Understanding Complex Trauma
What Is Complex Trauma?
Pervasive and prolonged psychological consequences, rooted in experiencing chronic interpersonal and early life traumas.
What Is Complex Post-Traumatic Stress Disorder (CPTSD)?
Complex post-traumatic stress disorder (CPTSD) or complex PTSD is a mental health condition that can develop from complex trauma.
As noted by the U.S. Department of Veteran Affairs (VA), complex PTSD typically refers to long-lasting traumas that occurred in childhood and were perpetrated by a trusted person in your life.
Is Complex Trauma The Same As PTSD?
Complex trauma and post-traumatic stress disorder (PTSD) are related, but are not the same thing.
Typically, complex trauma stems from repeated interpersonal trauma in childhood. Whereas PTSD can include childhood trauma, but it can also develop from a singular traumatic event or traumatic experiences in adulthood. Moreover, the American Psychological Association (APA) notes in “When Trauma Becomes Complex” PTSD isn’t inherently prolonged, but rather either a single or string of events that has a start and end point in time.
What Is Complex Childhood Trauma?
Complex childhood trauma is when a child is exposed to multiple, repeated, or prolonged negative, adverse, or traumatic experiences during their most formative years of development.
Additionally, these events or experiences typically occur with caregivers who directly harm the child or who are unable to protect the child from harm.
Causes of Complex Trauma
What Causes Complex Trauma?
Complex trauma is caused by repeated or prolonged exposure to traumatic experiences and typically occurs within close relationships like caregivers, family members, or romantic partners.
What Types Of Traumatic Experiences Lead To Complex Trauma?
Listed below are types of traumatic experiences that can lead to complex trauma:
- Child abuse: physical or sexual abuse, emotional abuse, and physical or emotional neglect
- Exploitation, captivity, and human or sex trafficking
- Persistent domestic violence, community violence, racism, and discrimination
- Prolonged separation, abandonment, or war
How Do Childhood Trauma And Caregivers Contribute To Long-Term Effects?
The Annals of Medicine notes that childhood trauma and unstable caregivers lead to the dysregulation of the body’s stress response systems, which contributes to significant cognitive, emotional, and neurodevelopmental impairments.
These significant long-term effects on well-being occur because early childhood is one of the most important periods for development. During childhood, children are learning essential skills, like executive functioning, emotional regulation, memory, and social awareness, which are all important skills for lifelong mental and physical health.
- Listed below are some of the ways impairments of childhood trauma and unstable caregivers manifest:
- Low self-esteem and fragmented sense of self
- Emotional dysregulation, impulsivity, and risk-taking behaviors
- Hypervigilance, distrust, and chronic health issues
- Unhealthy relationship attachments and relationship conflict and dysfunction
Can Domestic Violence, Sexual Abuse, And Community Violence Lead To CPTSD?
Yes, domestic violence, sexual abuse, and community violence can lead to CPTSD due to their severe and prolonged psychological effects.
Examples Of Complex Trauma
What Is An Example Of Complex Trauma?
Being sexually abused by one or more family members in childhood is an example of complex trauma.
Sexual abuse in childhood is often a repeated harm, perpetrated by someone they’re supposed to trust, which leaves the child feeling betrayed and powerless, along with other long-lasting emotional and psychological effects.
How Does Interpersonal Trauma Develop Over Time?
Interpersonal trauma develops over time due to:
- Repeated and prolonged harm in close relationships
- Threatened or broken trust in close relationships
- Traumatic experiences occur at an early age
- Severity of the traumatic event or experiences
- Lack of supportive relationships
These factors contribute to psychological overwhelm, which disrupts your ability to effectively cope.
How Can Repeated Traumatic Events Affect Young People?
