The “Four F’s” of C-PTSD

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I just began reading “Complex PTSD: From Surviving to Thriving” by Pete Walker. I can already tell I won’t be able to put it down (I will write a book review when I’m finished, which shouldn’t take long). I’m also going to bring this book to my next therapy session because I want my therapist to see it.

Walker, who is a therapist and also a survivor of narcissistic abuse and sufferer of C-PTSD, is an engaging writer and definitely knows his subject matter. In one of the first chapters, he discusses the “Four F’s”–which are four different “styles” of coping that people with C-PTSD develop to cope with their abusive caregivers and avoid the abandonment depression. Whatever style one adopts may be based on several factors–natural temperament, the role in the family the child was given (scapegoat, golden child, “lost” or ignored child), birth order, and other factors.

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Available on Amazon

The Four F’s are:

1. Fight (the narcissistic defense): often “golden children,” such children learn to project shame onto others; may go on to develop NPD
2. Flight (the obsessive-compulsive/anxiety defense): these children will grow up to become highly anxious, obsessive-compulsive, and avoidant.
3. Freeze (the dissociative defense): these children “protect” themselves by dissociating from others, themselves, and their environment.
4. Fawn (the codependent defense): the child learns to avoid harm by people-pleasing or siding with their abusers.

Walker speculates that if C-PTSD were recognized in the psychiatric literature, the DSM could probably be reduced to the size of a pamphlet, for many people diagnosed with other disorders actually have C-PTSD, which encompasses symptoms of many other disorders and have common roots.

What you may have been misdiagnosed with (or diagnosed yourself with) if you have C-PTSD (these are the most common):

Personality Disorders:
Borderline Personality Disorder
Narcissistic Personality Disorder

Dissociative disorders

Anxiety Disorders:
Generalized Anxiety Disorder
Panic Disorder
Social Anxiety
Obsessive-Compulsive Disorder

Mood Disorders:
Depression
Bipolar Disorder

Developmental Disorders:
Autism Spectrum Disorders
ADHD
ADD

Codependency

Addictive Disorders

While any or all of these diagnoses can be co-morbid with C-PTSD, they miss the mark or don’t tell the whole story. Personality disorders such as BPD can develop from severe, unrelieved C-PTSD and they do share many similarities, but personality disorder labels are stigmatizing and not very helpful for someone who has suffered prolonged childhood trauma and abuse. Labels like “panic disorder” or “depression” aren’t helpful because they only address one or two symptoms of C-PTSD and therefore can’t even begin to address the roots of the depression or anxiety. You can treat anxiety or depression with drugs or short term therapy, but you can’t cure the person of the C-PTSD that’s causing their chronic anxiety or depression. The same goes for labels such as alcoholism or codependency. These are merely symptoms. People with C-PTSD are also sometimes erroneously diagnosed with developmental disorders such as ADHD or autism, which not only don’t address the trauma that led to the ADHD- or Aspergers-like behaviors, but also have completely different causes.

16 thoughts on “The “Four F’s” of C-PTSD”

  1. I bought this book on the recommendation of another blogger. So glad I did! It helped me to understand complex PTSD which I had only heard mention of a few times. My coping mechanism was the freeze defense. I’m looking forward to reading your book review.

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    • Yes, I will definitely review this one. This book was sent to me as a gift from Linda Lee, who comments here. I can tell this book is a keeper. My coping mechanisms is all 4 of the 4 F’s, but mostly the “flight” one. I had to employ all 4, because I was in the completely mindf*cking role of both golden child and scapegoat (this happens a lot to only children who have to serve all the roles).

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  3. I like that, that the DSM could be reduced to the size of a pamphlet. Makes it a lot easier to to think of as PTSD as being the root of most other disorders. This would also mean differences in treatement, treat the PTSD first kind of thinking. I used the freeze technique myself while a former friend of mine definitely used fawn. I can see that.

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    • It’s at the root of most or all attachment/trauma based disorders, which is a big chunk of what’s in the DSM, including all the PD’s. I use all the 4 F’s.

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  5. Great post on an absolutely invaluable read. I also recommended it to a past therapist. I think everyone who goes to AA should get a copy as so many take on that label “alcoholic” (like I did) without understanding that like other so called personality disorders that label and coping strategy is just a symptom.

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    • Yes, I do think alcoholism is a real disease, but I don’t think it ends there and there are deep psychological problems that underlie it. Until those are addressed, an alcoholic may stop drinking but won’t really change (and could relapse) . I think this is called being on a “dry drunk”. At least AA attempts to get to the spiritual aspects of the problem — it has worked for many. At least it’s a start, but I think most alcoholics (and other addicts) could benefit from therapy as well to get to the roots of the issues that caused the addiction.
      I think many NPDs and BPDs become alcoholics to attempt to cover the emptiness they feel inside.

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  6. Very interesting. I think this book should be re-titled, The First Four F’s, as childhood sets the stage for many things to come. I was reading the categories and realized how horrible it must be for soldiers in particular, who sign up for the military with one of these Four F’s already lodged in the psyche. PTSD is like a cake. It has many layers, and they all start with the baking process. What begins in childhood grows to become many things as life unfolds. I’ve always said, “You’ve got just one shot” when it comes to raising children. I raised 5, and unfortunately spent too much time counter acting an emotionally abusive husband. I wasn’t his victim (he knew better!) unfortunately the kids were. Ultimately he divorced me because he refused to believe he was causing damage. His adoptive father was the culprit, and my husband was stuck in the ‘cycle.’ His denial was fierce. So, he divorced me to shut me down and shut me up. Which ultimately triggered my PTSD, associated with the sudden death of my very young, 46 year old father years before. Just a nightmare. Once we were divorced he was free to continue damaging them, and with the aid of his new wife, who was completely psychotic. I of course, was not there to stop him. My kids are grown, and I can assure you, in spite of my efforts, they all have deep issues in one way or another. I can slide each of my kids into each three of those four categories mentioned. The good news is none of them are in the fawn category, the bad news is one of them was victimized at the hands of her step mother, who thought is was a good idea to administer oxycotin to my daughter for cramps! She was 14. She’s had a long on going drug problem for ten years, including heroine. I encourage parents to live in awareness, because once the foundation is set, it’s set. You simply do not get a re-do.

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    • You don’t get any instruction manual either. There are so many ways you can traumatize a child, even without knowing. But if the love is there, I think the child knows that deep down and will be okay. The author does mention something called “good enough” parenting, which recognizes that parenting is never going to be perfect, but if it’s “good enough” your kids will be ok.

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      • Right, no manual. My kids trust me. That’s what matters. Strong love. My youngest is 21 now. They have adult issues that surface. The good thing is, we work to heal them. Lots of awareness. Including my daughter who battles addiction. Just sad in so many ways. Life.

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