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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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.

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