you that are scared of what that will require. Letting your brain and nervous system move toward something new without forcing it to let go of everything at once. This work is done little tiny bits at a time through building the ability to observe ourselves, our old learnings, and what we want in the present. If you’re feeling curious about that, check out my five steps to change guide, where I’ve laid out a neuroscience-backed process for changing neural pathways. It’s not simple, easy work; it takes time and repetition, but it is possible, and on the other side is so much goodness that you deserve (even if a part of you thinks you don’t).

Book Club Update

Want to dive in even deeper?

We’ve been moving through some big terrain in the book club lately by reading Adult Children of Emotionally Immature Parents, which opened the door to understanding how early relational ruptures shape the nervous system. In the archives, we’ve also read The Practical Guide for Healing Developmental Trauma, the book on which NARM is based, and No Bad Parts, the book on which IFS is blamed - both of which do excellent jobs at exploring how patterns of disconnection, self-blame, and over-functioning aren’t character flaws, but adaptive responses rooted in early environments that didn’t know how to hold us.

The conversations have been rich, emotional, and incredibly validating. We’ve talked about the parts of us that had to grow up too fast, the ways we learned to intellectualize instead of feel, and how the internalization of emotional immaturity gets passed down until someone decides to stop and turn toward it with curiosity. Paid members get full access to the archives to read/listen here on Substack or on Spotify/Apple Music (plus my eternal gratitude for supporting my work). For each book, we have two live meetings where we get to explore, ask questions, and connect.

Up next: we’re diving into Unlocking the Emotional Brain, a deeper look at how real change happens in the brain through memory reconsolidation. If you’ve ever felt stuck even after years of insight, this book puts language to why. It’s the missing piece in so many models of healing, and I’m excited to explore it together.

As always, you’re welcome to join in at any point. You don’t have to have it all together. You don’t even have to have read the book. Just bring your nervous system and your curiosity. We’ll go from there!

Sending tiny glimmers of goodness your way,

Trisha