Complex PTSD in the workplace
May 13, 2018 4:40 AM   Subscribe

Lately the stuff that has always previously manifested for me as a mood disorder has started manifesting more like complex PTSD, and it's beginning to impact my work. I've started a conversation about this at work with my manager and HR; I imagine someone's going to ask me what would be helpful in terms of accommodations at work fairly soon, and I have no idea what would actually help. Looking for advice and experiences from other people who've been through something similar. CW: childhood abuse.

Growing up, both of my parents were seriously abusive for various reasons (severe untreated anxiety than manifested as needing total control, developmentally inappropriate expectations for their children's behaviour, serious emotional neglect and also some medical neglect, rage, terrorising, only conditional love with standards so high I could never meet them, general volatility and occasional beatings). The abuse was severe and pervasive enough that my therapist has expressed surprise that I'm able to be as high-functioning as I am - we're both kind of astounded that I'm not dead/don't have a serious drug problem/haven't dropped out of society entirely.

My parents were also high-functioning and middle-class enough that no one ever suspected what went on at home - since both parents were abusive and the household was very closed off from other people, none of the other adults in my life knew how bad it was and no one was particularly interested in listening on the rare occasions when I tried to let someone else know. I feel that I was repeatedly failed by pretty much every adult in my life on multiple occasions throughout my entire childhood.

My early experiences left me ripe for retraumatisation and being predated on, and that's also been the case - I've had a few serious traumatic incidents as an adult as well, including being raped and some traumatic medical interactions.

I was a gifted child and all of my educators used this as an excuse to ignore other areas of my life where I desperately needed support. Both my therapist and I strongly suspect that I'm on the spectrum, but this was ignored growing up because I was academically brilliant. I was born female at a time when there was less awareness of autism in women, and at a time when "twice exceptional" wasn't really a concept - you could either be gifted or have social/learning difficulties but you couldn't be both as far as the schools I attended were concerned.

Fast forward to my adult life and I've been simultaneously exceptionally unhappy and surprisingly high-functioning for as long as I can remember. At the same time as feeling totally worthless as a person and profoundly depressed, I've also built an interesting and well-paying career for myself, own my own home, have a satisfying long-term relationship, etc. And as an adult I've really internalised the idea that I'm too smart to deserve any kind of help, to the point where I use this as an excuse to self-select out of accessing additional support.

I have a reasonable amount of personality splitting going on, where I feel like I'm only acceptable to the world if I present a positive, cheerful, competent, people-pleasing, can-do face and that no one would like me or want to know me if they knew how profoundly miserable and broken I am on the inside. It's very hard for me to be open at all about the bad stuff because I've had so many terrible reactions when I've tried to talk about it in the past.

A few years ago I was diagnosed with bipolar disorder, which at the time felt like a decent explanation for the chronic mood dysregulation issues I've experienced (also there's a history of bipolar and other mood disorders in the family). I was also in serious denial about how bad my childhood was for a lot of my late teens/early twenties, so when I first started seeking treatment for depression I wasn't able to articulate why I felt the way I did and would routinely deny the idea that anything had been wrong growing up, so the medical picture of what's wrong with me is missing a lot of crucial detail.

In the last few months, instead of manifesting as depression, my mental health stuff has instead been manifesting more like complex PTSD - I'm experiencing flashbacks to specific traumatic childhood feelings and experiences, repressed memories are un-repressing themselves, and I'm dissociating and spacing out a lot of the rest of the time. I experience some degree of executive dysfunction most of the time, but usually I can figure out a way to get through it (yet another area where being really smart and good at problem-solving has saved my ass so many times rather than letting me crash out and actually get some much-needed help).

Right now, though, the combination of intrusive thoughts/memories and spacing the fuck out a lot of the time is making it really difficult to concentrate on work stuff, even though the work is inherently interesting and I generally find the kind of work I do rewarding. I haven't screwed anything serious up (yet), but I've been dropping more stuff than I'd like to and it doesn't feel anywhere near as satisfying to get the work done as it usually does, which isn't helping with motivation.

