Post Traumatic Stress Disorder (PTSD) following
Narcissistic & Psychopathic Abuse
You fall in love and want to build a future with someone that seems pretty special. But this person is nothing like your other partners. Suddenly you find yourself defending your thoughts and opinions to someone who used to understand you. A normal conversation feels like a competition. You have to walk on eggshells. You’re exhausted and hurt.
Then it gets worse.
They begin to make up stories where they place you in the starring role of aggressor. You begin to hear that you are controlling, you are manipulative, you are confrontational, or you are paranoid. And they are the victim of your relentless bad behavior.
and blame shifting become nearly impossible for your mind to keep up with.
Then it gets worse.
They begin to attack you (verbally, through manipulation, or both) and play with your emotions like a cat with a ball of yarn. They seem to be having fun with your pain. They set their sights on your self-confidence, beliefs, and self-esteem – these represent the core of who you are.
‘How dare you think highly of yourself! That has to be destroyed!’ (Seems to be the philosophy of many abusers.)
For some people it will get even worse (e.g., assault, threats on their life, prisoner in their own home, their loved ones getting hurt, isolation, intimidation, not allowed to breakup, no food to eat, sexual violations, extreme control, or death).
It is no surprise that after a relationship with an abuser with pathological narcissism that someone can easily develop complex post traumatic stress disorder (cPTSD) or post traumatic stress disorder (PTSD).
Post traumatic stress disorder (PTSD)
Post traumatic stress disorder (PTSD) is the brain’s reaction to a severe stressor. And there is no finite list of experiences that are PTSD or non PTSD events. It can be any event that severely triggered your brain’s stress systems in a certain way. In a way that caused the brain to interpret what was happening in your environment as a severe threat to you or other being.
Post traumatic stress disorder is a neurobiological disorder. All of the symptoms are a reflection of a brain that has been changed.
PTSD extends beyond an anxiety condition because it reflects a dysregulation of emotions in general. There is more involved with this condition than anxiety and/ or fear alone.
The range of arousal and emotions with PTSD can extend from
A). intense hypersensitivity to Z). emotional numbing – feeling minimal emotions or disconnected from certain emotions.
This extreme range can be experienced in the same person, however at different times. This is why PTSD is best considered a disorder of emotional and arousal dysregulation within the brain (Frewen & Lanius, 2006).
Therefore, it would not be uncommon for a person with PTSD to feel dysphoric, hypersensitive, anxious, unable to access feelings of joy/ love, irritable, agitated, preferring to be alone with minimal stimulation, lacking motivation, hypervigilance, unable to sleep, and isolating self to one room or within the house in general.
Many with PTSD also struggle with cognitive (thinking) symptoms such as difficulties with memory, concentration, and executive functions (e.g., organization, planning, task completion, task initiation, working memory, & motivation). This often happens because the brain is allocating such a tremendous amount of energy and attention to the emotional/ survival system, that cognitive processes are also hindered by the gross dysregulation of the system in general. However, some of the cognitive symptoms are the direct impact of neurobiological damage to certain brain regions (e.g., hippocampus).
The natural internal regulator of the brain, the prefrontal cortex, is often not onboard or not functioning at its’ usual status for those with PTSD. Recall, the prefrontal cortex (frontal lobes) are the regulation areas. They help to soothe and manage an overactive limbic system.
With that being said, there is one important fact you should know about the prefrontal cortex and PTSD. It is not the entire prefrontal cortex that is hypo-responsive – Only certain regions (Hayes, Hayes, & Mikedis, 2012; Brown & Morey, 2012). There are portions of the prefrontal cortex that are actually highly reactive and hyper-responsive for those with PTSD.
‘Ok – so what does all that mean for someone who has PTSD?’
For the PTSD sufferer who was traumatized through a narcissistic, psychopathic, or abusive relationship, it will be important for them to find a mental health professional skilled with PTSD.
