Adult survivors of family scapegoating abuse have historically been diagnosed with one or more mental health conditions that ignore the trauma symptoms they are regularly experiencing. Rarely will their most distressing symptoms be recognized as Complex post-traumatic stress disorder (C-PTSD) secondary to growing up in an unstable, dangerous, rejecting, and abusive family system / environment.
Adult Survivors of Family Scapegoating Abuse and Trauma Symptoms
Many adult survivors of dysfunctional family systems and childhood abuse suffer from anxiety, panic attacks, depression, and anger management issues. They may have been diagnosed in the past with Generalized Anxiety Disorder, Major Depressive Disorder, and even Dissociative Identity Disorder with Psychosis.
In addition to the above disorders, several adult survivors of what I named (for qualitative research purposes) Family Scapegoating Abuse (FSA) have shared with me during the psychotherapy intake process that they have been diagnosed in the past with Attention Deficit Hyperactive Disorder (ADHD), Bipolar Disorder, Obsessive-Compulsive Disorder (OCD), and Agoraphobia. Others have been diagnosed as having a personality disorder (Borderline Personality Disorder, especially), or an attachment disorder. They also often present with codependency and/or addiction.
As related to my ongoing work with adult survivors seeking to recover from family scapegoating abuse, it is my experience that the rejecting, shaming, and otherwise non-nurturing, harmful, and abusive family environment my clients grew up in (and had no means of escaping from) has actually contributed to their experiencing symptoms of Complex post-traumatic stress disorder (C-PTSD – which is also known as complex trauma disorder) secondary to chronic parental / family psycho-emotional (and at times physical) abuse.
Most of my clients have never heard of C-PTSD and are not aware of how it might apply to them. I will then explain to them that Post-traumatic stress disorder (PTSD) is an anxiety disorder that can develop after a person experiences a traumatic event. Complex PTSD differs from PTSD in that the child or adult survivor has been chronically exposed to repeated and prolonged traumatic events (which, in many cases, may be applicable to a dysfunctional, abusive, or otherwise traumatizing family environment).
Regrettably, Complex PTSD is not currently recognized in the Diagnostic Statistical Manual of Mental Disorders in the United States as a diagnosis. Because Complex post-traumatic stress disorder is closely related to Post-traumatic stress disorder, some savvy doctors and clinicians will acknowledge a C-PTSD diagnosis via specific PTSD coding offered in the DSM. Others may diagnose anxiety and/or depression while psycho-educating their client on the features of C-PTSD as part of formulating an overall treatment plan.
Symptoms of Complex PTSD Diagnosis
As the National Center for PTSD website notes, Dr. Judith Herman of Harvard University proposed in 1988 that a new diagnosis, Complex PTSD, was needed to describe the symptoms of long-term trauma. Per Dr. Miller, such symptoms (which are acknowledged by the U.S. Department of Veterans Affairs) include:
- Behavioral difficulties (e.g. impulsivity, aggressiveness, sexual acting out, alcohol/drug misuse and self-destructive behavior)
- Emotional difficulties (e.g. affect lability, rage, depression and panic)
- Cognitive difficulties (e.g. dissociation and pathological changes in personal identity)
- Interpersonal difficulties (e.g. chaotic personal relationships)
- Somatization (resulting in many visits to medical practitioners)
As per the National Health Service (NHS) in the UK (which also now includes a page on C-PTSD on their website), Complex PTSD may be diagnosed in adults or children who have repeatedly experienced traumatic events, such as violence, neglect or abuse. The symptoms of Complex PTSD are similar to symptoms of PTSD, but may also include:
- Feelings of shame or guilt
- Difficulty controlling your emotions
- Periods of losing attention and concentration (dissociation)
- Physical symptoms, such as headaches, dizziness, chest pains, and stomach aches
- Cutting yourself off from friends and family
- Relationship difficulties
- Destructive or risky behaviour, such as self-harm, alcohol abuse, or drug abuse
- Suicidal thoughts
Family Scapegoating Abuse Symptoms
Based on my research on family scapegoating abuse (a non-DSM issue), as well as my clinical and ‘lived’ (personal) experience, adult survivors of family scapegoating typically experience several of the following symptoms / issues:
- Intense feelings of guilt, shame
