PTSD Professional Perspective: Understanding Complex Trauma, Complex Reactions, and Treatment Approaches, Part 2
Posted Oct 08 2010 4:16am
Last month we started a special series on Understanding Trauma. Dr Christine Courtois began the series with “ Understanding Complex Trauma .” This month Dr. Courtois helps us understand trauma by going over complex stressors.
Cumulative adversities faced by many persons, communities, ethno-cultural, religious, political, and sexual minority groups, and societies around the globe can also constitute forms of complex trauma. Some occur over the life course beginning in childhood and have some of the same developmental impacts described above. Others, occurring later in life, are often traumatic or potentially traumatic and can worsen the impact of early life complex trauma and cause the development of complex traumatic stress reactions. These adversities can include but are not limited to:
o Poverty and ongoing economic challenge and lack of essentials or other resources
o Community violence and the inability to escape/re-locate
o Disenfranchised ethno-racial, religious, and/or sexual minority status and repercussions
o Incarceration and residential placement and ongoing threat and assault
o Ongoing sexual and physical re-victimization and re-traumatization in the family or other contexts, including prostitution and sexual slavery
o Human rights violations including political repression, genocide/”ethnic cleansing,” and torture
o Displacement, refugee status, and relocation
o War and combat involvement or exposure
o Developmental, intellectual, physical health, mental health/psychiatric, and age-related limitations, impairments, and challenges
o Exposure to death, dying, and the grotesque in emergency response work
To summarize: complex traumatic events and experiences can be defined as stressors that are:
(1) repetitive, prolonged, or cumulative
(2 ) most often interpersonal, involving direct harm, exploitation, and maltreatment including neglect/abandonment/antipathy by primary caregivers or other ostensibly responsible adults, and
(3) often occur at developmentally vulnerable times in the victim’s life, especially in early childhood or adolescence, but can also occur later in life and in conditions of vulnerability associated with disability/ disempowerment/dependency/age /infirmity, and so on.
Such complex stressors are often extreme due to their nature and timing: some are actually life-threatening due to the degree of violence, physical violation, and deprivation involved, while most threaten the individual’s emotional mental health and physical well-being due to the degree of personal invalidation, disregard, deprivation, active antipathy, and coercion involved.
Many of these experiences are chronic rather than one-time or time-limited and they can progress in severity over time as perpetrators become increasingly compulsive or emboldened/entitled in their demands, as trauma bonds develop between perpetrator and victim/captive, and/or as their original effects become cumulative and compounded and the victims increasingly debilitated, despondent, or in a state of adaptation, accommodation, and dissociation. Because such adversities occur in the context of relationships and are perpetrated by other human beings, they involve interpersonal betrayal and create difficulties with personal identity and relationships with others.
Christine A Courtois, PhD & Associates, PLCis 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: