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Understanding and Healing Complex Trauma

When people talk about trauma, what often comes to mind is a single-event experience in which someone’s life or personal safety is at risk: a car accident, assault, natural disaster, or military combat. But what about when someone is exposed repeatedly, for years on end, to situations in which they feel unsafe? This can often result in what’s known as complex trauma: a condition that stems from a chronic pattern of traumatic stressors, typically occurring within relationships, often during childhood. Understanding this condition requires us to expand our idea of what trauma is. Instead of one single incident in which a person’s life or physical safety are threatened, it can be defined as anything a person experiences that overwhelms their resources to cope at that time in their life (Armstrong, 2019). 

Complex trauma, sometimes referred to as Complex Post-Traumatic Stress Disorder (C-PTSD), is a term used to describe this distinct form of trauma. It often emerges from childhood abuse or neglect, but can also result from adult experiences of repeated emotional, physical or sexual trauma, such as domestic violence, human trafficking, or long-term captivity. 

Complex trauma can be seen as the cumulative impact of these prolonged traumatic experiences, leading to a wide array of emotional, psychological, and physiological symptoms that often manifest in a chronic and pervasive manner. It is important to note that these experiences may not always lead to the development of C-PTSD, as individual responses to trauma can vary significantly. However, those who do experience C-PTSD often struggle with a complex interplay of symptoms and problems. Estimates of the prevalence of C-PTSD in the general population range from 1-8% (Maercker et al., 2022).

Track athlete with performance anxiety preparing to run at the starting line

Common Symptoms Associated with Complex Trauma

Complex trauma has been associated with a variety of difficult symptoms, including the following: 

Emotional dysregulation

One of the hallmark features of complex trauma is emotional dysregulation (i.e., difficulty managing emotions effectively). People with this condition may shift between intense feelings of fear, anger, sadness, loneliness and/or shame, get confused about why they experience such strong emotions at specific times, and have great difficulty preventing themselves from reacting in impulsive and problematic ways (e.g., lashing out at others, self-medicating with drugs or alcohol, etc.). 

Woman yelling due to trauma

Intrusive memories and flashbacks

Complex trauma can lead to the re-experiencing of traumatic events through intrusive memories and flashbacks. These distressing memories can pop into an individual’s mind seemingly out of nowhere, making it difficult to focus on the present.

Avoidance and numbing

Many individuals with complex trauma develop avoidance behaviors, as they seek to escape both physical and mental reminders of their traumatic experiences (e.g., avoiding the place(s) where this occurred, suppressing thoughts about the events, etc.). This avoidance can extend to a general numbing of emotions, leading to a feeling of detachment from oneself and others. In fact, people suffering from complex trauma may experience a specific form of emotional numbing known as “dissociation”, in which they detach from their emotions entirely as a way to avoid feeling the pain of their condition.

Impaired self-identity and self-esteem

Complex trauma can significantly impact an individual’s self-identity and self-esteem. It often leaves individuals with a profound sense of shame, guilt, and worthlessness, which can affect their ability to form a healthy sense of self and make positive life choices. 

Relationship difficulties

Prolonged exposure to trauma in interpersonal relationships can undermine an individual’s ability to form secure and trusting connections with others. This often results in difficulties in forming and maintaining healthy relationships.

Couple looking distressed due to trauma

Somatic symptoms

Complex trauma can lead to a range of physical symptoms, such as chronic pain, gastrointestinal issues, and other psychosomatic complaints such as fatigue and headaches. These physical symptoms can be both a manifestation of trauma and a means of coping with it, as they can serve as a distraction from emotional pain.

Woman suffering from stomach pain

Even more broad than these specific symptoms are the overarching difficulties people struggling with C-PTSD carry. Stephanie Foo, a journalist who has written about her own experience with C-PTSD, eloquently summarized the three Ps of complex trauma: personal, pervasive, and permanent. Personal in that someone believes they have caused all the problems they face; pervasive in that they believe their entire life is defined by their failings; and permanent in that they feel their pain will last forever (Foo, 2022).

