cinnamon_girl via Compfight
In one of my early posts I described how trauma symptoms are really the brain’s way of continuing to protect itself from further harm.  For example, think of the classic PTSD example of the veteran who dives for cover when a car backfires.  Diving for cover was a protective response that may have saved the life of the veteran many times over during combat.  Now that he/she has returned, however, the brain hasn’t unlearned this protective behavior. As we discuss trauma symptoms, both classic and complex, it is helpful to remember this principle.

Classic trauma symptoms are usually defensive against physical threats.   Again, think of the combat example.

  • Hypervigilance is helpful in surveying one’s surroundings,
  • avoidance can help someone stay away from harmful settings (or thoughts/memories that are overwhelming), and
  • flashbacks are a reliving of the experience, perhaps the mind’s way of rehearsing against future similar threats, or resolving unrealized fight or flight strategies.

Complex trauma symptoms, on the other hand, are usually related to emotional harm done when the individual is a child and unfortunately, many times it is a caretaker who is causing the trauma through neglect or abuse. What happens then is that the regulatory system that pushes us into fight/flight/freeze is activated way too often by routine events. The result is that much of the emotional regulatory system is dysregulated.  It also likely means that the child wasn’t able to integrate properly.

Here’s the deal.  As we mature, we learn to manage complex needs and agendas.  So while a baby or toddler can only handle one thing at a time–I want to eat! Now!—adults usually juggle several of these at a time.  I want to eat, but I’m going to wait for my partner to get home first.  Also, while I crave sugar another part of me wants me to be healthy, and while I’m tired, another part of me values that I do try to cook… and so on.  We are constantly managing competing interests within ourselves and our environment to stay as safe and healthy as possible.

Someone who is being repeatedly traumatized often has no model for how to do this.  When paired with a constantly heightened stress response, there’s a lot of dysregulation and dissociation happening.

Emotional dysregulation is often the result of an emotional/social hypervigilance.  Clients that I work with are often highly sensitive to my facial expressions, my energy level, a glance at the clock, anything.  Someone’s tone can drive someone who is dysregulated into a rage or despair.  Meeting a new lover can inspire great heights of rapture.  Not surprisingly, many people with complex trauma wind up with a Bipolar II diagnosis.

Attachment problems can show up a lot of ways but primarily a person will have

  • anxious attachment, clinging quickly to others and worrying about being abandoned,
  • avoidant attachment, where they want to connect but remain withdrawn and distant emotionally, or
  • disorganized attachment, where they will alternate in an I hate you, don’t leave me sort of fashion.

Maladaptive coping strategies develop when someone isn’t prepared to deal with their trauma in a healthy way.  An otherwise healthy adult who is in a car accident and has subsequent trauma symptoms may seek out friends, exercise, get professional support, play music and other healthy coping strategies that allow them to experience their feelings and work through them.  When the feelings or memories are too much, the individual will instead do something that helps them avoid these.  Addictions, including drugs, alcohol, sex, gambling, eating and others are popular methods.  Cutting and self-harm can serve this purpose.

Dissociation is also common.  Dissociation occurs on a spectrum, ranging from daydreaming or highway trance to parts of self that are not aware of other parts.  Studies show that more severe trauma is associated with dissociation.  A few important points about dissociation:

  • All parts are part of the individual; no one has separate people inside of them
  • A person does not split into different parts; rather early trauma results in a failure to integrate our parts
  • Everyone has parts, like the ones I described above.  It’s just that when we’re well integrated we tend not to notice how these different parts are interacting and negotiating.  I’m not afraid of my angry, protective (fight) part because I’m not worried that it will take over and cause me to harm someone.  If I were less integrated, this would be a concern and my angry part might be exiled and silenced.

Complex trauma symptoms are really what people mean when they talk about complex trauma.  Not everyone exposed to chronic abuse develops complex trauma symptoms, so defining complex trauma as the event has allowed many researchers to only include the “wellest of the traumatized” into randomized control studies of specific interventions. At the end of the day, the event isn’t nearly as important as how the individual responded to it.  That’s why it is crucial when researchers say they are including complex trauma survivors in their study, they aren’t including folks who report chronic child abuse but then excluding people with the symptoms listed above. In my next post, I share more about the state of evidence based practice for complex trauma.

This was a VERY brief overview. For more reading on complex trauma symptoms, check these out:

http://www.traumacenter.org/products/publications.php

http://www.isst-d.org/default.asp?contentID=52

http://www.sidran.org/sub.cfm?sectionID=4