Complex trauma is a term now being used by many sources as a diagnosis for people who are showing up with what seems initially to be post traumatic stress disorder symptoms but they don't quite fit that diagnosis, and for whom the usual post traumatic stress disorder treatments do not work.
These particular people may have had a history of having been through a significant traumatic incident but many do not. What they have been subjected to is multiple repeated stressors over time. The prototype of this kind of trauma was child abuse and researchers later began to apply what they were learning in this area to other situations as well, such as human trafficking, the torture of prisoners of war, refugee trauma, and other situation of coercive control such as cults.
This type of trauma occurs because of the abusive nature of the interpersonal relationships as opposed to post traumatic stress disorder where the trauma is a road traffic accident or witnessing some horrific event.
In the case of children the abusers are typically parents or siblings but can, of course, be relatives, step families, foster families, people in orphanages, and so on.
This interpersonal trauma of children is caused by their care givers. The very people who are supposed to be nurturing, helping and supporting the children are those who are deliberately and repeatedly abusing them. As expected, the bonds the child is forced to create are quite abnormal and consequently their growth and development are quite distorted.
Remember that post traumatic stress disorder (PTSD) was used to describe the symptoms shown by traumatized adult males who had been exposed to war trauma. It makes sense that vulnerable, malleable children exposed to years of repeated abuse and stress would express symptoms to a different trauma in different ways. Clinicians were noticing that people with complex trauma had many issues that were not actually covered in PTSD, such as identity issues, self hate, despair, self destructive behaviors, problems in building relationships and in parenting and re-victimization, and they were considerably more difficult to treat. The term Complex PTSD was used for this kind of complex trauma along with the phrase 'disorders of extreme stress not otherwise specified', or DESNOS.
Various studies indicated that it was indeed useful to consider Complex PTSD as a separate category from PTSD and they also noticed that those who had experienced complex trauma had an enduring personality change afterwards. More about this later.
There are 7 areas where problems arise when a child is subjected to early interrelational trauma. (Taken from a research paper in 2004 called "Complex Trauma, Complex Reactions: Assessment and Treatment" by Christine Courtois)
- The first is difficulty in regulation of emotions and impulses.
There may be difficulties managing anger and rage and the person may find it generally difficult to calm themselves. Living in a high stress environment often means that the individual is hyper-vigilant and over reacts to stressful stimuli.
The person can have difficulties when problems arise or in new situations and can be easily overwhelmed.
As a means of control the person may engage in self destructive behaviors, addictions and self harm as a way to establish some level of control, which often means numbing themselves. These self destructive behaviors can actually be life saving.
- The second aspect is alterations in attention and consciousness.
Familial abuse and trauma is very severe for a child and they have to find a way to cope. The child can't get help and they can't get away from the situation so one way to manage is to put less attention on the outside world and to place their attention internally. They often get very good at this as a way to protect themselves.
It's not without it's problems, however, as the person loses their ability to deal with the outside world. If the abuse starts before the age of 14 or 15, dissociative problems are more common than if the abuse starts in adulthood. These include amnesia, depersonalization (feeling that you are detached from yourself, often described as if you are observing yourself) and derealization (feeling as if the world is not real). When the abuse begins around three to five years of age, dissociative identity disorder was found to be more common in victims than when the abuse started later.
When abuse is very severe this 'going to a safe place inside' helps the victim to survive. Otherwise they risk going completely crazy.
- The third consideration is the distortion in the way the person sees themselves.
Victims of complex trauma typically have a particularly distorted view of themselves. There is a lot of guilt, shame, fear, helplessness and a very poor sense of self worth. They believe they are flawed or broken in some way and that they are inferior to those around them. They blame themselves for everything that is wrong (they have been trained to do this) and often experience shame for what was done to them because they think it was done because of who they are. They often believe what the abuser says about them to be true.
- The fourth aspect of complex trauma are alterations in the perception of the abuser(s).
There is often a great fear of the abuser with the abuser seen as all powerful and capable of doing all sorts of harm to the victim. The victim will typically take on many of the beliefs of the abuser.
When the abuser is a parent, the bond with such a parent is very confusing for the child. At one and the same time, the child wants and needs to bond in order to grow up but they are unable to protect themselves from the evil they have to tolerate.
- The fifth consideration is disordered relationships with others.
A child who grows up exposed to complex trauma does not have any healthy role models. Even if only one parent is abusive, this parent is also abusing the other 'normal' parent, too. This means that even the normal parent is being subjected to the complex trauma as well! It's no wonder that a child has difficulty in relationships later. They not only have problems in trusting and being intimate but they don't know what a normal healthy relationship is. It's very hard to do something you have never witnessed and cannot imagine. Add to this the abusive beliefs and ideas of the abuser that have been internalized and there are going to be problems in interactions with others. In some cases, the victim ends up abusing others.
