If you have experienced childhood trauma, you can speak with a Blue Knot Helpline trauma counsellor including for support and applications around national redress

1300 657 380
Monday - Sunday
between 9am - 5pm AEDT
or via email helpline@blueknot.org.au


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For support for Disability Royal Commission or general support contact our National Counselling & Referral Service

1800 421 468
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Blue Knot Foundation Blog

Check out our recent blog posts to stay up to date with our work, latest research and articles curated by the Blue Knot Foundation Marketing & Communications team. Should you have any suggestions or contributions please contact us via email: marketing@blueknot.org.au.


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Trauma is a state of high arousal in which severe threat or the perception of severe threat overwhelms a person's capacity to cope. It comprises a range of events, situations and contexts. These include natural disasters, accidents, betrayal in interpersonal relationships, and diverse forms of abuse.
There are differences between the main categories of trauma. Single incident trauma, commonly associated with Post Traumatic Stress Disorder (PTSD), relates to 'one off' events, while complex trauma is cumulative, underlying, and largely interpersonally generated (Shapiro 2010). As well as being more extensive in its effects (Courtois & Ford 2009), complex trauma is more frequent and prevalent (van der Kolk 2003), with complex trauma from childhood experiences being particularly damaging. Unresolved trauma, especially childhood (complex) trauma often has substantial impacts, on both mental and physical health (Banyard et al. 2009) into adult life.
The perception of extreme and overwhelming threat activates the physiological `survival' responses of 'fight-flight-freeze'. These innate, biologically programmed responses 'cannot be helped' as they are not thought about or reflected upon. Their trigger/s are often not clear. Recovery from trauma is not about `will power' or deciding to `move on'.
However it is important to remember that people can and do recover from even early childhood trauma, but that to do so, they need the right services and support (Siegel 2003).
Childhood Trauma And Health
Multiple systems of the body are interconnected. Trauma, particularly childhood trauma, disrupts the connections between the various systems of the body, and compromises a person's physical and psychological health as well as their daily functioning (Cozolino 2002). The greater the severity and duration of childhood trauma `the more severe are the psychological and physical health consequences' (Middleton 2012).
Overwhelming childhood experiences compromise the hormonal, endocrine immune and other body systems, but because chronic conditions evolve slowly these connections are often not recognised (Karr-Morse & Wiley 2012).
Children, like adults, develop coping strategies to protect them from being overwhelmed and help them manage the physiological and psychological effects of the dysregulated arousal, emotions and behaviour which occur with trauma. Such coping strategies are often creative and effective in the short to medium term, but risky and can damage health in the longer term.
The ground-breaking Adverse Childhood Experiences (ACE) Study (Felitti et al. 1998) established the relationship between childhood coping strategies and the development of the `symptoms' of impaired well-being and ill health later in life for unresolved underlying trauma. These findings have been repeatedly replicated in further research.
Childhood Trauma And Mental Health
Childhood (complex) trauma can seriously affect a person's ability to function, their sense of themselves, and their capacity to regulate arousal, emotions and behaviour. It impairs self-conception and cohesion, one's sense of meaning, and the capacity to relate to others (Howell & Itzkowitz 2016). Unlike PTSD, complex trauma disrupts a person's identity, severely adversely affecting a person's relationship to themselves, others and the world.
A history of childhood trauma is `[t]he single most significant predictor' of subsequent contact with the mental health system' (Middleton 2012). People who have complex trauma histories receive diverse psychiatric diagnoses because their trauma presents in many forms, with severe, wide-ranging and comorbid symptoms.
