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By Pete Walker
COMPLEX PTSD ARTICLES
Emotional Flashback Management
Flashback Management
Codependency/Fawn Response
Shrinking the Inner Critic
Shrinking the Outer Critic
Abandonment Depression
Emotional Neglect
Grieving and Complex PTSD
The FourF's: A Trauma Typology
13 Steps Flashbacks Management
Bibliotherapy
FAQs About Complex PTSD
14 Common Inner Critic Attacks
ARTICLES FOR THERAPISTS
Using Vulnerable Self-Disclosure their recovery.
to Treat Arrested Relational-
Development in CPTSD
Therapist Heal Thyself
Relational Healing
Treating Internalized Self-Abuse Untraumatized individuals also easily and appropriately access
& Self Neglect
BOOK EXCERPTS:
The Tao of
Fully Feeling
Recovering Emotional Nature Those who are repetitively traumatized in childhood however,
Recovery and Self-Pity often learn to survive by over-relying on the use of one or two
Forgiveness: Begin With Selfof the 4F Reponses. Fixation in any one 4F response not only
Intentions for Recovery delimits the ability to access all the others, but also severely
Human Bill of Rights impairs the individual's ability to relax into an undefended
Lovingly Resolving Conflict
state, circumscribing him in a very narrow, impoverished
Homesteading in the
experience of life. Over time a habitual 4F defense also "serves"
Calm Eye of the
to distract the individual from the accumulating unbearable
Storm:
feelings of her current alienation and unresolved past trauma.
Navigating CPTSD
My Top 10 Practices
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The 4Fs: A Trauma Typology in Complex PTSD
This paper describes a trauma typology for differentially
diagnosing and treating Complex Post Traumatic Stress
Disorder. This model elaborates four basic defensive structures
that develop out of our instinctive Fight, Flight, Freeze and
Fawn responses to severe abandonment and trauma
(heretofore referred to as the 4Fs). Variances in the childhood
abuse/neglect pattern, birth order, and genetic predispositions
result in individuals "choosing" and specializing in narcissistic
(fight), obsessive/compulsive (flight), dissociative (freeze) or
codependent (fawn) defenses. Many of my clients have
reported that psychoeducation in this model has been
motivational, deshaming and pragmatically helpful in guiding
Individuals who experience "good enough parenting" in
childhood arrive in adulthood with a healthy and flexible
response repertoire to danger. In the face of real danger, they
have appropriate access to all of their 4F choices. Easy access
to the fight response insures good boundaries, healthy
assertiveness and aggressive self-protectiveness if necessary.
their flight instinct and disengage and retreat when
confrontation would exacerbate their danger. They also freeze
appropriately and give up and quit struggling when further
activity or resistance is futile or counterproductive. And finally
they also fawn in a liquid, "play-space" manner and are able to
listen, help, and compromise as readily as they assert and
express themselves and their needs, rights and points of view.
Complex PTSD as an Attachment Disorder
Polarization to a fight, flight, freeze or fawn response is not only
the developing child's unconscious attempt to obviate danger,
but also a strategy to purchase some illusion or modicum of
attachment. All 4F types are commonly ambivalent about real
intimacy because deep relating so easily triggers them into
painful emotional flashbacks (see my article in The East Bay
Therapist (Sept/Oct 05): "Flashback Management in the
Treatment of Complex PTSD". Emotional Flashbacks are instant
and sometimes prolonged regressions into the intense,
overwhelming feeling states of childhood abuse and neglect:
fear, shame, alienation, rage, grief and/or depression.
Habituated 4F defenses offer protection against further re-
abandonment hurts by precluding the type of vulnerable
relating that is prone to re-invoke childhood feelings of being
attacked, unseen, and unappreciated. Fight types avoid real
intimacy by unconsciously alienating others with their angry
and controlling demands for the unmet childhood need of
unconditional love; flight types stay perpetually busy and
industrious to avoid potentially triggering interactions; freeze
types hide away in their rooms and reveries; and fawn types
avoid emotional investment and potential disappointment by
barely showing themselves - by hiding behind their helpful
personas, over-listening, over-eliciting or overdoing for the
other - by giving service but never risking real self-exposure
and the possibility of deeper level rejection. Here then, are
further descriptions of the 4F defenses with specific
recommendations for treatment. All types additionally need and
benefit greatly from the multidimensional treatment approach
described in the article above, and in my East Bay Therapist
article (Sept/Oct06): "Shrinking The Inner Critic in Complex
PTSD", which describes thirteen toxic superegoic processes of
perfectionism and endangerment that dominate the psyches of
all 4F types in varying ways.
