This post is really just bits and pieces taken from this and this research paper that I was reading after google searches in a desperate attempt to make sense of my experiences. So yes, it’s 4am and I’ve just read through a 23 page long psychology paper and for once it’s not for school. I’m such a typical psych student, gosh. It’s not always good, trying to put my experiences into words to avoid dealing with them. I intellectualize everything when I don’t know how else to cope. I think I just wanted it on paper, evidence that what I’m experiencing is legitimate. I don’t know, maybe even to just prove that I’m not crazy. A large part of my brain still feels like I’m not sick. I’m not diagnosed. I can’t use the words, I really don’t think anything I’ve been through would be as bad as ‘abuse‘ or ‘trauma‘ or ‘rape‘ or ‘assault‘. It feels like anything that happened to me doesn’t matter, nothing that happens to me ever feels like it matters. Not the awful memories & pain I’ve been running away from all these years, not the awful memories of the two incidents that have happened in the past year & week, not the (still) searing pain of the words my parents had said years ago. But what I found in the research gave me some comfort and this post consists of aspects that I personally relate to in some way, and I wanted to remember.
Complex trauma has been described as cumulative, underlying trauma and it is the name given to symptoms recognised as occurring frequently in people who have suffered severe, ongoing trauma, particularly where that trauma is caused by abuse that is of an interpersonal nature, and especially where it occurs in a childhood context, which has particular impacts on the development of a person’s sense of self, and a negative impact on attachment with caregivers.
Complex trauma differs from the “memory imprint” of PTSD in two aspects—the circumstances of the trauma event/s, and the effects this has on core aspects of a person’s
sense of self. The literature identifies issues of attachment and child development as a key factor, whereby early onset trauma has a particular impact on the developing brain especially when the trauma is prolonged, repetitive and unrepaired. Where early caregiving relationships are dysfunctional, either as a source of trauma or an inability to nurture and protect a child, the child’s developmental competencies in the areas of sense of self, agency, communication, and interpersonal relationships can be negatively impacted, thereby setting the scene for many of the problems associated with complex trauma. The presence of familiar caregivers plays an important role in helping children modulate their physiologic arousal and in the absence of a caregiver, children experience extremes of under-and over arousal that are physiologically aversive and disorganizing. Forming primary attachments to caregivers who are “either dangerous, or from [the victim’s] point of view, negligent, [developing] a sense of basic trust and safety with caretakers who are untrustworthy and unsafe” and maintaining a sense of control in situations of unpredictability, requires a range of adaptations and survival strategies that can manifest in a variety of ways such as denial, dissociation, fragmented/disordered attachment or self blame
Confrontations with violence challenges one’s most basic assumptions about the self as invulnerable and intrinsically worthy and about the world as orderly and just. After abuse, the victim’s view of self and world can never be the same again: it must be reconstructed to incorporate the abuse experience. Assuming responsibility for the abuse allows feelings of helplessness to be replaced with an illusion of control. Children are even more likely to blame themselves: “The child needs to hold on to an image of the parent as good in order to deal with the intensity of fear and rage which is the effect of the tormenting experiences.” Instead of turning on their caregivers and losing hope for protection, they blame themselves. They become fearfully and hungrily attached and anxiously obedient, a pattern of behavior in which avoidance competes with desire for proximity and care and in which angry behavior is apt to become prominent.
Anger directed against the self or others is always a central problem in the life of people who have been violated and this ‘acting out’ is seldom understood by either victims or clinicians as being a repetitive re-enactment of real events from the past.
Although these are often adaptive reactions at the time of experiencing abuse, in the
longer term they may become maladaptive. Six “symptom clusters” are involved in a complex trauma response:
Alterations in self regulation and impulses
Components: Affect regulation, Self-destructive, Suicidal pre-occupation, Difficulty modulating sexual involvement, Excessive risk-taking
Expressions: High levels of self-harm, Substance abuse & addiction, Overwhelmed by anger, Casual & unprotected sex, Suicide plan, Eating disorders
Alterations in attention or consciousness
Components: Amnesia, Transient dissociative episodes, Depersonalisation
Expressions: Clouded perception, Feeling/being dazed, Automation/being on “autopilot”, Difficulty remembering appointments/discussions/events
Alterations in self perception
Components: Personal ineffectiveness, Changes in personal identity, Disturbances in identity formation
Expressions: Feelings of hopelessness & helplessness, “Malignant” sense of self (contaminated; guilty; bad; self hatred, shame)
Alterations in relations with others
Components: Inability to trust, Re-victimisation, Victimising others, Perceives perpetrator as all powerful
Expressions: Difficulty seeing danger signs/unsafe situations, Confused boundary setting, Conflictual relationships, Desire for a “rescuer”
Components: Digestive system, Chronic pain, Cardiopulmonary symptoms, Conversion symptoms, Sexual symptoms
Expressions: “Acid” stomach, Irritable Bowel Syndrome, Pelvic pain, Headaches, Unexplained symptoms (e.g., numbing, tingling)
Alterations in systems of meaning
Components: Fatalism, Viewing world/people as malevolent, Loss of hope, Loss of belief
Expressions: Lack of self-efficacy, Despondency, Despair, Anger, Apathy
Extensive re-victimisation over the lifespan and poly-victimisation (co-occurrence of different forms of abuse) is linked to complex trauma. Poly-victimisation includes multiple types of abuse, including sexual abuse, physical abuse, neglect or psychological abuse, and emotional abuse. Revictimisation later in the lifespan is likely to compound the effects of prior abuse experiences. Severe and repeated victimisation experiences are strongly related to a range of mental health outcomes that often take the form of depression, addictive and self-harming behaviour, substance abuse, and dissociative and personality disorders. Moreover, these adverse outcomes are rarely singular and co-occurring disorders are prevalent among traumatised populations. Those subjected to early abuse and deprivation are vulnerable to engage in violent relationships with peers as adults and people who are exposed early to violence or neglect come to expect it as a way of life. Men and boys tend to identify with the aggressor and later victimize others whereas women are prone to become attached to abusive men who allow themselves and their offspring to be victimized further. It is clear that experiencing childhood abuse creates an increased risk of revictimisation and revictimization is a consistent finding. Victims of rape are more likely to be raped and women who were physically or sexually abused as children are more likely to be abused as adults.
