Complex Trauma: A Deep Dive and Personal Experience
Introduction
In my early 20s, I had an idea that the year ahead would be me “finally getting my mental health in order” – whatever that meant. After pretty extensive therapy and psychological evaluation, my mental healthcare providers came to a conclusion: I had post-traumatic stress disorder, or PTSD, and more specifically, had experienced complex trauma.
I was pretty in denial about this. PTSD was, in my head, a diagnosis given to survivors of natural disasters and life-threatening accidents, to soldiers returning from dangerous war zones. I’d always been told I had it pretty good – that somewhere people were starving, or someone didn’t get the chance at life that I had gotten. In hindsight, my life had been pretty unstable and unsafe-feeling for as long as I could remember, having had intense anxiety from what feels like the second I was conscious.
Ultimately, the lack of security I felt throughout my life had built up a pattern of little traumas that were affecting my ability to function, despite achieving relative stability. The complexity of everything I’d faced had distorted how I viewed others and myself, had wracked my self-esteem, and had kept me in a fight, flight, fawn, and freeze cycle that felt inescapable. I was always ready for the “other shoe to drop,” so to speak, unable to soothe my nervous system or believe that things were truly okay. When things did go wrong, it only served to prove that nothing was alright.
Everyone will experience some form of trauma in their lives, but the effects that the trauma has on life afterward can warrant the specific diagnosis for treatment. There are a lot of factors that go into whether or not someone will develop PTSD or C-PTSD, including demographic factors and past life experiences. It’s important to understand C-PTSD, or complex trauma, in its entirety – and to garner hope for a healed future.
How does complex trauma happen?
Complex trauma often results from a series of repetitive, invasive traumatic experiences that the individual cannot escape from, or feels as though they are unable to escape. This can include long-term abuse at home, exposure to domestic violence, bullying, and an array of other experiences that repeatedly threaten the safety and security of the individual.
Not feeling like you can escape from a bad situation can be really frightening! It can cause feelings of intense fear, hopelessness, and helplessness. Complex trauma often leaves the individual with difficult emotions, negative beliefs about themselves, and attachment difficulties that can show up in friendships, romantic relationships, and within the family. These patterns can persist for years, especially when untreated, impacting how someone navigates the world and connects with others.
How does complex trauma, or Complex-PTSD, differ from PTSD?
While post-traumatic stress disorder can result from one singular traumatic event, such as a car accident or a natural disaster, complex PTSD stems from prolonged and repeated exposure to trauma. Chronic exposure leads to more nuanced symptoms and challenges that take root deep within one’s sense of self and experience of the world.
In addition to the diagnostic symptoms of PTSD – flashbacks, avoidance, hypervigilance, and intrusive memories – individuals with C-PTSD have experiences with…
Emotional dysregulation, such as experiencing intense mood swings and difficulty calming down when emotionally activated;
Negative self-concept, often feeling worthless, unlovable, or fundamentally flawed;
Persistent, intense feelings of shame or guilt; and
Relationship challenges, including mistrust, fear of abandonment, or overdependence on romantic partners.
My own challenges with complex trauma had made me feel utterly worthless and unable to form healthy, honest relationships with others out of fear of rejection, abandonment, or abuse. It kept me hypervigilant and fearful of doing, saying, being the wrong thing around others.
How does complex trauma impact different populations?
The impact of complex trauma can look different depending on race, ethnicity, gender, sexuality, socioeconomic status, or any other identity one may hold. Children who experience complex trauma during development may have difficulty forming healthy attachments. They might find themselves getting into abusive relationships or having extreme difficulty communicating their needs with partners later in life. They may also struggle with emotional regulation as they grow, finding it hard to process feelings or maintain calm and collected when dealing with difficult emotions. Marginalized populations, such as individuals from low-income communities or those facing systemic discrimination, are at higher risk for experiencing prolonged trauma due to structural inequities.
Cultural factors can shape how trauma is experienced and expressed, too. Different cultures may experience different types of trauma depending on the marginalization they experience in life, especially in a culture that values some identities, life experiences, skin colors, and gender identities over others. In some cultures, mental health symptoms may be stigmatized or expressed somatically rather than emotionally, such as the experience of unexplained pains in the body. It is important to understand these differences not only to practice culturally competent care, but to understand others’ trauma on a deeper level.
How is complex trauma diagnosed?
A diagnosis of complex post-traumatic stress disorder (C-PTSD) can be given from the International Classification of Diseases, 11th edition (ICD-11). Many healthcare providers in the United States, however, use the most up-to-date version of the Diagnostic and Statistical Manual of Mental Disorders (DSM), which only includes PTSD as a diagnosis. This diagnosis can still be given when the trauma is better described as complex, though looking into the diagnosis of C-PTSD in the ICD-11 can give better insight into the unique challenges that complex trauma brings.
A diagnosis of C-PTSD may be given by a qualified mental health professional after the individual has been thoroughly evaluated. The process may look like hours of evaluations in which a psychologist looks at your trauma history, somatic and mental health symptoms, and how these symptoms show up and negatively interfere with everyday functioning.
What would treatment for C-PTSD look like?
Treatment for C-PTSD should be individualized, catered to the needs of the individual depending on the most pressing symptoms they face. Important parts of treating C-PTSD might include…
Therapy: Modalities such as Eye Movement Desensitization and Reprocessing (EMDR), trauma-focused cognitive-behavioral therapy (CBT), and somatic experiencing can be helpful in addressing both the cognitive and somatic aspects of trauma.
Skills Training: Developing emotional regulation, grounding techniques, and self-soothing strategies can help individuals manage overwhelming emotions and triggers. Mindfulness training and skills utilized in dialectical behavior therapy (DBT) can be helpful in the healing process as well.
Medication: Medications, such as antidepressants or anti-anxiety medications. can support healing from complex trauma, though this may not be for everyone.
Other supports: Connecting with others through support groups or online forums who have experienced similar traumas can provide a sense of community and validation. Being able to talk to trusted friends and family can also help to relieve the feelings of isolation that complex trauma causes.
For me, the most important aspects of my healing journey were therapy (LOTS of it) and finding support in friends, family, and others in my community. Somatic therapy, Internal Family Systems (IFS) therapy, and DBT skills were all incredible in helping me feel my feelings, garner self-compassion, and learn how to be a better communicator while honoring myself and my needs. Being able to talk about what I was experiencing with loved ones and to work through it with professionals who understood what I was going through was important to my healing.
Is there hope for people with C-PTSD?
Absolutely! Living with complex trauma can be extremely difficult, but recovery is possible. People with complex trauma can heal and live full, beautiful lives. Therapy, education, and building a supportive community can empower individuals to reclaim their lives and build a sense of safety and stability.
Healing is not linear, and it can be very difficult with C-PTSD: so many of us struggle with self-compassion and seeing the capacity for a better life ahead. I wouldn’t say I’m fully healed – every day might pose a new challenge – but life is beautiful, and I can confirm that there is a light at the end of the tunnel.