Studies have found that (particularly in the beginning stages) repeated review of the details of the abuse and/or the specific traumatic incidents can actually hinder progress. It creates a more difficult situation for the brain to manage. Therefore, many healthcare professionals tend to focus their services upon emotional regulation techniques and training first (Frewen & Lanius, 2006). In that way, they help their patient gain regulation … soothing before they tackle the bigger issues.
You see, the brain has to be able to handle the more complicated psychological issues associated with the trauma. And a brain that is overly emotional and dysregulated is not in a good place to be able to do this. A brain under such stress and trauma will have a significantly difficult time taking on such a goal – emotional growth.
What can be done about PTSD symptoms?
Therapy with a skilled professional is often very helpful for someone with PTSD. The patient’s emotional regulation abilities are aided by the therapeutic relationship, presence of limbic resonance, and the trust that is typically built with the therapist during the course of treatment.
Therefore, most therapists skilled in PTSD treatment will not spend a great deal of time discussing the narcissists or psychopath’s individual offenses, transgressions, and the specifics of the abuse in the first phase of treatment. To do so would be to work in direct contradiction to the limbic (emotional) system of the brain (Frewen & Lanius, 2006).
Usually the focus is on methods to soothe the limbic system and strengthen portions of the frontal lobes more into action. It has to be able to handle certain emotions before giving it the task of moving forward.
This is done in many ways — 1) specific psychological approaches tailored to the trauma population will be implemented by a skilled therapist/ psychologist.
2) Tools and trainings are usually provided to the patient that can reduce dysregulation (e.g., Mindfulness).
3) Treatments outside the realm of psychology are often encouraged in conjunction to psychotherapy, as they can tie in the ‘mind-body connection,’ which is important to address after trauma. Examples include acupuncture and yoga.
4.) Exercise plan and healthy eating regimen recommended by a specialist.
5) Most psychologists and therapists work with a primary care physician or psychiatrist, who can make decisions regarding the need for medications and/ or specific supplements to help the brain along. As a team, they can guide the survivor through the process of healing and toward a more regulated brain.
On a side note, for individuals who struggled with self regulation/ emotional regulation and self validation difficulties prior to the psychopathic relationship – perhaps in association with a childhood history of abuse or neglect. It will be important to enlist the assistance of a skilled healthcare professional who will be able to assist with teaching coping strategies to modulate intense emotions.
With treatment, does the brain return to it’s ‘old’ state prior to the abuse?
No, not completely.
In many ways, an individual will be stronger (e.g., recognizing a potentially disordered partner in the future). However, in other ways – weaker (e.g., some experience chronic anxiety/ heightened sensitivity).
The fact is, the brain is changed by trauma and it will not fully revert back to its’ pre-trauma state.
There have been numerous studies that support this phenomenon. This is how the limbic (emotional) system works – the amygdala will change based on the associations and connections it makes with certain stimuli and experiences. The limbic system ‘learned’ specific information through the abuse and therefore since it is its’ job to protect you, it will always hold on to that information and have a strong reaction if in a similar situation. Now mind you, you will not feel hypersensitive or triggered by nearly as much as during the intense PTSD symptoms.
After the Abuse – PTSD and moving forward
Let’s look at how a person changes, even after the primary symptoms of PTSD are treated. Here’s an an example of a couple – Karen and Joel. During ‘Karen’s’ relationship with ‘Joel’ (psychopath) they often went to the local mall. They ate at a little pub down the road on most Friday nights and they had a few favorite tracks they would play in the car on their road trips. For months after the relationship, when Karen was within the peak of her PTSD symptoms, she felt like she was falling apart. On one occasion she tried to go into the mall to buy a gift for a friend. The smell of the department store and the sound of her heels clicking on the marble floor sent her into a meltdown. She ran out and sat in her car crying for 20 minutes. The mall was triggering to her and she felt unable to handle going in. The same for the pub. Although she loved music her entire life, she felt overstimulated by the radio and was unable to listen to anything other than calm music or relaxation tracks. Karen decided to go for treatment with a psychologist to address her symptoms. She was diagnosed with PTSD and treated via therapy. Her primary care physician recommended an exercise routine, as well as a regimen of supplements, and a prescription medication. She discontinued her increased consumption of alcohol (which was started only after the breakup) and put her focus on healthy living instead.
