Complex Trauma, PTSD, Complex Posttraumatic Stress Disorder (C-PTSD or CPTSD), Disorders of Extreme Stress Not Otherwise Specified (DESNOS), Developmental Trauma, Attachment Trauma, Interpersonal Trauma, any Personality ‘Disorder’ – including Borderline Personality Disorder (BPD), Dissociative Disorders
The Many Faces of Complex Trauma
Complex trauma represents our structured or reactive organization of experience after ongoing or recurring interpersonal abuse/neglect. This directly influences our ability to self-regulate and stay present, and changes our beliefs about Self, Other, and World. With such a vast range of potential life strategies following every childhood experience, the confusing part – for those counseling and those seeking support – lies in identifying the underlying cause versus focus on individual symptoms. Complex trauma presents in more-obvious forms: suicidal ideation, dissociation, PTSD, relationship struggles and personality ‘disorders’. It also presents in less-obvious, more ‘benign’ forms, such as anxiety, depression, confusion, codependence, shame, addictions, and unwanted habits or patterns. And sometimes it presents in ways that initially seem unrelated: headaches, stomach pain, IBS, ADHD, cancer, weight loss or gain, hyper- or hypo-sexuality, sexual dysfunction, fear of abandonment, anger issues, failure to maintain work, hoarding, infidelity, isolation, lack of direction or purpose, derealization, depersonalization, a sense of continual crisis, complex or endless grieving, mood swings, panic attacks, fatalism, religious discontentment, caretaking, expectation of judgment, always questioning, inability to relax, inability to appreciate the present moment, or appreciation only in retrospect.
The language of mental health is constantly transitioning. Traumatology, in mental health, refers to the study and support of individuals exposed to traumatic (biopsychosocially overwhelming) events including…
- actual or perceived material, physical, or relational loss (including events such as: violence, criminal or familial abuse or benign/malignant neglect, hospitalization, bodily harm, sudden unemployment or loss of resources)
- actual or perceived loss of agency (physical, psychological, or relational events such as: major illness, abusive control or oppression, dependent/enmeshed parent, unpredictable dependent relationships such as a parent or caretaker with addiction or personality disorder)
Traumatic events prove particularly transforming when they are interpersonal, sudden, without support, without option of fight or flight, repeating/confirming negative beliefs developed from past trauma, or occurring to those that are genetically/generationally predisposed to stress reactivity.
The complexity of complex trauma
In adaptive response to experience, we sometimes split from parts of self or develop competing neural networks that create a sense of internal conflict. We choose sides in the conflict and polarize our own behavior. Those close to us might notice our behavioral patterns moving to extremes of rigidity or chaos. Even in counseling, when we learn to quiet and calm ourselves and begin our self-discovery, we notice that certain strategies or thought patterns trigger others, become confusingly entangled. This is where a knowledgeable and present therapist can help us identify and begin to differentiate our many ‘parts’, mediating between parts, honoring them, and bringing them closer to integration: internal cooperation and negotiation versus conflict and oppression.
How can complex trauma refer to such a wide range of psychological struggles?
The focus in this approach lies in transformation of underlying core beliefs. If you’re a cook or a chemist, consider the variety of recipes available from just a few basic ingredients. In work with complex trauma, we focus not on the recipe or on individual symptoms. We focus on adjusting the basic underlying ingredients. This affects the many strategies, perspectives, expectations, and habits that have built on that primary foundation. We focus on recognition, acceptance, honoring, and integration of all our conflicting internal ‘parts’, allowing release of long-held defenses, a greater sense of calm, increased ability to live in the present moment, and increased sense of Self and purpose.
When you’re born a light is switched on, a light which shines up through your life. As you get older the light still reaches you, sparkling as it comes up through your memories. And if you’re lucky as you travel forward through time, you’ll bring the whole of yourself along with you, gathering your skirts and leaving nothing behind, nothing to obscure the light. But if a Bad Thing happens part of you is seared into place, and trapped for ever at that time. The rest of you moves onward, dealing with all the todays and tomorrows, but something, some part of you, is left behind. That part blocks the light, colours the rest of your life, but worse than that, it’s alive. Trapped for ever at that moment, and alone in the dark, that part of you is still alive.
~ Michael Marshall Smith, Only Forward
How is complex trauma treated?
Studies have shown that therapy to be more effective than medications in the treatment of complex trauma/developmental trauma/childhood trauma (http://www.pnas.org/content/100/24/14293.full). The most effective therapies include mindful, body-based, schema-based (focused on beliefs formed in childhood) approaches. Hakomi Therapy includes all of these approaches.