The very good news is that I have an extremely supportive workplace - my boss already knows about the bipolar, has worked with me through a bad episode of depression before and knows what that looks like, and has shared his own experience of depression with me. The HR manager for our division is a mental health first aider. The CEO of the company also knows about the bipolar because I was working directly for him when I was diagnosed, and this hasn't been an issue or harmed my employment at all (in fact, I've been promoted a couple of times since then). There literally could not be safer people to talk to about this at work, and I am feeling reasonably comfortable with my decision to be more open about what's going on right now, although there is still part of my brain screaming "YOU KNOW YOU ONLY GET REJECTED AND HURT IF YOU TRY TO TELL PEOPLE WHAT IS WRONG WITH YOU".

That was a lot of preamble for the actual question: when I speak to these kind and supportive people at work about this some more next week, I imagine I'm going to get asked if there's anything that would help in terms of accommodations, and I have no idea what would actually help. I've read the askJAN advice on accommodations for PTSD and executive function issues (we're in the UK so ADA doesn't apply but I've found this a really useful resource in the past), but I'm really struggling to understand how any of the suggested accommodations would help me.

More time spent on task tracking/different task tracking systems are strongly recommended, but I've lived with enough executive dysfunction for long enough that I have good systems that generally work for me when I am well enough for them to work, and if I'm not well enough for those systems to work it's generally not the system that's the problem. Getting my boss to spend more time helping me with task management feels inappropriate for the kind of work we both do (I'm a high-level individual contributor working on big-picture/strategic stuff; he's a director).

Advice about specific triggers seems more helpful for "simple" PTSD with obvious triggers than it does for what is going on with me - I do have triggers, but they're usually subtle social stuff that it would be really weird to ask other people to stop doing around me, and I often don't realise something is going to be triggering for me until it's already happened.

People talking dismissively about their kids or casually discussing irritating things their kids have done (which happens a surprising amount in the workplace, particularly with parents of teens) is really difficult for me. I tend to assume all parent/child relationships are inherently abusive because of the power imbalances involved, so when I hear people complaining about their kids but don't see any of the normal loving family interactions that almost certainly happen at home, I find it really stressful. I had one coworker who thankfully no longer works here who was generally very emotionally immature and used to tell anecdotes about the way he interacted with his kids that made me feel panicky and sick because it was so reminiscent of my parents' emotional dynamic.

My dad was the more volatile and physically abusive of my parents, so I have a lot of fear reactions around similar behaviour and characteristics, but in a lot of ways he was also just a generic middle-aged dude. There tend to be a ton of generic middle-aged dudes in the workplace and at least some of them have characteristics that remind me of my dad, but again, "avoid guys who remind me of my terrifying dad in any way" doesn't sound like a particularly practical or reasonable accommodation.

As an example of a totally unexpected trigger, I was at a team lunch the other day and the conversation turned to casual jobs people had as teenagers. My family were weirdly and creatively abusive about the idea of me getting a job as a teenager (example: I was told I wasn't even allowed to apply for a retail job because "they will make you clean the toilet and your grandmother would be so sad if you had to clean a toilet at work" [of course there was nothing in the job ad about cleaning any toilets] and my family would make similar excuses any time I tried to apply for another job, but then my dad would also repeatedly verbally abuse me about how lazy and unmotivated I was because I didn't have a part-time job). It was a totally innocuous conversation but it caused me to spiral down into feeling terrible about myself and remembering a bunch of other crappy stuff my parents said and did.

The weird social triggers also intensify my feelings of otherness, like, "wow these people all have a totally normal response to this totally normal thing and they could never even begin to understand why this is weird and sad for me." I stay silent about my experiences a lot because talking about it tends to bum other people out or single me out as odd.