Repeated traumatic events can have long-term physical and psychological effects on young people, such as:
Loss of appetite, low energy, and chronic tension, aches, and pains
- Sudden mood swings and outbursts of anger or aggression
- Flashbacks, hypervigilance, dissociation, anxiety, or panic
- Regression and sleep issues like nightmares and insomnia
- Difficulty concentrating and communicating
Signs And Symptoms Of Complex Trauma
What Are The Signs And Symptoms Of Complex Trauma?
Some of the signs and symptoms of complex trauma include:
- Emotional dysregulation, interpersonal relationship problems, difficulty trusting others
- Negative sense of self, low self-esteem, feelings of shame and worthlessness
- Dissociation, lapses in memory, intrusive memories, and flashbacks
- Anxiety, avoidance behavior, and easily startled
- Emotional overwhelm, feeling numb or detached from yourself and your emotions
What Are The Symptoms Of CPTSD?
Symptoms of CPTSD can include:
- Flashbacks of the traumatic event, dissociation, and emotional numbness or detachment
- On alert for danger, emotional dysregulation, and more reactivity to anger and aggression
- Avoiding people, places, and situations that remind you of the trauma
- Impairment in forming and maintaining meaningful relationships
- Negative sense of self and frequent negative thoughts and feelings
- Somatic symptoms: chronic pain, headaches, upset stomach, fatigue, heart palpitations
How Does Complex Trauma Show Up In Daily Life?
Complex trauma shows up in your daily life as overwhelming emotions and reactions, disconnection, relationship difficulties, and sleep issues.
- Some of the things you may experience in your daily life include:
- Snapping at loved ones, shutting down when you want to connect, or difficulty trusting others
- Emotional outbursts of anger or sadness over small things
- Feeling overly calm in a crisis and always looking for danger when there’s no threat
- Unexplained body tension, stomach issues, headaches, and fatigue
- Always feeling like you’re overreacting, too sensitive, or broken
- Unexplained feelings of numbness, exhaustion, or disconnection from your body
How Do Flashbacks, Dissociation, And Self-Harm Present?
Listed below are some of the ways flashbacks, dissociation, and self-harm in complex trauma typically present:
- Self-harm: inflicting injuries like cutting to alleviate overwhelming emotions, distract from emotional pain, or express emotional pain that you can’t verbalize
- Flashbacks: re-experiencing intense emotions from the trauma and feeling on edge
- Dissociation: memory gaps of the traumatic event, feeling detached from your body and reality
Areas Of Life Affected By Complex Trauma
What Are The 7 Areas Affected By Complex Trauma?
The areas affected by complex trauma are relationship attachments, physical health, emotional regulation, cognitive functioning, behavioral regulation, sense of self, and social functioning.
How Does Complex Trauma Impact Sense Of Self And Identity?
Exposure to complex or interpersonal trauma disrupts the development and stability of sense of self and self-identity, which leads to diffusion and fragmentation instead of cohesion.
That diffusion and fragmentation of identity and sense of self come up as feelings of worthlessness and brokenness, disconnection from your emotions and experiences, emotional dysregulation, and relationship difficulties.
How Does It Affect Relationships With Loved Ones And Family Members?
Complex trauma disrupts your ability to form healthy attachments, develop emotional intimacy, trust, or communicate with family members and loved ones.
Additionally, difficulties regulating emotions also contribute to misunderstanding, resentment, and exhaustion that strains relationships because of intense mood swings.
How Does It Influence Mental Health And Overall Well-Being?
Complex trauma increases your vulnerability to mental health disorders like PTSD, complex PTSD, anxiety disorders, depression, and substance abuse, while impairing well-being through emotional dysregulation, chronic health conditions, and relationship difficulties.
Complex Trauma And Co-Occurring Conditions
What Mental Health Disorders Commonly Occur With Complex Trauma?
Mental health disorders and difficulties like PTSD, depression, anxiety disorders, borderline personality disorder (BPD), substance use, and dissociation commonly co-occur with complex trauma.
How Is Complex Trauma Linked To Borderline Personality Disorder?
Complex trauma or complex PTSD and borderline personality disorder are closely linked to each other because of shared childhood trauma development and overlapping symptoms.