High arousal causes people to engage in familiar behavior, regardless of the rewards. As novel stimuli are anxiety provoking, under stress, previously traumatized people tend return to familiar patterns, even if they cause pain. A history of victimisation strongly predicts future victimisation regardless of other potentially protective factors such as education and income.
One perspective suggests that revictimsation becomes an issue of the broader social context in which psychological and interpersonal functioning increases vulnerability to perpetrators, for example, by self-soothing with alcohol or other substances or engaging in compulsive sexual behaviour. This view reflects an ecological approach to understanding sexual victimisation. The victimisation can be multifaceted, can occur over time, may include childhood and adult instances of abuse, and may co-exist with other factors in the social environment that the person is situated. It is important to understand the interacting factors in order to see the complete picture of revictimisation over the lifespan. Grauerholz (2000) hypothesised that individual experiences (e.g., the initial victimisation) combine with factors in the microsystem (such as a victim’s decreased ability to be assertive) and the macrosystem (such as perpetuation of victim blaming culture) to create an environment ripe for revictimisation of the individual.
Part of Complex PTSD is what therapists call “repetition compulsion”, an effort by the victim to bring resolution to the traumatic memory. By repeating the experience, the victim tries anew to figure out a way to respond in order to eliminate the fear. Instead, the victim simply deepens the traumatic wound. The number of traumas one experiences simultaneously will factor into the strength of the trauma repetition cycle. Traumas compounded with other traumas will increase the overall risk for trauma repetition in adulthood. Repetitive maladaptive behavior of traumatic origin is characterized by defensive dissociation of the cognitive and emotional components of trauma, making it very difficult for the person to integrate the experience. Survivors become conditioned to engage in negative self-talk, blame themselves for the abuse they’ve suffered and continue to the vicious cycle of abuse, they may struggle with a shame and develop maladaptive ways of coping as attempts to survive unbearable, overwhelming lifelong trauma through destructive means that inevitably reenact and reinforce the trauma.
Toxic shame that arises can lead to behaviors such as sustaining abusive relationships, addiction, eating disorders, and reckless sexual behavior as futile attempts to avoid the trauma and create “numbing” in response to the symptoms. This reenactment of past trauma is not a coincidence – rather, it is a consequence of the trauma itself.
As well as being at risk of experiencing difficult and often violent interpersonal relationships, women with a history of child sexual abuse are more likely to engage in casual and unprotected sex while reporting less satisfactory sexual rewards and greater sexual costs. In examining self-dysfunction (i.e., dysfunctional behaviour such as substance abuse and indiscriminate sexual behaviours) as an aspect of sexual revictimisation, a study noted a link between risky sexual behaviour and sexual revictimisation, suggesting tension reducing and maladaptive sexual behaviour may function as a strategy to cope with post-traumatic symptoms related to previous victimisation experiences.
Chronic physiologic hyperarousal persists, particularly to stimuli reminiscent of the trauma and later stresses tend to be experienced as somatic states, rather than as specific events that require specific means of coping. Thus victims of trauma may respond to contemporary stimuli as a return of the trauma, and hyperarousal interferes with the ability to make rational assessments and prevents resolution and integration of the trauma. Disturbances in opioid systems have been implicated in this persistenence of all-or-nothing responses. Reactivation of past learning is relatively automatic: contextual stimuli directly evoke past memories and the more similar are the contextual stimuli are to conditions at the time of the original memories, the more likely the probability of retrieval. Both internal states or external events reminiscent of earlier trauma can trigger a return to feeling as if victims are back in their original traumatizing situation. Disinhibition resulting from drugs or alcohol strongly facilitates the occurrence of such reliving experiences, which then may take the form of acting out violent or sexual traumatic episodes. In traumatized people, visual and motoric reliving experiences, nightmares, flashbacks, and re-enactments are generally preceded by physiologic arousal.
