More Than a Diagnosis

Written By: Rana Amini, MS, LPC, EMDR Trained, NFNL Clinical Program Director

As mental health clinicians, it is understood that there is a significant overlap between trauma and its impact on mental health. Every day, people have learned to live with the aftermath of their traumas with no choice but to cope in order to survive. This is the experience of the women and girls that we serve. It is of no surprise that these women and girls have endured an arduous lifetime of traumatic experiences that undoubtedly have changed the way they view themselves, others, and the world around them.

Most of us are familiar with the term PTSD or post-traumatic stress disorder, which often develops when a person experiences something that is frightening or dangerous and that then combines with the brain’s perception of a threat to their safety or livelihood. The other type of PTSD that the world is less familiar with is complex PTSD and this is the one our members more commonly experience.

The layout of these types of PTSD, while they might sound similar, are wildly different. It all comes down to the chronic and pervasive nature of complex trauma, which is ultimately what differentiates the two. Someone who has gone off to war or has experienced a single incident car accident might experience PTSD symptoms whereas someone who has experienced chronic childhood abuse and continued adult experiences of trauma and abuse will likely be experiencing C-PTSD or complex PTSD.

In the world of trauma, traumas can be understood in two categories. We can refer to traumas as either big T’s or little T’s. Big T’s are typically isolated events or experiences like a car accident, a medical trauma or even a sexual assault. Whereas, little T’s are comprised of smaller but typically re-occurring and repetitive events. Little T’s can look like emotional abuse, harassment, neglect, bullying, etc. The contrast between the two is most notably the compounding effects of little T traumas that can over time create long term impact. This is a simplified way of better understanding the differences between what we refer to as PTSD or complex PTSD. PTSD often looks like big T traumas, whereas complex PTSD can be understood as the combination of big T’s and a chronic amount of little T’s over time. Complex PTSD is different in two very critical ways, the trauma is longer-lasting or pervasive and most notably the symptoms are much more severe.

I love this definition of C-PTSD from Beauty after Bruises, an organization that helps provide context and support for adult survivors of childhood abuse. They define complex post-traumatic stress disorder as follows:

“Complex PTSD comes in response to chronic traumatization over the course of months or, more often, years. This can include emotional, physical, and/or sexual abuses, domestic violence, living in a war zone, being held captive, human trafficking, and other organized rings of abuse, and more. For those who are older, being at the complete control of another person (often unable to meet their most basic needs without them), coupled with no foreseeable end in sight, can break down the psyche, the survivor’s sense of self, and affect them on this deeper level. For those who go through this as children, because the brain is still developing and they’re just beginning to learn who they are as an individual, understand the world around them, and build their first relationships – severe trauma interrupts the entire course of their psychologic and neurologic development.”

It is not uncommon to receive a misdiagnosis in the world of mental health as there is such an overlap between many of the most common mental health diagnoses; however, misdiagnosis happens at a starkly higher rate in the women and girls that we serve. Trauma easily can be misinterpreted as A.D.H.D, depression, anxiety, and bipolar diagnosis. The forgetfulness, inattention and memory issues can often be misinterpreted as attention deficit disorder while the vacillation in intense moods can be misdiagnosed as bipolar disorder.  

When you are misdiagnosed, it can pathologize behaviors that are very normal given the trauma one has experienced. When someone finally tells you for the first time that the behaviors, thought patterns, and symptoms you are experiencing are likely due to your trauma, it becomes normalized and often a weight is lifted. It can help give you context to a lifetime of shame and messaging that something is wrong with you. This messaging often bleeds into every aspect of the lives of the women we serve. They are experiencing symptoms of traumatic experiences that have quite literally changed the layout of their brain and the way they see themselves and the lens in which they view the world. And… that is a normal response to an abnormal experience.

This understanding is vital for the women and youth we serve every day as it allows them to make sense of their experiences and raise their awareness around how normal their emotional responses, thought processes and behaviors are, once they are understood in the context of their trauma. Once we begin to understand these behaviors and symptoms as adaptive survival skills, we can shift away from pathologizing them. We can then understand them for what they truly are: emotional response and behaviors that are simply just a response to the survival of trauma.

When our members gain this understanding, it begins to shift their perspective quite drastically.

84.6% of the women and 67% of the youth we serve have a mental health diagnosis by the time they enter the doors of New Friends New Life. Most of our members have been institutionalized, navigating through the systems of community mental health, the educational system, and the justice system throughout their lives. Through this navigation, they have been given diagnostic labels. Often, these labels that are intended to assist them become their scarlet letter, each label continuing to etch the message into them that they are “crazy.” This can lead to guilt, shame, and the messaging that they are broken, deficient, and flawed. When we help our members understand their symptoms for what they are, adaptive and functional skills, bred out of a need to survive their traumas, only then can we begin to re-frame their view of self. This mindset shift from pathologizing behaviors to a mindset of resilience and strength is critical.

Our hope is that this newfound understanding of complex PTSD helps send our members a new message. The message is that they are more than a diagnosis. They have survived unimaginable things, which makes them incredible, resilient, and powerful and that there is recovery, healing and a beautiful future waiting for them beyond their trauma.