Dr. Jacob Ham, a leading trauma therapist, explained that many of the problems associated with complex trauma arise from an impossible situation experienced by children who suffered from abuse or neglect. He suggests that as children, the natural way to deal with fear and other distressing emotions is to run to caregivers, but if parents are the ones hurting them it puts the child in a terrifying no-win scenario, where they want to run from those who are causing them harm or distress, but their body instinctively tells them to go find them. He adds that this type of relational trauma is “an act of violence against connection – against feeling human, against feeling like you deserved to be loved, and that loving is a good and safe thing” (Harris, 2022).

Treating Complex Trauma in Therapy

While complex trauma can be challenging to address, psychotherapy offers hope for recovery and healing. Several therapeutic approaches have proven effective in addressing the symptoms and problems associated with complex trauma, including Cognitive Behavioural Therapy (CBT). Most importantly, working with a trauma-informed therapist who has familiarity with the different concerns complex trauma can present and who understands how to tailor treatment to the specific concerns you experience is key.

Therapy patient smiles and looks positive during therapy session to heal trauma

Some components of therapy might include:

Psychoeducation

A trauma-informed therapist can help communicate to you why you experience the various symptoms and “stuck points” that you do. By sharing their knowledge of the neurobiology of trauma and common responses to complex trauma, a therapist can help normalize and validate feelings or behaviours that one is ashamed of. It can be liberating to move from a perspective of “there is something wrong with me” to “it makes sense that my body and mind would react this way.” A trauma-informed therapist can help explain how many symptoms are in fact adaptations to extremely difficult situations. From here, they can introduce alternative ways of coping with one’s history of trauma that help to free the individual from the sometimes problematic coping responses they have come to habitually rely on. 

Emotion regulation skills

Building the skills to tolerate, manage, and cope with strong and distressing emotions is an essential feature of therapy for complex trauma. The range of skills that can be learned are numerous and varied, but are ultimately intended to increase one’s capacity for experiencing difficult feelings, and responding to them in a way that serves the person well and improves mental health. Gaining a sense of mastery over one’s emotional reactions also has the pleasant side effect of increasing one’s confidence and self-respect. 

Emotional exploration and processing

Naturally, for people who have suffered through the experiences that can produce complex trauma, a wide range of feelings exist. These may include: grief for the happy or innocent childhood one was deprived of, anger that no one stepped in to protect them, profound hurt regarding how they were mistreated, and confusion regarding how to navigate relationships if some of the people involved in the trauma are still part of their lives. Therapy can represent a safe place to express, explore, and process the complicated emotional fallout of complex trauma. 

A healing relationship

Ultimately, what is routinely found to be the most important factor of any therapy is the quality of the relationship between therapist and client. It is especially important, within the context of treatment for complex trauma, for the therapeutic relationship to be one that emphasizes safety, empowerment, and collaboration. When this most essential therapeutic ingredient is in place, it creates a secure foundation for a person who has suffered complex trauma to show up as their authentic self, receive support, and begin to experiment with new ways of being with themselves, within their relationships, and within the broader world. 

Key Takeaways

Complex trauma is a difficult condition that arises from repeated exposure to traumatic experiences, particularly within the context of interpersonal relationships. Its impact on emotional, psychological, and physical well-being can be devastating. However, with appropriate therapeutic interventions such as Cognitive Behavioural Therapy (CBT), individuals can begin the journey of healing, recovery, and reclaiming their lives and mental health.

Ultimately, understanding and treating complex trauma is a multifaceted process that requires patience, compassion, and a commitment to the well-being of those affected by it. Connecting with a trauma-informed therapist can be a crucial first step in beginning the journey toward healing from this complicated and painful experience.

Dr Chris Parrish

Dr. Chris Edmondstone

Clinical Psychologist

Please note: this article is for informational purposes only, and is not intended as a substitute for therapy or advice from a qualified professional.