Unpacking Complex Trauma. What it looks like, How it Develops, and Ways to Heal.
How do you understand trauma? What does it look like, how does it happen, and what are the effects? Can you have trauma if you’ve never been in combat? What about if your family didn’t beat you, kept you fed, and sent you to college? Why can’t I sleep? Why can’t I rest easy in relationships- there’s always SOMETHING happening? Why can’t I ‘leave the past in the past’? These are all excellent questions, so let’s take some time to look at what trauma is based on its definition and symptoms. We’ll look at the differences between single-incident and complex trauma, then examine attachment trauma and how that plays out later in life.
Images of war, sexual violence, interpersonal strife abound in our cultural stories and our media. But do most people really understand the impact that trauma has, especially relationship-based trauma? The broad, deep psychological and physical effects have been widely accepted and documented by the medical and psychological community. We know much more now than we did when the condition of Post-Traumatic Stress Disorder was known as ‘shell shock,’ a syndrome that presented so consistently in soldiers of WWI that it finally procured a name. It should be noted that these clusters of symptoms existed and were documented long before WWI, but this is a convenient jumping off point. This recognition and the subsequent exploration of the condition calls for celebration, certainly. Today, we do not view the traumatized as weak, but as having another type of wound- an internal one whose effects are visible in biology, behavior, and relationships. Here, my aim is to bring light to the lesser known and more difficult to acknowledge phenomena of complex trauma and attachment trauma. We’ll examine what PTSD is, then what Complex PTSD is and how it develops, and finally steps to take to begin correcting it.
To begin with, not every unfortunate or unpleasant event in a person’s life will result in them experiencing trauma. Trauma results from a feeling of helplessness combined with a threat to one’s own or another’s life or well-being. We are creatures wired for action, for survival- this real inability to rescue ourselves results in the sensations and perceptions becoming stuck in the nervous system. The brain cannot properly digest this information. As a result, memory fragments become frozen in time, and they do not get processed into part of our coherent narrative of life. PTSD can evolve from a single incident, such as a car accident, a traumatic medical experience, a natural disaster, or a physical or sexual assault, among others. Symptoms of PTSD include:
Intrusive, unwanted memories of the event
Avoidance of reminders of the event
Attempts to numb, using distractions or substances
Nightmares
‘flashbacks’- being enveloped by the sense that the event is happening now, in real time
A sense of feeling distant from others
Feeling on edge, constantly alert (aka hypervigilance)
Difficulty managing emotion
Sleep disturbances
Dissociation (a feeling of not being in your body)
Typically, symptoms of PTSD show up within a year of the traumatic event. The specific constellation of symptoms is different for everyone- some people experience more avoidance than nightmares, some have more flashbacks than others, etc.
People who experience Complex PTSD present with all of the same symptoms as PTSD and then add a few more. Complex PTSD is likely to develop when
There are multiple instances of trauma
if the trauma happened at an early age
if trauma was inflicted by a trusted person
if you are or were required to see the person who caused the trauma on a regular basis
Complex PTSD (CPTSD) symptoms include all the above symptoms and add
difficulty managing relationships
emotional flashbacks- returning to the same emotional state without an obvious trigger
strong feelings of worthlessness or guilt
physical symptoms including chest and stomach pains, headaches
suicidal thoughts
feeling permanently damaged
feeling completely different from others or like no one can possibly understand you
feeling deeply angry and/or distrustful towards the world
loss of meaning making systems, like one’s faith or core beliefs
Trauma symptoms often make people feel as though they are out of control, that they are moral failures, and that no one (including themselves) could possibly understand them. Trauma symptoms and shame keep us separated from one another, isolated in bubbles of pain that feel like they will carry us forever. This is especially true in complex trauma, where the traumatic event was repeated over and over and/or by someone close to us. Although complex trauma is different from single event trauma, neither is more or less valid than the other. The effects on the nervous system and on our interpretation of events is the same. Frequently we tell ourselves that what we experienced ‘wasn’t that bad,’ excuse invalidation because ‘that’s just how they are,’ and attempt to minimize our own discomfort, either because it makes no sense to us or because it does not match what our perception of ‘valid’ trauma is.
