Complex Trauma

This can start when trauma begins in childhood and is chronic and interpersonal (Cook et. al. 2003). This includes emotional abuse, physical abuse, sexual abuse, neglect and witnessing family violence. This can present for treatment when the client is an adult. Sometimes classical PTSD symptoms follow an event as an adult which occurs in an adult who is vulnerable due to childhood Complex Trauma.

In particular, a disruption in the caregiver–child relationship negatively impacts a secure attachment and a coherent and stable sense of self, leading to a general distrust of self and others (Lawson et al., 2013). Lacking a sense of self-integrity, these individuals view themselves as bad, deserving of mistreatment, and undeserving of acceptance and love (Courtois & Ford, 2013). Along with self-regulation problems, these individuals have significant problems interpersonally. As a result, they may seek validation from others and yet anticipate and even facilitate their own rejection, or they may avoid relationships altogether by self-imposed social isolation. As a result, many of these individuals experience lifelong difficulties related to self-regulation, relationships, psychological symptoms, addiction, self-injury, alterations in attention/consciousness, identity, and cognitive distortions (Courtois & Ford, 2013).

 Clients with these backgrounds present particular problems for therapists. They have an especially difficult time forming and maintaining a therapeutic relationship, which is both a goal of treatment and a necessary precondition for successfully addressing trauma-related issues (Cloitre, Stovall-McClough, Miranda, & Chemtob, 2004). Not surprising, they tend to struggle with attachment bonds.

 

 

Those suffering the consequences of Complex Trauma experience

Six clusters of symptoms (Roth et. al., 1997; Pelcovitz et al, 1997)

  • alterations in regulation of affect and impulses;
  • alterations in attention or consciousness;
  • alterations in self-perception;
  • alterations in relations with others;
  • somatisation;
  • alterations in systems of meaning (Pelcovitz at al, 1997)

Experiences in these areas may include: (Herman, 1997, 199-22; National Center for PTSD, 2007).

  • Changes in emotional regulation, including experiences such as persistent dysphoria, chronic suicidal preoccupation, self-injury, explosive or extremely inhibited anger (may alternate), and compulsive or extremely inhibited sexuality (may alternate).
  • Variations in consciousness, such as amnesia or improved recall for traumatic events, episodes of dissociation, depersonalisation/derealisation, and reliving experiences (either in the form of intrusive PTSD symptoms or in ruminative preoccupation).
  • Changes in self-perception, such as a sense of helplessness or paralysis of initiative, shame, guilt and self-blame, a sense of defilement or stigma, and a sense of being completely different from other human beings (may include a sense of specialness, utter aloneness, a belief that no other person can understand, or a feeling of nonhuman identity).
  • Varied changes in perception of the perpetrators, such as a preoccupation with the relationship with a perpetrator (including a preoccupation with revenge), an unrealistic attribution of total power to a perpetrator (though the individual’s assessment may be more realistic than the clinician’s), idealisation or paradoxical gratitude, a sense of a special or supernatural relationship with a perpetrator, and acceptance of a perpetrator’s belief system or rationalisations.
  • Alterations in relations with others, such as isolation and withdrawal, disruption in intimate relationships, a repeated search for a rescuer (may alternate with isolation and withdrawal), persistent distrust, and repeated failures of self-protection.
  • Changes in systems of meaning, such as a loss of sustaining faith and a sense of hopelessness and despair.

Those suffering from the consequences of complex trauma can also fulfil the diagnostic criteria for PTSD.

It has been suggested that treatment for complex PTSD should differ from treatment for PTSD by focusing on problems that cause more functional impairment than the PTSD symptoms. These problems include emotional dysregulation, dissociation, and interpersonal problems (Van Der Kolk, 2005).

Another route to Complex Trauma.

In some individuals Complex Trauma can develop in individuals who have not experienced trauma in childhood.

The fear system is not built for chronic activation. When this happens multiple systems become chronically dysfunctional. This is experienced as Complex Trauma.

The dysfunctional systems include

  • Physical/ biological
  • Mental/cognitive
  • Behavioural/rational
  • Social/environmental