PTSD Professional Perspective: Understanding Complex Trauma, Complex Reactions, and Treatment Approaches, Part 1
Posted Sep 10 2010 7:39am
Today we begin a really exciting series! Once a month for about the next 7 months we’ll add an installment about understanding trauma. Not only will it educate you, but it will be a great resource to share with family and friends who need to understand, too….
What is complex trauma and what makes it different from other forms of psychological trauma? Complex trauma generally refers to traumatic stressors that are interpersonal, that is, they are premeditated, planned, and caused by other humans, such as violating and/or exploitation of another person.
In general, interpersonal traumatization causes more severe reaction in the victim than does traumatization that is impersonal, the result of a random event or an “act of God,” such as a disaster (i.e., a natural disaster such as a hurricane or tsunami, a technological disaster) or an accident (i.e., a motor vehicle or other transportation accident, a building collapse) due to its deliberate versus accidental causation. A third type of trauma, a crossover between the two, refers to accidents or disasters that have a human cause (i.e., technological disaster such as the recent Gulf oil leak or a transportation or building accident caused by human error, neglect, or malfeasance). Traumatic stressors of this type have been found to cause reactions that are more severe than those that are impersonal and less severe than those that are strictly interpersonal.
While interpersonal violence can be a one-time occurrence that takes place without warning and “out of the blue” usually perpetrated by a stranger (i.e., a robbery, a physical assault, a rape), when it occurs within the family between family members or in other closed contexts that involve significant roles and relationships, it is usually repeated and can become chronic over time. Child abuse of all types (physical, sexual, emotional, and neglect) within the family is the most common form of chronic interpersonal victimization. Such abuse is often founded on problematic and insecure attachment relationships (between parent and child or others who have primary caretaking responsibilities). Parents and other caregivers who abuse exploit a child’s physical and emotional immaturity and dependent status to meet their own needs or do so in response to their own inadequacies or distress, quite often their own history of unresolved trauma and/or loss.
Rather than creating conditions of protection and security within the relationship, abuse by primary attachment figures instead becomes the cause of great distress and creates conditions of gross insecurity and instability for the child including misgivings about the trustworthiness of others. When it occurs with a member of the family or someone else in close proximity and in an ongoing relationship with the child (i.e., a clergy member, a teacher, a coach, and a therapist), it often occurs repeatedly and, in many cases, becomes chronic and escalates over time. The victimization might take place on a routine basis or it might happen occasionally or intermittently. Whatever the case, the victim usually does not have adequate time to regain emotional equilibrium between occurrences and is left with the knowledge that it can happen again at any time. This awareness, in turn, leads to states of ongoing vigilance, anticipation, and anxiety. Rather than having a secure and relatively carefree childhood, abused children are worried and hypervigilant. The psychological energy that would normally go to learning and development instead goes to coping and survival.
Child abuse, occurring in the context of essential relationships, involves significant betrayal of the responsibilities of those relationships. In addition, it is often private and the child is cautioned or threatened to not disclose its occurrence. Unfortunately, when such abuse is observed or a child does disclose, adequate and helpful response is lacking, resulting in another betrayal and another type of trauma that has been labeled secondary traumatization or institutional trauma. It is for these additional reasons that complex traumatization is often compounded and cumulative and becomes a foundation on which other traumatic experiences tragically occur over the course of the individual’s lifespan. Research studies have repeatedly found that when a child is abused early in life, especially sexually, it renders him/her much more vulnerable to additional victimization. Such child victims can become caught in an ongoing cycle of violence and retraumatization over their life course, especially if the original abuse continues to go unacknowledged and the aftereffects unrecognized and untreated.
Christine A Courtois, PhD & Associates, PLC is a private practice that specializes in the treatment of adults experiencing the effects of childhood incest/sexual abuse and other types of trauma. Dr. Courtois has worked with these issues for 30 years and has developed treatment approaches for complex posttraumatic and dissociative conditions for which she has received international recognition. For more info: www.drchriscourtois.com . Email: CACourtoisPhD@aol.com