The Fight Type and the Narcissistic Defense
Fight types are unconsciously driven by the belief that power
and control can create safety, assuage abandonment and
secure love. Children who are spoiled and given insufficient
limits (a uniquely painful type of abandonment) and children
who are allowed to imitate the bullying of a narcissistic parent
may develop a fixated fight response to being triggered. These
types learn to respond to their feelings of abandonment with
anger and subsequently use contempt, a toxic amalgam of
narcissistic rage and disgust, to intimidate and shame others
into mirroring them and into acting as extensions of
themselves. The entitled fight type commonly uses others as an
audience for his incessant monologizing, and may treat a
"captured" freeze or fawn type as a slave or prisoner in a
dominance-submission relationship. Especially devolved fight
types may become sociopathic, ranging along a continuum that
stretches between corrupt politician and vicious criminal.
TX: Treatable fight types benefit from being psychoeducated
about the prodigious price they pay for controlling others with
intimidation. Less injured types are able to see how potential
intimates become so afraid and/or resentful of them that they
cannot manifest the warmth or real liking the fight type so
desperately desires. I have helped a number of fight types
understand the following downward spiral of power and
alienation: excessive use of power triggers a fearful emotional
withdrawal in the other, which makes the fight type feel even
more abandoned and, in turn, more outraged and
contemptuous, which then further distances the "intimate",
which in turn increases their rage and disgust, which creates
increasing distance and withholding of warmth, ad infinitem.
Fight types need to learn to notice and renounce their habit of
instantly morphing abandonment feelings into rage and disgust.
As they become more conscious of their abandonment feelings,
they can focus on and feel their abandonment fear and shame
without transmuting it into rage or disgust - and without letting
grandiose overcompensations turn it into demandingness.
Unlike the other 4Fs, fight types assess themselves as perfect
and project the inner critic's perfectionistic processes onto
others, guaranteeing themselves an endless supply of
justifications to rage. Fight types need to see how their
condescending, moral-high-ground position alienates others
and perpetuates their present time abandonment. Learning to
take self-initiated timeouts at the first sign of triggering is an
invaluable tool for them to acquire. Timeouts can be used to
accurately redirect the lion's share of their hurt feelings into
grieving and working through their original abandonment,
rather than displacing it destructively onto current intimates.
Furthermore, like all 4F fixations, fight types need to become
more flexible and adaptable in using the other 4F responses to
perceived danger, especially the polar opposite and
complementary fawn response described below. They can learn
the empathy response of the fawn position - imagining how it
feels to be the other, and in the beginning "fake it until they
make it." Without real consideration for the other, without
reciprocity and dialogicality, the real intimacy they crave will
remain unavailable to them.
The Flight Type and the Obsessive-Compulsive Defense
Flight types appear as if their starter button is stuck in the "on"
position. They are obsessively and compulsively driven by the
unconscious belief that perfection will make them safe and
loveable. As children, flight types respond to their family
trauma somewhere along a hyperactive continuum that
stretches between the extremes of the driven "A" student and
the ADHD dropout running amok. They relentlessly flee the
inner pain of their abandonment and lack of attachment with
the symbolic flight of constant busyness.
When the obsessive/compulsive flight type is not doing, she is
worrying and planning about doing. Flight types are prone to
becoming addicted to their own adrenalization, and many
recklessly and regularly pursue risky and dangerous activities to
keep their adrenalin-high going. These types are also as
susceptible to stimulating substance addictions, as they are to
their favorite process addictions: workaholism and busyholism.
Severely traumatized flight types may devolve into severe
anxiety and panic disorders.
TX: Many flight types are so busy trying to stay one step ahead
of their pain that introspecting out loud in the therapy hour is
the only time they find to take themselves seriously. While
psychoeducation is important and essential to all the types,
flight types particularly benefit from it. Nowhere is this truer
than in the work of learning to deconstruct their
overidentification with the perfectionistic demands of their inner
critic. Gently and repetitively confronting denial and
minimization about the costs of perfectionism is essential,
especially with workaholics who often admit their addiction to
work but secretly hold onto it as a badge of pride and
superiority. Deeper work with flight types - as with all types -
gradually opens them to grieving their original abandonment
and all its concomitant losses. Egosyntonic crying is an
unparalleled tool for shrinking the obsessive perseverations of
the critic and for ameliorating the habit of compulsive rushing.