I also find it really difficult to talk about with people who I know are (non-abusive) parents (which is true of both my boss and my HR manager), because people who have normal healthy ideas about child development and have children themselves tend to get really upset at the idea of a vulnerable child going through what I went through. I feel so gross and weird most of the time, and also like it's my job to contain all of those feelings and experiences inside myself so that they don't hurt other people (it doesn't seem to matter to me that I get even more hurt by doing this, as I feel like I'm already so broken it doesn't matter if I experience even more trauma, there's nothing good left here to ruin and my parents got to me so early that there never was anything good to ruin in the first place).

I'm much more used to being pervasively depressed and low-functioning for long periods of time - whatever is going on right now is a lot more unstable and episodic-feeling. I can concentrate sometimes, I can feel okay sometimes, I can still read books and work on creative projects and take care of myself with stuff like sleep/hydration/exercise. But every day I'm getting 5-10 spikes of feeling really anxious or absolutely terrible about myself (including the meta-despair of conceiving of the enormity of my own brokenness) or having flashbacks or intrusive thoughts, and I don't know what I could change at work to make that easier/better.

Taking time off is always an option, but right now I feel like I'd spend it working on my YA fantasy novel rather than working on myself, which feels disingenuous. Also I really struggle to take proactive sick leave/mental health days for stuff like this; I've only ever taken time off when I was so severely depressed I was afraid I would hurt myself while driving to work. I feel like I can't trust myself to take one day off - why today and not yesterday or tomorrow? What if I take one day and never feel like coming back? (I can't afford not to work for various reasons and I'm terrified that a day might come when I literally can't work). The medical neglect during childhood (including my parents blocking access to any kind of mental health treatment when I was a very depressed teenager who was self-harming, drinking to excess and starving myself) really doesn't help with this stuff.

So, what I am looking for is examples of workplace accommodations that have helped other people with similar challenges, particularly from people with PTSD from pervasive childhood abuse. I'm also open to "hey this one thing really helped me reframe the way I was feeling about myself/my past"-type advice. And any kind of stories of hope that it's possible to live through this much shit and actually feel like a coherent person who isn't chronically miserable at some point would also be very welcome.
posted by anonymous to Work & Money (12 answers total) 16 users marked this as a favorite
 
Take the time off. Write your YA novel. I expect exploring that part of your life through words will be incredibly therapeutic. It seems to me that you are stable enough in your real life that your memories are now banging on the hatch to be addressed. And you can do it through the magic of semi-autobiographical fiction.
posted by seanmpuckett at 5:54 AM on May 13, 2018 [2 favorites]


Is there any way you can take some time off every week for therapy/treatment specifically for PTSD/complex PTSD? The first bit is education about the symptoms and teaching really practical coping strategies for the intrusions/nightmares/flashbacks and generally helps people manage better in the day to day. I work in a specialist NHS service for complex PTSD in London but I know symptom management courses can also be accessed through primary services like IAPT etc. - your GP can refer you!
posted by monocot at 6:00 AM on May 13, 2018 [7 favorites]


I would gently encourage you to talk about your fears about taking time off of work with your therapist. It seems to me that 1) you need an extended period of time away from work to do some intensive therapy (and to write that book!) and 2) it is the mental illness telling you that number one is not a viable option. I feel like it may be the mental illness telling you that you can’t get intensive help without crashing and burning first. That is untrue.

The reason I am suggesting time away and intensive therapy is because the causes of your triggers, as far as I can tell, all stem what are common interactions with coworkers. Parents talk about their children/hardships of parenting with other parents because it is a method of managing stress for themselves. People often talk about their own childhoods as a way to bond with other people/coworkers. I don’t think there is a legal or realistic way for a workplace to offer an accommodation for that as it would mean requiring other employees to not talk about their children, etc. I suppose they could offer you an accommodation that would allow you to work off-site or in a remote area as to provide less possibility for these types of interactions. Is that something the type of work you do would allow for? If it often happens that the content of meetings trigger you perhaps they could accommodate you by not requiring you to attend. Are there particular people who are most likely to have conversations that lead to distress? Can they offer ways to minimize interactions with those folks?


