When we think of trauma, a single overwhelming event often comes to mind: an accident, a natural disaster, an assault, a loss, or another life-threatening experience.
Some forms of trauma, however, do not consist of one event.
Sometimes danger is repeated. Sometimes it continues for years. Sometimes it occurs within relationships that should feel safe and from which the person finds it difficult to escape.
Complex trauma is a term used to describe the broader effects of prolonged, repeated and especially interpersonal traumatic experiences on a person’s emotional regulation, sense of self and relationships.
Ongoing neglect, violence or abuse in childhood; an unpredictable and frightening caregiving environment; prolonged domestic violence; or other traumatic circumstances from which escape is difficult may all be considered within this framework.
What matters here is not only what happened, but what the person had to learn in order to protect themselves while it was happening.
The human mind adapts to danger.
If a child cannot predict when their environment will be safe and when it will become threatening, they may grow highly attentive to small changes around them.
A change in someone’s tone of voice.
A facial expression.
A door closing a little too forcefully.
A silence that lasts longer than usual.
Small signs that other people might not notice can become significant. At one time, recognising these signals early may have been one way of anticipating approaching danger.
The difficulty emerges years later, when the environment changes.
The danger may have passed, but the system that learned to detect danger may not change at the same pace.
In adulthood, a person may experience a small criticism with unexpected intensity. A delayed message may trigger a fear of abandonment. An ambiguous expression on another person’s face may quickly become the thought, “Something is wrong.”
From the outside, the response may appear to belong entirely to the present.
Yet sometimes the current event has only pressed the button; the experiences that taught the alarm system how to operate are much older.
It is therefore incomplete to think of complex trauma merely as the sum of bad events in the past. Even after traumatic experiences have ended, the patterns they leave behind may continue in a person’s emotions, relationship with themselves and ways of approaching other people.
A person may, for example, remain constantly on alert.
They may find it difficult to relax.
They may become rapidly overwhelmed by intense emotions or, conversely, withdraw as though they feel nothing at all.
The body may also carry part of the experience: tension, an exaggerated startle response, freezing, or a difficult-to-explain sense of unease may arise.
The effects of complex trauma are not limited to fear.
Trauma may also become embedded in the story a person tells about themselves.
Especially when traumatic experiences happen in childhood and within close relationships, it may be difficult for a child to formulate the thought:
“The person who should care for me is behaving wrongly.”
Another explanation may feel more possible instead:
“There must be something wrong with me.”
“I am not good enough.”
“I ask for too much.”
“I must be more agreeable in order to be loved.”
“I must not make people angry.”
“I must not be a burden to anyone.”
Thoughts that once helped make sense of what was happening may become the silent rules of the person’s self-perception in adulthood.
For this reason, one of the traces of complex trauma may be not only fear, but shame.
Rather than thinking that something bad happened to them, the person may believe there is something bad or deficient within them.
Relationships may also carry the effects of this past.
A person may want closeness while closeness itself feels threatening. They may long to be loved and fear abandonment at the same time. They may want to trust while constantly monitoring the other person’s behaviour. During conflict, they may feel not only the present disagreement but the possibility of losing the relationship altogether.
Sometimes the opposite happens.
The person avoids conflict.
They find it difficult to say “no.”
They notice other people’s feelings before noticing their own.
They set aside their own needs in order to preserve harmony around them.
From the outside, these behaviours may look simply like being “too sensitive,” “distant,” “controlling,” or “eager to please.”
In some cases, however, they may be present-day expressions of strategies that once helped the person stay safe.
What once protected a person may become what limits them today.
This may be one of the hardest aspects of complex trauma.
Survival strategies do not automatically disappear when the danger is gone.
If a child protected themselves by staying silent, they may struggle to make their voice heard as an adult.
If safety depended on constantly monitoring other people’s moods, they may continue to notice everyone else’s needs before their own years later.
If trusting no one protected them in the past, closeness may feel dangerous today.
If maintaining control reduced uncertainty, situations beyond their control may create intense anxiety in adulthood.
Healing, therefore, does not mean erasing the past or simply “not thinking about it anymore.”
As Judith Herman emphasises in her work on trauma, recovery involves processes such as re-establishing safety, making meaning of the traumatic experience, and reconnecting with life and relationships.
Perhaps one of the most important changes is beginning to distinguish the present from the past.
“I was in danger then; I am not in the same place now.”
“I had no choice then; I may have choices today.”
“I needed this to protect myself then; I can learn other ways today.”
This distinction does not minimise what happened in the past. On the contrary, it allows us to understand why defences were once necessary and gradually change them in situations where they are no longer needed.
Healing may not mean never being triggered.
It may mean noticing what is happening when we are triggered, distinguishing an alarm from the past from a real danger in the present, and developing new possibilities in place of responses that once occurred automatically.
Perhaps one of the most important aspects of healing from complex trauma is gradually making room, within a life shaped for years around survival, for another question:
“If I no longer have to devote myself only to protection, how do I want to live?”
Sometimes healing is not forgetting the past, but discovering that the past does not have to govern the present.
Complex trauma is a term used to describe the multidimensional effects of prolonged or repeated traumatic experiences. Complex trauma and complex post-traumatic stress disorder (CPTSD), as defined in ICD-11, are related but distinct concepts. CPTSD is a clinical diagnosis characterised by difficulties in emotional regulation, a negative self-concept and persistent relational difficulties in addition to the symptoms of PTSD.
References
- Herman, J. L. (1992). Trauma and Recovery.
- van der Kolk, B. A., Roth, S., Pelcovitz, D., Sunday, S., & Spinazzola, J. (2005). Disorders of extreme stress: The empirical foundation of a complex adaptation to trauma.
- Cloitre, M., Garvert, D. W., Brewin, C. R., Bryant, R. A., & Maercker, A. (2013). Evidence for proposed ICD-11 PTSD and complex PTSD: A latent profile analysis.
- World Health Organization. ICD-11: Complex post traumatic stress disorder.
- Herman, J. L. (2022). Truth and Repair: How Trauma Survivors Envision Justice.