What Is Complex Trauma?

Complex trauma (also known as chronic trauma or C-PTSD) refers to prolonged exposure to stressful or traumatic experiences. Where the trauma relates more to childhood, it may also be referred to as developmental trauma. Unlike singular traumatic events, such as a car accident or physical attack, which can cause PTSD (click here for more information),  complex trauma can result in enduring psychological, emotional and physical effects. These effects can often last years, decades or go on unresolved for a lifetime.  Some examples of complex trauma are:

• Prolonged or Repeated Trauma Exposure: Enduring traumatic experiences over an extended period, such as ongoing abuse, or experiencing multiple traumatic events in succession, such as natural disasters, accidents or community violence, can lead to complex trauma.
• Childhood Abuse or Neglect: Experiencing physical, emotional, or sexual abuse, as well as neglect, during childhood can have long-lasting effects on mental health and contribute to complex trauma.
• Interpersonal Trauma: Trauma inflicted by close relationships, such as intimate partner violence, betrayal or prolonged bullying, can lead to complex trauma due to the profound impact on one's sense of safety and trust.
• Attachment Disruptions: Early attachment disruptions or insecure attachments to caregivers can contribute to difficulties in regulating emotions and forming healthy relationships, increasing vulnerability to complex trauma.
• Chronic Stress: Chronic stressors such as poverty, discrimination, or chronic illness can compound the effects of trauma, increasing the risk of developing complex PTSD.
• Personality Factors: Certain personality traits or predispositions, such as high sensitivity or a history of mental health issues, may increase susceptibility to developing complex PTSD.
• Cultural and Societal Factors: Cultural beliefs, societal attitudes towards trauma and mental health and systemic inequalities can impact the experience and expression of trauma, influencing the development of complex PTSD. Generational trauma can also impact individuals and families, see my article about this here. 

Emotionally, individuals who have experienced complex trauma may exhibit symptoms similar to PTSD including anxiety, depression, emotional dysregulation and flashbacks. They may also struggle with an overwhelm of emotion and feelings of being “stuck in the past”. These symptoms can lead to feelings of anxiety, fear, sadness, guilt, shame, and anger, making it challenging to regulate their emotions and maintain a sense of emotional wellbeing, which can impact their confidence, self-esteem and their self-worth. 

Christine A. Courtois discusses the impact of trauma on the victim's sense of identity and self-perception, typically manifesting in detrimental forms such as self-loathing, diminished self-esteem, and self-confidence. Consequently, relationships and the individual's inner landscape, encompassing emotions, thoughts and perceptions, may evoke fear, despair, anger, or extreme disconnection, or result in numbed and dissociated responses.

Complex trauma can take a serious toll on the body, leading to chronic pain, fatigue, gastrointestinal issues, autoimmune disorders, diseases and cancers. The constant activation of the body's stress response system in response to ongoing trauma can disrupt immune function, hormonal balance, and overall physical health, contributing to a cycle of chronic illness and distress. Furthermore, the chronic holding of suppressed emotions can also result in ill health, which is most notably found in John. E. Sarno’s writings. For more information about chronic pain and ill health, click here.  

A study by Arnold & Fisch noted that complex trauma causes compromised attachment security, self-integrity and self-regulation. It is a threat not only to physical, but also to psychological survival - to the development of ourselves and the capacity to regulate emotions. 

Socially, complex trauma can reduce the quality of relationships, impact social functioning, and limit opportunities for growth and connection. Individuals who have experienced chronic trauma may struggle with trust, intimacy, and boundaries, leading to difficulties in forming and maintaining healthy relationships. The effects of chronic trauma can also manifest in disruptions to work or academic performance, financial instability, and social isolation or withdrawal.

As with PTSD, complex trauma has a variety of approaches to help heal, without the need for prescriptions or pharmaceutical intervention. As I state in my article about PTSD, we live in a society where we are instantly prescribed anti-depressants or turn to other substances or behaviours to numb or blunt the sensations (which do nothing to resolve the trauma), instead of teaching people skills to address such distressing, yet natural reactions. 

The approaches between complex PTSD and PTSD are largely similar, although the framework for healing is slightly different.  

However, firstly we must acknowledge the impact of the trauma from a place of kindness, self-acceptance and compassion. We must be patient too, as for some individuals, the trauma has had a more profound impact than thought. 

As Lundy Bancroft, author of Healing Trauma through Self-Parenting teaches “there is no shame in asking for help to heal. It is courageous to reach out and seek the support you need.” The only way to heal from the effects of PTSD is to acknowledge and embrace the trauma; the only road to recovery is through it. It is no secret that prolonged, unresolved trauma can manifest in behavioral and/ or substance addictions, such as drugs or alcohol, or result in chronic pain and ill health. 

A expert in the field of trauma, Bessel van der Kolk, talks about trauma-focused therapies which involve a “top-down” and “bottom-up” approach can significantly reduce the effects of PTSD and help an individual to overcome PTSD altogether. This is a neat way of being able to categorise the various approaches to trauma and healing. 

Top-Down Interventions are when the trauma is processed cognitively i.e. from the mind (top) down. This can include approaches such as: 

1. Education – informing a person how and why the trauma may have impacted them and about approaches that may work for them 
2. Mindfulness – cultivating self-awareness, empathy and being non-judgmental helps to heal trauma
3. Gratitude Journal – being grateful in the face of adversity can help to build resilience now and in the future 
4. CBT – allows us to develop more effective beliefs and resourcing behaviours (such as exercise, relaxation strategies)
5. Hypnotherapy – hypnosis and relaxation are an effective way to help alleviate PTSD symptoms 
6. Core beliefs – working through our own personal beliefs and how this affects us 
7. Parts work – working with the different parts of us and how they have been affected
8.  Talk therapy - talking about the trauma can help shift a person’s narrative and support them to work through the trauma being feeling and be-friending emotions. 

In her book, A Practical Guide to Complex PTSD, Arielle Schwartz notes “the burden of unexpressed emotions can leave you feeling heavy and weighted down, as if you have been carrying a heavy backpack for many years… feel your emotions and empty the backpack.”

Bottom-Up Interventions is when the trauma is processed from the body, or somatically, i.e. from the body (bottom) up. This can include: 

1. EMDR (Eye Movement Desensitisation and Reprocessing) helps process images, emotions, beliefs and body sensations associated with traumatic memories that seem to be stuck

2. Trauma release exercises can be great way to re-connect with our body and feel safe, whilst releasing trauma tension 

3. Somatic movement – such body scans & breathing exercises can also help in locating where trauma may be held and releasing it 

4. Yoga – helps to reduced physiological arousal and support the nervous system to feel more balanced and calmer 

Self-care practices such as relaxation techniques, regular exercise, and good lifestyle habits can play an important role in managing symptoms and promoting overall wellbeing. 

Peer support groups, community resources, and trauma-informed care environments can provide invaluable support and validation to individuals navigating the challenges of complex trauma. As Bessel van der Kolk says, “in the same way that people can drive each other mad, the company of people, and being understood by people, can also heal us.” It allows individuals to feel seen, heard and loved.  

By changing our current view of trauma, we can curate a culture of empathy, understanding, and acceptance, creating spaces where those impacted by trauma feel seen, heard, and empowered on their journey toward healing and recovery.

In conclusion, complex trauma requires comprehensive understanding and holistic approaches to treatment. By de-stigmatising trauma and adopting a healing mindset, we can work towards better health and wellbeing.