Learn / What Is Complex Trauma?: Causes, Signs, and Treatment
Complex trauma, sometimes called complex post-traumatic stress disorder (c-PTSD), is caused by prolonged exposure to traumatic events and has subsequent effects on psychosocial functioning and neurodevelopment. It differs from PTSD, which is typically associated with a singular traumatic event. Complex trauma accumulates over time with repeated activation of the stress response during sensitive developmental periods1, creating a web of emotional and psychological challenges.
Usually, but not always, complex trauma forms in childhood. Professionals defined adverse childhood experiences (ACEs) as a set of potentially traumatic events that can happen during childhood2 and are linked to negative long-term health and well-being. The more ACEs a child has, the more likely they are to develop complex trauma. ACEs can negatively impact education and job opportunities and are associated with chronic health problems, mental health disorders, and substance use problems.
However, complex trauma can form in any stage of life through various circumstances.
Complex trauma comes in many shapes and forms, as it can develop during any sensitive time period, especially for vulnerable populations.
Childhood abuse: Complex trauma often stems from childhood abuse or neglect, including physical, emotional, or sexual abuse. This abuse can be caused by family or caregivers, disrupting a child’s sense of safety, attachment, and self-worth.
Domestic violence: Long-term exposure to domestic violence, where one partner emotionally, physically, or sexually abuses the other, can lead to complex trauma. Children who witness domestic violence within their family may also experience this form of trauma.
War and conflict: People living in areas affected by ongoing conflict and violence can develop complex trauma. This includes combat trauma, displacement, and loss of loved ones.
Human trafficking: Victims of human trafficking, whether for sexual exploitation or forced labor, endure captivity, manipulation, and violence, contributing to complex trauma.
Institutionalized abuse: Incarceration in prisons or detention centers with violence, isolation, and harsh conditions can cause complex trauma. Additionally, people who have been involved in cults or religious sects that use manipulation and emotional abuse can experience this type of trauma.
Chronic medical trauma: People with chronic or life-threatening medical conditions who undergo multiple surgeries, treatments, or hospitalizations may experience complex trauma from the ongoing stress and pain associated with their illness.
Complex trauma can significantly impact psychological and emotional well-being. Often, it can mirror or result in the onset of other mental health conditions3 such as PTSD, eating disorders, and personality disorders like borderline personality disorder. People with complex trauma are also more likely to turn to drugs or alcohol4 to self-medicate and cope with emotional pain.
In addition to mental health disorder symptoms, someone with complex trauma can have self-regulatory disturbances3, which can manifest as difficulties in emotion regulation and impulsivity. Complex trauma patients may also experience intrusive thoughts and dissociation, which is a disconnection from one’s thoughts, feelings, or surroundings. Physically, it can cause insomnia, gastrointestinal issues, headaches, and cardiovascular problems from the prolonged stress5.
Long-term, complex trauma can greatly hinder a person’s ability to trust and form close relationships because a lack of safety leads to hypervigilance to potential threats. They may experience challenges developing healthy and secure attachment patterns. Someone with complex trauma may also have low self-esteem and intense shame or guilt.
Trauma-informed care6 is an all-encompassing approach to providing services and support that accounts for the unique experiences of people with complex trauma history. Healthcare professionals take patients’ past traumatic events into consideration when asking questions, creating a treatment plan, and executing therapies. It creates an environment that is sensitive to the needs of those who have experienced trauma and aims to promote trust and empowerment. This helps the patient feel safe and supported throughout their recovery.
Trauma-informed care aims to avoid retraumatization during recovery, which is key for complex trauma patients. To achieve this, healthcare providers will conduct an evaluation to screen for trauma history. Then, they can appropriately care for your needs though enforcing safety during treatment, avoiding triggering situations, and practicing crisis intervention. A cornerstone in treatment will also be trauma-informed therapy.
Trauma-informed care is based on several key principles7, as defined by The Center for Disease Control (CDC) and the Substance Abuse and Mental Health Services Administration (SAMHSA). Providers should strive to incorporate these ideas into their practices.
First, it emphasizes that trauma is prevalent, and many people seeking treatment have experienced trauma. This recognition helps create a non-judgmental environment for patients to share their experiences without retraumatization.
This approach emphasizes the importance of trustworthiness and transparency between patients and providers. It involves building trust through clear communication, consistency, and reliability.
Trauma-informed care is based on a holistic understanding of traumatic experiences. Physical, mental, and emotional well-being are interconnected, so it takes into account the patient’s unique strengths, needs, and cultural background.
Trauma-informed care highlights collaboration and empowerment by actively involving patients in the decision-making process and providing them with opportunities for autonomy. This approach helps to restore a sense of control that may have been lost due to trauma.