After receiving treatment for her PTSD with the psychologist and physician, her emotional arousal level returned to nearly the same as before- she was regulated. Karen was able to blast music and sing along in her car. She enjoyed going to the mall again and bought herself a new wardrobe. She met up with a few friends at the pub down the road for dinner and started enjoying life again. A place she thought she would never be able to go to again. Her ability to feel the full range of emotions had returned fully. All the little environmental triggers were no longer triggers anymore – they were neutral again. The frontal lobes were able to do their job and extinguished those connections. However, it kept the most important connection in place: psychopaths = pain.
Although her brain clearly learned what it should have learned from the experience and her world was no longer one big overstimulating trigger, she noticed there was a difference. She was more sensitive now than in the past. She found it difficult to wind down after any stressful incidents, regardless of how minor. She would be easily startled if someone walked into the room, and quick to feel distressed and nervous when comparing herself to her status before the relationship. Karen was able to live with this and she was a very happy young lady. The sleep difficulties were gone and most of the time she felt calm. However she was aware she was changed by the experience and had to handle herself with more tender loving care than in the past. She was prepared, because her psychologist made her aware that this change can accompany treated PTSD.
As you can see, that heightened sensitivity (although you may not want to have it) is a part of the workings of the brain’s emotional system and usually remain – even after PTSD has been treated. However, most can manage this heightened sensitivity so long as they have done what is needed to treat any lingering trauma related changes that were treatable – such as PTSD, Major Depressive Disorder, substance abuse, eating disorders, etc.
If one has done all they could for their brain and the remnants are the presence of hypersensitivity – due to the amygdala, then they can usually proceed with their life. They will have to put forth effort to live a healthy lifestyle BOTH emotionally and physically. True, they will have to give effort to avoid overstimulation and negativity (e.g., high stress jobs / toxic friends and family). But, a happy life can often proceed just fine! Unfortunately trauma changes a person usually resulting in a more sensitive individual prone to feeling easily distressed.
Rhonda Freeman, PhD
© 2013 All Rights Reserved
Bremner, J.D., (2004). Does Stress Damage the Brain? Understanding Trauma-related Disorders from a Mind-Body Perspective. Directions in Psychiatry, Volume 24, 15, 167 -176.
Brown VM & Morey RA. (2012). Neural systems for cognitive and emotional processing in post traumatic stress disorder. Front Psychol. 2012 Oct 30;3:449.
Frewen, P. & Lanius, R. (2006). Toward a Psychobiology of Post traumatic Self-Dysregulation Reexperiencing, Hyperarousal, Dissociation, and Emotional Numbing. Ann. N.Y. Acad. Sci. 1071: 110–124
Hayes, J., Hayes, S., Mikedis, A. (2012). Quantitative meta-analysis of neural activity in post traumatic stress disorder. Biology of Mood & Anxiety Disorders 2:9.
Hayes, J.P., VanElzakker, M., & Shin, L. (2012). Emotion and cognition interactions in PTSD: A review of neurocognitive and neuroimaging studies. Frontiers in Integrative Neuroscience, 6:89.
Lawlis, Frank (2011). PTSD Breakthrough: The Revolutionary, Science-Based Compass RESET Program. Sourcebooks, Inc..Kindle Edition.
Shin, L., Rauch, S., Pitman, R. (2006) Amygdala, Medial Prefrontal Cortex, and Hippocampal Function in PTSD. Ann. N.Y. Acad. Sci. 1071: 67–79.
Schore, A.N. (1994). Affect regulation and the origins of the self: the neurobiology of emotional development. Hillsdale, N.J.: Erlbaum & Co.
Van der Kolk, B.A., McFarlane, A.C. & Weisaeth, L., Eds. (1996). Traumatic stress: the effects of overwhelming experience on mind, body, and society. New York: Guilford Press.