Exploring the Effects of Complex Trauma on Mental Health

Trauma impacts everyone. The knowledge that trauma impacts wellness has existed long before psychology was accepted as a field 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 Melanie 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:

“Traumatic events overwhelm an ordinary human adaptation to life and generally involve threat to life, or bodily integrity. 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” (Zepinic, 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 lifetime 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:

“Little compares to ghastly attachment injuries that painfully blast our psyches during critical and vulnerable moments. Injuries from childhood abuse and emotionally traumatizing relationships continue to haunt fundamental needs for many years, if not the remainder of our lives” (Murphy, 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.

​Christine 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” (Courtois, 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” (Tarocchi, 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” (Courtois, 2008). Hilary I. Lebow describes complex trauma as having “similar symptoms to PTSD, with additional adaptations that impact your personality or relational style” (LeBow, 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:

“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” (Wamser-Nanney, et al., 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” (Courtois, 2008).

A PTSD committee was authorized to conduct field 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 specified (DESNOS).” Now complex trauma falls under “unspecified trauma- and stressor-related disorder” in the DSM-5 and DSM-5TR (Lebow, 2022).

See Post-Traumatic Stress Disorder for more on the disorder

​​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. 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 (Courtois, 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” (Siegel, 2009).

Often children adopt maladaptive patterns to escape the emotional trauma of abuse. Childhood trauma is a common factor in personality and dissociative disorders.

​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​ (Janoff-Bulman, 2002).

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These primary and basic assumptions are robbed from children developing in recurring 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” (Zepinic, 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” (Murphy, 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” (Murphy, 2015a).

Complex childhood trauma invites these recurring 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.

Treatment for Complex Trauma

Victims of complex trauma often require a multifaceted treatment approach that addresses the wide-ranging effects of their experiences. Here are some of the treatment options available:

Psychotherapy (Talk Therapy)

This is the cornerstone of treatment for complex trauma. Therapists may use various modalities, including:

• Cognitive Behavioral Therapy (CBT): Helps patients understand the relationship between their thoughts, feelings, and behaviors and work towards changing negative patterns.
• Dialectical Behavior Therapy (DBT): Focuses on providing skills to manage painful emotions and decrease conflict in relationships.
• Eye Movement Desensitization and Reprocessing (EMDR): Aims to help patients process and integrate traumatic memories.
• Exposure Therapy: Encourages patients to face and gain control of fear by gradual exposure to trauma reminders.

Medication

While there is no specific medication for complex trauma, medications can be prescribed to alleviate symptoms such as depression, anxiety, and sleep disturbances.

Trauma-Focused Therapies

These are designed to address the specific symptoms of trauma, such as:

• Accelerated Experiential Dynamic Psychotherapy (AEDP): Utilizes the therapeutic relationship to help clients process emotional experiences.
• NeuroAffective Relational Model (NARM): NARM is a clinical therapeutic approach designed to address complex trauma and relational issues. It focuses on resolving early childhood attachment and developmental trauma to help individuals establish healthy relationships and self-regulation.
• Internal Family Systems (IFS): Focuses on healing the parts of the self that are wounded by trauma.
• Skills Training in Affect and Interpersonal Regulation + Modified Prolonged Exposure (STAIR/MPE): Combines skills training with exposure therapy to help patients regulate emotions and improve relationships.

Mind-Body Therapy

Psychologists and researchers designed mind-body therapy approaches to help individuals heal from trauma by integrating the mind and body in the treatment process. These therapies treat both psychological and physical manifestations with holistic healing. Here are some of the mind-body therapy approaches geared towards treating trauma:

• Somatic Experiencing: This approach focuses on the body’s role in psychological conditions, helping individuals release tension and trauma that may be physically stored in the body.
• Yoga: Trauma-sensitive yoga is tailored to individuals with trauma histories, emphasizing safety, mindfulness, and physical grounding.
• Meditation and Mindfulness: These practices help individuals become more aware of their present moment experiences, which can be beneficial in managing trauma-related symptoms.
• Biofeedback: This technique teaches individuals to control physiological functions such as heart rate and muscle tension, which can be altered due to trauma.
• Guided Imagery: This method uses mental images to help individuals relax and focus, potentially accessing and processing traumatic memories in a safe space.
• Massage: Therapeutic massage can help release physical tension and stress, which are often held in the body after traumatic experiences.
• Tai Chi and Qi Gong: These ancient Chinese practices involve slow, deliberate movements. Consequently, these exercises help improve mental and physical balance. Some research suggests that these practices help restore wellness disrupted by trauma.
• Dance/Movement Therapy: This therapy uses movement to help individuals connect with their emotions and release trauma-related energy from the body.
• Art, Music, and Theatre-Based Approaches: These creative therapies allow for expression and processing of trauma through artistic mediums.

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Each of these therapies offers a unique way to engage the body in the healing process, recognizing that trauma can deeply affect both the mind and the physical body. A therapist may use them independently or in conjunction with traditional talk therapies.

Integrative Approaches

An integrative approach that combines education, self-care, psychotherapy, and medication if necessary, can be beneficial.

