Fact Sheet I – Trauma and Complex Trauma: An Overview

What is Trauma?

Trauma literally means “wound, injury, or shock.” A traumatic event is one that a person finds overwhelming. People differ in what they find traumatic. However, some events are so stressful that most people would find them traumatic.

In the past many people believed that only physical harm or danger caused trauma. We now know that emotionally stressful events can also cause trauma, particularly in the absence of caring supports.

Traumatic events can include:

  • Natural disasters such as earthquakes and floods;
  • War and conflict;
  • Being a victim of a crime (e.g. being raped, assaulted, held up or car-jacked);
  • Being involved in, or witnessing, a serious accident;
  • Being exposed to death, injury or violence through work or volunteer roles;
  • Being exposed to an unexpected tragic or stressful event (e.g. unexpected or violent death of a loved one; complicated or violent childbirth; enduring painful or degrading medical procedures);
  • Interpersonal violence or abuse; and
  • Serious lack of care, emotional connection, or neglect, particularly when a baby or young child, including prolonged separation from caregivers.
What is Complex Trauma?

‘Complex Trauma’ describes a particular type of trauma that goes beyond a one-time incident. It tends to:

  • be repeated or ongoing;
  • be difficult or impossible to escape from;
  • occur within a personal relationship;
  • begin in childhood, so that it affects a child’s development; and
  • be covered up, kept secret or denied.

Common causes of Complex Trauma are child abuse and domestic violence. However Complex Trauma is also seen among people who have survived imprisonment, torture or sex trafficking. Being a refugee or being exposed to long term conflict can also cause Complex Trauma.

The Differing Effects of Single Incident Trauma and Complex Trauma

Single incident and complex trauma may be similar in many ways, but there are some important differences. Complex Trauma has more wide-reaching effects. This is not just because people with Complex Trauma have had more episodes of trauma. There are a number of additional reasons why Complex Trauma results in more significant problems.

Firstly, single incident trauma such as accidents or natural disasters are more likely to be public events. Other people know about or share the trauma so there is more community acceptance. This can provide validation and reduces secrecy and shame.

Single incident events usually have a clear beginning and end. Once the event is over, survivors can reach a place of safety and may be able to seek help and recover. However, Complex Trauma is ongoing, or repeated frequently, so there is little time to recover. Complex Trauma often occurs in secrecy, so the person is unable, or afraid to talk about it and get help.

Also, in most cases, Complex Trauma begins in childhood or adolescence. Because the brain is still growing, ongoing trauma can cause changes in brain structure and functioning that can affect future development. Because survivors have had their development affected, they find it more challenging to cope with everyday life and relationships. Problems with healthy development leads to chronic difficulties with emotions, concentration and memory, and challenges in having stable and safe relationships.

In cases of Complex Trauma people are often harmed by someone in a position of power over them. Survivors usually feel that they have been unable to escape. This leads to chronic feelings of helplessness.

Complex Trauma often occurs within a relationship that is meant to be safe. This leaves the survivor feeling very confused. All humans have an innate need to attach to their caregivers and loved ones. When a caregiver is not safe this causes a big conflict between needing to connect and needing to be safe. This conflict is not something that people, particularly children, can solve by themselves. It can result in survivors doubting themselves and feeling unsafe when they grow close to people.

Secrecy and shame are common in child abuse, sexual assault and domestic violence. Survivors often blame themselves. They may doubt their reality and feel alone, as if they are the only person this has happened to. They may feel others can never understand them.

When abuse is long-term it can affect the survivor’s sense of self and identity. This means that Complex Trauma changes the way people think, feel and behave towards themselves. They sometimes believe that they are ‘bad’, ‘worthless’ or ‘broken’. These beliefs interfere with self-confidence and with relationships.

People who have had prolonged trauma, and could not escape physically, learn to use mental strategies to escape. As a result, people with Complex Trauma may experience problems with thinking and concentration, difficulties feeling ‘present’ as they go about life, lack of attention, dissociation; and problems with memory.

Trauma and Your Health

Ongoing trauma, or unresolved symptoms related to trauma, can affect your mental and physical health. The major symptoms of single incident trauma include flashbacks, avoiding thinking about the trauma, avoiding reminders of the trauma, physical and emotional numbness, and constantly looking out for danger. Survivors may also have significant depression, anxiety or sleep problems. They may cope by using drugs or alcohol. Both the trauma symptoms and the attempts to cope with them can cause further physical and mental problems.

The symptoms of Complex Trauma include all of the above symptoms. Despite this overlap people with Complex Trauma tend to have broader problems, or experience more severe problems than those with single-incident trauma.

