Navigating Intimate Relationships with Complex PTSD

Where post-traumatic stress disorder (PTSD) can be the result of a single traumatic incident, complex PTSD, also known as cPTSD, is a condition that arises from surviving repeated or long-lasting traumatic events, often in childhood. Victims of childhood abuse, adult domestic abuse, and combat veterans are common sufferers.

Rebellious columnist Jera Brown interviewed Dawn Cooperstein, LCSW about common issues folks with cPTSD face when it comes to intimate relationships and sexual desires.

Professionally Dawn has a private practice and has specialized training in helping folks who live with PTSD, cPTSD, borderline personality disorder, and dissociative disorders. She started working with people in 1997 doing street outreach, and has had many interesting pitstops along the way. Personally, she is a parent, partner, and has five dogs. She has lived experience with mental illness, problematic drug use, not having stable housing, and the general chaos that life can bring. She likes to share those aspects of herself, too, because those experiences are a part of her life. But they don’t define her, and she can say that now because people can heal…and continue to heal from cPTSD.

Folks with cPTSD can struggle to have hope that things will improve regarding interpersonal relationships, as well as their own relationship with their sexuality and desires. What messages of hope do you have for people working on fostering healthier relationships with themselves and with others?

We adapt to our traumatic surroundings and systems for the purpose of survival just like a person who is in war or prison. Complex PTSD is a relational trauma that shakes our sense of safety in the world and disrupts our sense of self. In the past, we needed to watch people carefully to learn every hint of a threat and we practiced a variety of behaviors to manage chaos. In the present, we may be out of dangerous situations but our nervous system is still on high alert, and the old extreme coping skills may now create problems.

It takes time to adapt to a more predictable life, but we can do it. After we have had some safe experiences, we become more flexible, and our personality starts to shine through again. We can consciously engage in our life and our personal narrative slowly shifts. Trauma responses become less intense and happen less often.

 There are many avenues for healing; therapy, yoga, art, medication, meditation, spirituality, ketamine infusions, music etc. And it is helpful to explore your options. Just seeking help and deciding what is the right fit is a step in breaking the pattern of trauma responses. When someone becomes discouraged about their progress, I encourage them to “pull the camera back” to get a broader perspective of their progress. Sometimes we don’t even recognize how we have already started healing. 

I have had the opportunity to witness profound transformations in the folks I work with. I am constantly in awe at the ability of people to survive and then transcend.

Many folks have already identified their personal trauma triggers, but they’re not always easy to avoid. Are there strategies for desensitizing oneself to one’s triggers that so easily arise in our day-to-day life?  

YES! Identifying our triggers is usually the hardest step because they have been a part of the background for such a long time that we don’t really notice them. Identifying the trigger shows that you have the capacity for dual awareness, or the ability to be aware of the past and the present at the same time. That in itself is a sign of growth!

Different triggers may require slightly different interventions, but the core is mindfulness. We need to develop an awareness of our internal and external experience (something that we may have needed to numb out in the past). Becoming mindful can also help to pull us out of the past when we are overwhelmed and bring us back to the present moment with our current values and skills.  We start the mindfulness practice by grounding ourselves; this helps us to reconnect to our Self, our core. Grounding doesn’t require anything fancy, it is just becoming aware of the present moment through our five senses. We can also carry (or wear) an object with us to touch and ground throughout the day when we know we will be exposed to a trauma trigger. When grounding, it can be helpful to remind ourselves that we have skills, we are grown up, we are out of a bad situation, and have more options. For instance, if we need to see doctors regularly for a chronic illness and the smell of the waiting room triggers a strong response, just remember if you REALLY want to leave then you can just walk out, no one has the right to stop you or force you to do anything. I understand that the procedure still needs to happen but that’s a longer-term goal than just getting through the terror that may come with a trauma response. Reminding ourselves that we have choices, body autonomy and the ability to leave a situation is helpful in soothing our bodies’ alarm system. 

As we heal, we are working on updating our “software”, so our nervous system begins to respond to what is happening in the present and not the past, we begin to accept ourselves and become more tolerant. We expand our capacity for emotions and tolerating tension so our emotional experience is more regulated, and we can enjoy the people we choose to have in our lives.

If we have a trauma response when we are touched by our partner or even when we touch ourselves, we can slowly desensitize our nervous system by practicing intimacy, closeness and safe touch. There are some fun exercises to try where we can enjoy touch, identify what feels good and ways to feel safe saying no. We begin to feel our own bodies in a new way and can cultivate curiosity about our bodies and develop compassion for all parts of our physical selves. Trauma-informed bodyworkers, skilled massage therapists, reiki practitioners, etc may also assist in the process of becoming safely embodied.

At the end of the day, our amygdala is screaming every time there is the slightest hint of being hurt. We don’t have to fight against our survival response. Just notice it, maybe acknowledge it then ground yourself. Over time your body will have less of a somatic reaction when exposed to the triggers.

How can someone learn not just self-coping mechanisms, but practical ways to ask for help and comfort from a partner?

I encourage people to talk to their partners when they are feeling centered and having a good day. That is when we have a full tank and can connect with them more easily. You might write down some of what you need to share so if you do become flustered you can ground yourself and get back into the conversation. Brainstorm what your partner can do to soothe you and practice it during the conversation. Come up with a safe word for the situation; our executive functioning takes a hit when we are triggered so it’s hard to articulate what we need. If we have the conversation beforehand and have a safe word, then you don’t need to explain, your partner will know that you need them and they have a way to help soothe you.  

When someone’s sexuality (desires, interests) feels shameful or wrong, how can they start to build confidence in their perception of what feels good or their ability to be a good partner?

When we begin to feel like our interests or desires are wrong we need to take a time out. Take a few seconds to reflect on what old tape is playing in your head. Now reflect on your own personal values. Is there a difference? Was the message delivered by a person or group you respect?  For instance, if I start feeling ashamed of something that is a turn-on, then I need to check in with myself. What internalized sexism is leaking out? What message from media was burned into my psyche? What did someone say or do to me that left an imprint on my mind? Typically, the message was from some jerk(s) with whom I wouldn’t want to be in the same room, but with repetition, those messages stuck. The process of clarifying our values and needs is a way to become more of our authentic self and quiet the internal dialogue that causes so much shame.