Unlike a ‘single incident’ trauma complex trauma is cumulative, repeated, often intentional and extreme. Complex trauma in childhood often occurs in the context of severe disturbances in primary caregiving relationships. Unlike PTSD, it involves difficulties with attachment, brain development and developmental trauma. People with complex trauma experiences often carry multiple diagnoses without acknowledging the the underlying trauma. This can be pathologising and re-traumatising, as well as ineffective (Jennings, 2004; Fallot & Harris, 2009; Davidson, 1997).
Complex trauma, especially as a result of adverse childhood events, including abuse, impacts the developing brain structurally, functionally and chemically compromising the hormonal, endocrinal, immune and other systems of the body. Sustained traumatic stress is associated with chronic inflammation, disease, illness, hospitalisations, surgery and accidents.
Complex trauma affects the integration between the left and right brain processes, as well as top to bottom creating a disconnection between the body, mind and emotions. When fight- flight- freeze responses are activated in an ongoing way, arousal states increase and cognitive functions can be impaired. This includes impacts on thinking, concentration, focus and memory. Dissociation is also common especially from childhood trauma and abuse.
Children who are in an ongoing state of ‘hypervigilance’, ‘aroused by fear and anxiety’ can develop behavioural problems. Much ADHD, ODD, truancy, aggression is based in trauma and the coping strategies children, as well as adults adopt to mediate their distress can become behaviourally challenging. Substance abuse is a common mechanism for managing/numbing or avoiding painful feelings but there are many more. A trauma-informed lens helps to identify a person’s strengths, and honour their creativity and resilience in developing strategies which allowed them to survive. Understanding such ‘behaviours’ in the first step in working with traumatised people, and helping them to feel safe.
The capacity to self-soothe and manage big feelings (affect regulate) comes from living in safe environments with well attuned caregivers. Many survivors struggle to feel safe. Anxiety and depression are the most common outcomes of child abuse (Fergusson & Mullen 2007). Traumatised children and adults often have issues of impulsivity, passivity, compliance, hypervigilance, hyperarousal, startle response, numbness and shutdown.
Interpersonal trauma is an attachment trauma in which safe, respectful boundaries have been violated. People can then find it difficult to trust or can trust too easily. Many also have issues around intimacy, sexuality and identity, and this includes challenges with being a parent. Research shows that unresolved parental trauma increases the risk of transmission of relational problems to infants.
Other effects include those on learning, education and work, and challenges finding a sense of purpose and a meaningful role. Many survivors struggle to ‘survive’ and are unable to dream, have hopes and ambitions for the future. They may believe that people and life are not trustworthy or ‘just’ and that life is worth little. Making meaning of terrible experiences is a challenge and hallmark of healing.
These traumas often have serious impacts and cause a legacy of pain and suffering. Traumatised people are over-represented in mental health services, refuges, homelessness, gaol, substance abuse facilities. It is important however to remember that people can and do recover from trauma, even extreme early trauma. And that when parents have worked through their trauma, the children do better.
That there is hope and support available, even when it isn’t apparent to the survivor.