In the first article in this series, I introduced you to my experience with suddenly having to manage the effects of CPTSD in the workplace. Today, I would like us to explore the symptoms of CPTSD, as they are classified in the World Health Organization (WHO) International Classification of Disease (ICD-11), how these symptoms may show up in the workplace, and provide you some guidance on how to manage your symptoms in the workplace.
What is Complex PTSD?
In 2017, the World Health Organization recognized complex post-traumatic stress disorder in the International Classification of Disease (ICD-11) as a legitimate stress disorder separate from PTSD.
According to the ICD-11, "Complex post-traumatic stress disorder (Complex PTSD) is a disorder that may develop following exposure to an event or series of events of an extremely threatening or horrific nature, most commonly prolonged or repetitive events from which escape is difficult or impossible (e.g. torture, slavery, genocide campaigns, prolonged domestic violence, repeated childhood sexual or physical abuse). All diagnostic requirements for PTSD are met. In addition, Complex PTSD is characterised by severe and persistent 1) problems in affect regulation; 2) beliefs about oneself as diminished, defeated or worthless, accompanied by feelings of shame, guilt or failure related to the traumatic event; and 3) difficulties in sustaining relationships and in feeling close to others. These symptoms cause significant impairment in personal, family, social, educational, occupational or other important areas of functioning."
Common mental diagnoses for trauma survivors include: Major Depressive Disorder (MDD), Generalize Anxiety Disorder (GAD), Bipolar Disorder, Obsessive-Compulsive Disorder (OCD), Post Traumatic Stress Disorder (PTSD), Dissociative Identity Disorder (DID), Addiction, Eating Disorder, Attention Deficit Hyperactivity Disorder, and Borderline Personality Disorder (BPD). Unfortunately, the American Psychiatric Association's (APA) Diagnostic and Statistical Manual for Mental Disorders (DSM-V) for the United States does not recognize CPTSD as an accepted diagnosis. While many Americans may present the symptoms noted above, they will not be diagnosed with CPTSD because it doesn't exist in the DSM-V.
Complex PTSD Symptoms
Complex PTSD symptoms include affect-dysregulation, negative self-concept, interpersonal disturbances, and the symptoms for PTSD. Symptoms related to PTSD are re-experiencing the traumatic event in the present, avoidance of traumatic reminders, and a sense of current threat, which I will cover in another article. I am going to give a brief description of the CPTSD symptoms below.
Affect regulation, sometimes called emotional dysregulation, relates to having strongly felt emotions, like overwhelming fear, shame, alienation, rage, grief, and depression, that leave us feeling powerless to control them. The emotional outbursts, sometimes called emotional flashbacks, can last anywhere from a few seconds to a few hours and can be triggered by seemingly minor events that most people wouldn’t react to. Shirley Davis, chief staff-writer for CPTSD Foundation, has an excellent series on emotional flashbacks that is worth the read.
Having a negative self-concept is when we feel inherently worthless, guilty, shameful, less than, or defeated. This negative self-concept is an internal sense that we may have no awareness of.
Interpersonal disturbances are not being able to initiate or maintain interpersonal relationships. Given the interpersonal nature of CPTSD trauma, this is understandable. CPTSD is, at its core, a relational trauma. It is something that is inflicted on people continuously, by people. Brene Brown talks about how we are hardwired for connection, but if connecting to people in the past caused you a tremendous amount of pain, especially as a child, when there was no way of escape, you learn to avoid connection to protect yourself.
CPTSD Symptoms in the Workplace
I want to take a moment to connect the dots between Complex PTSD symptoms and how they play out in the workplace, so people can understand the struggle that we face in this environment.