Comorbidity is the norm rather than the exception. Coexisting depression and anxiety are common, as is the diagnosis of personality disorder, particularly Borderline Personality Disorder. While not all childhood trauma leads to psychosis, and not all psychosis is trauma-related, greater insights into the vulnerability of the developing brain to stress are informing our understanding of psychopathology (Howell 2005).
Psychosis features poor reality-testing and inability to distinguish the internal from the external: `[i]t is exactly this distinction that trauma disrupts' (Howell 2005). Childhood trauma is a well-documented potential risk factor for psychosis (Aas et al. 2016; Szalavitz 2012). Presentations related to trauma, particularly around dissociation and dissociative disorders can also be confused with psychosis, including within the mental health system. (Spiegel et al. 2011).
Childhood Trauma And Physical Health
Overwhelming stress such as occurs with childhood trauma negatively impacts the hypothalamic-pituitary-adrenal (HPA) axis which controls a person's reaction to stress and trauma (Siegel 2012). Stress triggers the HPA axis, i.e. `the relationship between the hypothalamus (H), the pituitary gland (P) and the adrenal glands (A) that produces finely tuned chemical messages that connect the central nervous, endocrine and immune systems' (Karr-Morse & Wiley 2012).
Increased stress hormones lead to an elevated inflammatory/ immune response, which is associated with poor health outcomes and increasing cardiovascular, pulmonary and auto- immune disease (Shonkoff & Garner 2012). Chronically overstimulated immune responses can also cause the system to attack the organs, leading to autoimmune disease such as psoriasis and lupus. They can also `catalyse inflammation at various sites in the body', paving the way for conditions such as osteoarthritis, fibromyalgia and irritable bowel syndrome (Karr-Morse & Wiley 2012).
Other diseases linked to overproduction of cortisol include functional gastrointestinal disease, diabetes, anorexia nervosa, hyperthyroidism and Cushing's syndrome (KarrMorse & Wiley 2012). A number of publications substantiate the serious physical impairments associated with trauma in general and complex trauma in particular. For example, research shows that `[t]hose with complex childhood trauma have roughly double the rate of fibromyalgia, chronic fatigue, and disorders of musculoskeletal, digestive, circulatory, endocrine and immune systems' (Banyard et al. 2009).
Physical health issues such as cancer, diabetes, heart disease, and asthma are also highly correlated with early life stress (Karr-Morse & Wiley 2012). The Adverse Childhood Experiences Study replicates these findings, with changes in the ACE score, i.e. number of adverse childhood experience categories, establishing links between childhood experience and adult biomedical disease including liver disease, chronic obstructive pulmonary disease, coronary artery disease and autoimmune disease (Felitti & Anda 2010).
Trauma And Primary Care
Primary health care plays a critical role in health promotion, prevention, screening, early intervention and treatment. For these reasons, primary health care providers need to be able to intervene early and effectively with patients with a lived experience of trauma to promote better care and health and well-being outcomes.
Epidemiological data suggests that on a daily basis a significant proportion of patients attending general practices have trauma histories (Felitti & Anda 2010). Primary care practices work with patients who present with co-morbid mental health challenges, drug and alcohol issues, suicidality and self-harm, sexual health issues as well as cardiovascular disease, asthma, diabetes, obesity, and cancer. All of these challenges can be and often are associated with unresolved trauma in general, and childhood trauma, in particular. Yet primary health services do not routinely screen for trauma.
If people have not connected their distress and health problems to their prior trauma they can't share their concerns. Even patients who suspect their issues are trauma-related might not speak about them fearing a negative response to disclosing.
As many primary care personnel are not adequately equipped to respond effectively to patients who experience the impacts of trauma, they are unable to intervene in trauma-related problems and address the cumulative negative individual, community and systemic legacies.
