“Complex trauma” is not a disease you are born with, and its causes and development cannot be linked to any single-incident trauma. By definition, complex trauma is the result of multiple, repeated experiences of interpersonal trauma. Often, it can be understood as a sort of “piling up” of layers of trauma, initiated by an abusive or neglectful relationship (usually during childhood). CPTSD is a diagnosis that helps us understand how chronic interpersonal trauma has a cascading effect, interrupting a number of important areas of psychological development, often leading to further traumatic experiences of disconnection and unhealthy relationships.
But how exactly do traumatic events impact victims? Why do they interrupt psychological development? To understand how CPTSD develops, we can look to the areas where survivors usually show deficits in development: (Ford and Courtois, 2009).
How CPTSD Develops
Regulation of Emotions
When children don’t have “safe…opportunities for playing, exploring, learning, and developing relationships with adults and peers,” they may struggle to express emotions and goals in controlled, healthy ways (Courtois, 2014). After learning to compartmentalize and avoid distressing situations in childhood, trauma victims may find emotional states to be “too much to handle,” or may struggle to even recognize the meanings of their own emotional states. What started as simply a survival tactic in childhood becomes an engrained pattern of behavior, and an impediment to having a balanced, self-controlled adult life.
Memory, Attention, and Decision-Making
Prolonged situations of severe stress can have lasting impacts on brain chemistry and functioning, making it difficult for victims to organize thoughts and memories, and plan courses of action to pursue their goals.
Ongoing traumas often create patterns of “avoidance and hypervigilance” as victims try to protect themselves from harm. Over time, this self-protection can lead to compartmentalization of consciousness, so that the “self” fragments into multiple, disconnected parts. Essentially, the various “parts” of the mind that should be in communication with each other are not, and so thoughts and feelings become disorganized, and the victim becomes “out of tune” with her/himself.
Dysregulation of Bodily Functioning
People with CPTSD often experience chronic or episodic physical discomfort and illness. These can often be the results of emotional stress manifesting physically in the body.
This includes illnesses and injuries made worse by stress (orthopedic conditions, asthma, cardiovascular or neurological syndromes, irritable bowel syndrome), or physical symptoms with emotional/psychological causes (gastrointestinal or sexual organ pain, tics, pseudoseizures, paralysis).
Early-life relationships shape a person’s core understandings about how to connect with and relate to other people. When those early-life relationships are neglectful or abusive, this leads to “disorganized attachment” patterns — traumatized individuals may find it very hard to trust others, and may seek damaging relationships because that is what feels “familiar.”
One of the key differentiators of CPTSD is the understanding that past traumas are always relevant in understanding symptoms. This perspective helps survivors makes sense of the symptoms they struggle with, by fitting them into a larger narrative. However, the emphasis on addressing past traumas is not about finding a single “root cause” of CPTSD symptoms. What CPTSD offers, as a diagnosis, is the ability to see how traumatic experiences interrupt development and create a “piling up” of damaging relationships, disconnection from the self, and trouble regulating emotion. CPTSD helps us recognize that seemingly-irrational, self-damaging behavior is often the result of understandable coping mechanisms and survival tactics, carried over from extremely stressful situations.
CPTSD Related Trauma
There are many types of trauma that can result in Complex Post-Traumatic Stress Disorder (CPTSD). CPTSD is defined not so much by the specific type of trauma the victim experiences, but by the frequency with which it happens, the stage of life when it occurs, and the role of caregivers or authority figures in connection with the trauma.
Any type of trauma can lead to CPTSD, if it (1) involves repetitive and prolonged exposure to stressors, (2) involves harm or abandonment by caregivers or authority figures, and (3) happens during early stages of life, while the victim is still developing psychologically (Courtois and Ford, 2013).
It is important to understand that CPTSD is not caused by “single-blow” trauma — for example, natural disasters, violent crimes, or military attacks; none of which would cause CPTSD (unless they are recurring, or lead to other ongoing traumas, such as loss of a caregiver or disconnection from community).
Chronic (or long-term) traumas can be either “impersonal” traumas, like illness, injury, and disability; or interpersonal traumas, like abuse, family violence, or neglect.
The following is a partial list of the most common forms of trauma that can cause CPTSD: (Courtois, 2014)
- Physical abuse
- Sexual abuse
- Neglect — this can be lack of proper physical care (not enough food to eat, not being given clean clothes, etc.), or psychosocial neglect – where emotional and social needs are ignored (this can be harder to identify).
- Witnessing violence or abuse — violence toward a caregiver such as one parent’s violence toward another which can be especially traumatic for a child.
- Emotional/psychological abuse — intentional cruelty intended to hurt another person emotionally (this can also be equally hard to identify). Examples include humiliation, deprivation of basic needs, blackmailing, manipulation, Gaslighting, withholding emotional comfort, etc.
- Family members’ substance abuse — substance-abusing parents behave erratically and leave their family members constantly on-edge.
- Community violence — for example, living in a violent neighborhood.
- Illness, injury, and disability
- Grief and loss
- Identity and cultural trauma — for any cultural minority group, daily life is filled with potentially traumatic moments. A culturally-driven sense of inferiority, whether through overt discrimination or subtle, persistent exclusion, can form long-term trauma.
The commonality between this diverse array of traumas is that they all involve situations which destabilize a child’s world, making it difficult to establish trust, and often leaving the child on-edge all the time, waiting for the next trauma to occur (Courtois, 2014). Very often, one form of trauma begets others, in a cyclical way — for example, family violence leads to distrust and emotional instability, which leads to unhealthy relationships later in life, and potentially more violence. The “complexity” of CPTSD comes in the “piling on” of multiple layers of trauma over time. These early-life situations of trauma set the stage for a child or young person to go through life always expecting further traumas to be “just around the corner,” and putting up extreme defenses as a sort of reflex reaction, inadvertently causing more traumatic relationships and situations to develop.
Courtois, Christine A. It’s Not You, It’s What Happened to You: Complex Trauma and Treatment. Place of Publication Not Identified: Telemachus, 2014. Print.
Courtois, Christine A., and Julian D. Ford. Treatment of Complex Trauma: A Sequenced, Relationship-based Approach. New York: Guilford, 2013. Print.
Ford, Julian D., and Christine A. Courtois. Treating Complex Traumatic Stress Disorders in Children and Adolescents: Scientific Foundations and Therapeutic Models. New York, NY: Guilford, 2009. Print.