Complex trauma therapy utilises several modalities to address different symptoms. The current method of treating complex trauma is a combination of talk therapy, cognitive behavioural therapy, and exposure therapy. Because trauma also impacts the portion of the brain responsible for survival, a person who suffers from complex trauma either becomes numb (hypo-aroused) to the trauma, or they hyper-react to the slightest hint of danger.
The term ‘complex trauma’ describes the dual problem of children’s exposure to traumatic events and the impact of this exposure on immediate and long-term outcomes in them. Complex traumatic exposure also refers to children’s experiences of multiple traumatic events that occur within the caregiving system (such as babysitting, homecare period) – the social environment that is supposed to be the source of safety and stability in a child’s life. Typically, complex trauma exposure refers to the simultaneous occurrences of child maltreatment, including emotional abuse, neglect, sexual abuse, physical abuse, and witnessing domestic violence that are chronic in a family. Children who experience initial traumatic experiences (e.g. parental neglect and emotional abuse) are likely to also witness emotional dysregulation, loss of a safe base, loss of direction, and the inability to detect or respond to danger cues later in life. They are also at risk of subsequent trauma exposure (e.g. physical and sexual abuse).
Complex trauma outcomes refer to the range of clinical symptomatology that appears after such exposures. Exposure to traumatic stress in early life is associated with enduring sequelae, which is a pathological condition resulting from a prior disease, injury, or attack, that not only incorporates, but also extend beyonds Post-traumatic Stress Disorder (PTSD). For instance, during intercourse with his or her spouse, a married person may relieve a sexual trauma that took place during childhood and feel on edge or become violent.
Children who are exposed to complex trauma carry enormous burdens, which also weigh heavily on families and society in general. Although in many ways the costs are inestimable, the repercussions of childhood trauma may be measured in medical costs, mental health utilisation, societal cost, and the psychological toll on victims and families. The current psychiatric diagnostic classification system does not have an adequate category to capture the full range of difficulties that traumatised children experience. Although the narrowly defined PTSD diagnosis is often used, it rarely captures the extent of the developmental impact of multiple and chronic trauma exposure. Other diagnoses common in abused and neglected children include Depression, Attention Deficit Hyperactivity Disorder (ADHD), Oppositional Defiant Disorder (ODD), Conduct Disorder, Generalised Anxiety Disorder, Separation Anxiety Disorder, and Reactive Attachment Disorder. Each of these diagnoses captures an aspect of the traumatised child’s experience, but frequently does not represent the whole picture. As a result, treatment often focuses on the particular behaviour identified, rather than on the core deficits that underlie the presentation of complexly traumatised children.
There are seven primary domains of impairment observed in children exposed to complex trauma. These include: (1) Attachment; (2) Biology; (3) Affect regulation; (4) Dissociation; (5) Behavioural regulation; (6) Cognition; and (7) Self-concept. Provided below is a list of each domain of impairment in Children Exposed to Complex Trauma, along with examples of associated symptoms:
1. Attachment: Attachment relationship also provides the scaffolding for the growth of many developmental competencies, including the capacity for self-regulation, the safety with which to explore the environment, early knowledge of agency (i.e., the capacity to exert an influence on the world), and early capacities for receptive and expressive communication. The associated symptoms include: Uncertainty about the reliability and predictability of the world, problems with boundaries, distrust and suspiciousness, social isolation, interpersonal difficulties, difficulty attuning to other people’s emotional states, difficulty with perspective taking, difficulty in enlisting other people as allies.
Children may re-enact behavioural aspects of their trauma (e.g. aggression, self-injurious behaviours, sexualised behaviours, controlling relationship dynamics) as automatic behavioural reactions to reminders or as attempts to gain mastery or control over their experiences.