The health, social and economic costs of unrecognised, untreated or inappropriately treated trauma are substantial. They not only impact the individual health and psychosocial burdens of survivors but also reverberate through families, friends, communities, and society at large. If people don't receive the right support their trauma not only undermines their psychological and physical health but also erodes their capacity for healthy relationships, educational opportunities, and ongoing work participation.
Lost productivity and direct costs also impact substantially on health, welfare and criminal justice budgets. Health budgets are stretched by repeated hospitalisations, crisis intervention, frequent use of services and medication, and the burden of chronic disease, compounded morbidity and premature mortality. The financial costs of not providing adult survivors of childhood trauma in Australia with the services they need are conservatively estimated at $9.1 billion annually (Kezelman et al. 2015).
Not only does trauma literacy highlight the burden of trauma-related disease, morbidity and mortality, but it also provides opportunities for enhanced treatment outcomes when practitioners and practice personnel work from a trauma-informed frame. We owe it to those with a lived experience of trauma to safely screen for, recognise, identify and appropriately address the needs of those affected.
Aas, M, Andreassen, OA, Aminoff, SR, Faerden, A, Romm, KL, Nesvag, R, Berg, AO, Simonsen, C, Agartz, I & Melle, I 2016,`A history of childhood trauma is associated with slower improvement rates: Findings from a one-year follow-up study of patients with a first-episode psychosis' BMC Psychiatry.
Banyard, VL, Edwards, VJ, Kendall-Tackett, K (eds) 2009, Trauma and physical health: Understanding the effects of extreme stress and of psychological harm, Routledge, London.
Courtois, C & Ford, J 2009, `Defining and understanding complex trauma and complex traumatic stress disorders', in Treating complex traumatic stress disorders, The Guilford Press, New York, pp. 13–30.
Cozolino, L 2002, The Neuroscience of Psychotherapy, Norton, New York, p. 270.
Felitti, VJ & Anda, RF 2010, `The relationship of adverse childhood experiences to adult medical disease, psychiatric disorders and sexual behaviour: implications for healthcare', Ch. 8 in Ruth, R, Vermetten, E & Pain, C (eds), The impact of early life trauma on health and disease: the hidden epidemic, Cambridge University Press, UK.
Felitti, V J, Anda, RF, Nordenberg, D, Williamson, DF, Spitz, AM, Edwards, V, Koss, MP, Marks, JS 1998, `Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults: The Adverse Childhood Experiences Study', American Journal of Preventive Medicine, 14 (4), pp.245–258.
Howell, E 2005, The dissociative mind, Routledge, New York.
Howell, E & Itzkowitz, S 2016, (eds), The dissociative mind in psychoanalysis, Routledge, New York, p. 37.
Karr-Morse, R & Wiley, MS (collaborator) 2012, Scared Sick: The role of childhood trauma in adult disease, Basic Books, New York.
Kezelman, C, Hossack, N, Stavropoulos, P, Burley, P 2015, The cost of unresolved trauma and abuse in adults in Australia, Adults Surviving Child Abuse & Pegasus Economics, Sydney.
Middleton, W 2012, `Foreword' to Kezelman, C & Stavropoulos, P, The Last Frontier: Practice guidelines for treatment of complex trauma and trauma informed care and service delivery, Adults Surviving Child Abuse, Sydney, p. x.
Shapiro, R 2010, The Trauma Treatment Handbook: Protocols across the spectrum, Norton, New York, p.11.
Shonkoff, J P & Garner, AS 2012 `The lifelong effects of early childhood adversity and toxic stress', American Academy of Pediatrics Vol, 129, Issue 1.
Siegel, DJ 2012, Pocket guide to interpersonal neurobiology, Norton, New York, A1–37.
Siegel, DJ 2003, `An interpersonal neurobiology of psychotherapy: The developing mind and the resolution of trauma', ch. 1 in Siegel DJ & Solomon, MT (eds), Healing trauma: Attachment, mind, body and brain. Norton, New York, pp. 1–56.
Spiegel, D, Loewenstein, RJ, Lewis-Fernandez, R, Sar, V, Simeon, D, Vermetten, E, Cardena, Dell, PF 2011, `Dissociative disorders in DSM-5', Depression and Anxiety 28: 824–852.
Szalavitz, M 2012, `How child abuse primes the brain for future mental illness', Time, 15 February.
van der Kolk, B 2003, `Posttraumatic Stress Disorder and the nature of trauma', in Siegel DJ & Solomon MT (eds), Healing trauma: Attachment, mind, body and brain, Norton, New York, p. 172.

