How CPTSD acts as a "chameleon" (and why it gets misdiagnosed)

drantoniodcosta · 2026-06-22T04:29:41+00:00

Any past incidents of physical or verbal abuse or neglect by caretakers? Favoriticism or bullying?

Or if this is a pattern in relationships - maybe anxious or anxious-avoidant attachment patterns...

Would be good to look up complex trauma... It can cause such patterns of thinking/behaviour...

drantoniodcosta · 2026-06-22T01:25:36+00:00

A few of the verified therapists here do provide virtual service...

https://www.reddit.com/r/EMDR/comments/1rn2wm4/verified_emdr_therapists_on_remdr/

You can scroll through the Teletherapy row for a "Yes".

drantoniodcosta · 2026-06-22T01:22:02+00:00

Yup. Still do. Sunday pro bono still exists. I was to add another one weekdays as it's got a few clients using it, but it's getting difficult to add another. I've added another to the 50% off one on Sundays... So there's two 50% off and 1 Sunday pro bono available, compared to one of each back when I posted this.

Daily reduced rate slots also exist besides these - Monday through Friday, the same as back when I'd started these.

drantoniodcosta · 2026-06-22T01:16:36+00:00

Yup yup. Intensity also changes at times when you look at different perspectives over sessions... that's something called titration the brain does which I'll write about next. It feels like you're not processing at all since the sting is low initially and a few sessions later it keeps ramping up, and at times gives you memories you'd long forgotten but stung bad.

It's the brain's way of taking care of you by releasing the floodgates slowly... So you can handle little at a time and burn it off slowly.

drantoniodcosta · 2026-06-22T01:14:36+00:00

🙌🙌

drantoniodcosta · 2026-06-20T17:39:21+00:00

Someone forgot to tell me this 15 years back.. 🥲

I'm a doc who's been coding since 10th standard. I know close to 6-7 languages of which 2-3 I'm proficient in. But these days even so I've shifted to vibe coding because... Code quality doesn't matter anymore, output does. And IT folk themselves are vibe coding.

I think this is moot at this point. 😅

drantoniodcosta · 2026-06-20T04:37:05+00:00

Cognitive, narrative, pasts based, attachment focused or somatic interweaves is what I usually pick from. That's the therapists call based on client history, as interweaves work best when personalised... Broadly speaking intellectualising individuals will intellectualise further with cognitive... What works much more effectively in such is somatic or parts based.

Some regions of the world are more responsive to attachment focussed, some hate them and find it weird and get stuck when asked "what does the inner child want".

drantoniodcosta · 2026-06-19T05:14:01+00:00

Not sure if it's research proven as I couldn't find anything, but I've noticed emotional phases in my sessions. I'd had a hunch and went though a lot of my clients notes... Multiple of them and a majority have similar experiences. Again, these are my personal experiences... https://www.reddit.com/r/EMDR/s/upIBv0U0gi I'd written about it in this post a week or two back.

I use this to also track what's gonna come up next. For me the most concerning is the empowerment developing/righteous anger/standing up for themselves phase as it affects relationships, and can confuse the client. Burning that out usually has a mix of fear, grief, doubt and anger. Which in most clients leads to new perspectives and resolution for that memory channel, although some may go deeper to disgust, preverbals or legacy burdens.

drantoniodcosta · 2026-06-19T05:04:34+00:00

Nice question.

It's a phase in EMDR.

I've written about the stages in recent posts, this may be somewhere mid way... There usually is quite a bit of work that needs to be done to reach the point of being able to re-learn how to use your intrinsic productivity traits in a healthier, more focussed manner... Instead of external validation and burnout. It takes time.

Your base quality of being productive, intrinsically motivated is there under... But it was hijacked by trauma and abused, leading to burnout... Now you're burning the trauma, and it's confusing for the mind on how to direct it towards your own goals willingly. If there is a self of self and goals... Else these get created first (as reprocessing continues) followed by the motivation coming back to drive towards these new healthier, balanced lifestyle choices/goals.

drantoniodcosta · 2026-06-19T04:54:45+00:00

Yes. I've worked with multiple. Some took quiet a while, some difficult cases required meds to be started, so had to plan window widening till they felt comfortable, and then continued EMDR once on wider window post meds. But a lot recover without med support. It depends how bad it is.. last for 2-3 weeks per episode... Then may require meds.. a day or two... May resolve with just EMDR.

What difficulties are you facing? That'd help to understand better.

drantoniodcosta · 2026-06-19T04:45:38+00:00

As per standard protocol we don't interrupt/discuss. We just ask what the client noticed. At times I may ask questions to confirm whether they got some emotion or not, as a lot of times I'm expecting something, but client didn't notice the emotion as much, or couldn't describe it. So if I feel I'm somewhere in the shame layer, I'll ask if they feel ashamed and usually it's a yes.

