What Makes Complex Trauma So Complex?

Old man holding hands to face in despair.Thankfully, health care providers have come to recognize and better understand psychological stress and trauma over the past few decades. While we used to reach for terms like shell shock, hysteria, and catatonia to describe mental health symptoms, we now have a more refined understanding of the nervous system and its window of tolerance. Nowadays, we are able to conceptualize more clearly how overwhelming experiences impact individuals and communities.

It is common to associate posttraumatic stress (PTSD) with veterans of wars or with people who have suffered through intense natural disasters. While those exposed to firsthand violence in this way are at high risk of experiencing PTSD, trauma is not always as cut-and-dried as we would like to think. Diagnostically, posttraumatic stress relates to an experience of threatened death or loss. However, it is the reaction less than the event itself that determines whether someone is experiencing posttraumatic stress, and PTSD symptoms can occur in a wide array of circumstances.

You may have heard the term “complex trauma” and wondered what, exactly, that means. Indeed, the terms complex trauma and developmental trauma are becoming more popular in the mental health community. These terms describe a phenomenon that mental health providers are seeing in people who have experienced more than one instance of traumatic experience.

Complex trauma occurs when multiple traumatic experiences occur over time, and it becomes difficult to differentiate the effect of one trauma from another. For example, someone who is born into a low-income family, lives in a violent neighborhood, and experiences physical abuse and loss during key stages of life may develop complex trauma, particularly if there are minimal supports available to cope with these challenges. Alternatively, an adult who experiences a natural disaster, is trapped in rubble, and loses family members can have a much more complex presentation than someone who experienced just one of these horrific challenges.

The first example of complex trauma above would also classify as developmental trauma. Developmental trauma is a term coined by Bessel van der Kolk. In addition to noting that this describes multiple instances of trauma, developmental trauma highlights the importance of these traumas occurring during key developmental stages of life. While a child who experiences multiple instances of violence, neglect, and/or abuse may have PTSD as a result of one or more of these experiences, it can also interfere with the child’s psychological, neurological, social, and emotional development.

Interestingly, mental health professionals often diagnose youth and adults who have experienced developmental trauma with disorders related to attention, mood, and attachment—all which may be accurate descriptors but do not capture the full context of the person’s trauma history and the relevance of his or her symptoms. In addition, symptoms of developmental trauma can impact educational and vocational development, and many people with complex trauma histories feel betrayed by systems that are meant to protect them. This poses an even greater challenge to receiving help.

If you or someone you love grew up in an environment where they were exposed to multiple experiences of trauma, therapy can help. Therapists who understand complex trauma often pull from a tool bag of interventions known to assist in resolving trauma, including hypnosis, eye movement desensitization and reprocessing (EMDR), neurofeedback, yoga, and more. Each of these can reduce symptoms related to trauma and increase the crucial coping skills needed to deal with stress and improve relationships.

If you are struggling with complex traumatic experiences, find a therapist who understands this evolving conceptualization of trauma and is committed to supporting you in your healing.

© Copyright 2014 GoodTherapy.org. All rights reserved. Permission to publish granted by Lisa Danylchuk, MEd, LMFT, E-RYT, therapist in Oakland, California

The preceding article was solely written by the author named above. Any views and opinions expressed are not necessarily shared by GoodTherapy.org. Questions or concerns about the preceding article can be directed to the author or posted as a comment below.

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  • Aaron

    Aaron

    December 8th, 2014 at 10:31 AM

    It is so immensely sad to me that in many individuals there has been so many traumatic and tragic events in their lives that it becomes next to impossible to differentiate one from the next.

