Complex Trauma

Trauma impacts everyone. The knowledge that trauma impacts wellness has existed long before psychology was accepted as a filed of study. Early explorations into “war neurosis” was conducted by notable figures such as Sigmund Freud and Alfred Adler. Later, other pioneers, such as John Bowlby, Mary Ainsworth, Margaret Mahler, and Melonie Klein focused research and treatment almost exclusively on children suffering from neglect and abuse. However, not all trauma is equal. Some environments expose children to multiple forms of abuse. In psychology we know refer to this as complex trauma.

Zepinic Vito, complex trauma specialist, explains that “traumatic events overwhelm an ordinary human adaptation to life and generally involve threat to life, or bodily integrity.” He continues, “a close personal encounter with severe violence, threat of death, confronts trauma victims with extremities of hopelessness, disconnection, terror, disempowerment, and evoke the response of inescapable catastrophe” (2020).

Childhood traumas include many of these elements. However, while the severity of a single incident may not match, the accumulating impact of abuse from a position of vulnerability may enhance the impact, leaving victims of extended abuse suffering with life time physical and psychological ailments stemming from abuse perpetrated by person relied upon for security.

Our childhoods significantly bless and curse future development, especially our ability to attach and relate. T. Franklin Murphy wrote that “little compares to ghastly attachment injuries that painfully blast our psyches during critical and vulnerable moments” (2013). Murphy explains that “injuries from childhood abuse and emotionally traumatizing relationships continue to haunt fundamental needs for many years, if not the remainder of our lives” (2013).

What is Complex Trauma?

In scientific research we may find complex trauma listed as Complex PTSD (CPTSD) or “disorders of extreme stress not otherwise specified” (DESNOS). For ease of reading, I will refer use the term complex trauma unless specifically referring to the differences between CPTSD or DESNOS.

​Cristine A. Courtois, PhD, a retired counseling psychologist, specializing in trauma psychology, describes complex trauma as “a type of trauma that occurs repeatedly and cumulatively, usual over a period of time and within specific relationships and contexts” (2008).

​Researchers Anna Tarocchi, and her colleagues explain that complex trauma “describes the unique psychological profile of survivors of repeated interpersonal trauma occurring in circumstances in which physical, psychological, maturational, environmental, or social constraints made escape impossible” (2013).

The prototype of complex trauma is child abuse, however, the current understanding has expanded to include “all forms of domestic violence and attachment trauma, occurring in the context of family and other intimate relationships” (2008).

Hilary I. Lebow describes complex trauma as having “similar symptoms to PTSD, with additional adaptations that impact your personality or relational style” (2022).

​Because complex trauma typically occurs during key stages of development, the disrupted and dangerous environment interferes with key developmental tasks associated with those particular time ages. They disruptions may appear as:

•     difficulty with self-concept or identity
•     challenges with emotional regulation
•     interpersonal difficulties

Development and History of Complex Trauma

​A large population of soldiers returning from the Vietnam war experienced adverse psychological reactions to the trauma. War neurosis needed diagnostic nomenclature to assist in treatment of this growing population of suffering veterans.

The diagnosis of posttraumatic stress disorder was first included in the the third version of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III) in 1980. The formal diagnostic model paved the way for research, opening up volumes of new data available to better understand the disorder.

​During the 1980’s, the psychological community began to push for a new classification to specifically designate psychological trauma (typically experienced in childhood) caused by repeated and intrusive interpersonal events at the hands of caregivers or intimate partners. Findings suggested that symptoms and treatment for these victims of abuse significantly differed from research conducted on war veterans with posttraumatic stress disorder.

While repeated and prolonged trauma shared many similar symptoms and characteristics of post traumatic stress disorder (PTSD), it also had many unique qualities to differentiate it from classic definitions of a PTSD diagnosis.

The flow of research uncovered significant differences between acute trauma and prolonged trauma. Successful diagnosis and treatment of of survivors of chronic and multiple traumas requires a different approach. Rachel Wamser-Nanney and her colleagues wrote that “there is a dose-response relationship between number of trauma exposures and symptoms, the negative affects of trauma may be amplified in the context of multiple traumas” (2021).

