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Complex Post Traumatic Stress Disorder

Post Traumatic Stress Disorder (PTSD) is a natural emotional reaction to a deeply shocking and disturbing experience. It is a normal reaction to an abnormal situation. Any human being has the potential to develop PTSD. The cause is external not internal. It is a Psychiatric Injury not Mental Illness. It is not resulting from the individual’s personality. The Whistleblower who is the victim of the retaliation is not inherently weak or inferior. In fact, any human being has the potential to develop PTSD. Whistleblower retaliation is extremely stressful and may lead to burnout or stress break-down - which is not the same as nervous or mental break-down; as stated above, everyone breaks down under the stress of a life altering trauma that is deeply wounding.  Thus individuals suffering PTSD are injured, not mentally ill.  PTSD indicates severe trauma and stress which causes a weakness in the individual, and not the reverse. This is confusing for mental health practitioners and laypersons alike.  But the distinction is important if mental health practitioners desire to assist a traumatized victim.  Too often reactions which are normal under excessive or prolonged stress are assumed to be signs of abnormality or deficiency within the person affected, which may then be assumed to be the cause of the problem rather than a consequence of it (this is sometimes referred to as the "Mental Health Trap"). The diagnosis Complex PTSD comes from being exposed to multiple traumas, sometimes small but causing cumulative emotional damage over a long period of time.  PTSD changes the diagnosed individual’s life and greatly impacts the lives of those with whom they are close and regularly interact.  The explosive rage, depression, isolation, anxiety, cognitive difficulties, and lack of vitality combine to cause loved ones to leave.   But a strong support network is essential for healing.  Friends and families are an integral part of that network.  Trusting relationships are essential to combat the dehumanizing effect of trauma.   Many therapists practice narrative therapy believing this is essential to overcoming the trauma.  This however is not good for all who are suffering from PTSD because it forces them to relive the events of the trauma.  Some people do better never narrating the trauma and should instead focus on coping techniques to deal with triggers.  A trigger is something that causes memory flashbacks and intrusive thoughts of the previous trauma.  Under extreme or prolonged stress people of a previously very strong constitution may become unassertive, over-anxious, compliant and unable to cope with even the most trivial of stressors. A person's reactions under stress may resemble symptoms of mental illness - loss of emotional control, apparent over-reactions to seemingly trivial stimuli, hypervigilance (e.g. being on constant alert for further abuse) etc., may be mistaken for instability, irrational behavior and paranoia.  It is important for supporters to provide a safe physical environment, but also emotional safety and be willing to accept a wide range of emotions.  According to Maslow’s (1970) hierarchy of needs, the being needs, the three higher-order needs, cannot be met until the deficiency needs the four lower-order needs, are met.. This is critical to relationship building, which will help provide the strong support network that is essential for healing. Recovery requires a sense of power and control. All relationships should be respectful and empower the Whistleblower to make choices. The Whistleblower 's symptoms and behaviors are adaptations to trauma, so services should address all of the Whistle-blower’s needs rather than just symptoms.

Relaxing Aquarium (watch in high definition)

Mental Injury vs Mental Illness

Differences between mental illness and psychiatric injury

Thanks to Tim Field see his website:

The person who is being bullied will eventually say something like "I think I'm being paranoid..."; however they are correctly identifying hypervigilance, a symptom of PTSD, but using the popular but misunderstood word paranoia. The differences between hypervigilance and paranoia make a good starting point for identifying the differences between mental illness and psychiatric injury.



  • paranoia is a form of mental illness; the cause is thought to be internal, eg a minor variation in the balance of brain chemistry
  • is a response to an external event (violence, accident, disaster, violation, intrusion, bullying, etc) and therefore an injury
  • paranoia tends to endure and to not get better of its own accord
  • wears off (gets better), albeit slowly, when the person is out of and away from the situation which was the cause
  • the paranoiac will not admit to feeling paranoid, as they cannot see their paranoia
  • the hypervigilant person is acutely aware of their hypervigilance, and will easily articulate their fear, albeit using the incorrect but popularised word "paranoia"
  • sometimes responds to drug treatment
  • drugs are not viewed favorably by hypervigilant people, except in extreme circumstances, and then only briefly; often drugs have no effect, or can make things worse, sometimes interfering with the body's own healing process
  • the paranoiac often has delusions of grandeur; the delusional aspects of paranoia feature in other forms of mental illness, such as schizophrenia
  • the hypervigilant person often has a diminished sense of self-worth, sometimes dramatically so
  • the paranoiac is convinced of their self-importance
  • the hypervigilant person is often convinced of their worthlessness and will often deny their value to others
  • paranoia is often seen in conjunction with other symptoms of mental illness, but not in conjunction with symptoms of PTSD
  • hypervigilance is seen in conjunction with other symptoms of PTSD, but not in conjunction with symptoms of mental illness
  • the paranoiac is convinced of their plausibility
  • the hypervigilant person is aware of how implausible their experience sounds and often doesn't want to believe it themselves (disbelief and denial)
  • the paranoiac feels persecuted by a person or persons unknown (eg "they're out to get me")
  • the hypervigilant person is hypersensitized but is often aware of the inappropriateness of their heightened sensitivity, and can identify the person responsible for their psychiatric injury
  • sense of persecution
  • heightened sense of vulnerability to victimization
  • the sense of persecution felt by the paranoiac is a delusion, for usually no-one is out to get them
  • the hypervigilant person's sense of threat is well-founded, for the serial bully is out to get rid of them and has often coerced others into assisting, eg through mobbing; the hypervigilant person often cannot (and refuses to) see that the serial bully is doing everything possible to get rid of them
  • the paranoiac is on constant alert because they know someone is out to get them
  • the hypervigilant person is on alert in case there is danger
  • the paranoiac is certain of their belief and their behavior and expects others to share that certainty
  • the hypervigilant person cannot bring themselves to believe that the bully cannot and will not see the effect their behavior is having; they cling naively to the mistaken belief that the bully will recognize their wrongdoing and apologize