- Intense feelings of anger, rage
- Intense feelings of sadness, and disenfranchised grief
- Intense feelings of desperation and despair
- “Stuffing” and/or deliberately withholding feelings / emotions
- Flight, Fight, of Freeze response to perceived conflicts / threats
- Physical symptoms, such as headaches, dizziness, chest pains, hives, and stomach aches
- Family disconnection (by necessity or by choice)
- Self-destructive behavior
- Low Self-Esteem / Self-Hatred (feeling ‘bad’, ‘wrong’, ‘defective’, ‘damaged’, ‘worthless’)
- Learned helplessness
- Relationship difficulties
- Fear of intimacy
- Inability to trust others (for fear of being betrayed / abandoned / hurt)
- Persistent abandonment fears (at times includes ‘abandonment depression‘)
- Codependency (this can include high sensitivity to people’s emotional states and being over-focused on others)
- Inability to negotiate interpersonal boundaries
- Addiction / Alcoholism
- Loss of control of emotions / anger outbursts
- Ruminating (reliving harmful interpersonal events experienced with scapegoating family members)
- Panic Attacks
- Suicidal thoughts
Most clients being treated in my practice who report mental and emotional distress secondary to family scapegoating issues have at least five of the above symptoms. It is my experience that symptoms that overlap with C-PTSD symptoms warrant further investigation. Careful assessment of symptoms, including using the International Trauma Questionnaire (ITQ), often reveals that many clients new to my practice who are seeking help with family dysfunction / abuse issues are actually suffering from symptoms of Complex PTSD. Identifying C-PTSD symptoms early on in the therapy process will help the clinician to build a more robust, trauma-informed treatment plan, which has the potential to greatly benefit the client.
Why Global Acceptance of C-PTSD as a Legitimate Diagnosis Matters
While C-PTSD is not yet formally recognized as a diagnosis in many countries, the World Health Organization (WHO) will be including C-PTSD as a billable and insurable diagnosis internationally in the next ICD (11), effective January, 2022. (The United States Department of Veterans Affairs also acknowledges C-PTSD, as mentioned).
As of 2013, Post-traumatic stress disorder is included in a new category in the current DSM (5): Trauma and Stressor-Related Disorders. It is this category that lends itself most to trauma caused by repeated and prolonged (over months and even years) stressors, but this category still falls far short on acknowledging the primary symptoms associated with Complex PTSD, which can be frustrating to trauma-informed clinicians when diagnosing their clients / patients.
Complex PTSD ( which is sometimes interchanged with terms such as complex relational trauma, developmental trauma, and interpersonal trauma) is a relatively recent concept. With the recognition of C-PTSD by the WHO, healthcare providers around the world are slowly gaining access to critical information about complex / chronic forms of trauma experienced by children and adults, including adult survivors of childhood abuse and neglect.
Although the American Psychiatric Association does not acknowledge C-PTSD in the current DSM (5), clinicians practicing in the United States may now point to the WHO’s recognition of C-PTSD as a legitimate diagnosis when inviting their clients to explore the possibility that they may have been ‘under’-diagnosed (or outright misdiagnosed) in the past. This is especially important due to the fact that when trauma symptoms go unacknowledged, treatment of the client and their symptoms is much less likely to be effective.
Note: To access C-PTSD resources, including forums and support groups, I encourage you to visit ‘Out of the Storm’ at https://www.outofthestorm.website/
If you related to anything in this article, I’d love to hear from you in the comments. What you share may help others in their own recovery!
Have you been impacted by Family Scapegoating Abuse (FSA)? Find out more by visiting my website (link included in my profile, below, along with a link to purchase my introductory eBook on FSA. -Rebecca).
Articles of Interest
You are welcome to reprint this post with the following attribution:
Rebecca C. Mandeville, MFT, specializes in recovering from the negative effects of being raised in dysfunctional / abusive family systems. She served as Core Faculty at the Institute of Transpersonal Psychology and is a pioneer in defining and describing what she named (for research purposes) Family Scapegoating Abuse (FSA). Today she focuses on helping family scapegoating abuse survivors navigate the unique challenges they face.