Recovering from complex trauma often requires talk therapy. These therapies allow you to practice emotional regulation and learn coping skills.
Trauma-focused cognitive-behavioral therapy (TF-CBT) is an evidence-based therapy designed to help patients process and manage the impact of trauma. It focuses on identifying and changing negative thought patterns and managing uncomfortable emotions. This approach often includes techniques like exposure therapy, cognitive restructuring, and stress management.
Eye Movement Desensitization and Reprocessing (EMDR) is a specialized therapy for trauma. It incorporates bilateral stimulation, such as rapid eye movements or taps, to help patients process and integrate traumatic experiences, reducing their emotional charge.
Many trauma-informed programs also integrate holistic and experiential therapies. Somatic experiencing emphasizes the mind-body connection in trauma and releases related physical tension and stress responses. You will also likely practice mindfulness techniques to develop greater self-awareness, emotional regulation, and stress reduction.
Complex trauma could potentially lead to personal growth and positive changes8, also called post-traumatic growth (PTG). You may even look at the positive consequences in parallel with the negative, as opposed to its own separate island.
PTG doesn’t deny the pain and challenges of complex trauma but acknowledges that growth can occur alongside suffering. Through professional and personal healing, you can discover a sunnier outlook on life, leading to increased resilience, confidence, and improved relationships. It’s a testament to your strength and the capacity for positive change, even in the aftermath of severe adversity.
So, how can you achieve PTG?—By making your healing a priority. Reach out for help from mental health professionals and trusted friends and family. Attend therapies that fit your needs, and openly communicate about your experiences. Work on developing healthy coping mechanisms for dealing with stress and emotional distress. And take time to do some deep self-reflection. Evaluate what’s truly important to you and your path to move forward by writing down recovery goals.
To find a trauma-informed provider, ask your primary care physician for referrals. They can guide you to a specialized professional or clinic that can address your specific needs. Look for professionals with relevant credentials and specializations, such as Licensed Clinical Social Workers (LCSWs), Psychologists (Ph.D. or Psy.D.), or Psychiatrists (MD). Additionally, check if they have certifications or training in trauma-focused therapies like eye movement therapy or trauma-focused cognitive-behavioral therapy.
After an evaluation, talk through your treatment options. Consider asking questions such as:
Peer support can allow you to share experiences, learn coping strategies, and connect with others who have faced similar challenges. CPTSD Community Safe Group9 offers private online support groups and resources to those in recovery. There may also be in person support groups in your area, and you can find those by asking your primary care physician.
For assistance finding a provider near you, call SAMHSA’s National Helpline at 1-800-662-HELP (4357)10, or text your zip code to 435748.
Alpay, E. H., & Çeli̇k, D. (2022). Complex post traumatic stress disorder: A review. Psikiyatride Güncel Yaklaşımlar, 14(4), 589–596. https://dergipark.org.tr/en/pub/pgy/issue/68249/1050659
Adverse childhood experiences(Aces). (2023, September 5). https://www.cdc.gov/violenceprevention/aces/index.html
Kletter, H., Matlow, R., Tanovic, S., & Carrion, V. (2021). Cue-centered therapy for youth experiencing posttraumatic symptoms. Current Treatment Options in Psychiatry, 8(3), 125–140. https://link.springer.com/article/10.1007/s40501-021-00241-3
Khoury, L., Tang, Y. L., Bradley, B., Cubells, J. F., & Ressler, K. J. (2010). Substance use, childhood traumatic experience, and Posttraumatic Stress Disorder in an urban civilian population. Depression and Anxiety, 27(12), 1077–1086. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3051362/
Stress effects on the body. (n.d.). Https://Www.Apa.Org. Retrieved November 1, 2023, from https://www.apa.org/topics/stress/body
MPH, M. T., MD. (2018, October 16). Trauma-informed care: What it is, and why it’s important. Harvard Health. https://www.health.harvard.edu/resources/trauma-informed-care-what-it-is-and-why-its-important-2018101613562
Infographic: 6 guiding principles to a trauma-informed approach | cdc. (2023, February 23). https://www.cdc.gov/orr/infographics/6_principles_trauma_info.htm
Dell’Osso, L., Lorenzi, P., Nardi, B., Carmassi, C., & Carpita, B. (n.d.). Post traumatic growth (Ptg) in the frame of traumatic experiences. Clinical Neuropsychiatry, 19(6), 390–393. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9807114/
Safe support groups | cptsdfoundation. Org. (n.d.). Retrieved October 19, 2023, from https://cptsdfoundation.org/safe-support-groups/
Samhsa’s national helpline. (2023, June 9). https://www.samhsa.gov/find-help/national-helpline
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