Other differences between mental illness and psychiatric injury include:

Mental illness

Psychiatric injury

  • the cause often cannot be identified
  • the cause is easily identifiable and verifiable, but denied by those who are accountable
  • the person may be incoherent or what they say doesn't make sense
  • the person is often articulate but prevented from articulation by being traumatized
  • the person may appear to be obsessed
  • the person is obsessive, especially in relation to identifying the cause of their injury and both dealing with the cause and effecting their recovery
  • the person is oblivious to their behavior and the effect it has on others
  • the person is in a state of acute self-awareness and aware of their state, but often unable to explain it
  • the depression is a clinical or endogenous depression
  • the depression is reactive; the chemistry is different to endogenous depression
  • there may be a history of depression in the family
  • there is very often no history of depression in the individual or their family
  • the person has usually exhibited mental health problems before
  • often there is no history of mental health problems
  • may respond inappropriately to the needs and concerns of others
  • responds emphatically to the needs and concerns of others, despite their own injury
  • displays a certitude about themselves, their circumstances and their actions
  • is often highly skeptical about their condition and circumstances and is in a state of disbelief and bewilderment which they will easily and often articulate ("I can't believe this is happening to me" and "Why me?" - click here for the answer)
  • may suffer a persecution complex
  • may experience an unusually heightened sense of vulnerability to possible victimization (ie hypervigilance)
  • suicidal thoughts are the result of despair, dejection and hopelessness
  • suicidal thoughts are often a logical and carefully thought-out solution or conclusion
  • exhibits despair
  • is driven by the anger of injustice
  • often doesn't look forward to each new day
  • looks forward to each new day as an opportunity to fight for justice
  • is often ready to give in or admit defeat
  • refuses to be beaten, refuses to give up

Post Traumatic Stress References

Further Reading  - on psychiatric injury

Post Traumatic Stress Disorder: the invisible injury, 2005 edition, David Kinchin, Success Unlimited, 2004, ISBN 0952912147

Supporting Children with Post-traumatic Stress Disorder: a practical guide for teachers and professionals, David Kinchin and Erica Brown, David Fulton Publishers,  12.00, ISBN 1853467278

Stress and employer liability, Earnshaw & Cooper, IPD, 1996, 16.95, ISBN 0852926154 (updated edition in preparation)

Why zebras don't get ulcers: an updated guide to stress, stress-related diseases, and coping, Robert M Sapolsky, Freeman, 1998, ISBN 0716732106

The Body Bears the Burden: Trauma, Dissociation and Disease, Robert C Scaer, MD, The Haworth Medical Press, NY, ISBN 0789012464

Recovering damages for psychiatric injury, M Napier & K Wheat, Blackstone Press, 19.95, ISBN 1854313525

Understanding stress breakdown, Dr William Wilkie, Millennium Books, 1995

Understanding stress, V Sutherland & C Cooper, Chapman and Hall

Trauma and transformation: growing in the aftermath of suffering, R Tedeschi & L Calhoun, Sage, 1996

The Railway Man, Eric Lomax, Vintage, 1996, ISBN 0099582317 (a poignant story of undiagnosed PTSD from World War II)


The Inner Bookshop, 111 Magdalen Road, Oxford OX4 1RQ: mind, body, spirit, esoteric, holistic, paranormal, contact experience etc.


European Journal of Work and Organizational Psychology (EJWOP), 1996, 5(2), whole issue devoted to bullying and its effects, including PTSD. Published by Psychology Press, 27 Church Road, Hove, East Sussex BN3 2FA, UK.

