What is Complex Trauma?
This text is about complex trauma, also known as developmental trauma or C-PTSD, it’s relational aspect and how it differers from the diagnosis of PTSD. I’ll also share a bit about my own process of healing and how I personally view it.
what is trauma anyway?
Depending on where you are in the world and who you ask, the definitions will vary. The view that I follow is the one that many of the world’s leading body-mind and trauma specialists have, which is that trauma is not in the event, but it’s what happens inside the body as a result, and if there wasn’t a caring empathetic other to help support us through it.
I particularly like the way Dr. Albert Wong describes trauma in this article here in Psychology Today saying, “Trauma impacts much more than just our thoughts and actions. Trauma is far-reaching and systemic—it cuts us to our bones. It can dissolve our sense of identity, diminish our capacity to locate ourselves accurately in time and space, inhibit our tolerance for interpersonal relatedness, disrupt the coherence of our experience, impair our capacity for emotional regulation, and so much more.Trauma impacts much more than just our prefrontal cortex or our behavioral activation system. It impacts our whole being—and it must be treated from a whole being perspective. Importantly, any legitimate trauma treatment must consider all of our being—the entirety of our body-mind—not just our thoughts and behaviors, alone… A tidal change in our zeitgeist is slowly emerging. The importance of the body—and the felt experience therein, once again, is starting to rise.”
Things that can cause trauma are big horrific events like war, accidents, natural disasters, operations, the death or loss of a loved one, assault, or sexual, physical and emotional abuse- it can be traumatic to go through it personally and we can also be impacted by trauma if it happens to someone we love.
The truth is we are all complex, multi-layered, living beings and since we are all different, trauma and its impacts will also vary and depend on many factors. Two people can live through the same catastrophe and be effected differenty, one will bounce back quckly, and the other may suffer debilitating symptoms. Why, you may be wondering? IT’s not just the event, but our nervous system’s internal reaction to it. When something is too much, too fast too soon, or too little too late, is another way that trauma is often described. This will drastically vary from individual to individual, and according to the CDC ( Center for Disease Control and Prevention from the US) here’s some added layers that might contribute: generational embodiment/ historical trauma, social conditions/local context, and adverse childhood experiences which lead to disrupted neurodevelopment and social, emotional & cognitive impairment to name a few).
Confusion of different names and diagnosis of trauma
PTSD was the first official diagnosis of trauma and came about from American war Veterans. Before that, it was thought that it was a kind of mental weakness and that it just something made up, the said “it’s all in your head”.
The diagnosis of PTSD ( post traumatic stress disorder) consists of 3 main symptom clusters: re-experiencing of the trauma (for example nightmares, flashbacks), avoidance of reminders of trauma-related stimuli (for example places that reminded the person of the event, talking about the experience) and hypervigilance (for example easy startle, excessive attention to potential threat). In the US, the DSM has since that first 1980 diagnosis expanded the symptom profile to include 20 symptoms, 4 clusters and dissociation. According to Cambridge, “One consequence of this expansion has been that the possible symptom combinations allow for 636 120 ways to be diagnosed with DSM-5 PTSD, leading to potential complications in assessment and treatment planning.”
In the US there have been efforts to make trauma less about symptoms and more about encompassing the totality of the pain and suffering of the human experience by creating new diagnosis like “developmental trauma” and complex post traumatic stress disorder (C-PTSD), but at least in the US its complicated because of how the DSM (Diagnostic and Statistical Manual of Mental Disorders) functions – if you don’t know what the problem is, follow the money and who is funding what, cough big Pharma cough.
Besides the diagnosis of PTSD since 2018, the eleventh revision of the IDC-11 ( International Statistical Classification of Diseases and Related Health Problems) that is used here in Europe where I live, has added a new diagnosis of C-PTSD (complex post traumatic stress disorder). Well actually it may seem new, but decades ago Judith Herman was talking about the impact of chronic relational power dynamics and trauma in her research and her 1992 book Trauma and Recovery. Herman worked with mostly child and women survivors of abuse and atrocities that were relational and chronic in nature, before her trauma was mostly a diagnosis reserved for male Veterans. In The British Journal of Psychiatry Marylène Cloitre explains, “a long history of clinical observation that individuals who experienced chronic, repeated and prolonged traumas, such as childhood sexual abuse or domestic violence, tended to experience more complex reactions extending beyond those typically observed in PTSD”.
According to the IDC-11 C-PTSD “ includes the three core elements of PTSD as well as three additional elements called disturbances in self-organisation that are pervasive and occur across various contexts: emotion regulation difficulties (for example problems calming down), negative self-concept (for example beliefs about self as worthless or a failure) and relationship difficulties (for example avoidance of relationships).”
Some examples of complex trauma (C-PTSD) could include:
• Childhood abuse or neglect
• Domestic violence/sexual assault
• Human trafficking
• War or political conflict
• Being chronically misgendered
Recognising this is a step forward, at least in Europe, however there is still a big elephant in the room. Mainly, these diagnosis are mostly focused on “getting rid of the symptoms”, not on looking at and understanding the whole person- are the symptoms the problem or is it important information and self-protective response? ANd if we were to go back to the ACEs pyramid for a moment and zoom out, we would see that besides the complex individual layer of experience and suffering there is also the collective sphere of the dominat culture that we live in. So again the question is, is trauma in the event(s), or is it in how our whole being (nervous system and perhaps even spirit) ADAPT post-traumatically to the event(s)? The below diagram illustrates this:
In the words of Judith Herman, “trauma is an affliction of the powerless. At the moment of trauma, the victim is rendered helpless by overwhelming force. When the force is that of nature, we speak of disasters. When the force is that of other human beings, we speak of atrocities.” Since complex trauma is relational, the recovery and healing is based in connection and empowerment, and recognises that a human system cannot be look at in isolation – like in systems theory, a conceptual framework based on the principle that the component parts of a system can best be understood in the context of the relationships with each other and with other systems, rather than in isolation – but rather as the way that same human system managed to adapt to life adversity.