  • john

    john

    November 2nd, 2016 at 6:53 PM

    hello I am John,,i was sexually abused from the age of 9 to 11 ….1 was a family member the other was a neighbor,,then my father beat the hell o ut of me,and told me when I was 13 he would kill me if I told about a affair he was having on my mother who was dying of cancer in 1997…I never told mom ,I did not even know what a affair was,,,Jan 20th 1986 mom passed in my arms ,I told her it was alright to go..she took me too a mental health doctor when I was 12 ,she saw things in me that needed attention,and never told a soul….the dr put me on meds and mom would give them too me everyday…I have had Mental Illness now for 40 years ,and yes it is very painful…so if I can help someone please let me know..i was in 6 mental hospitals,,tried too take my life twice and still on meds for major depression,complex ptsd,panic attacks,phycoiss …sorry if any missed spelled words,,,

  • Cass

    Cass

    November 26th, 2016 at 2:04 PM

    I am sorry John. I can’t say my experience is comparable, but I understand never knowing okay…. my mom died in my arms, but I was older. I have also been on meds forever. I’ve been targeted by abusers and my life consists of mostly just, hoping no one steals my money or my meds and being afraid and ashamed though not always clear on what, my whole life. Where is the hope in this? Maybe if we live long enough, there will be something invented to help. Therapy has been non magical, but it’s there, though I’ve been abused in that context in the past as well. Um, I’m waiting for a miracle, I guess.

  • Stef

    Stef

    December 8th, 2014 at 3:12 PM

    Even if the events do not control your life like some with PTSD have to live with, it is still important to discover ways that you can work through the things which may have had an adverse effect on you throughout your life. There are things that happen to us that we may have no clear idea how much they can change us until you begin working with someone who can help you get that out and reframe that experience so that something positive can be gained from it.

  • Morgan Campbell

    Morgan Campbell

    December 22nd, 2014 at 7:14 PM

    I am finally reached the other side of ptsd. I am free, lost most of symptoms and have met a wonderful male friend. we are working hard to change our thinking and old thinking.
    I am finally ready to live fully awake

  • Lisa

    Lisa

    December 8th, 2014 at 10:38 PM

    Aaron, I completely agree. There is so much avoidable trauma in the world, which is why I am such a proponent of healing practices – as one person heals, all those around them benefit.

  • Lisa

    Lisa

    December 8th, 2014 at 10:40 PM

    Stef, yes when trauma is concerned we call this posttraumatic growth, but it can happen in many areas of life that we learn from challenging experiences. It’s a helpful practice, to look and see what you have learned and gained from experiences in life. Thanks for your comment!

  • macy

    macy

    December 9th, 2014 at 3:45 AM

    Unfortunately there are those who have experienced all of these terrible things in their lives and yet they will never seek out treatment for that.

    They are wither never receiving the correct diagnosis or even more sadly many of them will simply think that this is what makes up life and that this is just how you have to live.

    I hope that someone out there will read this, will see that this does not have to be what they would classify as their version of normal, and that there is help out there for them.

  • Jinni

    Jinni

    July 10th, 2016 at 7:36 PM

    I believe that I deserve to be treated the way that I was treated. I was sold to men for 10 plus years, and that’s just the way it’s supposed to be. Sex is vial and disgusting. I’m disgusting, used trash that deserves to be used in any way imaginable. Drugged beyond belief, although it was better that way. Well sometimes it was, except when I’d wake up with some strange perverted weirdo on top of me…

  • Lisa Danylchuk

    Lisa Danylchuk

    July 15th, 2016 at 4:38 PM

    Jinni, I don’t think anyone deserves to be treated this way, and I am so sorry that you’ve had these experiences. I hope that you have or find some supportive people who recognize your worth. I believe we all deserve to feel loved in an appropriate way.

  • Imelda

    Imelda

    February 12th, 2017 at 7:47 AM

    May those men all die an awful death. You most certainly deserve none of it.

  • Jayden

    Jayden

    December 9th, 2014 at 10:46 AM

    What an emotional journey this has to be for anyone trying to unravel the complexities of all of this in their lives and somehow make some sense of how all of this cane to be and led you to where you are right now.
    I know that it will take the help of a very special person to help you unravel the threads of trauma in your life but it is certainly possible to do if you are committed to this change and work with anemone who is equally dedicated to helping you regain the life that you deserve.

  • Mike

    Mike

    December 9th, 2014 at 10:25 PM

    I came into therapy with symptoms of PTSD, but I didn’t remember a specific traumatic event. I now think that my earliest developmental period was traumatic due to my mother’s anxiety (I probably felt her anxiety like a separation from me and like an attack). Also, one of my coping mechanisms was, in a very early and primitive state, to develop cruelty toward myself. This cruelty was so extreme that it became traumatic in itself, living every moment from very early on with a monster inside of me who could torture me on a very primitive level. I also now understand that I am genetically prone to OCD and bipolar II, which means essentially that I have a high baseline of irritability and obsessiveness. These factors amplified the cruelty toward self. I have made a lot of progress as an adult toward resolving these things, but I have far to go.

