Out of the Storm: The Enduring Silence of Relational Trauma by Kizzie

Author’s Note:  This is an article I wrote which was published October 2021 in a special edition of “Complex Trauma Perspectives”, a newsletter published by the Complex Trauma Special Interest Group at the International Society for Studies in Traumatic Stress.

Out of the Storm (OOTS) is an online web site and forum for survivors of ongoing Relational Trauma (RT) who suffer from Complex PTSD (https://www.outofthestorm.website/). Since its inception in 2014, over 9,200 [now 9600+] people from 47 countries [now 51 countries] have registered. This is suggestive of a public health crisis on a global scale, a pandemic of relational abuse/neglect which until very recently has been surrounded by an enduring silence.

RT is a form of Complex Trauma involving repeated/ongoing physical, sexual and/or emotional abuse/neglect of an individual by someone with whom they are in a relationship. Complex PTSD develops where there is a degree of dependency on the perpetrator and survivors are or perceive themselves to be trapped. Those who should be trustworthy are not; parent, sibling, spouse or other family member; employer, teacher, coach. Thus, central to RT is a profound sense of interpersonal betrayal.

 I founded OOTS in 2014 when I learned I suffer from Complex PTSD via the book “Complex PTSD: From Surviving to Thriving” (Walker, 2013). I was in my mid-fifties. It had taken decades for me to finally discover what was going on, that I had developed a set of strategies to survive the trauma of abuse in my childhood. I immediately recognized myself in the diagnosis and it was such a relief to learn that it wasn’t me, it was what happened to me (Courtois, 2014). I started OOTS because I needed information and to talk to other survivors, but there were few resources and no online groups I could find back then.

 At the time I started OOTS, Complex PTSD was not an official diagnosis in either the American Psychiatric Association’s (APA) DSM or the World Health Organization’s (WHO) ICD. It has since been accepted for the WHO ICD-11 due to the efforts of a group of dedicated clinicians and researchers such as Judith Herman, Julian Ford, Marylene Cloitre, Christine Courtois and many others. A special note of appreciation is offered here on behalf of the OOTS community for their determination and perseverance in pushing for the diagnosis to be made official. This only happened nearly thirty years after Complex PTSD was first identified by Dr. Judith Herman in her 1992 book “Trauma and Recovery” though.

Many survivors consider this protracted unwillingness to legitimize Complex PTSD as a form of institutional betrayal. That is, “trusted and powerful institutions (schools, churches, military, government) [act] in ways that visit harm upon those dependent on them for safety and well-being” (Smith & Freyd, 2014). In the case of Complex PTSD, the betrayal was a failure to act which left survivors to languish. Little was available – treatment, services, resources - to help with what is a profoundly debilitating, impactful and lasting stress disorder. Not only does RT result in the psychological symptoms of ICD-11 Complex PTSD, but also in serious and life-threatening physical illness/disease (Lanius et al., 2010). This confusion over and reluctance to go firm on the diagnosis meant other important institutions failed us (e.g., medicine, police, justice, social work).

 So often at OOTS members post about a deep sense of betrayal and abandonment they have felt because of the actions of someone with whom they are/were in a relationship with, and the institutions that were meant to protect them and their well-being. OOTS serves to counterbalance this to some extent by providing a safe space where members can speak openly about the trauma they’ve suffered and receive support and encouragement from other survivors who understand and validate their experiences and feelings. The site is not part of or funded by any system/institution and as such, owes no allegiance to any person or body.

 OOTS was also meant to fill the gap in resources, support and credible information about RT and Complex PTSD. It is a safe space for survivors to anonymously share, validate and build knowledge based on their lived experience. What is unique about OOTS is that it was designed in accordance with self-determination and self-directed learning theory in mind (Deci & Ryan, 2016; Knowles, 1975). That is, the emphasis is on recovery through the development of a sense of agency, shared/expanded knowledge, and belonging by survivors. Members share their lived experience and contribute resources which results in iterative growth of the site and knowledge building by survivors about RT and Complex PTSD (Herod & Kop, 2016). It is intended to help bring a survivor’s “learning brain” back online after hijacking by the “survival brain” that is the hallmark of protracted RT (Ford & Courtois, 2020, pp. 35-36).

ISTSS members can support survivors by acknowledging RT as a distinct form Complex Trauma in which an individual is emotionally, physically and/or sexually abused in the context of a relationship (e.g., domestic violence, childhood abuse, stalking, bullying, coercive control). This would serve to distinguish RT from other forms of Complex Trauma such as racism, natural disasters, war. Grouping us under the umbrella of RT makes us a larger, more visible population much like PTSD and soldiers, emergency services/health care workers and police. It would serve to legitimize and empower RT survivors, focus treatment and services, and spur funding, research, and political and social action.  

As a small step forward in recognizing and legitimizing RT survivors as a group, it is suggested that ISTSS consider revising its online clinician database. Currently under “Special Interests” PTSD is identified, but RT/Complex PTSD are not. Thousands of RT survivors around the world are looking for clinicians who treat Complex PTSD specifically; why not make this a clear option/focus in the database now that it is an accepted diagnosis by the WHO?  

Finally, ISTSS can also support RT survivors by inviting them to become members of the organization, to serve on committees and in special interest groups, and take part in conferences. This will not only go a long way toward identifying/reducing any institutional betrayal but will do much to guide research and practice. (Note: This will require discussion by leadership about much lowered fees given the economic barriers to this particular group.)

Inclusion and mutual respect, understanding and collaboration; together we can do better.

References:

Courtois, C. (2014). It’s Not You, it’s what Happened to You. USA: Telemachus Press.

Deci, E.  & Ryan, R.  (2016).  Self-determination theory:  Basic psychological needs in motivation, development, and wellness.  New York: Guildford Press.

Ford, J., & Courtois, C. (Eds.) (2020). Treating complex traumatic stress disorders in adults: Scientific foundations and therapeutic models (2nd ed.). New York: Guilford Press.

Herman, J. (1992). Complex PTSD: A syndrome in survivors of prolonged and repeated trauma. Journal of Traumatic Stress, 5(3). https://doi.org/10.1002/jts.2490050305

Herman, J. (1992, 1997). Trauma and recovery: The aftermath of violence - from domestic abuse to political terror. New York: Basic Books.

Herman, J. (2012). CPTSD is a distinct entity: Comment on Resick et al. (2012). Journal of Traumatic Stress, 25(3), 256-257. https://doi.org/10.1002/jts.21697

Herod, L. & Kop, R. (2017). It’s not just about support: Self-directed learning in an online self-help group [for Complex PTSD]. International Journal of Self-Directed Learning, 14(2), 13-26.

Knowles, M. (1975). Self-directed learning: A guide for learners and teachers. New York: Association Free Press.

 Lanius, R., Vermetten, E., & Pain, C. (Eds.) (2010). The impact of early life trauma on health and disease: The hidden epidemic. New York: Cambridge University Press

Smith, C. & Freyd, J. (2014). Institutional betrayal. American Psychologist, 69(6), 575–587. https://doi.org/10.1037/a0037564

World Health Organization. (2018).  ICD-11: International Classification of Diseases 11th Revision. https://icd.who.int/en/