"You can't possibly have PTSD, because your trauma is still happening." A not-so-helpful statement by a Clinical Psychologist colleague of mine. We - as individuals, professionals and society - think of Post Traumatic Stress Disorder as a "pathological" response to a one-off or short term trauma. Say PTSD, and people think of soldiers or people who've been assaulted or raped. Totally fair - those are two potential triggers for this trauma response.
But where does that leave survivors of long term trauma? What if your trauma lasted two years? Five? Fourteen and a bit?
It's a bit more complex...
Complex PTSD is the result of repeated traumatic experiences in either adults or children. The "traditional" symptoms like flashbacks and hypervigilance happen, but they often come with intense experiences of shame, isolation and relationship difficulties, issues with staying present in the moment and physical symptoms like stomach pains, IBS, headaches or chest pains. The NHS is starting to recognise complex PTSD, although not every professional has caught up with the guidance.
I was incredibly lucky to have a GP who understood c-PTSD and was able to provide me with support. When I went for an appointment to discuss my mental health, she was the one who made the link between my poor mental health and the traumatic situation I was still experiencing. I believe that she very literally saved my life with her combination of antidepressants, a referral for talking therapy and the telephone number for Newcastle Women's Aid.
The rest of this article includes detailed descriptions of the mental health impact of domestic abuse. Please use your own discretion as to whether to continue reading - keeping yourself safe is important!
I Deserve to be Heard
Women's Aid UK are currently running a campaign to highlight the impact of domestic abuse on mental health. Their research shows that around 50% of women living in refuges have reported feeling depressed or having suicidal thoughts as a direct result of the domestic abuse they have experienced. They also recognise that self-reported statistics like this often hide the true scale of the problem because not everyone feels safe or comfortable talking about their mental health. I hope that in sharing this, I help someone else seek the support they need or galvanise movement towards systemic changes.
In the last year of the abusive relationship I survived, I was having suicidal thoughts several times a day. I didn't have any specific plans and I never made an attempt on my life, but the thoughts were my constant companion. Looking back now, I'm not sure that I actually wanted to die - I think wanted the emotional turmoil to stop, and I didn't see any other options from the viewpoint of that deep depression. Antidepressants were - for me - the thing that gave me the headspace to discover another option.
When I left the relationship - after a brief period of euphoria - my mental health took another dip. I was grieving the relationship and all the things I had left behind, as well as coming to terms with what had happened to me. This is where the c-PTSD really started to kick in for me.
I've always had quite an anxious disposition. I had a well-acknowledged childhood habit of checking the toilets in every new place we went (to make sure that I wouldn't get locked in) and I stayed up late planning escape routes out of my childhood home in case of fire. As an adult, this showed up as a tendency to over-prepare, see catastrophes in every action and be pretty risk-averse.
C-PTSD scaled my anxiety up exponentially. Hypervigilance took over my life - I needed to check locks multiple times to make sure my door was locked. The sound of unfamiliar male voices put me into a panic, and I struggled to have any unfamiliar men in my house (even when my boiler broke). My phone needed to be 80%+ charged at all times, and I carried my lone-worker device with me constantly.
I realised that this anxiety could be triggered by seemingly innocuous things. An incomplete list of trauma triggers I've worked through includes supermarkets, popcorn, the band Metallica, hiking boots, Wimbledon, the band U2, my favourite Waterstones branch, Boba Fett from Star Wars, the smell of chicken korma, stomach pain, specific computer games, townhouses, my friend Nikki's house, the TV show Dexter, the Tour de France...
Some of them might seem pretty weird, but I know where each and every one came from. I started off avoiding them, but as I've healed I've learned to handle the ones that are still uncomfortable and a lot of them don't even register most of the time.
Now, I'm living a life filled with happiness and safety, and my mental health is generally pretty good. I'd say my c-PTSD has only been triggered once or twice in the past year, and my suicidal thoughts haven't shown up for many years. I'm still prone to the odd burst of anxiety, but it's under better control than ever and I have the tools I need for those moments where I do start to go into the catastrophe spiral.
How I healed
As well as therapy and antidepressants, there were some key things that helped me to move forward with my mental health...
Dropping the 'D' - throughout this post I've used the terms c-PTSD and PTSD for their google-ability, but there's a growing movement advocating for dropping the label of "disorder" from conditions like this. I experienced post-traumatic stress, but choosing to view the mental health impact as a normal and understandable response to the things I had survived was incredibly liberating.
Making time for healing - for several years after leaving the relationship, I made healing a priority, and that meant making time for it. I had sessions with a Psychotherapeutic Counsellor and Healer, I journaled regularly, I did a mindfulness course and of course, I got coaching.
Finding community - sessions at Newcastle Women's Aid were helpful in understanding how domestic abuse works, but the true magic was connecting with other people who had experienced similar things to me. I could show up honestly, make myself totally vulnerable, and I was met with waves and waves of love and "me too" moments.
Choosing what to reclaim - I sometimes joke that my ex "got X in the divorce". It's usually things like bands, books, experiences - things that I loved, but haven't made the effort to reclaim. During my healing, I had to get really honest with myself about what I wanted to put in the effort to desensitise myself to, and what wasn't important at the time. I couldn't fight every trigger at once, so I had to put some down. Some of them I picked up again later, some still upset me, and some I've decided were loved in the context of the trauma bond but weren't actually mine at all.
Here's the thing though - many survivors don't have the resources I did to aid my healing journey. As Women's Aid highlight: "fewer than 1 in 5 refuges have trained mental health support workers and many women face barriers in attempting to access support. From long waiting times, victim-blaming and communication barriers, to the stigmatisation of mental health, and a lack of trauma-informed responses and services – support is failing survivors."
You can support their campaign by seeking out and sharing things under the #HearHer and #DeservetobeHeard hashtags on social media, and by supporting local and national Women's Aid services. You could also write to your MP and ask them to support the campaign. A template letter is provided here and you can find your MP's contact details here.