  • Lisa

    Lisa

    December 9th, 2014 at 10:33 PM

    Macy I agree and hope that all those experiencing the effects of trauma find safety, comfort and support. A new normal is indeed possible for survivors.

  • Susan

    Susan

    December 9th, 2014 at 11:50 PM

    I have tried hypnosis (made it worse), Hakomi Method, EMDR and Somatic Experiencing. I found some improvement with EMDR, because it’s slow and gentle. However have found a lot of improvement in learning DBT skills (Dialectical Behavioral therapy) and Developmental Needs Meeting Strategy (DNMS) is on the docket.

  • Francine

    Francine

    December 16th, 2014 at 10:54 AM

    I guess that because we all have a different make up, it is weird how there are some of us who can endure what I would consider to be terrible things and still come off like nothing ever happened and then there are others of us for whom even small events can seriously harm and traumatize and they are left to cope with a lifetime of hardship as a result.

  • Lisa

    Lisa

    December 30th, 2014 at 9:46 AM

    Morgan, it is so wonderful to hear of your success! Congratulations to you and to all of the effort and attention you put into your healing.

  • Lisa

    Lisa

    December 30th, 2014 at 10:05 AM

    Francine, I agree. It is fascinating to understand what helps people be resilient in the face of trauma.

  • Lisa

    Lisa

    December 30th, 2014 at 10:07 AM

    Susan, I am so glad DBT has been helpful for you and that you are continuing to seek out what will help you most. Your tenacity and drive to heal will help move you forward.

  • Lisa

    Lisa

    December 30th, 2014 at 10:16 AM

    Jayden, Indeed it is emotional and healing is possible. I think many trauma therapists are special people and can facilitate great healing, and I hope that all those seeking support find it quickly and easily.

  • Lisa

    Lisa

    December 30th, 2014 at 10:17 AM

    Mike, It is clear you have developed an important level of insight and understanding and I wish you the best on your continued journey of healing and growth.

  • Phill R.

    Phill R.

    January 6th, 2015 at 10:58 PM

    I’m 41 and the first “traumatic” event I remember was my parents divorce when I was about 14. I feel that many other occurances (including a not so great marriage of 13 yrs.) has contributed to multiple traumatic experiences and the pile has become so deep I don’t know where to begin. To top it off, I don’t have insurance and just cannot afford therapy; especially to the extent that I feel I need at this point. Any suggestions would be greatly appreciated! Thank you!

  • Pauline R

    Pauline R

    February 19th, 2015 at 7:46 AM

    Lot of voluntary agencies charge what you can afford so work searching for voluntary counselling agency

  • wendy

    wendy

    March 30th, 2015 at 9:40 PM

    You could try Uniting Care Community. They provide free counselling.

  • Yolanda Harper, LCSW

    Yolanda Harper, LCSW

    May 24th, 2015 at 2:08 PM

    Hi Phill,

    Please look into Accelerated Resolution Therapy. It works very quickly and effectively to help resolve trauma in as quickly as 3-5 sessions, depending on the number of traumatic experiences. Best wishes!

  • Lisa

    Lisa

    January 7th, 2015 at 11:05 PM

    Hi Phil, I’d recommend looking for a reputable clinic in your area, either through an online search or by asking a local therapist for some recommendations for clinics or group therapy. There are also a few online therapy sites, so you may be able to find something there or go to a student clinic, which some schools have. I’d recommend persevering until you find something that works for you, so you can get support processing any residuals of the trauma and begin to feel better. I hope this helps, wishing you the best!

  • Joe

    Joe

    March 30th, 2015 at 8:35 PM

    I fall into the category of complex birth trauma and child abuse. I was born 2 months early after a fall from my mother and given last rights 3-4 times, in an incubator for 6 weeks then home to a depressed mother who neglected and abused me for 18 years. As an angry adult child of an alcoholic with 6 kids she created and controlled the family with the secret of abuse towards me from time I came home at 6 weeks. I survived emotional, mental and physical abuse at the hands of a mentally sick woman who hid her illness well.