- Number six is somatization.
The high stress environment can cause somatic reactions and/or medical problems. These can be related to the type of abuse or the effects can be more diffuse, and they can affect all systems. There is often constant anxiety, over reactive startle response, difficulties sleeping, nightmares, eating problems as well as memory and concentration problems. There is a nice TED talk here about the effects of childhood complex trauma on physical health across a lifetime.
- Number seven is alterations in systems of meaning.
There is hopelessness and despair about being able to recover or even finding anyone who will understand. It is hard for the victims to make sense out of life and what has happened to them.
In situation of complex trauma there are significant factors that are important for the victim to understand as well as for the helpers/therapist to deal with.
A child who is abused in the family does not have many of the normal experiences that children in normal, healthy environments do. Children grow and develop by learning, exploring and testing reality. They are given opportunities to find out what they can do, how to respond to the world and how to get the world to respond to themselves. They learn how they are different from others, they develop a sense of self by understanding these differences as well as the similarities. They learn who they are, that they are lovable and that they are valued. They grow up to be adults who know how to make their own decisions, who know what they like and what they don’t like and who know how to interact with others.
The effect of interpersonal abuse on this process is devastating. The child is repeatedly hurt and humiliated by someone they should be able to trust. They are betrayed in a devastating way by their caregivers. Instead of spending time learning and developing the child has to spend that time protecting him or herself from those very people. The people who should be helping the child to grow and mature are not just preventing this process, they are putting something destructive in it's place.
The very essence of the child becomes disordered. He or she is not allowed to have their own beliefs, thoughts, emotions or behaviors. Their world view is colored by the abuser. Their perceptions and thought processes are manipulated. Their very identity, their personality, is constantly being shaped by the abuser.
A young child has no way of making sense of these things. They don't have the life experience to work it out. Consider, too, that many adults who experience trauma often compartmentalize it for themselves. It's as if they store memories in different places. They can tell you bits and pieces about their story and the story itself is often disjointed. For a child it's impossible to store the memories and understand them. Hence the dissociative features they develop in order to manage. They need to be able to separate from the abuse and the memories in some way to be able to hold onto their sanity.
Children are dependent on their caregivers for many years. In abusive environments they are kept dependent. They are typically not allowed to separate from the abuser. Even as adults, while they have contact with the abuser, they will spend much of their lives doing things to appease the abuser and making decisions that they know the abuser will approve of. Their identity is so enmeshed with the abuser that they have a very strong sense of obligation to the abuser, even after they have worked out that the abuser is abusing them, which is not an easy task. You can read more about dependency in mind control environments here.
With complex trauma, the environment is such that the victims live in constant distress, even when not with the abuser. There is never any emotional stability. After a single traumatic event, there is obviously emotional upset but then things calm down and return to 'normal' again, even if that normal is somewhat different than before. With complex trauma there is no settling down. Just when the victim thinks that things may be settling, or even getting better, something bad happens to them. They come to expect that bad and dangerous things will happen on an ongoing basis. Instead of one terror-filled event, the complex trauma victim has a series of such events which creates a terror-filled life.
Remember that this kind of trauma is considered by many sources to be premeditated. That means that the abuser is knowingly treating the children badly. Who does this? Well psychopaths and narcissists are one group who treat people in this fashion.
Indeed, research shows that upwards of 80% of abusers who were sent for therapy in family court cases had a personality disorder, including antisocial personality disorder and narcissistic personality disorder.
If you have suffered complex trauma at home, it is worth checking out whether your parents fit the profile of a psychopath or a narcissist because if so, the implications are enormous. It's not easy to do this but it's worth the effort.
Why do they do what they do? To control others. For these people, their relationships are based on domination, coercion and exploitation. Their motivation is power and control. It's important to remember that there is no stereotypical psychopath and these drives can show up in different ways. For example, some psychopaths want to control every aspect of a child's life. On the other end of the spectrum there are those manipulators who have no interest in the children's day to day living and they only have children to give the outward appearance or normality or to keep control of a wife at home by keeping her so busy that she has no time to think or reflect on her circumstances.
Complex trauma can silence people. There is such a complicated web of beliefs and ideas that a victim is unable to make sense of their relationship, or the abuse at work, or their time in a cult. This is especially true of children who have been brought up in abusive environments.
There are very strong emotions including anger, shame, fear, guilt, embarrassment, loss and betrayal. In psychologically abusive environments the beliefs and emotions are used to keep the victim entangled. They are often used in a self reinforcing way by the abusers, driving the victim deeper and deeper into the destructive reality that the abuser is creating in the mind of the victim.
Trying to reason one's way out of the situation using these same beliefs and ideas only causes more confusion and is doomed to failure.