One of the things you might want to do is ask yourself what would your perfect workplace look like? Then think about the ways in which your employer could help you make that happen. What has your mental health provider suggested?
posted by teamnap at 6:01 AM on May 13, 2018 [1 favorite]


Hey! Hi. I’ve been on a similar path the past few years. My first thought is that it might be difficult to identify the accommodations you need, because the triggers vary so much and will also change / you’ll discover more. It might be more practical to ask for accommodations around a particular coping method you find useful, so that when you get overwhelmed you can just go to the Place and do the Thing. But that means you need to have some sort of ritualized coping mechanism that you know works reasonably well to bring you out of a flashback. (I solve this problem by being self-employed, which...has its pros and cons.)

So are you seeing someone who specializes in complex PTSD or developmental trauma? This is a really big deal. The thinking on this stuff has changed so radically in the last 10 years, even, that most therapists aren’t trained in it, and traditional approaches can actually be retraumatizing. Someone who is well informed about trauma will also likely have a bunch of different management strategies for you to try while you pursue recovery. It’s also possible that you might need to see more than one person, or try more than one approach. I would encourage you to pursue an embodied therapy, too — somatic therapy, EMDR, trauma-informed yoga, mindfulness meditation working towards self-compassion.

I have an ever-growing list of books for this particular subject, which I’ll be happy to share. Please feel free to PM me, too. I can say that this process is sometimes very, very difficult, but it is absolutely worth it. And while I still have very difficult episodes, my every day life is so different — in a good way — as to be almost unrecognizable. My life is a lot better, a lot more hopeful. And while I’m not done becoming who I’m going to be, I like the changes I’m seeing. This is very possible, and you seem well equipped and positioned to do it.

In the meantime, it might be helpful to remember that the high functioning version of yourself is still you. It’s not a mask, it’s not false, and it won’t disappear. It’s just part of you.
posted by schadenfrau at 6:14 AM on May 13, 2018 [12 favorites]


It also might be helpful to know that CPTSD and DTD (developmental trauma disorder) aren’t really “mental illness” (which is a phrase that should probably be retired — it’s just illness, the qualifier isn’t necessary). They are probably more accurately thought of as disorders of the nervous system. You can train your brain and body into something different. It takes time, but it’s not like fighting the mystery ghost of “mental illness.”
posted by schadenfrau at 6:18 AM on May 13, 2018 [5 favorites]


I'm really sorry for what you've gone through. I'm not sure whether it will help to hear this, but I find it striking how resilient you seem to be, in terms of building a good life for yourself. That's not to say that you shouldn't deserve to feel good also (you do, and I'm glad you're working on that), just to say that having constructed a functional adult life for yourself under these circumstances is no small thing.

I was struck by your suggestion that working on your YA novel is different somehow from working on yourself! Like seanmpuckett I'm inclined to disagree.

How would you feel about working remotely part-time? A number of these triggers seem to involve small talk with colleagues in the office. Could reducing your exposure to these conversations help? Not to say that you should be seeking complete isolation (I don't think that'd be good either, or practical in the kind of job you describe).
posted by eirias at 6:41 AM on May 13, 2018 [1 favorite]


It's ok to talk to your boss about what's going on without having immediate solutions to offer. "This is why I'm really distracted right now; I'm working on it with my therapist, and if we come up with ideas for accommodations going forward, I will absolutely let you know" is a reasonable thing to say. It sounds like you've got supportive enough people that you can risk some vulnerability and say, "I don't know."

I tend to call this phase of trauma work the "thaw" phase, where the traumatized person's been so frozen in denial/repression/"being strong" that actually starting to process feelings is like that razor-sharp pain that comes when one's snow-numbed fingers start to thaw. Eventually the circulation comes back and the fingers work again but it's horribly painful in the meantime. Good for you for doing the work.
posted by lazuli at 7:09 AM on May 13, 2018 [13 favorites]


I'm 17 years down the road from about where you are and for me personally, staying working while I entered the therapy work was really good as it kept me grounded and focused. YMMV of course!