See Integrative Therapy for more on these styles of treatment

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It’s important for individuals seeking treatment for complex trauma to work with healthcare providers who are experienced in treating trauma. They can tailor a treatment plan to the individual’s unique needs. Recovery from complex trauma is a gradual process that involves building trust, learning to regulate emotions, and developing coping strategies. With the right support and treatment, individuals can heal and lead fulfilling lives.

Associated Concepts

• Attachment Theory: This theory emphasizes the importance of a secure attachment between a child and caregiver. Complex trauma can disrupt this attachment, leading to difficulties in relationships and self-regulation.
• Intergenerational Transmission of Trauma: This refers to the process where the psychological and physiological effects of a traumatic experience are passed from one generation to the next.
• Trauma Resiliency Model: This is a therapeutic approach that focuses on building resilience and promoting healing in individuals who have experienced trauma. It emphasizes the natural and innate capacity of individuals to heal from trauma when provided with the right support and resources.
• Adverse Childhood Experiences (ACEs): This refers to childhood events that lead to cognitive struggles later in life.
• Self Psychology: This theory focuses on the development of the self and how traumatic disruptions can lead to a fragmented sense of self. A fragmented self is a symptom of complex trauma.
• Neurobiology of Trauma: Research in this area explores how prolonged exposure to stress and trauma affects the brain’s structure and function, particularly areas involved in emotion regulation, memory, and executive functioning.
• Traumagenic Dynamics Model: This model suggests that traumatic experiences can distort a person’s cognitive and emotional sense of self and the world, leading to changes in behavior, thoughts, and feelings directly related to the traumatic event.

A Few Words From Psychology Fanatic

In the journey of healing from complex trauma, it is essential to recognize that while the scars may linger, they do not define us. Each step towards recovery is a testament to resilience and strength, revealing our capacity for joy, connection, and intimacy despite past wounds. The path may be fraught with challenges as we navigate through the memories and emotions tied to our experiences. However, with the guidance of compassionate therapists who specialize in trauma-informed care, individuals can begin to reclaim their lives. These skilled professionals create safe spaces where survivors can explore their narratives without judgment—empowering them to transform pain into personal growth.

As we embrace this transformative process, let us remember that healing is not a linear journey but rather an evolving experience marked by self-discovery and newfound hope. Our brains remain adaptable throughout life; even in adulthood, there lies an incredible potential for renewal and change. By engaging in therapeutic practices such as cognitive behavioral therapy or EMDR—and fostering supportive relationships—we open ourselves up to healthier environments that nurture our emotional well-being.

Ultimately, we have within us the capacity to rewrite our stories and forge connections filled with love and understanding—a true testament to the human spirit’s unwavering ability to heal and thrive amidst adversity.

Last Update: January 29, 2026

References:

Courtois, C. (2008). Complex Trauma, Complex Reactions: Assessment and Treatment. Psychological Trauma: Theory, Research, Practice, and Policy, S(1), 86-100. DOI: 10.1037/1942-9681.S.1.86
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Lebow, Hilary, I. (2022). How Does the DSM-5 Define Trauma? PTSD and More. Psychcentral. Published: 5-26-2022. Accessed: 11-11-2022. Website: https://psychcentral.com/ptsd/dsm-5-trauma-ptsd-stress-related-disorders
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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. DOI: 10.1037/0022-006X.74.6.1055
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Murphy, T. Franklin (2013). Healing Attachment Trauma: Unlocking Healthy Connections. Psychology Fanatic. Published: 4-5-2013; Accessed: 11-11-2022. Website: https://psychologyfanatic.com/attachment-trauma/
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Murphy, T. Franklin (2015). How Adverse Childhood Experiences Shape Our Lives. Psychology Fanatic. Published: 8-19-2015; Accessed: 11-11-2022. Website: https://psychologyfanatic.com/childhood-trauma/
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Murphy, T. Franklin (2015a) Engulfment in Relationships: A Psychological Perspective. Psychology Fanatic. Published: 3-26-2015; Accessed: 11-12-2022. Website: https://psychologyfanatic.com/engulfment/
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Murphy, T. Franklin (2021). Attachment Injury: Navigating the Challenges of Trust and Healing. Psychology Fanatic. Published: 5-3-2022; Accessed: 11-11-2022. Website: https://psychologyfanatic.com/attachment-injury/
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Siegel, Daniel J. (2009). Mindsight: The New Science of Personal Transformation. Bantam. ISBN-10: 0553386395; APA Record: 2010-04183-000
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Tarocchi, A., Aschieri, F., Fantini, F., & Smith, J. (2013). Therapeutic Assessment of Complex Trauma. Clinical Case Studies, 12(3), 228-245. DOI: 10.1177/1534650113479442
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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. DOI: 10.1177/0886260518760019
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Zepinic, Vito (2016). The Dynamic therapy Model in Treating Complex Trauma Syndrome. Studies in Sociology of Science. DOI: 10.4236/psych.2017.813132
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Zepinic, Vito (2020). Suicidal Behaviour in Complex Trauma Syndrome. Mental Health & Human Resilience International Journal, DOI: 10.23880/mhrij-16000136 (PDF).
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