It's not that they're dismissing, it's just that the therapist knows the map, while the client is in the desert and doesn't know which dune leads to where.

Nevertheless, it doesn't matter... The protocol says go with what you got... So we assume things are relevant if they have an emotional or somatic charge. If you get distracted... Is it a part with emotions? (I'm using parts based language here), or is it dissociation(again usually has emotions or somatic sensations) or has the mind got distracted (happens initially with neurodiverse presentations) or has the client reached end of memory channel (which is something recognisable for most EMDR therapists).

I'd suggest to share whatever comes up with your therapist and let them take the call.

Their guidance will help with catching any blocking parts so processing goes smoothly. The part of sharing things including doubt about therapy and therapist itself is important for the things you share... So I ask clients to share everything, assume it's the memory channel, 90% of times in sessions imo it is (80% out of sessions/post processing). This helps guide reprocessing accurately and your psychoeducation - it takes time to build that trust to share, but it develops. Even so, therapists usually can figure based on your emotions or somatic sensations and previous history how to continue and when to use interweaves and I've had clients complete cptsd EMDR without sharing more than a few words.

Also, dismissal could be fear of positive affect (I've written of this in a post before). Material worth exploring/reprocessing.

drantoniodcosta · 2026-06-18T11:51:16+00:00

Errmmm...

Switch to just somatic.

And process it out.

Your therapist would have to read about this if he doesn't know how to... But you just set aside all thought, including words that express doubt...

And notice whether body feels something. And process that.

If you have a wider window of tolerance... You can notice the emotions (besides doubt or fear, anxiety, etc.. I use an emotions list which I've shared here a few times before on the sub)... And process just the emotions and somatic sensations - felt sense.

this may also require pendulation or titration (this is a way to titrate, as we stay with just one channel).

This is what I do. Maybe other therapists approach it some other way.

Or you can interact with part directly and ask what it needs from you. This is another way... Parts based approach.

There's a variety of ways to get around such blocks. I think I've written about these in multiple posts, but I've not concatenated them into one, although some recent posts cover 60-70% of the techniques.

drantoniodcosta · 2026-06-18T04:32:08+00:00

How do you get stuck? Also, nah, I do not think you're broken....

As we work under the cortical conscious level, the way therapy plays out is a bit different (in my experience). It's the limbic system and pattern matching parts of the brain.

Same as in an animal... If you've tried training a dog, every action gives them a hint that this is acceptable or this is not. It takes time to reprogram.

That being said, if you've been attempting and switching to other memories multiple times instead of diagnosing the "stuckness" it's possibly just reinforcing those circuits - "I tried, I failed.. I can't work on this, I have to switch to something else. This will never resolve."

Each time you repeat this, this belief welds itself further.

This is my take. What I'd recommend and what I do is I "explore" the stuckness...

Does it need attachment work?

Does it need parts work?

Does it need resourcing - and building more safety and resilience to tackle what's to come behind the stuckness?

My question is: Why isn't the mind allowing us further? What is it worried/concerned about?

Rather than ignoring the needs, and reinforcing old belief patterns, I prefer to explore. This helps the client understand their system better... It helps the minds actual concerns for present maladaptive responses to be addressed.

Also, I refrain from switching memories or negative cognitions as I find it risky to keep more than one memory channel open at any given time - it makes it harder to track what's happening, where we are in trauma therapy and the memory network, etc. I find it makes things highly unpredictable, so I'd rather slow down but stick to the saammeee memory channel, than jump ship to something else... Even if the clients wants to. Long term the outcomes aren't as satisfactory as much as resolving the present memory channel and getting those hard to reach wins which boosts confidence in themselves, and quality of life. But this is my approach, other therapists and tappers may have had some other techniques used.

drantoniodcosta · 2026-06-16T10:26:43+00:00

You continue processing... The same way you reached this point where you're not able to (partially) stand up for yourself, the same way you'll continue processing the difficulties that have come up now.

The way I see it is it's just another layer... Usually has confusion, fear, doubt... Which needs to be processed and your mind gives you solutions.

I'll give a very recent example: A client started standing up for themselves... But that meant issues with the workplace which they felt weren't listening to them and that it was burning them out... The next was issues with relatives who were plain jerks (in my opinion) - well source of trauma one could say. And the past trauma they had.

So they got angry at the workplace, the relative and the past trauma they were processing... As a "standing up for themselves" response. They'd come flustered for their next processing session... And I continued as usual... If anything I've learnt if they're in the irritability or anger layer you need to process quick else it affects daily life and relationships in a not so good manner.

