In cases involving complex trauma, treatment providers may find themselves exposed to some of the enigmatic and challenging cases they will face throughout their careers. Take, for example, cases of trauma that stem from early childhood; the resulting biopsychosocial problems, defenses, and maladaptive coping skills have been in place for many years and will be thoroughly engrained in a person’s system. Individuals with childhood trauma commonly present with blatantly negative views of self and others, as well as intense physiological and emotional distress, and feelings of anger, low self-esteem, distrust, shame, and self-loathing. Often, these individuals exist in survival mode, which becomes ingrained in their psyche, even when life becomes less perilous or strained. In addition, many of these individuals fluctuate between being flooded with intense emotions, to being completely detached and dissociated from them. To top it off, individuals with complex trauma histories often feel like outsiders, feel incredibly alone and misunderstood, and can’t seem to fit in with others (often leading to further abuse in adolescent years in the form of bullying).
According to the DSM-V, there are several events that may be defined as traumatic. These events may involve death or threat of death, interpersonal traumatization, and threats to the integrity of the self and personal development (APA, 2013). Complex trauma is often repeated, lending to the complexity of the trauma, which often exists in layers. In addition, complex trauma may be related to a person’s very identity, further resulting in damage to the sense of self, safety, and hope.
According to child psychiatrist Lenore Terr, two main types of children’s trauma exist (that also apply to adults). Type I, a single-incident trauma, occurs unexpectedly and out of the blue. Type II refers to repetitive trauma or ongoing abuse, neglect, and other interpersonal maltreatment, whether intentional or unintentional (Terr, 1991).
In considering the multitude of dynamics and symptoms that vary on a case by case basis when treating complex trauma, a starting point would be comprehending how the traumatic experiences drastically mold not only the individual’s lives, but their sense of self. Potential sequelae include, but are not limited to: extreme mood lability, social isolation, substance use and other addictions, impulsivity, high-risk behaviors, anger, self-injury, suicidality, social problems, dysfunctional relationships, dissociation, medical conditions, chronic low self-esteem, feelings of helplessness, hopelessness, conduct disorders, psychotic experiences, and psychosis. These symptoms may be categorized into alterations in: regulation of self, consciousness, self-perception, perception of the perpetrator, relationship to others, somatization, and systems of meaning.
Therapists treating complex trauma must be able to recognize and effectively treat a multitude of symptoms, particularly maladaptive approaches to emotions and reactions, emotional dysregulation, and loss of self-integrity. In spite of how overwhelming the complexities of trauma may seem, practitioners working with this population will likely discover an incredible resoluteness of spirit, sense of empathy, and innate strength in these most remarkable individuals who have found the inner fortitude to experience the unimaginable or intolerable.