I don't think you need to know all your accommodations right now. But some things that helped me were:

- an ability to go for a walk/go hang out in a quiet room, if something did get to be overwhelming
- headphones or a closed office, if I needed to not deal with other people's noise around me
- not having my back to a door or an open area
- the ability to work from home one day a week
- time off for therapy or after therapy (although I found after work time worked best for me)

I agree on the framing of this as "thaw" and it is a very acute stage, but it does not define your future forever.
posted by warriorqueen at 8:36 AM on May 13, 2018 [5 favorites]


I also agree on staying working if you can and that therapy should be after work so you have time to process.

I struggle with poor concentration and emotional lability as part of a mood disorder. I've found the following helpful:
- Reduced hours in the office/split schedule, where I work from home at least an hour each morning and sometimes in evening
- Plan for day during my hour at home, so I know what it is I need to do in the day and I have set goals for the day. Also I will send correspondences to coworkers to get the ball rolling
- No standing meetings before 11 AM (I skip the team's standup) so I can have my morning time outside of office
- Play music on headphones to concentrate on deliverables in the office if I have to work on them there
- Schedule unimportant meetings for the short attention span portions of the day in the afternoon
- Meetings should be short, 30 minutes, to ensure that there is limited time for daydreaming
- Go for a short walk if I catch myself spaced out or having an emotional reaction to an interpersonal interaction, 10-20 minutes will often help
- Keep a written to-do list on a piece of paper on my desk so I can always see it and pick a new activity if I need to switch due to waning attention
- Go home if a walk/switching activites doesn't help, work from home in evening to make it up
- Call in sick if there has been some acutely traumatic issue for a day and my concentration is completely shot. I limit sick time to a day at a time.
- No internet slacking while at work. No reddit, mefi, askme, social media, games, personal email/calls etc. Texting is limited to immediate parenting tasks only. I only do personal business at work if it's part of the goals for the day. Spacing out is limited to looking out the window and staring blankly at Slack/work email.

The key here for long term sustainability for me is the "chunk" method. I have scheduled daydream time interspersed with work (I take transit) so I can lean into my tiny concentration span. More available short spans = more work completed in a day.

I think it's important for you to go to the office so you can practice the coping techniques you learn in therapy. With time you might be able to go back to full days, however you might like chunks so much you might find a full day undesirable! Again YMMV.
posted by crazycanuck at 11:42 AM on May 13, 2018 [5 favorites]


You do not need accommodation at work as much as you need to expand your efforts outside of work to process the past and build strength as part of the ongoing self-work you are already doing for yourself. As a survivor of childhood abuse eerily similar to yours in many respects, I urge you to temporarily increase your efforts on recovery outside of work.

Right now your focus is therapy and that's good. It's just time to upgrade how you are addressing your recovery. I think you're at the stage where your needs are better addressed by something you can self-start and do alone at any time, not just during that weekly appointment.

During lifelong recovery from childhood abuse there are times where things seem a bit worse, but this is a signal you are ready for the next step forward. IMHE, what you are describing is a TRUE opportunity if you leverage it correctly. Seriously, this is your moment. You can be someone who functions well and is not continually triggered. It takes effort and commitment, but you can get to that stage. You feel a little bit like you're losing it because it's time to upgrade your efforts towards yourself, or at least that's what I eventually figured out worked for me.

There are many ways to address this opportunity beyond traditional therapy. I want to say the best results seem to come from marrying any modality to some sort of practice or structure.

Often it's important to have an experienced guide/practitioner/teacher + maybe community to help you process and improve. As an example, in my city there are meditation groups that meet regularly with a leader doing a guided meditation for the group. Making an activity like this the scaffolding of your self-work is great because if you are having a bad day, there's something you can actively learn and do to immediately feel better.