Exposure to inescapable aversive events also has widespread behavioral and physiologic effects including deficits in learning to escape novel adverse situations, decreased motivation for learning new options, chronic subjective distress. Under ordinary conditions, most previously traumatized individuals can adjust psychologically and socially. However, they do not respond to stress in the same ways as their nontraumatized peers. Stress causes a return to earlier behavior patterns. Under ordinary circumstances, an animal will choose the most pleasant of two alternatives but when hyperaroused, it will seek the familiar, regardless of the intrinsic rewards.
People, particularly children, who have been exposed to severe, prolonged environmental stress will experience extraordinary increases in opioid responses to subsequent stress which may produce both dependence and withdrawal phenomena which could explain in part, why childhood trauma is associated with subsequent self-destructive behavior. Depending on which stimuli have come to condition an opioid response, self-destructive behavior may include chronic involvement with abusive partners, sexual masochism, self-starvation, and violence against self or others. Reports of early childhood physical and sexual abuse were highly correlated with self-mutilation and self-starvation in adulthood. Self-mutilation is a common response to abandonment; it is accompanied by both analgesia and an altered state of consciousness, and it provides relief, return to normality, and attempts at “repairing the cohesiveness of the self in the face of overwhelming anxiety.”
Treatment & Services
People experiencing complex trauma have a very strong need to feel safe. Healing and recovery is stage-based and emphasises establishing safety first. Core stages for treatment and recovery are: stabilisation/establishing safety, processing trauma—the exploration and reintegration of traumatic memories into a personal narrative; and the positive reconnection with others. Although there may be no “final” resolution, healing from an experience of trauma should be focused on the need to increase the capacity of survivors to be aware of and control their reactions to a range of trauma stimuli, including flashbacks, extreme emotion states, and interactions with others.
Compulsive repetition of the trauma usually is an unconscious process that, although it may provide a temporary sense of mastery or even pleasure, ultimately perpetuates chronic feelings of helplessness and a subjective sense of being bad and out of control. Gaining control over one’s current life, rather than repeating trauma in action, mood, or somatic states, is the goal of treatment.
Although verbalizing the contextual elements of the trauma is the essence of treatment of acute post-traumatic stress, the essential elements generally are retrieved with difficulty and failure to approach trauma-related material very gradually leads to intensification of the affects and physiologic states related to the trauma, leading to increased repetitive phenomena. Prior to unearthing the traumatic roots of current behavior, people need to gain reasonable control over the longstanding secondary defenses that were originally elaborated to defend against being overwhelmed by traumatic material, such as alcohol and drug abuse and violence against self or others. The trauma can only be worked through after a secure bond is established with another person, and healing needs to occur within a safe and predictable external environment. A safe environment is one which supports and encourages, and which does not recreate situations of humiliation, isolation, danger, unpredictability and disempowerment.
Despite a lack of settled diagnosis, the terms “complex trauma” and “complex PTSD” are relevant to the care of victim/survivors of interpersonal abuse. Becoming trauma-informed is a way for services to be able to provide clients with a service that is attuned to the whole person’s array of needs and provide survivors with a more comprehensive approach. Given the absence of an over-arching construct for trauma-related behaviours, individuals are often diagnosed with a range of other disorders such as major depressive disorder, anxiety, borderline personality disorder, conduct disorders etc, and behaviour such as self-harm, suicidal ideation, and substance abuse as symptoms of these. This complexity has impacts on treatment approaches and about what the most important element to address is—the trauma, the mental health problem, or the substance use? It is often the secondary (e.g., substance abuse) or tertiary (e.g., drug-induced mental illness) expressions of trauma that result in treatment and/or support. Flexible and individually focused care is a very important factor in the care of people with complex trauma. The nature of victimisation is such that cases can be varied in type, intensity of abuse and impacted by factors such as the relationship to the abuser and the age and developmental stage of the victim. Because each victimisation experience can be so vastly different and result in different symptoms or degrees of need, it is important that care can be attuned to the level and type of need of that person.
I never really went through abuse or trauma, I don’t think. Nothing.. really bad. I was never raped or sexually assaulted or abused as a child, my family was okay-enough, I never went through anything majorly traumatic. But oh boy, do I relate to so so much of what has been in the literature, and oh boy do I have.. almost all of the symptoms of Complex PTSD? Things like flashbacks, intrusive memories, anxiety, shakiness etc have always been short term symptoms but everything else like inability to trust, dissociation, high levels of self harm, disturbances in identity, affect regulation, re-victimisation etc have been present for as long as I can remember.
I don’t know. I’m honestly exhuasted, the past 2 days have felt like months. Too much has happened and I don’t know what to make of any of it. All I can think about is my fault my fault my fault i want to die i want to die i want to die.