When we talk about complex trauma it’s a combination of multiple types of trauma. Acute trauma, chronic trauma and covert trauma can all be a part of complex trauma. Often these traumas are unresolved, untreated and unacknowledged.
This article will be updated with further research and sources soon.
Sources
What is complex trauma?
Why PTSD does not encompass complex trauma
How complex trauma in early childhood affects brain development
The impact of psychological maltreatment such as emotional abuse or neglect
Racial trauma as a complex trauma
Three types of therapy approaches to complex trauma
DEVELOPING THE COVERT TRAUMATIC EXPERIENCE SCALE (COTES): A RETROSPECTIVE EARLY PSYCHOSOCIAL TRAUMA ASSESSMENT TOOL
Tiffany E. Vastardis PhD, LMHC, CCTP, CMHIMP
Clinical Education Specialist • Florida Residential Clinical Training Liaison • Mental Health Researcher • Licensed Psychotherapist • Clinical Trauma Specialist • Integrative Medicine Practitioner
Complex Traumatic Distress Disorder (cPTSD)
Though the terms complex trauma and Complex Trauma Disorder (cPTSD) have been represented in the body of research and treatment literature for quite some time, neither currently represent a formal diagnostic or symptomological profile, nor classification (APA, 2013; World Health Organization, 1993). In fact, at present, two decades have elapsed since a formal inclusion of cPTSD was initially proposed to the WHO, and trauma-related symptomology that falls outside of a diagnosis of PTSD remains in the DSM-5 (APA, 2013) as Disorders of Extreme Stress Not Otherwise Specified (DESNOS); however, efforts are currently underway to ensure inclusion in the 11th iteration of The International Classification of Diseases (ICD-11; Giourou et al., 2018). Complications lie in the conceptualization of what constitutes complex trauma, and; subsequently, its accompanying diagnosis of cPTSD. Initially, The National Child
Traumatic Stress Network (NCTSN; n.d-a) has defined complex trauma as “a series of traumatic experiences that are usually interpersonal in nature and lead to numerous long term adverse effects on health and well-being,” (Hudspeth, 2015, p.195). This definition was further supported by van der Kolk et al. (2009). However, recent research in the medical and neuroscientific fields have sought to expand this definition, incorporating both physical illness and bullying (Hudspeth, 2015). In fact, the NCTSN (n.d.-b) has reconfigured the definition of complex trauma to represent the following:
Cumulative adversities faced by many persons, communities, ethnocultural, religious, political, and sexual minority groups, and societies around the globe can also constitute forms of complex trauma. Some occur over the life course beginning in childhood […]. Others, occurring later in life, are often traumatic or potentially traumatic and can worsen the impact of early life complex trauma and cause the development of complex traumatic stress reactions.
These adversities can include but are not limited to:
• Poverty and ongoing economic challenge and lack of essentials or other resources
• Community violence and the inability to escape/relocate
• Homelessness
• Disenfranchised ethno-racial, religious, and/or sexual minority status and repercussions
• Incarceration and residential placement and ongoing threat and assault
• Ongoing sexual and physical re-victimization and re-traumatization in the family or other contexts, including prostitution and sexual slavery
Human rights violations including political repression, genocide/“ethnic cleansing,” and torture
• Displacement, refugee status, and relocation
• War and combat involvement or exposure
• Developmental, intellectual, physical health, mental health/psychiatric, and age-related limitations, impairments, and challenges
• Exposure to death, dying, and the grotesque in emergency response work
(NCTSN, n.d.-b, para. 7; Hudspeth, 2015, p.196).
Still yet, other researchers pose a case for the inclusion of various forms of household dysfunction, such as exposure to drug abuse in the household (Stephens & Aparicio, 2017). Across the board, proponents of the notion of complex trauma as divergent from that of which pertains to the criteria for PTSD, agree that complex trauma involves stressors that are:
(a) are repetitive and prolonged;
(b) cause direct harm and/or neglect and abandonment by caregivers or seemingly responsible adults;
(c) occur at developmentally vulnerable times in the victim’s life, such as early childhood; and
(d) have significant potential to severely compromise a child’s (and subsequently adult’s) development
(Mahoney & Markel, 2016, p.5; Courtois & Ford, 2009, p. 1).
Wamser-Nanney and Vandenberg (2013) and Wamser-Nanney and Cherry (2018) turn to expressions of symptomology, such as widespread impairments in functioning, affective and behavioral dysregulation, and internalizing problems to pose a case for the necessity to operationally define and design specialized treatments for the experience of complex traumas. Walker (2014) considers cPTSD to be a more severe form of PTSD, which he delineates from PTSD by the additional presence of: emotional flashbacks, toxic shame, self-abandonment, the presence of a vicious inner critic, social anxiety, and developmental arrest. Additional symptomology include those inherent in various psychological disorders, but are not limited to: abject feelings of loneliness, abject feelings of abandonment, fragile self-esteem, Attachment Disorder, relational difficulties and interpersonal problems, labile mood, cognitive distortions, somatization and chronic health problems, irritability and impulsivity, faulty coping mechanisms, anhedonia, insomnia and other sleep disturbances, hypersensitivity to stress, hypervigilance, dissociation, disorientation, avoidance and agoraphobia, impaired neurodevelopment, concentration difficulties, suicidality, trichotillomania and/or excoriation, and developmental regression (Schwartz, 2016; Walker, 2014).