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Across the country communities are acknowledging – as part of the national Blue Knot Week – the harm done to the one in four Australian adult survivors of complex childhood trauma. Feelings are being validated, stories shared and support networks strengthened.

Community support is vital. However, for survivors of childhood trauma to really move forward, there needs to be structural change.

There is an urgent necessity for the federal government and its state and territory counterparts to establish a National Centre of Excellence to respond to all childhood trauma. Not providing appropriate services to adult survivors of childhood trauma costs Australian governments an estimated minimum of $9.1 billion a year.  

The Centre would focus on the many Australians who have experienced childhood emotional, physical and sexual abuse as well as neglect – including those who have grown up with community or family violence or other adverse childhood experiences. Many of these traumas occurred outside of institutions – in the home, family and neighbourhood.

The Centre would deliver best-practice services informed by research, a national prevention strategy and a workforce development and training arm.

Prime Minister Scott Morrison’s announcement last week that the government would establish a National Centre of Excellence to raise awareness and understanding around the impacts of child sexual abuse was an important start. However, now the commitment needs to be broadened.

When Prime Minister Morrison and the Opposition Leader Bill Shorten apologised to the estimated 60,000 Australian victims of institutional child sexual abuse, it was an opportunity to honour our fellow Australians who were brutalised and betrayed while in the care of our institutions.

For many victims this recognition was profound and incredibly moving as they had spent decades in the wilderness of secrecy, silence and denial.

Both leaders also acknowledged the need for action.

The time for perpetrating a hierarchy of trauma and creating tiers of victims has passed. This is about our nation showing compassion and support and helping to turn shattered lives around.

Dr Cathy Kezelman AM, President of Blue Knot Foundation

Source: https://www.theherald.com.au/story/5736437/now-is-the-time-to-repair-shattered-lives/?cs=7597

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Spreading the Word The Blue Knot Foundation, Australia Shelley Hua Dr. Cathy Kezelman AM with The Hon. Justice Peter McClellan AM Welcom...

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Do we choose to become leaders? Or does leadership choose us?

These questions came strongly to mind in my recent talk with Dr Cathy Kezelman AM (pictured) about how we can help support the next generation of not-for-profit leaders in Australia.

I’ve had the privilege of knowing Cathy for over a decade, especially around efforts to build a national approach to child safety and wellbeing. Cathy is a medical practitioner, a mental health consumer advocate, and President of the Blue Knot Foundation National Centre of Excellence for Complex Trauma. Her many other leadership roles include membership of the NSW Mental Health Community Advisory Council.

Under her leadership, Blue Knot has grown from being a peer support organisation to a national centre of excellence that combines a prominent consumer voice with that of researchers and clinicians who advocate for socio-political trauma-informed change and informed responsiveness to complex trauma.

She has been a prominent voice in the media and author of a memoir that chronicles her own journey of recovery from child sexual abuse: Innocence Revisited: A Tale in Parts[i]. She was appointed a Member of the Order of Australia in 2015 for significant service to community health as a supporter and advocate for survivors of child abuse.
The long view

Cathy began by reflecting on the challenges of advocating on the issue of childhood trauma. She took a long-term view.

‘The challenge’, she said, ‘is to work around an issue that has a lot of stigma and is poorly understood but which has enormous prevalence and impact across society at all levels’.

‘In terms of measuring achievements, particularly over the last 5-10 years, the whole issue of complex trauma and childhood trauma and understanding of the long-term impacts of trauma and abuse have entered the public consciousness and is spoken about a lot more than previously’.

One of Cathy’s driving goals is ‘to build capacity across diverse services around trauma and to move from a place of judgement, fear and ignorance and punitive response to one which is trauma-informed and about acceptance, understanding and respect’.

‘There’s still a long way to go. We are seeing parallel processes around domestic and family violence and the Royal Commission into Institutional Responses to Child Sexual Abuse. All these previously hidden, highly-stigmatised areas are now on the map’.
Seeing others access what they need

I asked Cathy what sustained her as a leader. The answer lay deeply embedded in her personal story. She reflected on being sexually and emotionally abused as a child, about her long road to recovery, and about how her training as a GP did not prepare her.

‘The system,’ she said, ‘really had no idea what to do with me when I was unwell and dealing with my own history’. She talked about having been ‘in a relatively privileged position in that [she] could get help to regain health and get some sense of understanding’, but noted that that was not the position for many others.

Out of that experience arose her passion to change things so ‘others could access what they needed…and to see systemic changes [that moved] from a purely biomedical approach of symptoms, diagnosis and pathology, to one which understands what’s happened to a person’.
Building pressure for change

Cathy was clear that she didn’t choose to be a leader as if by some carefully designed plan. Rather, she said, ‘it was chosen for me by my circumstances and then I needed to acquire a whole lot of skills along the way’.

To take the lead, she had to learn how ‘the system’ worked, how to use its levers, ‘to understand why certain ways of doing things were entrenched’, to identify the steps that were needed for change, and how to take a collaborative approach of working with others to effect change.