The triggers for emotional dysregulation seem endless, especially in the work environment. A look, a tone of voice, or a power-over situation can trigger an emotional flashback. An emotional flashback can be particularly disturbing because we may not know why we have such powerful emotions over something seemingly insignificant or why we feel powerless to control it. For me, the unpredictable nature of the emotional flashback was the most disturbing. Often it is not something I can avoid or prepare. They seem to come out of nowhere, like a ninja, and overwhelm my nervous system, leaving me with a tremendous sense of powerlessness. I am learning to tell when I overreact to something that happened because the intensity doesn’t match the situation. In the beginning, however, it was incredibly frightening. When I have an emotional flashback at work, my immediate response is to withdraw from people, so they can’t see me struggling and avoid the shame that inevitably comes when I've "lost control."
A negative self-concept can play out in a couple of ways within the workplace. We may enter the workplace with low self-esteem and constantly feel like a failure. We might not believe in ourselves and ultimately think that whatever we do will fail. Often, we have a sense of powerlessness in our ability to succeed and thrive. There is another response to this negative self-concept, which I call the high-functioning overachiever. These folks are continuously fighting against those inner demons and work incredibly hard not to allow their past to impact the rest of their life. They have a hard time saying "no." They may take on impossible projects to demonstrate their worthiness. Their happy place may be at work, where they feel a sense of accomplishment. I fit into that category. I inherently felt like something was wrong with me and that I had to overcompensate so people wouldn't see how inadequate I honestly felt on the inside. I worked hard to appear "normal" (whatever that is).
Out of all the CPTSD symptoms, I have found the difficulty establishing and maintaining relationships the most debilitating to my career advancement. For me, networking has not been a problem. I seem to be pretty good at it. The challenge is in cultivating relationships that have some depth to them. It isn't easy to move up if you don't feel like you can trust anyone, including your manager or the other leaders of your company. If you don't trust people, you will not ask for help when you need it because that feeds into your feelings of worthlessness and inadequacy. I had Senior Executive tell me once, “performance + relationships = advancement," and all I could think about was how impossible that seemed to me.
Another relational component that impacts us in the workplace is the nagging feeling that we don’t belong. Often, we don't feel like we belong anywhere. For me, there was a certain paranoia that if people knew what was going on inside of me and how much I was struggling, "they" would never let me work here. Employee engagement is an essential topic for companies because it influences the retaining of top talent. However, if you don't feel like you belong, are you going to engage in the company's activities?
Managing CPTSD Symptoms in the Workplace
An essential skill for managing our symptoms in the workplace is awareness. When CPTSD showed its ugly head in my happy place, I had no idea what was going on or why I could no longer function like I used to. I never even heard of CPTSD or its effects. If you haven’t already, educate yourself on the symptoms. Figure out what symptoms you have and how they affect you in the workplace. Having symptoms of CPTSD does NOT mean you are broken or defective or that there is something wrong with you. These symptoms are normal/typical responses to the terrible experiences we've suffered.
The second most important skill for managing our symptoms in the workplace is radical, unconditional acceptance of our symptoms and who we are. That is easy to say and difficult to achieve. I get it. When I was initially diagnosed, I went through a period of denial. I was not a happy camper when I learned what the symptoms were and that I would more than likely have to live with them the rest of my life. It was not fair. I didn’t ask for any of this. Maybe you can relate to the struggle. While those statements are both factual, I eventually realized that I could not control what happened to me, but I could control how I dealt with it. It was, what it was, but I was determined not to allow my father or any of my abusers to win. I was not going to let them keep me down and to suffer for the rest of my life.
Somehow, I was going to figure out how to turn this into my competitive advantage. You might be thinking, "yeah, right," but hear me out. One thing I know about trauma survivors, we are absolutely resilient. Resilient means being “able to withstand or recover quickly from difficult conditions." If you've suffered through trauma and are alive today, you are resilient, full stop. You already know how to do hard things because you've been through hard things, AND you survived. I hope you understand what a big deal that is. Today, companies find it necessary to train their employees to be resilient because they quit when they come across hard things. You didn't quit on yourself; you survived.
We need to embrace the lessons we learned to survive and allow them to teach us how to thrive in the workplace. We will continue to learn how to do that as we continue our series, CPTSD in the Workplace.
International Statistical Classification of Diseases and Related Health Problems (11th ed,; ICD-11; World Health Organization, 2019).