British Journal of Psychiatry, (1997), 170, 199-201, The 'glucocorticoid cascade' hypothesis in man: prolonged stress may cause permanent brain damage, Dr John T O'Brien MRCPsych, Department of Psychiatry and Institute for the Health of the Elderly, University of Newcastle.

Cortisol - keeping a dangerous hormone in check, David Tuttle, LE Magazine July 2004

T cells divide and rule in Gulf War syndrome (and asthma, TB, cancer, ME), Jenny Bryan, Immunology section in The Biologist, (1997) 44 (5)

  Traumatic stress under-recognised
5% of males and 10% of females will develop PTSD in their lifetime says the National Institute for Clinical Excellence (NICE):


David Kinchin's own web page and PTSD workshops


The late Professor Heinz Leymann was one of the world's pioneers and foremost authorities on mobbing (bullying) and PTSD, with over a decade of experience. His web site is essential reading for anyone studying the effects of bullying on health.

David Kinchin, author of Post traumatic Stress Disorder: the invisible injury, 2004 edition

BBC News Online: bullying at school causes PTSD, name calling and verbal abuse worse than physical bullying

Ex-soldier Michael New wins 620,000 damages for PTSD:

US soldiers return from Iraq with PTSD:

Untreated PTSD may mean a lifetime of impoverished physical health including heart disease and cancer:

Bullied workers suffer 'battle stress' and show the same symptoms of armed forces personnel who have been engaged in war:

National Center for PTSD factsheets  & their site.

Helpguide for Post-traumatic Stress Disorder (PTSD): Symptoms, Types and Treatment

High percentage of youth in the USA report symptoms of Post Traumatic Stress and other disorders; study involving 4,023 adolescents finds that exposure to interpersonal violence (including bullying) increases the risk for PTSD.

PTSD Public Service Announcement Website

Patience Press aims to ensure that other people never have to be alone with the pain of PTSD, struggling to heal without help or support.

The Traumatic Stress Clinic in London has good online information about PTSD.

UK Trauma Group web site.

Contact information about local specialist resources in the UK offering advice about the assessment or treatment of people with psychological reactions to major traumatic events.

NICE guidelines for PTSD:

CODT - Cooperative Online Dictionary of Trauma, a dictionary of trauma terms:

The National Institute for Clinical Excellence (NICE) page on Post Traumatic Stress Disorder (PTSD).

American Psychiatric Association (APA) public information

Dave Baldwin's site at contains comprehensive links.

A Valuable Stress Information Resource Website

Stress Spot is a stress information resource with links to Post Traumatic Stress Disorder web sites.

The Panic Center.

Brain Injury Resource Center page on Post Traumatic Stress Disorder

The Trauma Center in Alston, Massachusetts. The Medical Director of the Trauma Center is Dr Bessel van der Kolk.

Partners with PTSD by Frank Ochberg, M.D.

Why a broken heart hurts so much; social rejection may affect your brain as much as physical pain

Legal Abuse Syndrome: how the courts and legal system may cause Post Traumatic Stress Disorder

Essentials for litigating Post Traumatic Stress Disorder (PTSD) claims:

Descriptions of Post Traumatic Stress Disorder (PTSD) and Acute Stress Disorder (ASD).

Gift From Within is a private, non-profit organization dedicated to those who suffer post-traumatic stress disorder (PTSD), those at risk for PTSD, and those who care for traumatized individuals.

Articles from Psychology Today: When Disaster Strikes by Hara Estroff Marano, Recovering From Trauma and Life Lessons by Ellen McGrath Ph.D., plus Trauma Do's and Don'ts

The Healing Centre Online is at

Ask the Internet Therapist

The International Society for Traumatic Stress Studies (ISTSS) has a comprehensive web site on various aspects of trauma and its causes.

The European Society for Traumatic Stress Studies (ESTSS) web site.

The Invisible Epidemic: Post-Traumatic Stress Disorder, Memory and the Brain by J. Douglas Bremner, M.D.

Information for for ex-servicemen & servicewomen who think they are suffering from PTSD.

PTSD and dissociation

Information on Falsification of Type (Dr Carl Gustav Jung's description for an individual whose most developed and/or used skills were outside one’s area of greatest natural preference) and PASS (Prolonged Adaption Stress Syndrome) is at

Links to PTSD and PTSD-related sites are at

Gillian Kelly, barrister at law, looks at the development of Post Traumatic Stress Disorder and the legal recognition thereof on her web site at

Hope E. Morrow's Trauma Central contains a large collection of links to online articles on trauma and related subjects.

Risk Factors in PTSD and Related Disorders: Theoretical, Treatment, and Research Implications, Anne M Dietrich MA, Doctoral Candidate, University of British Columbia, Canada

See the ability, not the disability list of PTSD links