This invites us to look at complex trauma from a wider perspective, perhaps also encompassing the systems of power abuse where the side with power over is hoarding and manipulating the side with power under, forcing them into a position of survival – like in the case of systemic oppression.
Some examples of systemic complex trauma (C-PTSD) could include:
- Systemic racism
- Systemic misogyny
Systemic transphobia/homophobia - White supremacy
- Capitalism
- Colonialism
- Over-policing
So the issue becomes, how are we to treat and resolve complex trauma in individuals when these abusive power structures are still in place? It’s complex and complicated, and requires things as changing policies and perspectives around individual rights and easing the means by which people can achieve safety, security, equality, equity, and dignity – which are the basic needs and rights of ALL HUMANS, not just some. We need social justice and equity for all because trauma is complex and also political.
The effects of complex trauma
On the right is a long list of complex trauma domains of impairment aka symptoms that in children that can go on way into adolescence and adulthood if not recognised.
Here I would like to introduce a strength-based reframe, how these symptoms perhaps aren’t a sign of brokenness or dis-ease, but a genius survival-driven adaptation.
So the invitation here is to go from “What’s wrong with you?” to “what happened to you”?According to complextrauma.org, “all of these difficulties can be viewed — partially or completely on a case by case basis — as adaptive strategies to survive overwhelming experiences and prepare for ongoing threat in a hostile world.”
What studies say
Besides the famous American ACEs study that showed the impact of survival stress on the development of the whole human system ( you can take the ACEs quiz here), there has been a lot of other reaserch documenting the severe impact of chronic relational trauma – especially in early development- through neuroscience, attachment studies and other clinical research all pointing to the fundamental changes in:
- the stress response
- brain development
- neurochemistry
- affect regulation
- adaptations in identity, behavior, and relationships linked to the individual’s attempts to survive, break free, and comprehend these traumatic encounters.
The more we understand how complex trauma works, the more obvious it may become how being exposed to this kind of chronic and ongoing trauma is linked to the individual creating survival adaptations – it makes sense, your body is protecting you.
In 2003 a conceptualisation of complex trauma was offered by The National Child Traumatic Stress Network in The White Paper by Dr. Joseph Spinazzola and colleagues ( you can view it here). They defined it as both the traumatic event(s) – especially in early development of the human system in context of early caregiving relationships- and the adaptations that happened because of the event(s), both immediate and long lasting.
The silver lining
Despite all the science and being embraced by internationally, the battle in America for complex trauma to be validated continues. It’s complexity and inability to fit in all the diagnostic boxes makes it “problematic”. Luckily here in Europe the complexity of complex PTSD has been embraced and is slowly becoming more known, understood and accepted.
So is complex trauma the event(s)? Or is it perhaps more complex, and the result of experiencing and adapting to this event(s)?
According to complextrauma.org the answer is simple, “the problem lies in this faulty insistence upon binary answers to a multidimensional problem. Complex trauma is the Brontosaurus in the basement. Closing one’s eyes and insisting that it is does not exist will not stop the cracks in the foundation of outdated medical and diagnostic paradigms from spreading.” What do you feel to be true for you?
Empowerment and Healing
For me personally this strength-based reframe and understanding of what complex trauma is and how it impacts our whole human system and it’s development was pivotal in my own healing journey.
For a long time I believed there was something wrong with me. Stemming from my childhood wounds that left me with a feeling of toxic shame and a feeling that “im broken, the many potential diagnosis, and the “brain disease” of addiction. It all really confirmed that I was the problem.
That’s what I heard in all the rehabs I sat in, the jail cells, the hospitals, and even NA and AA meeting that wanted me to identify with having a life threatening incurable illness. I believed it, it wasn’t difficult since I already felt poorly about myself, until I got diagnosed with a real life threatening illness.
Fining our I had thyroid cancer 7 years ago was both a dark night of my soul and a breakthrough moment in my 17 year healing journey. Even though I had already processed a lot of stuff, there was still a lot of shame, guilt and blame pointing at myself. I intrinsically felt this was an invitation to stop being so cruel to myself and instead, inviting some compassion, kindness and curiosity. THis is when I started educating myself and diving deep into my shadows, learning, feeling and experiencing all those things I forgot but my body remembered.
Understanding and having clarity around my story made me feel validated and seen, I wasn’t broken. Getting to know the science of complex trauma and how it impacts the nervous system made me feel empowered, that I wasn’t a victim but I could choose new ways of being and experiencing life. Seeing all the hurtful ways I treated myself and others, made sense as an adaptation to the pain and suffering I was feeling with internally and it helped me to start to let go of the toxic shame and hatred I had towards myself.
It was the next level of my healing – finding self love and self-forgiveness – and it wouldn’t be possible if I continued to only see the diagnosis, the brokenness, the addiction.
ANd it’s not about blaming anyone, it’s about understanding and validating my experience, and how all that trauma and pain I lived through was the reason I adapted in many maladaptive ways. This paradise shift was eye opening and I think it contributed in me being able to release a lot of the burden I was carrying and heal from cancer.
Today I am 6 years in remission and I’ve never felt more alive, happy and peaceful. I continue this healing process through different body mind and spirit modalities and therapies but one thing I am convinced of, starting to view my life through this trauma-informed, strength based lens not only helped me understand my self better and be kinder to myself and others, but it saved my life.
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