This is a follow up to another post I did entitled, What is trauma?

Complex trauma differs from shock trauma in a variety of ways. This brief post is intended to break down this distinction. Of course, by name, complex trauma is difficult to explain in a brief post. This post is intended as an entry point into understanding complex trauma.

Quick definition:

Complex trauma is an enduring emotional response to ongoing or repeated relational trauma.

Let’s break that down a bit further:

Response

Trauma is not only the event(s) that occur, but the way our bodies and minds involuntarily adapt in response to the event(s). Over time, those adaptations endure and begin to cause us further pain or distress. This mind/body response is typically what is addressed in therapy when (as opposed to the traumatic event(s) themselves).

Ongoing and/or repeated

With complex trauma, the traumatic events or circumstances are ongoing and/or repeated, sometimes with no clear beginning or end. Sometimes they are persistent, “everyday” themes that feel familiar. The individual events might not be traumatic on their own, but as a whole, they have a cumulative effect.

Relational

Complex trauma usually* describes trauma that happens within the context of a relationship. Oftentimes it is a relationship where we have no real control or agency, such as with our caregivers when we’re young. We rely on others for inner security and a sense of self, especially when we’re young. When our environment is harmful or our needs are consistently unmet, this has a profound impact on the way our identity is organized.

*There are subsets of complex trauma, such as intergenerational trauma or racial trauma, that do not exactly fit into this definition, as these occur on systemic levels in addition to individual, person-to-person levels.

What leads to complex trauma?

There are many subsets of complex trauma such as relational trauma, developmental trauma, cultural trauma, intergenerational trauma, and racial trauma. Below are some* examples of the types of experiences across our lifespan that can lead to complex trauma.

Growing up with caregivers who did not adequately recognize your needs
Growing up with caregivers who used rejection, shame, or abandonment
Growing up in a chaotic or unpredictable environment
Growing up with caregivers who were abusive, violent, or neglectful
Intimate partner violence, gender-based violence
Discrimination, systemic oppression, violation of human rights
Loss of a loved one or attachment figure, prolonged/complex grief
Bullying, violence, or repeated mistreatment

*This is a non-exhaustive list.

What the above experiences have in common is that they cut us off from our most basic human desires such as safety, dignity, choice, nurturance, connection, love and a sense of self. When these are forcibly taken from us or not given to us when we need them, we adapt by disconnecting from ourselves and our needs. These adaptations, “practiced and patterned” over long periods of time, can endure long after the threat is over and become symptoms of distress.

Complex trauma can occur when our basic needs are taken from us, intentionally violated, or withheld over a period of time.

*Complex trauma lives up to its name. Living with C-PTSD can often feel like being deeply entangled with the thoughts, emotions, sensations that arose from the adversity you went through.*

What does complex trauma look and feel like?

*Source: The Practical Guide for Healing Developmental Trauma by Laurence Heller and Brad Kammer (2022)*

The diagram above shows the broad categories of symptoms that are associated with these two different kinds of post-traumatic stress.

Complex trauma includes the same symptoms as PTSD, as well as additional symptoms from the three categories above. It is important to remember that regardless of the relative severity, duration, or frequency of the event or circumstances, these symptoms can arise. These symptoms are the result of our brains, minds, and bodies involuntarily adapting to any circumstances in which our sense of self, our sense of belonging, or our physical safety is repeatedly threatened.

Here is what the above symptoms mean in non-clinical terms:

Sense of threat: feeling unsettled or unsafe often, even when no clear danger is present
Avoidance: difficulty accessing or expressing painful internal experiences like emotions, beliefs, thoughts, and memories
Re-experiencing: feeling intense emotions or sensations associated with past memories; flashbacks or dreams that feel like you’re reliving past memories
Affect dysregulation: difficulty regulating emotions or reactions, sometimes dissociating to cope with emotional overwhelm
Negative self-concept: believing you are essentially bad, shameful, or worthless, having a harsh inner critic
Interpersonal disturbances: patterns that show up in relationships like difficulty experiencing trust, healthy conflict, intimacy, or agency around friends, relatives, partners, colleagues, etc.

Formal diagnosis is somewhat rare with complex trauma as it is a relatively new way of understanding how humans respond to adversity. It is not recognized in the DSM-V, the diagnostic manual that psychologists and psychiatrists use in many parts of the world, including North America. However, it is newly recognized in the ICD-11, which is a more widely used diagnostic tool in Europe and elsewhere.

Often, trained psychotherapists recognize these patterns in collaboration with their clients who share experiences and personal stories that fit with the framework of c-PTSD. Since these patterns emerge from our histories, each person’s experience will look and feel different. Some people may experience some of these symptoms, while others will experience all of them. There can be overlap with other mental health challenges like anxiety and depression as well.

It is possible to recover from complex trauma

I am trained in NARM (the Neuro-Affective Relational Model), one of the first treatment approaches designed specifically to treat complex trauma.

NARM is a comprehensive, neuroscientific approach that is focused on addressing how you feel now as a result of what you’ve been through, rather than re-experiencing your trauma. In a nutshell, NARM is about gently inquiring into the ways you have adapted to your life experiences, and reconnecting you with who you are underneath these patterns. The relationship between client and therapist provides an anchor of safety and connection for this process.

I find that there is an immense amount of hope for people who come to therapy to recover from complex trauma. It is not easy to do, but it is truly a beautiful and rare opportunity to re-establish connection with yourself and live more authentically.

I have dedicated my career to supporting those who are undoing patterns resulting from complex trauma. It is my honour to do this work and witness my clients move toward what feels preferred and authentic to them. If this is of interest, you can learn more about my approach here.

What is complex trauma?