So, you have mustered courage and left the abusive relationship. Why do you still feel so bad, so down, and so sick at heart? Repeated abuse has long lasting pernicious and traumatic effects such as panic attacks, hypervigilance, sleep disturbances, flashbacks (intrusive memories), and suicidal ideation.
Victims and survivors experience psychosomatic and “real” bodily symptoms, some of them induced by the secretion of stress hormones such as cortisol: increased blood pressure, racing pulse, headaches, excessive sweating and myriad self-imputed diseases. The victims endures shame, depression, anxiety, embarrassment, guilt, humiliation, abandonment, and an enhanced sense of vulnerability.
Surprisingly, verbal, psychological, and emotional abuse have the same effects as the physical variety [Psychology Today, September/October 2000 issue, p.24]. Abuse of all kinds also interferes with the victim’s ability to work. Still, it is hard to generalise. Victims are not a uniform lot. In some cultures, abuse is commonplace and accepted as a legitimate mode of communication, a sign of love and caring, and a boost to the abuser’s self-image. In such circumstances, the victim is likely to adopt the norms of society and avoid serious trauma.
Deliberate, cold-blooded, and premeditated torture has worse and longer-lasting effects than abuse meted out by the abuser in rage and loss of self-control. The existence of a loving and accepting social support network is another mitigating factor. Finally, the ability to express negative emotions safely and to cope with them constructively is crucial to healing.
Typically, by the time the abuse reaches critical and all-pervasive proportions, the abuser had already, spider-like, isolated his victim from family, friends, and colleagues. She is catapulted into a nether land, where reality itself dissolves into a continuing nightmare.
When she emerges on the other end of this wormhole, the abused woman (or, more rarely, man) feels helpless, self-doubting, worthless, stupid, and a guilty failure for having botched her relationship and “abandoned” her “family”. In an effort to regain perspective and avoid embarrassment, the victim denies the abuse or minimizes it.
No wonder that survivors of abuse tend to be clinically depressed, neglect their health and personal appearance, and succumb to boredom, rage, and impatience. Many end up abusing prescription drugs or drinking or otherwise behaving recklessly.
Dr. Judith Herman of Harvard University has proposed a new mental health diagnosis to account for the impact of extended periods of trauma and abuse: C-PTSD (Complex PTSD).
The first phase of PTSD involves incapacitating and overwhelming fear. The victim feels like she has been thrust into a nightmare or a horror movie. She is rendered helpless by her own terror. She keeps re-living the experience through recurrent and intrusive visual and auditory hallucinations (“flashbacks”) or dreams. In some flashbacks, the victim completely lapses into a dissociative state and physically re-enacts the event while being thoroughly oblivious to her whereabouts.
In an attempt to suppress this constant playback and the attendant exaggerated startle response (jumpiness), the victim tries to avoid all stimuli associated, however indirectly, with the traumatic event. Many develop full-scale phobias (agoraphobia, claustrophobia, fear of heights, aversion to specific animals, objects, modes of transportation, neighbourhoods, buildings, occupations, weather, and so on).
Most PTSD victims are especially vulnerable on the anniversaries of their abuse. They try to avoid thoughts, feelings, conversations, activities, situations, or people who remind them of the traumatic occurrence (“triggers”).
This constant hypervigilance and arousal, sleep disorders (mainly insomnia), the irritability (“short fuse”), and the inability to concentrate and complete even relatively simple tasks erode the victim’s resilience. Utterly fatigued, most patients manifest protracted periods of numbness, automatism, and, in radical cases, near-catatonic posture. Response times to verbal cues increase dramatically. Awareness of the environment decreases, sometimes dangerously so. The victims are described by their nearest and dearest as “zombies”, “machines”, or “automata”.
The victims appear to be sleepwalking, depressed, dysphoric, anhedonic (not interested in anything and find pleasure in nothing). They report feeling detached, emotionally absent, estranged, and alienated. Many victims say that their “life is over” and expect to have no career, family, or otherwise meaningful future.
The victim’s family and friends complain that she is no longer capable of showing intimacy, tenderness, compassion, empathy, and of having sex (due to her post-traumatic “frigidity”). Many victims become paranoid, impulsive, reckless, and self-destructive. Others somatize their mental problems and complain of numerous physical ailments. They all feel guilty, shameful, humiliated, desperate, hopeless, and hostile.
PTSD need not appear immediately after the harrowing experience. It can – and often is – delayed by days or even months. It lasts more than one month (usually much longer). Sufferers of PTSD report subjective distress (the manifestations of PTSD are ego-dystonic). Their functioning in various settings – job performance, grades at school, sociability – deteriorates markedly.
What can you do about it?
The short and long of it is: seek professional help. You cannot cope with the aftermath of harrowing abuse all by yourself. The prognosis in case of treatment – even brief treatment – is good: PTSD can be alleviated and eliminated.
Second: re-connect with friends and family. Make amends where necessary. Re-establish your network of emotional support and share, share, share. The more you share, the easier the burden.
by Sam Vaknin, PhD, the author of “Malignant Self-love: Narcissism Revisited” – an excellent, comprehensive book about Narcissistic Personality Disorder and abusive behavior – and other books about personality disorders.