Article: The 4Fs: A Trauma Typology in Complex PTSD
Author: Pete Walker
My personal note: Another great article by Pete Walker and a follow up to the previous one (Complex PTSD And Emotional Flashbacks), explaining about the different types of reactions that sufferers display in the face of emotional flashbacks. I found this article to be very beneficial in giving me answers that I've searched for over a number of years and hopefully, others will find the same.
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 their recovery.
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. Untraumatized individuals also easily and appropriately access 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.
Those who are repetitively traumatized in childhood however, often learn to survive by over-relying on the use of one or two of the 4F Reponses. Fixation in any one 4F response not only delimits the ability to access all the others, but also severely impairs the individual's ability to relax into an undefended state, circumscribing him in a very narrow, impoverished experience of life. Over time a habitual 4F defense also "serves" to distract the individual from the accumulating unbearable feelings of her current alienation and unresolved past trauma.
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 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.
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.