In truth, trauma can occur after a single intense incident, multiple low intensity incidents, or both.
Additionally, CPTSD can result from attachment wounds. Early in life, humans depend on larger, more experienced caregivers to keep them fed, clothed, and away from any relevant saber-tooth tigers. Our attachment to these caregivers keeps us alive, and as we develop, helps us find our way in the world and in relationships. Attachment trauma develops when a caregiver does not regularly meet the child’s physical or emotional needs. This type of trauma plays out in relationships, as the very places where we are meant to feel safest- connection with others- become the cue that we are in danger. Remember, helplessness plus threat results in trauma- who is more helpless than a child? How terrifying is it when those closest to us fail to see us and take us into account?
PTSD and CPTSD strike at the core of us, directly at our sense of safety. CPTSD additionally corrupts our sense of self out trust in ourselves, our inherent worth, and the safety of our relationship. Our nervous systems are well developed to detect a threat and respond accordingly. People with trauma have highly specialized, well-trained nervous systems. To heal, the goal is to bring the nervous system to a point of regulation so that we can reconnect with others. So, where do we begin?
Treatment for CPTSD can include developing a safe relationship with a trauma-informed therapist. While you might not know what that feels like yet, it is absolutely possible to develop one. The therapist can help you to hold space to understand your triggers as well as learn skills to soothe your nervous system when it moves out of alignment. Being in a safe relationship has healing benefits in and of itself- it helps teach our nervous system what safety feels like so that it can be accessed when a threat is detected. Skills include grounding, breathwork, visualization, evaluating thought processes, and effective communication tactics. The main goal is to develop an internal sense of safety to help you move through the world, replacing the bubble of pain with a bubble of protection and self-efficacy.
A quick note: every human being is different, so everyone has a slightly different path to walk when it comes to their healing. The following is not meant to be a definitive treatment guide, but a beginning to the journey, with some potential stops highlighted along the way. If any of these either do not or have not worked for you, there are more options available. Some indicators that you are on the right track include
feeling safe in your body
practicing boundary setting
responding instead of reacting
there is emotional space between your current reality and your past
Several kinds of trauma focused therapy are available. Some practitioners focus intensely on one mode of treatment, others utilize several types. A few are listed below.
Prolonged Exposure- teaches relaxation techniques, then gradually introduces stressors in order to reduce and eventually eliminate the traumatic responses
Eye Movement Desensitization and Reprocessing (EMDR)- spends time ensuring that you have internal resources and then harnessing the way that your brain already processes and stores memories to reduce the pain associated with traumatic memories and repackage them in a more coherent format.
Dialectical Behavioral Therapy (DBT)- focuses on skill development, deliberately strengthening gaps in learning to help you respond to triggers, regulate yourself and communicate effectively.
Somatic Experiencing (SE)- explores what natural responses the body wants to complete in order to ‘unstick’ body-bound traumatic memories while helping to improve tolerance to distressing body sensations
Cognitive Processing Therapy (CPT)- challenges thoughts and beliefs about why the trauma occurred and the thoughts and beliefs you developed since
Internal Family Systems- Focuses on understanding the internal “parts” that have been wounded as a result of trauma in order to establish trust and harmony between the “parts” and one’s whole self.
There are so, so many people out there who want to help you. I hope this brief overview has helped you further understand your symptoms
Do you find that you resonate with much of the information presented about complex trauma? Are you curious about how else we might be able to help? While complex trauma can be difficult to understand and presents itself uniquely in each person there is hope for deep healing and repair. To find out more about our approach or to connect with a therapist that is right for you, contact us for a free phone consultation. Our team of Therapists are licensed, experienced, and specifically trained in treating attachment wounds, trauma, addiction, and relationships.
About the Author
Morgan Hanley is a Licensed Marriage and Family Therapist, Eye Movement Desensitization and Reprocessing Therapist (EMDR), and Couples therapist trained in Gottman Method, Level 2. Morgan works with clients to heal attachment wounds, family dynamics, and intimate relationships as each system relates to complex trauma responses.