For example, you mentioned writing a YA novel. Writing is tremendously therapeutic, but also very heady and solitary. On the one hand, the practices outlined in the famous The Artist's Way book come to mind. At the same time, belonging to a writer's workshop + processing emotional things that come up during your writing process in traditional therapy can be a concrete way to find yourself and acquire emotional skills. Just writing alone without a practice, mentorship, community, and/or therapeutic support could be a way to lose yourself in reverie and other worlds. So instead, writing your novel + a strong support structure is one path you can take towards addressing and overcoming childhood abuse.

For some people the activity part is dropping in as needed to a spin class studio. Martial arts classes at a dedicated studio can be this. Climbing gyms. Running. Maintaining a community garden plot. You get the idea, any positive activity that you can access at will and without much planning is ideal. If you need it, you can go do it almost any time, then walk out feeling better. An activity or practice you can access regularly (or more, as needed) is a tool that's there for you in a way talk therapy isn't because the only barrier to feeling better is your own willingness to show up at the studio or gym.

I do kundalini yoga because it combines movement with mantra and meditation, I can attend class AND do it anytime for a few moments anywhere, as needed. One of my first teachers always talks about "using mantra as medicine" and I found she was right. It's a great way to reprogram your subconscious from all the toxic messages we absorbed as children.

One of the classes I go to that is very popular is taught by a Phd that just wrote this book available on Amazon May 14th. Her website is here. I've had some pretty big shifts as a result of attending her classes, I haven't read the book yet, but I have a feeling her book will very directly address the concerns you have shared here.

One last thing...

It IS remarkable you have come this far. My hope for you is that one day you'll forget how remarkable you are because it will truly become normal for you to feel strong, safe, and loved. Cultivating self-love through self-care and self-work is the key. On the outside you're ok, your insides have to catch up to where you are truly are in life today. You can do this!
posted by jbenben at 1:18 PM on May 13, 2018 [4 favorites]


Suggestions for accommodations:
-What about an admin assistant for deadline and scheduling support? Could be an existing admin (use your knowledge of your company's culture for this; don't suggest that they reassign the CEO's admin to you). Or you could ask them to use a virtual assistant service or engage a job coach. 12% time would give you an hour each day. I'm thinking the admin would have access to a shared calendar you and your boss set up. Admin can call and email you each morning with upcoming deadlines. A job coach could also help you prioritize.

-Say you are highly distractible right now and ask for personal conversations to be moved away from your work area and minimized during essential meetings. Ask to be excused from non-essential meetings. (This idea is from JAN's series on ADD accommodations, which I recommend browsing. I think some of the suggestions for reducing distractions could be used to reduce triggers.)
-Excused from work social events as needed.
-Working from home or adjusting your schedule so that you are physically in the office less or when fewer people are there.

These last few don't have to be all or nothing. You could try working from home two days a week or shifting to a Sat-Wed schedule (gives you two full weekdays available for more intensive therapy and self care). You can offer to lead (or attend) some kind of lunch and learn twice a month that is still social but allows you (or a trusted ally) to gently steer the conversation.

If you don't feel able to take leave, can you go to 80% time? You could work four days a week or take two afternoons or mornings off.

I highly recommend poking around JAN more, without limiting yourself to accommodations for a specific dx. Accommodations are meant to be flexible. It can also be worth trying an acc you aren't sure will work or matter; it may surprise you once in place. I hope things get easier for you soon.
posted by Snarl Furillo at 3:33 PM on May 13, 2018


If you are able to adjust your schedule to work away from the office one or two days a week, pick Fridays and/or Mondays. People usually talk more about their kids close to the weekend, and not being present for those conversations might help you minimize one of your current triggers. Wearing headphones when you are in the office can muffle co-worker personal chit-chat as well as sharpen your focus.

[This is a period of transition, and it's difficult, and I'm so sorry for your trouble. Above all, please know that you are in no way "broken." Though you had primary caregivers who should not have been trusted with a goldfish, never mind a baby, you've succeeded anyway. You're amazing. This situation will improve, because you, with the assistance of a robust personal and professional support network, will improve it. And then there are such good things waiting for you.]
posted by Iris Gambol at 6:48 PM on May 13, 2018 [3 favorites]


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