As recovery progresses, flight types can acquire a "gearbox"
that allows them to engage life at a variety of speeds, including
neutral. Flight types also benefit from using mini-minute
meditations to help them identify and deconstruct their habitual
"running". I teach such clients to sit comfortably, systemically
relax, breathe deeply and diaphragmatically, and ask
themselves questions such as: "What is my most important
priority right now?", or when more time is available: "What hurt
am I running from right now? Can I open my heart to the idea
and image of soothing myself in my pain?" Finally, there are
numerous flight types who exhibit symptoms that may be
misperceived as cyclothymic bipolar disorder; I address this
issue at length in my article: "Managing Abandonment
Depression in Complex PTSD".
The Freeze Type and the Dissociative Defense
Many freeze types unconsciously believe that people and
danger are synonymous, and that safety lies in solitude.
Outside of fantasy, many give up entirely on the possibility of
love. The freeze response, also known as the camouflage
response, often triggers the individual into hiding, isolating and
eschewing human contact as much as possible. This type can
be so frozen in retreat mode that it seems as if their starter
button is stuck in the "off" position. It is usually the most
profoundly abandoned child - "the lost child" - who is forced to
"choose" and habituate to the freeze response (the most
primitive of the 4Fs). Unable to successfully employ fight, flight
or fawn responses, the freeze type's defenses develop around
classical dissociation, which allows him to disconnect from
experiencing his abandonment pain, and protects him from
risky social interactions - any of which might trigger feelings of
being reabandoned. Freeze types often present as ADD; they
seek refuge and comfort in prolonged bouts of sleep,
daydreaming, wishing and right brain-dominant activities like
TV, computer and video games. They master the art of
changing the internal channel whenever inner experience
becomes uncomfortable. When they are especially traumatized
or triggered, they may exhibit a schizoid-like detachment from
ordinary reality.
TX: There are at least three reasons why freeze types are the
most difficult 4F defense to treat. First, their positive relational
experiences are few if any, and they are therefore extremely
reluctant to enter the relationship of therapy; moreover, those
who manage to overcome this reluctance often spook easily and
quickly terminate. Second, they are harder to psychoeducate
about the trauma basis of their complaints because, like many
fight types, they are unconscious of their fear and their
torturous inner critic. Also, like the fight type, the freeze type
tends to project the perfectionistic demands of the critic onto
others rather than the self, and uses the imperfections of others
as justification for isolation. The critic's processes of
perfectionism and endangerment, extremely unconscious in
freeze types, must be made conscious and deconstructed as
described in detail in my aforementioned article on shrinking
the inner critic. Third, even more than workaholic flight types,
freeze types are in denial about the life narrowing
consequences of their singular adaptation. Because the freeze
response is on a continuum that ends with the collapse
response (the extreme abandonment of consciousness seen in
prey animals about to be killed), many appear to be able to
self-medicate by releasing the internal opioids that the animal
brain is programmed to release when danger is so great that
death seems immanent. The opioid production of the collapse
or extreme freeze response can only take the individual so far
however, and these types are therefore prone to sedating
substance addictions. Many self-medicating types are often
drawn to marijuana and narcotics, while others may gravitate
toward ever escalating regimes of anti-depressants and
anxiolytics. Moreover, when they are especially unremediated
and unattached, they can devolve into increasing depression
and, in worst case scenarios, into the kind of mental illness
described in the book, I Never Promised You A Rose Garden.
The Fawn Type and the Codependent Defense
Fawn types seek safety by merging with the wishes, needs and
demands of others. They act as if they unconsciously believe
that the price of admission to any relationship is the forfeiture
of all their needs, rights, preferences and boundaries. They
often begin life like the precocious children described in Alice
Miler's The Drama Of The Gifted Child, who learn that a
modicum of safety and attachment can be gained by becoming
the helpful and compliant servants of their parents. They are
usually the children of at least one narcissistic parent who uses
contempt to press them into service, scaring and shaming them
out of developing a healthy sense of self: an egoic locus of self-
protection, self-care and self-compassion. This dynamic is
explored at length in my East Bay Therapist article
(Jan/Feb2003): "Codependency, Trauma and The Fawn
Response" (see www.pete-walker.com). TX. Fawn types
typically respond well to being psychoeducated in this model.