For example, research shows that people who have experienced Complex Trauma are more likely to have a range of physical and mental health problems such as

  • Depression and anxiety;
  • Sleep problems;
  • Feeling suicidal and/or using self-harm to cope;
  • Unexplained body aches and pains, including migraines, stomach and digestion troubles and arthritis;
  • Type 2 Diabetes;
  • Sexual difficulties;
  • Low energy and fatigue;
  • Problems with relationships such as not wanting to be around others, difficulty trusting others;
  • Problems protecting oneself in an unhealthy or abusive relationship; and
  • Using drugs, tobacco, alcohol, or over and under-eating to cope with feelings. This also causes additional health problems.

In addition, because people with Complex Trauma have often had their development interrupted, they may have lost opportunities. They tend to have lower incomes, less education and more housing problems. This in turn negatively affects their health.

The good news is that a reduction in PSTD Symptoms also leads to reduced physical and mental health problems including better moods, better sleep, reduced risk of Type 2 diabetes, healthier blood pressure and fewer aches and pains.

Getting Therapy for Trauma

If you have experienced a trauma and do not feel the symptoms have reduced over several months, it is important to seek support. Trauma can be treated so you get relief from distressing symptoms.

  • For more information on different diagnoses, see Facts Sheet II: Post Traumatic Stress Disorders
  • For more information on therapy and finding a therapist see Facts Sheet V: Getting Treatment for Complex Trauma and Dissociation
References

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Carlson, E.B., & Dalenberg, C. (2000). A conceptual framework for the impact of traumatic experiences. Trauma, Violence, and Abuse, 1, 4-28.

Cloitre, M. (2015). The “one size fits all” approach to trauma treatment: Should we be satisfied?, European Journal of Psychotraumatology, 6:1, 27344, DOI: 10.3402/ejpt.v6.27344

Cloitre, M., Garvert, D.W., Brewin, C.R. Bryant, R.A. & Maercker, A. (2013). Evidence for proposed ICD-11 PTSD and complex PTSD: a latent profile analysis, European Journal of Psychotraumatology, 4:1, 20706, DOI: 10.3402/ejpt.v4i0.20706

Cloitre, M, Garvert, D.W, Weiss, B., Carlson, E.B. & Bryant, R.A. (2014) Distinguishing PTSD, Complex PTSD, and Borderline Personality Disorder: A latent class analysis, European Journal of Psychotraumatology, 5:1, 25097, DOI: 10.3402/ejpt.v5.25097

Courtois, C., (2014). It’s not you, it’s what happened to you. Telemachus Press, LLC.        

Courtois, C.A. & Ford J.D. (2013) Treatment of Complex Trauma: A Sequenced, Relationship-Based Approach, Guilford Press, New York, p 9 – 27

Elklit, A., Hyland, P. & Shevlin, M. (2014) Evidence of symptom profiles consistent with posttraumatic stress disorder and complex posttraumatic stress disorder in different trauma samples, European Journal of Psychotraumatology, 5:1, 24221, DOI: 10.3402/ejpt.v5.24221

Emily, J.O., Best, S.R., Lipsey, T.L., & Weiss, D.S. (2003). Predictors of posttraumatic stress disorder and symptoms in adults: A meta-analysis. Psychological Bulletin, 129, 52-73.

Foa, E.B., Zinbarg, R., & Rothbaum, B.O. (1992). Uncontrollability and unpredictability in post-traumatic stress disorder: An animal model. Psychological Bulletin, 112, 218-238.

Ozer, E.J., Best, S.R., Lipsey, T.L., & Weiss, D.S. (2003). Predictors of posttraumatic stress disorder and symptoms in adults: A meta-analysis. Psychological Bulletin, 129, 52-73.

Pacella, M.L., Hruska, B. & Delahanty, D.L. (2013) The physical health consequences of PTSD and PTSD symptoms: A meta-analytic review. Journal of Anxiety Disorders 27, 33–46

Pietrzak, R.H.,Goldstein, R.B., Southwick, S.M. & Grant, B.F (2012) Physical Health Conditions Associated with Posttraumatic Stress Disorder in U.S. Older Adults: Results from Wave 2 of the National Epidemiologic Survey on Alcohol and Related Conditions Journal of the American Geriatric Society, 60(2): 296–303. doi:10.1111/j.1532-5415.2011.03788.x.

Scherrer, J.F., Salas, J., Norman, S.B., Schnurr, P.P., Chard, K.M., Tuerk, P. … & Lustman, P.J. (2019). Association Between Clinically Meaningful Posttraumatic Stress Disorder Improvement and Risk of Type 2 Diabetes, JAMA Psychiatry. doi:10.1001/jamapsychiatry.2019.2096

Steele, K., Boon, S. & Van der Hart, O. (2017). Treating Trauma-Related Dissociation: A Practical Integrative Approach, WW Norton and Co, New York.

Waelde, L.C., Koopman, C., Rierdan, J., & Spiegel, D. (2001). Symptoms of Acute Stress Disorder and Posttraumatic Stress Disorder following exposure to disastrous flooding. Journal of Trauma and Dissociation, 2 (2), 37-52.

Yehuda, R. (2002). Posttraumatic stress disorder. New England Journal of Medicine, 346, 108-114.

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