Both trauma-related conditions are often rooted in prolonged and severe interpersonal trauma in childhood. Further, the overlapping symptoms between borderline personality disorder and complex PTSD include emotional dysregulation, dissociation, a distorted sense of self, and unstable relationships.
How Are Substance Use And Substance Abuse Connected To Trauma?
Exposure to trauma, especially for children and young people, increases their vulnerability to substance use and the development of substance abuse due to overwhelming emotional pain or distress.
The emotional pain of severe and prolonged trauma, like domestic violence, community violence, neglect, and emotional, physical, or sexual abuse, overwhelms your ability to cope. Thus, you may seek out substances to cope with those traumatic experiences.
Self-medicating with substance use temporarily alleviates distress, but substance use alters brain function and makes you more dependent on drugs or alcohol to feel better. Then that dependence turns into substance abuse as the substances exacerbate trauma symptoms and reinforce the need to use substances to function.
Diagnosis And Clinical Recognition
Is Complex Trauma In The DSM?
Complex PTSD or CPTSD is not formally recognized as a distinct diagnosis in the Diagnostic and Statistical Manual 5th Revision (DSM-5).
How Is CPTSD Defined In The ICD-11?
In the International Classification of Diseases 11th Revision (ICD-11), CPTSD is defined as a disorder that may develop after exposure to a traumatic event or series of traumatic events that are extremely threatening in nature.
Moreover, the ICD-11 notes that those threatening or horrific traumatic events are most commonly prolonged or repetitive events from which escape from the situation is dangerous or impossible. Thus, CPTSD is a disorder that includes symptoms of PTSD and disturbances in emotion regulation, self-identity, and relational impairment.
How Do Clinicians And Mental Health Professionals Diagnose Complex Trauma?
There is no specific test to diagnose CPTSD, so clinicians and mental health professionals utilize the DSM-5 criteria to confirm PTSD, and they also use the criteria from the ICD-11 to help diagnose CPTSD.
Additionally, during your assessment, a clinician or mental health professional will ask you about your current symptoms, medical history, mental health history, family history, and trauma history.
When Should You Seek Help From Psychiatry Or Health Care Providers?
Seek support in psychiatry or from a health care provider if you’re experiencing persistent trauma symptoms like flashbacks and dissociation that interfere with your work life, home life, and relationships.
dditionally, during your assessment, a clinician or mental health professional will ask you about your current symptoms, medical history, mental health history, family history, and trauma history.
How To Know If You Have Complex Trauma
How Do I Know If I Have Complex Trauma?
You may have complex trauma if you’ve experienced prolonged or repeated distressing events that have left you with long-lasting:
- Persistent emotional distress: anxiety, sadness, anger
- Emotional dysregulation: Feeling like you can’t control your emotions
- Relationship difficulties: unable to trust or relate to other people
- Feeling guilt, shame, worthless, broken, damaged, or unlovable
- Other types of trauma symptoms: flashbacks, nightmares, dissociation, hypervigilance, avoidance
What Patterns Or Symptoms Indicate You May Experience Complex Trauma?
Some common patterns or symptoms that can indicate complex trauma are always being on edge, on guard with others, intense and unpredictable emotions, negative self-beliefs, self-isolation, and somatic symptoms like chronic pain.
Treatment Options For Complex Trauma
How Is Complex Trauma Treated?
Complex PTSD can be treated with psychotherapy, trauma-informed interventions, and off-label FDA-approved medications like antidepressants.
What Evidence-Based Interventions Are Most Effective?
The most effective evidence-based interventions for complex trauma include cognitive-behavioral therapy (CBT) and eye movement desensitization and reprocessing (EMDR).
How Do Psychotherapy And Trauma-Informed Care Support Healing?
Psychotherapy and trauma-informed care provide a supportive environment where you can restore physical and emotional safety, build autonomy through the power of choice, and foster your sense of self-efficacy through collaboration to heal.