2. Biology: In early childhood, biologically compromised children are at risk of disorders in reality orientation (e.g. autism), learning (e.g. dyslexia), or cognitive and behavioral self-management (e.g. ADHD). Its associated symptoms include: Sensorimotor developmental problems, hypersensitivity to physical contact, analgesia (the inability to feel pain), problems with coordination, balance, somatisation (the physical manifestation of psychological or emotional concerns), increased medical problems across a wide span, e.g., pelvic pain, skin problems, autoimmune disorders, pseudoseizures.
3. Affect Regulation: Childhood trauma appears not only to increase risk for major depression, but also to alter the course of illness in ways that contribute to a poorer prognosis. Its associated symptoms include: Difficulty with emotional self-regulation, difficulty describing feelings and internal experience, problems knowing and describing internal states, difficulty communicating wishes and desires
4. Dissociation: Dissociation is one of the key features of complex trauma in children. In essence, dissociation is the failure to integrate or associate information and experience in a normally expectable fashion. Its associated symptoms include: Distinct alterations in states of consciousness, amnesia, depersonalisation and derealisation, two or more distinct states of consciousness, with impaired memory for state-based events.
5. Behavioural Control: Children may re-enact behavioural aspects of their trauma (e.g. aggression, self-injurious behaviours, sexualised behaviours, controlling relationship dynamics) as automatic behavioural reactions to reminders or as attempts to gain mastery or control over their experiences. Its associated symptoms include: Self-destructive behaviour, aggression against others, pathological self-soothing behaviours, sleep disturbances, eating disorders, substance abuse, excessive compliance, oppositional behaviour, difficulty understanding and complying with rules, communication of traumatic past by reenactment in day-to-day behaviour or play (sexual, aggressive, etc.).
6. Cognition: A history of childhood trauma is associated with lower grades, lack of creativity and poor problem-solving skills. These findings have been demonstrated across a variety of trauma exposures (e.g. physical abuse, sexual abuse, neglect, exposure to domestic violence). Its associated symptoms include: Lack of sustained curiosity, problems focusing on and completing tasks, difficulty planning and anticipating, problems understanding one’s own contribution to what happens to them, learning difficulties, problems with language development, and problems with orientation in time and space.
Complex trauma disrupts different aspects of a person’s life, and their connections. A long-standing body of research shows that adverse childhood experiences, such as child abuse, trauma and sexual assault, can negatively affect people well into adulthood.
7. Self-Concept: Traumatised children perceive themselves as powerless and expect others to reject and despise them. They are more likely to blame themselves for negative experiences. Its associated symptoms include: Low sense of self, poor sense of separateness, disturbances of body image, low self-esteem, shame and guilt.
Complex trauma disrupts different aspects of a person’s life, and their connections. A long-standing body of research shows that adverse childhood experiences, such as child abuse, trauma and sexual assault, can negatively affect people well into adulthood. Children know when bad things happen, and they remember what they have been through. It is important to be non-judgmental and allow them to tell their stories, because it helps to make sense of their situations and helps them cope better with it.
Complex trauma therapy utilises several modalities to address different symptoms. The current method of treating complex trauma is a combination of talk therapy, cognitive behavioural therapy, and exposure therapy. Because trauma also impacts the portion of the brain responsible for survival, a person who suffers from complex trauma either becomes numb (hypo-aroused) to the trauma, or they hyper-react to the slightest hint of danger. For children who are exposed to complex trauma, it is difficult to love and get involved in pleasure and engagements because their brains have been re-organised to essentially deal with danger.
Some measures to assist a complex trauma victim could include body-based approaches e.g. trauma-informed yoga, and mindfulness can help the body and mind reconnect. People affected by complex trauma often find it difficult to regulate their levels of arousal, emotions and behaviour. They often also find it difficult to reflect. Trying to mediate thoughts before learning to self-regulate can be re-traumatising. Studies show that people in treatment for complex trauma may react adversely to current, standard PTSD treatments. For these reasons, effective treatment should focus on self-regulatory deficits, rather than processing the trauma.
Chinna Okoroafor, a licensed psychotherapist, writes from Colorado Springs, Colorado, U.S.A.