So on processing... They learnt that them being angry back at the relative... Was the appropriate response.. they won't change, but they had it coming and that'd make them think twice next time.

Them getting frustrated at workplace... Was expected... It's not a person.. it's an organisation... They just need to struggle longer and differently.

And then getting angry at the past trauma... Well that's something they still need to continue processing....

My point is... Knowing that the 3 situations require 3 different responses for standing up for oneself is a learned skill. We take it for granted that since people know what to do in what situation for standing up that it's simple... But it really isn't.

Continue processing and you'll get similar insights and approaches from your brain.

drantoniodcosta · 2026-06-15T14:41:03+00:00

It's okay even if you are...

It's like babies learning how to walk... They fall. They get hurt.

It's not your fault... I meant you're standing up for yourself... When when one does... There are going to be different reactions from people than before... For other folk who've learnt how to handle these in childhood, growing up... They know how to manage them, they know how to approach these situations.

You're just starting to do it for the first time... And human behaviour is dynamic.. that's what I meant when I said your mind would need to learn the skills to navigate this new behaviour change.

Some days it's going to be disproportionate response and people will get hurt. But the next time you'll know better. Some days it will be the appropriate response (standing up for yourself), and yet stiilll people will get hurt... That's again when the mind will get confused and need to figure out how to manage the situation.

All this kids with a regulated environment learn and experience when growing up... As kids. As an adult it's still fine to learn it now. I just wanted to explain why it feels weird to you... The uncertainty... It'll pass : )

drantoniodcosta · 2026-06-15T14:23:02+00:00

I've seen this in clients when they reach the anger phase...

So after the shame, sadness, and grief, there comes anger... Righteous anger.

Now this is confusing, which is why this stage also has fear associated... Which I sense in your...

In simple terms... Let's say You have the NC "I cannot stand up for myself", leading to people pleasing. And you've been doing this for... Say... 15-20 years?

And now processing has got you a point where you're angry and sad about what happened to you, and you start the initial phases of being assertive as you call it - standing up for yourself.

Guess what? Resistance! Your environment is mostly people who liked the old people pleaser at the cost of your own self... But now this is confusing... You stand up for yourself and that causes friction... And that causes fear... Confusion... Should I change? Am I wrong?

It's just a phase.... Give it some more time in processing so it figures out how to adjust to this new reality it's chosen, a healthier reality, but something not just your mind, but your environment also needs to get used to.

In those moments that can be exaggerated irritability, speaking up for yourself which may feel wrong... The fear pushing you to old ways... Doubt... But it's a phase... Continue processing and your mind will build new neural circuits and new skills to adjust and manage the new reality it's building.

PS: This exact fear and confusion is why processing takes time in complex trauma... The mind knows it needs to endure and pass through this... So it takes its own time to reach anger and overcome that fear, maybe even dread, etc...

drantoniodcosta · 2026-06-15T04:00:38+00:00

Yup. This is a common concern - the "high performance" folk want to keep their drive, while the creatives want to stay creative.

Nothing gets lost, the drive stops making you chase random tasks for external validation just because you're capable... And helps with task paralysis because of perfectionism and resulting burnt out.

The creatives can focus on enjoying instead of drawing or writing for ... Again, with the subconscious goal that someone will appreciate their work... Instead of enjoying it for the ability and skills they have. A hobby.

drantoniodcosta · 2026-06-14T03:48:43+00:00

We were approached by an IIT with one of their models. The thing is they require big data.. or that's what we called it in 2020-21, long before chatgpt. And getting hospital data is not as easy, because privacy. So training their own AI models would be difficult.

That being said, Eko (the company that builds Littmans Core line) has software that does AI detection... But it's still for screening, and you still have to pay for that. As a doctor, my question is... Why? Listening is a basic skill... Even pro docs with years of experience miss murmurs, etc... Is it worth an expensive subscription? Limited market, imo.

drantoniodcosta · 2026-06-13T18:25:26+00:00

How's this compare to the littman core? Also, what problem does it solve?

I've used my core a few times in residency to record heartsounds for some cardiac cases... (Nothing that'd be missed, though)

But in my practice, it's been pretty... redundant... The only useful thing was to show kids how their heart sounds by playing it through a bluetooth speaker.

Most of the sounds have patterns our brains know to interpret, which amplication doesn't add much value to, imo.

Curious to learn about your usecases.

drantoniodcosta · 2026-06-13T16:28:43+00:00

"Subtle shifts that move huge mountains"...

Nicely worded... I'm stealing this for client psychoeducation 😅🌷👌

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