Listed below are some of the other ways psychotherapy and trauma-informed care supports healing:
- Building trust: a therapeutic relationship with clinicians, built on honesty and respect
- Peer support: build trust, connection, and community through shared experiences
- Empowerment: identifying and celebrating your individual strengths
- Responsive care that recognizes the intersection of cultural, historical, and gender biases
What Role Does Cognitive-Behavioral Therapy Play In Recovery?
CBT helps with effective reprocessing of traumatic experiences in a safe setting, changing negative thinking patterns and self-beliefs, improving emotional regulation, and building healthy coping mechanisms.
EMDR And Trauma Reprocessing
What Is Eye Movement Desensitization And Reprocessing (EMDR)?
EMDR is a trauma-informed intervention designed to help alleviate psychological and physical distress that’s rooted in memories of traumatic experiences.
How Does EMDR Help Reprocess Traumatic Experiences?
EMDR helps with reprocessing traumatic experiences by using bilateral stimulation as a mind-body tool to recall traumatic memories that are stuck in the body and to effectively store them as past memories.
Using side-to-side eye movements, auditory sounds, or tapping while recalling a traumatic event to not only support reprocessing but also to reduce the emotional distress of those memories.
How Long Does EMDR Take For Complex Trauma?
The duration of EMDR is dependent on several factors like the severity of the trauma, but for many with complex trauma, it can take twelve or more sessions over several months.
How To Heal From Complex Trauma
How To Heal From Complex Trauma?
Engage in psychotherapy and trauma-informed therapies, connect with others in group therapy and support groups, and practice self-care like deep breathing, journaling, and physical activity.
What Steps Support Long-Term Emotional Regulation And Stability?
Engaging in mindful practices like meditation, reframing negative thoughts, and building other healthy coping strategies like leaning on your support system.
How Can You Rebuild A Sense Of Safety And Reduce Vulnerability?
You can rebuild a sense of safety and reduce vulnerability by:
- Practice self-regulation with mindful meditation
- Reconnect to your body with grounding techniques
- Build supportive and trusting relationships with others
- Set small, realistic goals in your daily routine
Supporting Someone With Complex Trauma
How Can You Support A Loved One With Complex Trauma?
Some ways to support a loved one with complex trauma include:
- Educating yourself about complex PTSD
- Be a good listener and provide a safe setting without judgment
- Offer practical support like driving them to therapy appointments
- Respect their boundaries and spend quality time together
What Role Do Family Members Play In Healing?
Family members can play a crucial role in healing by providing emotional support and a safe environment, having open communication, helping set healthy boundaries, and strengthening bonds through shared activities.
How Can You Encourage Someone To Seek Professional Help?
Clearly express your concern and support, validate their feelings without judgment, share resources about therapy, offer to research clinicians, be patient, and respect the pace that works for them.
When To Seek Professional Help
When Should You Seek Help For Complex Trauma?
If you’re experiencing persistent overwhelming emotional distress that’s disrupting your relationships and ability to function at work or in your daily life.
How Can Mental Health Professionals And Clinicians Support Recovery?
You should expect our Alta Health outpatient mental health care program to provide compassionate, evidence-based care that meets you where you are with clinically proven therapies, interventions, practical skill-building, peer support, family involvement, and medication management without stepping away from your daily life.
FAQs
Yes, it can cause chronic pain and increase risk for chronic conditions like heart disease.
It’s more commonly associated with childhood.
Yes, it can significantly impair memory and your ability to concentrate.
Symptoms like emotional dysregulation and trust issues can contribute to unstable relationships.
Understanding complex trauma, complex PTSD, and your outpatient treatment options provides an invaluable foundation to help you make an informed decision about your well-being. If you or a loved one is struggling with overwhelming emotional distress, our Alta Health team can provide guidance and a supportive environment where you can restore emotional safety, rebuild trust, and foster resilience and stability in your daily life.