  • Lisa

    Lisa

    March 31st, 2015 at 4:14 PM

    Joe, its clear you have a lot of resilience. I am sorry you had to endure that suffering and hope you have a lot of positive support in your life now.

  • Maureen

    Maureen

    April 1st, 2015 at 7:32 AM

    Thank you for your response to Joe. It is such a comfort to those of us with complex trauma when someone dearly gets how we are formed and the limits it can impose. I have resolved complex trauma having worked on it for 30 years beginning with ending a variety of addictins, clean and sober is a difficult walk with trauma but it can be achieved. I am 68 now have been in business for myself for 15 years and regularly face the elements of how I react/respond to life. I have no intimate support except my courageous child in me who longed for wholeness and we have it almost. I live each day in deep regard for life and enjoy it’s beauty. Many in my family chose suicide to end the pain and never got to experience freedom like I have so I am grateful thanks again for your commitment to us and this page.

  • Krystal

    Krystal

    February 14th, 2016 at 8:34 PM

    I’m struggling now. I don’t trust anyone. Meds just aren’t working any longer. I hate being that patient who always complains. I know what I’ll be told to do. I’ll fall again.

  • Lisa

    Lisa

    February 25th, 2016 at 1:44 PM

    Krystal. It can be very overwhelming, I hope you have found some support. Look for anyone you can talk to to find some emotional support – know that there are people who want to and can help.

  • moriah

    moriah

    March 30th, 2016 at 7:01 PM

    I appreciate this article for focusing on developmental trauma which is a key distinction but then in the last paragraph suggests things like ” hypnosis, eye movement desensitization and reprocessing (EMDR), neurofeedback, yoga”. Those are find for symptoms of PTSD NOT OF developmental issues which are not addressed in any way or any therapy that I have heard of except on a minor level group therapy or in patient programs, the later not affordable for most. What is so vital to convey about developmental trauma in particular is the lack of help, even palliative care/disability for those whose developmental damage interferes with employment and other vital social activities.

  • Greg

    Greg

    November 1st, 2016 at 7:31 PM

    Having been molested as a preteen and teen and then experiencing over ten years of EMS and an additional 5 with the sheriff dept. I have been diagnosed with PTSD. I didn’t realize until reading this that they all compounded to make things worse.

  • moriah

    moriah

    November 2nd, 2016 at 8:34 AM

    Sorry you went through all that Greg. Wonderful that people like you who have been through exceptional hardships then go into helping fields and caregivers need care too and sometimes more than those in less emotionally demanding fields. I hope you join in the struggle to have better care and treatment and that you have some support that you use while you do so.
    I liken PTSD in general to a heart murmur or poorly healed fracture in that it can either go undetected or seem to have healed, be relatively benign but nonetheless leave one unsuspectingly vulnerable; and I have found also with age and lack of resources (high stress in general) it gets worse. However, when PTSD is acquired by repeated early abuse by those we know and who know us intimately so much gets driven deep into the intricate marrow of our psyches and not available to our conscious or are not visual memories available for therapies like EMDR; yet like the Shingles virus it is lurking and waits for increased vulnerability to strike. So many people give examples of living with PTSD, surviving and even thriving with it BUT they do not acknowledge that like any other malady there are exceptions and miracles (their stories go viral for that reason) and there are varying degrees of severity. Protective factors prior to trauma are also not taken into account – the ACE scale shows promise but is not in use much if at all for adult diagnosis, prognosis or care. Palliative care, such as the Housing First movement started by Dr. Sam Tsemberis is promising but not widely available. We and those who are tangentially affected, family and friends etc. must really fight if significant care is ever going to be available. In a very interesting TED Talk by a physician/researcher linked below, the time it takes for knowledge not only be discovered but accepted and applied can be excruciating long: “Randomized trials in the 1600s showed that putting limes aboard ships headed out for long voyages completely illuminated the 40% mortality from scurvy but it took 264 years for British government to mandate citrus be carried about ships.” tedxtalks.ted.com/video/The-surprisingly-dramatic-role

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