​DSM Diagnosis of Complex Trauma Disorder

Despite considerable pressure from the psychology community, complex trauma is not listed in DSM-V published in 2013 or DSM-V-TR published in 2022. However, complex trauma (C-PTSD) is found in the International Classification of Diseases, 11th revision (ICD-11), the diagnostic manual used outside North America, published in 2018 (Lebow, 2022).

After PTSD was included in DSM-III, researchers begun to notice patients diagnosed with Dissociative Disorders were “often related to reported histories of severe child abuse and neglect.” Researchers of child abuse and dissociative disorders also began to link both areas of research with “trauma and posttraumatic reactions” (Courtois, 2008).

While some obvious connection were discovered between PTSD and posttraumatic reactions to repeated and severe abuse, the two categories were not a perfect fit. There were some key differences in the post traumatic reactions.

The PTSD diagnoses was derived mostly from research conducted on adult male combatants exposed to war trauma. Individuals that experienced complex trauma in familiar environments at the hands of someone expected to protect them “suffered from a variety of psychological problems not included in the diagnosis of PTSD” (2008).

A PTSD committee was authorized to conduct filed trials for the inclusion of CPTSD in DSM-IV. While these field trials provided significant evidence of differences between complex trauma and war combatants, CPTSD was identified as a separate diagnosis. The research has led to changes, however, in both DSM-IV and DSM-V. In DSM-IV complex trauma fell under “disorders of extreme stress, not otherwise specific (DESNOS).” Now complex trauma falls under “unspecified trauma- and stressor-related disorder” in the DSM-5 and DSM-5TR (Lebow, 2022).

​​How Does Complex Trauma in Childhood Impact Future Wellness?

Complex trauma can severely disrupt normal development. When occurring in childhood, the abuse often spans across several key developmental periods, leading to leaded and alter developments. Research has found that victims of perpetual abuse often suffer from a healthy formation of a sense of self. A second common reaction to complex trauma, since it often occurs at the hands of a primary figure in the child’s life, is that the trauma impacts the child’s ability to form secure attachments later in life.

Healthy physical and mental development rely on environments that provide safety and stability. Toxic home environments that create fear, pain, and chaos interrupt young lives in a variety of ways.

Cristine Courtois includes the following list of common reactions to complex trauma: depression, anxiety, self, hatred, dissociation, substance abuse, self-destructive and risk-taking behaviors, revictimization, problems with interpersonal and intimate relationships (including parenting), medical and somatic concerns, and despair (2008).

The abuse actually disrupts normal development in the brain. Daniel Siegel, clinical professor of psychiatry at the UCLA School of Medicine and executive director of the Mindsight Institute explains that “childhood trauma and neglect have been found to impair the growth of the integrative fibers of the brain” (2009, location 3335).

​Healthy Sense of Self

​Ronnie Janoff-Bulman theorizes that most children learn to rely on three basic assumptions:

• The world is benevolent
• The world is meaningful
• The self is worthy​ (2010).

These primary and basic assumptions are robbed from children developing in reoccurring trauma. Their world is not benevolent and kind. It is harsh and chaotic. While PTSD often occurs as a result of these basic beliefs being shattered, abused children never have the opportunity to form these basic assumptions about life.

Repeated severe trauma from the hands of those we trust (child abuse, domestic violence) falls outside our normal range of comprehension. The psychic adaptations to assimilate fail, accommodations to such radical experiences comes at the expense of a healthy sense of self.

Vito Zepinic explains that these victims may develop “a sense of identity diffusion, fragility, feelings of self-discontinuity, with severe disruption in one’s psychological equilibrium and interpersonal relationships” (2016).

​​Complex Trauma and Attachment

​”After prolonged abuse, we burden the load by abandoning ourselves. The scars resurrect the past, searing our peace in the present. These painful remnants trigger emotions that wreak havoc in attempts at a new relationship. The past intrudes, destroying the security of acceptance needed to heal. Instead of enjoying the healing comfort of a safe relationship, internal insecurities erupt, signaling danger—driving away the healthy while inviting the exploiters” (Murphy, 2015).

Murphy also wrote “once gouged and bleeding, hopeful dreams of security are shattered against the bare walls of aloneness. Avoidance and numbing become welcome guests in these lonely halls” (2021). Relationships are a primary source of well-being. When complex trauma impacts our future ability to connect, the injury caused in the past continues to wreak havoc in our lives. The curse that keeps on cursing.

