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:
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:
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.
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