Complex PTSD in the Queer Community

Nick Fager, Expansive Cofounder

A pensive therapy patient working through CPTSD

Table of Contents
PTSD vs Complex PTSD
Complex PTSD and the Queer Experience
Do I have cPTSD?
Healing from cPTSD
Making Neglect Conscious
Embrace the Healing Journey

Despite many years of advocacy from the mental health community, Complex PTSD is still a relatively new diagnosis that was only recognized by the ICD-11 in 2018 and is still not recognized by the DSM. Due to this, research on the diagnosis is limited, but initial indications show that rates of Complex PTSD are significantly higher in the queer community. Understanding why that is can create a roadmap for healing.

First, it’s important to understand the difference between PTSD and Complex PTSD.

PTSD vs Complex PTSD

PTSD typically involves an isolated incident that feels overwhelming to our nervous system. Think of a car accident. The experience is so emotionally intense, and we don’t have enough support to help us process those emotions through the completion, so our nervous system gets stuck in a state of fight, flight, or freeze. Therapy is about providing the support that we didn’t have when the incident occurred, in order to process the event through to completion and return to our emotional equilibrium. In other words, therapy helps to transform the experience from something we still feel that we are in the middle of, into a memory.

Complex PTSD, on the other hand, does not develop from a single incident of a small series of incidents. cPTSD stems from a prolonged experience of trauma, typically over the course of many years. This often involves growing up in an unsafe environment where we feel powerless, trapped, and alone. The trauma is not something that we are aiming to clear out of the nervous system in order to return to equilibrium. The traumatized state becomes the state that feels the most like home. In this case, therapy is about gradually building new neural pathways and experiencing safety and validation in relationships, often for the first time.

Now, let’s move into the queer experience of Complex PTSD.

Complex PTSD and the Queer Experience

One of the core features of cPTSD, and what often makes it so hard to heal from, is a sustained pattern of emotional neglect.

Emotional neglect is often at the core of the queer childhood experience as well. This is a more subtle form of trauma that often gets overlooked, but queer children often experience an emotional distancing from their caretakers, starting at very young ages and progressing into adolescence and adulthood.

What does this usually look like? Perhaps we don’t conform to gender norms at a young age, and that feels unconsciously threatening or scary to our caretakers, and so they distance unconsciously (or sometimes consciously).

We as young ones feel the distancing, and we realize that in order to survive, we need to hide certain parts of ourselves. This forms the foundation of a deeply traumatic pattern. We are emotionally neglected by our caretakers, and then we internalize that pattern of emotional neglect and learn to habitually move away from our own authentic experience for the sake of survival.

Once this pattern of neglect becomes established, our young nervous systems become fertile ground for additional trauma. Disconnected from ourselves and our caretakers, we don’t get the support we need, both internally and externally, and so difficult experiences become traumatic more easily. We lack the resources and the resilience to cope with the inevitable (micro and macro) discriminatory experiences of growing up queer in a queer-phobic world. This combination of holding a marginalized identity and establishing a deep pattern of emotional neglect is a recipe for Complex PTSD.

Do I have cPTSD?

If the above sounds familiar, you might be wondering if you have Complex PTSD. Besides exploring the past, there are a few signs in the present that might indicate this is an appropriate diagnosis. As with everything mental health, however, there is always a lot of overlap and diagnoses fall on spectrums, so it’s wise to talk to a therapist.

The three areas you want to focus on are your ability to regulate emotions, your self esteem, and your ability to form intimate relationships. Complex PTSD can make our internal reality so threatening and overwhelming that all three of these things suffer greatly.

A pensive queer therapy client looking for answers

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Healing from cPTSD

Healing from cPTSD is a gradual process that essentially rewires your nervous system. It’s important to recognize that you are not alone, and in the queer community in particular this is a common experience. Think of healing as an ongoing process of building something new and chipping away at a longstanding pattern. The slower you go, the faster you’ll ultimately go.

Before shining a light directly on the prolonged trauma, you want to start with focusing on resourcing, or giving your nervous system some space to breathe. Since trauma gets held in the body, a body based practice is a great place to start: yoga, dance, tai chi, a workout class, whatever works for you.

You also want to make sure you have some relational support around you. Focus on strengthening your relationships with the people in your life who can handle emotions. And look for some sort of community that will stimulate you and let you be yourself.

In addition to this foundational resourcing, longer term therapy is typically considered the best treatment for Complex PTSD. We say longer term because you’ll need to establish a feeling of safety and trust in a relationship so that you can begin to explore and reveal parts of yourself that have felt off limits for many years. As much as we would like to heal our trauma by ourselves, a great deal of trauma healing happens in relationships, when we feel truly seen and supported in ways that we never did during the trauma.

Of course it’s difficult to find the right therapist, and it’s a significant financial investment, so if therapy isn’t the path for you at this point, you can also do this work with trusted friends, family members, elders, and community members. There are also times when doing the work with our actual parents or caretakers plays an important role in healing. Often the reason that we were neglected originally is because our caretakers lacked the tools and the internal space to cope with emotional complexity. They might have learned some of those tools over time, and sometimes we need to teach them the tools needed to hold space for us, if they are open to that learning. This very much varies case by case, and sometimes doing the work with our direct family members is not in our best interest, but maybe consider testing the waters.

Making Neglect Conscious

Once you are able to establish some emotional and relational safety for yourself, whether with a therapist or someone else, you want to start to bring awareness to the pattern of emotional neglect that has played out in your life, going back as early as you can remember. We have to bring the neglect into consciousness so we can begin to understand how we internalized the neglect and are continuing to neglect ourselves today.

We want to start to build a relationship with the part of ourselves that is in charge of continuing the neglect. We want to thank that part for all the work that it has done to protect us, make friends with it, and start to invite it to relax a bit more through loving care.

With deeper awareness and deeper relationships with our internal parts comes choice. We can begin to choose to validate our story and our lived experience, even if it conflicts with someone else’s story. We can choose to stay with our internal emotional experience a little bit longer. We can choose to share our emotions with someone who has demonstrated that they can handle them. Small step by small step, we begin to undo a deeply held pattern of emotional neglect, and we start to emerge more fully into the world.

It’s possible, and even probable, that as neglect and shut down shifts to presence and vulnerability, some big emotions emerge. These are the intense emotions that we’re never safe to feel because of the emotional neglect. A good therapist will welcome those emotions into the room, help you to tap into them in manageable ways, and help you build out some tools for getting that energy out of your system.

Embrace the Healing Journey

There will be setbacks. There will be moments when you question why on earth you are choosing to get closer to your internal experience. And there will also be moments of breakthrough, where you feel grateful, hopeful, and loving. There will be times when relationships fall apart because too much is changing internally. There will be other times when your relationships strengthen and you break through to intimacy, all because of the deeper work you are doing. There will be times when you feel that you’ve drifted off the path, times when you feel nothing, and other times when it feels like too much. All that matters is that in the big picture, you are still moving slowly in the direction of reconnection.

Take breaks, listen to your nervous system, and be gentle with yourself.

One thing that I often tell clients is to allow themselves to be young again. Being born queer, most of us had to grow up quickly due to unsafe surroundings, and so our inner emotional children didn’t get much room to explore and test the waters. As difficult as working through Complex PTSD can be, remember to give yourself grace, have some fun, and let yourself be young.