Belongingness

Relationships throughout our lives have a substantial impact on wellbeing. Abandonment in any form leaves scars. We have biological needs to belong. “Following traumatic abandonment, the injured partner may exhibit symptoms characteristic of posttraumatic stress disorder” (Makinen & Johnson. 2006, p. 1055).

Murphy wrote, “when needs are continually neglected, the biological motivational system is confused, the self becomes blurred, and psychological oddities intrude on normalcy. The sharp blade of emotional neglect punctures the soul, deeply wounding the lonely, even the most stable suffer in one-sided relationships; the expected security from attachment is missed and loneliness prevails. Neglectful relationships zap vitality, leaving an empty shell where a whole person once lived” (2015a).

Complex childhood trauma invites these reoccurring relationship hurts that retraumatize the victim. The lost stages of development interfere with the child’s later ability to attach as adults. Traumatized children often associate love with fear. They may fear abandonment so intensely that they become clingy, even to abusive partners. Or they may experience the opposite, frightened by attachment and commitment, continually running from the connections they desperately need to heal.

A Few Final Words From Psychology Fanatic

While complex trauma wounds are significant, they can heal. The scar may remain but life may discover joys and intimacy beyond our imagination. Usually a competent therapist, skilled in working with patients emerging from abusive pasts is necessary for healing.

Several therapy models have proven effective. Cognitive behavioral therapy, EMDR, and several others. While young brains are particularly vulnerable, adult brains have been found to retain plasticity, slowly adapting and evolving new and healthier environments.

References:

(2021). PTSD & CPTSD – What’s the difference and does it matter? EMDR Gateway. Published 11-2021. Accessed 11-11-2022.

(2022). Trauma During Childhood Triples the Risk of Suffering a Serious Mental Disorder in Adulthood. Neuroscience News. Published 11-4-2022. Accessed 11-11-2022.

Courtois, C. (2008). Complex Trauma, Complex Reactions: Assessment and Treatment. Psychological Trauma: Theory, Research, Practice, and Policy, S(1), 86-100.

Janoff-Bulman, R. (2010) Shattered Assumptions (Towards a New Psychology of Trauma). Free Press; Completely Updated ed. edition.

​Karr-Morse, R., Wiley, M. S. (2014). Ghosts from the Nursery: Tracing the Roots of Violence. Atlantic Monthly Press; 1st edition.

Lebow, Hilary, I. (2022). How Does the DSM-5 Define Trauma? PTSD and More. Psychcentral. Published 5-26-2022. Accessed 11-11-2022.

Makinen, J., & Johnson, S. (2006). Resolving Attachment Injuries in Couples Using Emotionally Focused Therapy: Steps Toward Forgiveness and Reconciliation. Journal of Consulting and Clinical Psychology, 74(6), 1055-1064.

Murphy, T. Franklin (2013). Attachment Trauma. Psychology Fanatic. Published 4-2013. Accessed 11-11-2022.

Murphy, T. Franklin (2015). Childhood Trauma. Psychology Fanatic. Published 8-2015. Accessed 11-11-2022.

Murphy, T. Franklin (2015a) Abandonment of Engulfment. Psychology Fanatic. Published 3-2015. Accessed 11-12-2022.

Murphy, T. Franklin (2021). Attachment Injuries. Psychology Fanatic. Published 5-3-2022. Accessed 11-11-2022.

Siegel, D. J. (2009). The Healing Power of Emotion: Affective Neuroscience, Development & Clinical Practice (Norton Series on Interpersonal Neurobiology). W. W. Norton & Company; Illustrated edition.

Tarocchi, A., Aschieri, F., Fantini, F., & Smith, J. (2013). Therapeutic Assessment of Complex Trauma. Clinical Case Studies, 12(3), 228-245.

Wamser-Nanney, R., Cherry, K., Campbell, C., & Trombetta, E. (2021). Racial Differences in Children’s Trauma Symptoms Following Complex Trauma Exposure. Journal of Interpersonal Violence, 36(5-6), 2498-2520.

Zepinic, Vito (2016). The Dynamic therapy Model in Treating Complex Trauma Syndrome. Studies in Sociology of Science.

Zepinic, Vito (2020). Suicidal Behaviour in Complex Trauma Syndrome. Mental Health & Human Resilience International Journal.

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