‘You work on a shared language, a shared vision to get to a place where you have a different way of functioning. It’s iterative. We know the system is very piecemeal and you need a coordinated approach so you can build up a head of pressure.’

She also came to recognise that it would take time to achieve change – for example, in embedding trauma-informed principles across and within services for those affected by childhood trauma. These things would not happen overnight and ambitious goals had to be ‘chunked-down’ or reduced to be made realistic, manageable and achievable.
People of generosity and goodwill

Finally, I asked for Cathy’s advice to emerging or aspiring not-for-profit leaders.

‘Choose what inspires and drives you and, when it’s tough, remember your overarching agenda and values – keep the bottom line in mind’, she said.

And, with characteristic optimism, she concluded: ‘It is endlessly rewarding to get feedback from unexpected sources that you are getting traction. I never cease to be amazed by people’s generosity and goodwill despite the harm done to them.’
Final thought: pursuing intrinsic motivation

In his excellent book on leadership, Discover Your True North. Becoming an authentic leader, businessman and Harvard management professor Bill George reflected on how leaders can become side-tracked by failing to take on jobs that speak to their inner values and beliefs. He wrote:

Moving away from external validation of personal achievement isn’t easy. Achievement-oriented leaders grow so accustomed to successive accomplishments in their early years that it takes courage to pursue their intrinsic motivations. But, at some point, most leaders recognize they need to do what they love rather than achieving external acclaim.[ii]

My time with Cathy was a strong reminder of the variety of paths to becoming an authentic leader and the courage needed to follow an inner passion for a better world. Thanks Cathy.

Dr Brian Babington
18 October 2018

[i] Kezelman, Cathy 2009, Innocence Revisited: A Tale in Parts 2009, Jojo Publishing, Melbourne, Victoria.

[ii] George, Bill 2015, Discover Your True North. Becoming an authentic leader, John Wiley & Sons, Inc. New Jersey, p. 136.

Source article here: https://familiesaustralia.org.au/so-others-can-access-what-they-need-a-conversation-with-dr-cathy-kezelman/

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The National Redress Scheme to support people who were sexually abused as children while in the care of an institution starts on 1 July 2018 and will ...

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Many people within our community are living with the ongoing effects of past and present trauma and without the right support are left struggling with...

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This article is an abridged version of “International Spotlight: ISSTD Spotlight on Australia, written by Professor Warwick Middleton, ISSTD Imm...

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'Sesame Street' Characters Are Now Teaching Kids How To Cope With Trauma This powerful initiative launched by the creators of “Sesame Street,&r...

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This article is an abridged version of “Establishing a Trauma-Informed Lawyer-Client Relationship” written by Talia Kraemer and Eliza Patt...

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“Blue Knot Foundation has a key role to play in the building of community capacity in care provision to those who have experienced childhood abuse and trauma in any environment.”

NIALL MULLIGAN Manager, Lifeline Northern Rivers

“I think Blue Knot Foundation is a fantastic support organisation for people who have experienced childhood trauma/abuse, for their families/close friends and for professionals who would like to learn how to more effectively work with these people.”

Psychologist Melbourne

“It's such a beautiful thing that you are doing. Helping people to get through this.”


“It was only last September when I discovered the Blue Knot Foundation website and I will never forget the feeling of support and empathy that I received when I finally made the first phone call to Blue Knot Helpline, which was also the first time I had ever spoken about my abuse.”


"At last there is some sound education and empathetic support for individuals and partners impacted by such gross boundary violations.”


Contact Us

Phone: 02 8920 3611
Email: admin@blueknot.org.au
PO Box 597 Milsons Point NSW 1565
Hours: Mon-Fri, 9am-5pm AEDT

Blue Knot Helpline
Phone: 1300 657 380
Email: helpline@blueknot.org.au 
Hours: Mon-Sun, 9am-5pm AEDT

For media comment, please contact:
Dr Cathy Kezelman
+61 425 812 197
+61 2 8920 3611
or ckezelman@blueknot.org.au

For media enquiries, please contact: 
Julia Macerola
+61 422 337 332
or julia@fiftyacres.com