In order to undo complex trauma, to reverse the effects of it, it is necessary to understand it. This means learning about how specifically you were manipulated, controlled and taken advantage of. Once a person learns about the mind control techniques used against them, how they were used in their own particular case, what effects these techniques had on their thinking, their beliefs, their emotions and their actions, things begin to change.
It's often only by understanding how one has been led to believe and think certain things can that person begin to change those things. Simply being told, 'now you are no longer in the situation you don't have to think that way' is not enough to help people. The world view, the beliefs, the thinking processes, are very deeply ingrained and simply being told to change them is never enough. When a person recognizes how they came to believe something, or why they think in a certain way, then they begin to have options about how to respond differently.
In order to do all this, a person has to be in a safe environment. While they are still being abused, any recovery will be slowed considerably. And if the abuser finds out that the victim is learning, they will typically do anything they can to put a stop to it. For these reasons, stopping or limiting the abuse as much as possible is an important step in recovery.
Talking about the trauma is widely considered to be vital. But just telling the same story over and over often does not go anywhere. The victim simply relives the trauma. The victim has to be allowed to describe their experiences and not be made to feel bad for it and of particular importance is that they should not be made to feel responsible for what was done to them.
When a victim starts to tell their story, it typically does not have a start, a middle and an end. It tends to be disorganized where they jump around from one thing to another and they may be unable to think about or verbalize certain parts of it. They have to be allowed to tell their story at their own pace over time. Piecing it all together is part of the recovery process. Facing up to the truth of their own story takes tremendous courage and many people cannot do that alone. It's usually best done with the help of an expert in the field.
The victim has been in a situation where their world-view, their perceptions and their thinking processes have been shaped and molded by the abusers. Their beliefs, thoughts, emotions and behaviors were directly influenced and controlled by the abusers. The individual developed coping strategies and decision making strategies to cope with and survive within the abusive environment. Basically the identity or personality of the individual was determined by the abusers. (This false personality, or pseudopersonality, was first described by Edgar Schein in the 1950s.)
While many of these coping strategies were necessary and even life saving within that system, they may not serve the individual outside the system. Many of them will cause further problems out in the real world.
These things need to be labeled, their source identified, and the mechanism of creation understood. In other words, 'how did the abuser get you to think or do that?' When the victim has a clear answer to the question, it becomes much easier to put a different pattern in place.
But it's not just the odd pattern that needs to be updated, it's the whole system. Remember the abuser molded the personality of the victim. So that programmed personality needs to be undone and the real personality has to be allowed to grow and develop and take over control. This is not an easy job.
When someone is recruited into a cult at the age of 30, they have 30 years of normal development before their cult experience against which they can compare and reference their cult years. They have a before and after. The job of re-establishing their personality is still a major task. A child brought up in an abusive situation does not have a 'before'. The abuse is all they have known. Their real personality has never been allowed to develop. This adds extra layers of complexity to their recovery.
As well as learning new strategies for thinking, reasoning and making decisions, the victim often has to learn how to relate to others in a different way. They may have to rework their criteria for making friends, they have to learn what it's like to be loved, they have to learn what is normal behavior in many situations. They have to learn how to look after themselves, their health often having been neglected as a result of the abuse. The victim coming out of a complex trauma situation may not know what their likes or dislikes are, they don't know how to make decisions where they put themselves first, they often don't know what they want because they are so used to tending to the wants and needs of others first.
Someone who has suffered complex trauma will have a very distorted idea of themselves. They have been trained to consider themselves as broken, flawed, useless, damaged, worthless and inferior to others and in need of work or change. This needs to be addressed and updated.
There is usually all sorts of odd and conflicting beliefs and ideas about emotions in place, too. The psychopath's inability to experience emotions does not stop them from manipulating and controlling the emotions of their victims. The victims have to learn that it's ok to express emotions. All of them! Because there are such strong emotions when recovering from a situation of complex trauma, they have to learn how not to be overwhelmed by them, too.
Complex trauma has a very profound effect on all aspects of a victim's life. Working with someone who understands this area, including mind control and psychopathy is invaluable. It's not enough that a therapist has worked with one or two ex-members of cults, or 'had a client before who grew up in an abusive family'.
To undo pseudopersonalities, to teach you about the subtleties of mind control, to lead you through the potential mine field that is a toxic family, you need someone who understands the terrain, someone who will not inadvertently blame you for things that are absolutely not your fault, someone who will teach you the psychopaths' or narcissists' games and tricks and who will help you to deal with all the things you need to change or undo.
Read more about psychopaths, sociopaths and narcissists, mind control, dealing with a toxic family, healing from emotional abuse, how to leave an abusive relationship, and help for sexual abuse victims.
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