Post Traumatic Stress Disorder (PTSD) has become a well recognized and discussed mental health concern. PTSD is a psychological disorder caused by severe, life-threatening trauma such as witnessing a death or natural disaster. In today’s social and political climate, war-torn soldiers, refugees, and natural disaster survivors are continually being diagnosed with PTSD. This has spurred much research and inquiry into the identification and treatment of PTSD and trauma in general.
The traditional criteria that comprises the diagnosis of PTSD includes the intrusive re-experiencing of traumatic memories, emotional numbing and avoidance of reminders of the trauma, and hyperarousal, in addition to associated features such as depression and anxiety. Trauma researchers however began to see specific trauma symptoms that fell outside the usual PTSD presentation. This is when the identification and understanding of complex trauma began to emerge.
Complex trauma has now been identified as a type of trauma that occurs repeatedly and accumulatively, usually within the context of relationships. The defining feature of complex trauma is interpersonal victimization, whereas single PTSD is mainly impersonal—the result of a natural disaster or accident. Symptoms of complex trauma most often emerge from exposure to repetitive childhood physical, sexual, and/or psychological abuse, domestic violence, sex trafficking or slave trade, experiencing torture, and exposure to organized crime.
The criteria for complex trauma includes the core three symptoms of PTSD in conjunction with a range of self-regulatory disturbances. The latter, non-PTSD-specific symptoms include inability to control emotions, dissociation, difficulties with one’s sense of identity or body image, physical symptoms that can’t be explained medically, disturbed relationships, inability to trust others, being vulnerable to abuse or exploitation, and externalizing behaviors such as self-mutilation and substance abuse.
Complex trauma is most often seen in children and adults who experienced ongoing abuse as a child. The majority of abused or neglected children have difficulty developing a strong healthy attachment to a caregiver. Children who do not have healthy attachments have been shown to be more vulnerable to stress. They have trouble controlling and expressing emotions, and may react violently or inappropriately to situations. Lasting effects of a complex trauma history may lead to latter problems in romantic relationships, in friendships, and difficulties with emotional regulation and self-harming behaviors. Unfortunately, these difficulties often create future vulnerability to further abuse, exploitation, and self-harm.
Currently, the DSM-V does not have a diagnostic category for complex trauma. However, there is much research going into complex trauma and its treatment. John Briere Ph.D. has done years of research on complex trauma and he developed the Trauma Symptom Inventory II—an assessment for PTSD symptoms as well as non-PTSD-specific symptoms that are associated with childhood and adult interpersonal victimization (i.e. somatization, identity disturbance, insecure attachment styles, and emotional dysregulation). Further, there are also treatment protocols being developed and refined to uniquely treat complex trauma, such as Integrative Treatment of Complex Trauma (ITCT). It is important for clinicians to be aware of the defining characteristics of complex trauma and what research-supported treatments are available.