This is especially true when the therapist persists in helping
them recognize and renounce the repetition compulsion that
draws them to narcissistic types who exploit them. Therapy also
naturally helps them to shrink their characteristic listening
defense as they are guided to widen and deepen their self-
expression. I have seen numerous inveterate codependents
finally progress in their assertiveness and boundary-making
work, when they finally got that even the thought of expressing
a preference or need triggers an emotional flashback of such
intensity that they completely dissociate from their knowledge
of and ability to express what they want. Role-playing
assertiveness in session and attending to the stultifying inner
critic processes it triggers helps the codependent build a
healthy ego. This is especially true when the therapist
interprets, witnesses and validates how the individual as a child
was forced to put to death so much of her individual self.
Grieving these losses further potentiates the developing ego.
Trauma Hybrids
There are, of course, few pure types. Most trauma survivors are
hybrids of the 4F's. There are for instance, three subsets of the
fawn type: the fawn-fight (the smothering-mother type) who
coercively or manipulatively takes care of others, who smother
loves them into conforming with her view of who they should
be; the fawn-flight type who workaholically makes herself
useful to others (the "model" secretary) in the vein of her
favorite role model Mother Theresa; and the fawn-freeze type
who numbingly surrenders herself to scapegoating or to a
narcissist's need to have a target for his rageaholic releases
(the "classic" domestic violence victim).Space in this article only
allows for the description of two other common hybrids: the
Fight/Fawn and the Flight/Freeze.
The Fight/Fawn, perhaps the most relational hybrid and most
susceptible to love addiction, combines two opposite but
magnetically attracting polarities of relational style - narcissism
and codependence. This defense is sometimes misdiagnosed as
borderline because the individual's flashbacks trigger a panicky
sense of abandonment and a desperation for love that causes
her to dramatically split back and forth between fighting and
clawing for love and cunningly or flatteringly groveling for it.
This type is different than the fawn/fight in that the narcissistic
defense is typically more in ascendancy. The fight/fawn hybrid
is also distinct from a more common condition where an
individual acts like a fight type in one relationship while fawning
in another (the archetypal henpecked husband who is a tyrant
at work), and from the many "nice" mildly codependent people
who have critical masses where they will eventually get fed up
and blow up about injustice and exploitation. The borderline-
like fight/fawn type however may dramatically vacillate back
and forth between these two styles many times in a single
interaction.
The Flight/Freeze type is the least relational and most
schizoid hybrid. This type avoids his feelings and potential
relationship retraumatization with an obsessive-compulsive/
dissociative "two-step" that severely narrows his existence. The
flight/freeze cul-de-sac is more common among men, especially
those traumatized for being vulnerable in childhood, and those
who subsequently learned to seek safety in isolation or
"intimacy-lite" relationships. Many non-alpha type males
gravitate to the combination of flight and freeze defensiveness
stereotypical of the information technology nerd - the computer
addict who workaholically focuses for long periods of time and
then drifts off dissociatively into computer games. Many sex
addicts also combine flight and freeze in a compulsive pursuit of
a sexual pseudo-intimacy. When in flight mode, they
obsessively scheme to "get" sex and/or compulsively pursue
and/or engage in it; when in freeze mode, they drift off into a
right brain sexual fantasy world that is often fueled by an
addictive use of pornography; and even during real time sexual
interaction, they often engage more with their idealized fantasy
partners than with their actual partner.
Self-Assessment. Readers may find it informative to self-
assess their own hierarchical use of the 4F responses. They can
try to determine their dominant type and hybrid, and think
about what percentage of their time is spent in each type of 4F
activity. Finally, all 4Fs progressively recover from the
multidimensional wounding of complex ptsd as mindfulness of
learned trauma dynamics increases, as the critic shrinks, as
dissociation decreases, as childhood losses are effectively
grieved, as the healthy ego matures into a user-friendly
manager of the psyche, as the life narrative becomes more
egosyntonic, as emotional vulnerability creates authentic
experiences of intimacy, and as "good enough" safe
attachments are attained. Furthermore, it is also important to
emphasize that recovery is not an all-or-none phenomenon, but
rather a gradual one marked by decreasing frequency, intensity
and duration of flashbacks.