Counselors talk about trauma as if all traumas lead to traumatic reactions. They do not. Some people have significant distress from what might be considered slight traumatic experiences (surely an oxymoron!) while others appear not have any negative or ongoing reactions to very large distressing events.
There’s another problem. We sometimes talk as if all traumatic reactions are the same. This is also not the case. While the symptoms of posttraumatic stress disorder (PTSD) are well-known to many (i.e., intrusive re-experiencing of trauma experiences, emotional numbing and other attempts of avoiding memories or triggers, and hypervigilance), you can find counseling students and practitioners who are less aware of a cousin of PTSD: Complex Trauma.
Defining Complex Trauma
I’m reading Treating complex Traumatic Stress Disorders: An Evidence-Based Guide, edited by Christine Courtois and Julian Ford (Guilford Press, 2009). This is an excellent text if you are interested in exploring the symptoms, neurobiology, and treatment protocols for complex trauma. In the foreword, Judith Herman helps the reader clarify the main difference between regular and complex trauma
These days, when I teach about complex PTSD, I always begin with the social ecology of prolonged and repeated interpersonal trauma. There are two main points to grasp here. The first is that such trauma is always embedded in a social structure that permits the abuse and exploitation of a subordinate group… The second point is that such trauma is always relational. It takes place when the victim is in a state of captivity, under the control and domination of the perpetrator. (xiv, emphases mine).
For trauma to become complex one needs to experience the trauma at the hands of those who are most perceived to control a social unit (family, community, etc.). It needs to be repeated and woven into the fabric of distorted relationships. You can see that prolonged abuses experienced as a child prior to development of an understanding of the world and of the self would have more devastating impact than an unfortunate and distressing event that happens as an adult. If I experience a horrific accident and an unexpected attack by a stranger, I would not, usually, begin to feel unsafe amongst friends and family. I would likely continue to trust them even as I might not trust the larger community. However, if I experience repeated abuse by a teacher, a parent, a relative, a church leader as a young child, I do not have the prior experiences of safety to rely on and thus, I am likely to experience all of the symptoms of PTSD and then some more.
What More Symptoms?
Courtois and Ford give a cursory description of complex trauma on the first page of the book,
…involving traumatic stressors that (1) are repetitive or prolonged; (2) involve direct harm and/or neglect and abandonment by caregivers or ostensibly responsible adults; (3) occur at developmentally vulnerable times in the victim’s life, such as early childhood; and (4) have great potential to compromise severely a child’s development.
Adding to the typical symptoms of PTSD, complex trauma victims also struggle to regulate emotions, impulses, somatic experiences, consciousness, and evidence significant distortions in views of the self and others leading to difficulty forming trust relationships and finding meaning in life and faith.
Those interested in learning more about the current thinking on complex trauma conceptualization and treatment may find this book useful. Others may wish to check out the latest articles at www.traumacenter.org, one of the leading centers in the country focused on the problem of trauma.
Musings on Faith and Psychology 
Can an individual have complex trauma even though their experiences seem mild in comparison to the traumas given as examples in the articles and books? (that I’ve read) If so, why? A related question then is: Does the severity of the trauma correlate with the severity of the response? As in, if the trauma is lesser, the severity of complex trauma symptoms is also lesser.
I think the short answer is yes, a person can have what appears to one to be milder trauma (again an oxymoron) but have a larger reaction than expected. Why? Well, I am only speculating here but I am guessing that at least 2 reasons are most likely: 1. biological predisposition or 2. the result of cumulative traumas. We do know that someone in the military is at greater risk for PTSD if they have had prior traumas. So, someone might have 3-4 milder traumas and have a greater reaction than one with one larger trauma. This might mean a person who is raised in an environment where they have no voice (but aren’t being abused) might have more difficulty with traumatic stress than someone who was raised in a more positive envronment and then experienced a trauma.
And then there’s the issue of people with similar experiences (siblings) and completely different reactions. Some personalities are more resilient than others, I think.
I wouldn’t say it’s necessarily about resilience.
Firstly, just because two people are siblings doesn’t mean they were treated equally by the parents. Every child has their own personality, and every parent has a unique relationship with each child, whether they would like to admit it or not.
Secondly, sometimes what may appear to be resilience and a better handling of a situation may actually be a danger sign. Someone who appears to walk away unscathed from a bad childhood and is decently functioning in life by society’s materialistic standards, while the other sibling is acting out and appears to be more troubled in life, may actually be the reverse situation. The sibling that appears to be troubled may be truly dealing with what happened and not afraid to find her own way by stumbling, falling, and recovering. Meanwhile the sibling that puts on an air of how great everything is going, is the one that has buried all feelings and consequences, is the one that may be living in denial the entire time, is the one that is quietly and secretly suffering, is the one that is still bound to other’s wills and expectations of her – is the one still enslaved, who never found herself. We all know what happens when you bury and never deal with your issues.
So, point being, people deal with things differently, and oftentimes things are not what they appear to be.
Sorry for the delay in getting this up. Missed your reply. I don’t disagree with you.
Thank you so much for this article. This is the area I am interested in and so I was glad to see your commentary on this topic as it is always so helpful – I will order this book and will visit the site. I think taking a look at the relational aspect of trauma is huge. In particular, how do we as therapists give our counselees the eyes to see and experience the “other” without their trauma glasses on? How do we get them to remove (or not be hindered) by their trauma glasses without encouraging them to separate off from a huge part of their lives in an artificial and harmful (and debilitating) way? But then again, how do we avoid having the trauma become everything? Especially where the trauma was ongoing and occurred during the developmental phase – how do we avoid having the trauma define the individual? What is the best path to cut for them in terms of ongoing safety without ongoing distortions? How do we help them form healthy attachment bonds not only with other healthy individuals they desire (and need) to form them with, but what is the best way to lead (or aid them) to a healthy attachment bond with God Himself? It seems to me that with trauma survivors, that journey looks a lot different (for a variety of reasons) than it does for your more typical sufferer who is struggling to love God and others. What does redeeming trauma look like? But here we need to be careful there as well. There has been some detrimental work done here (that I have read about) that could potentially lead someone further away from Christ. There is a uniqueness to this journey I think – one we need incredible insight and skill for. Thank you again for these helpful resources and for the extra light along the way!
Thanks Phil. Interesting… This from two of the more prolific advocates of recovered memory therapy during the 1990’s. As I recall, complex trauma was suggested as the mechanism responsible for repression of memories. Given that the RM paradigm was largely discredited, I’m a little surprised that Courtois and Ford (and Herman) continue with this line of thinking. Does their work represent a meeting (merging?) of the minds between practitioners and researchers. And is CT now more recognized as a legitimate diagnosis in places like the DSM or other standard setting bodies?
Tom, I would argue that these authors are not prolific advocates of recovered memory (popular version). Much of what has gone on in RM in the popular realm was not that connected to clinical research. Surely these two and others (including myself) recognize the capacity of dissociation and repression as well as the possibility of memories resurfacing. So, the popular RM (and in the christian world–SRA) was discredited but so was Elizabeth Loftis’ work or at least some of her interpretations. Now, I am aware that much of the 80s saw folks writing about SRA unconneted to empirical research, including multiple personality disorder (another real thing that was sometimes created by therapist suggestion, but not always).
Just to give you one tidbit from the book on what to do with clients who want you to find their hidden abuse memories: “Many clients enter therapy with the hope or expectation that the therapist will find their abuse memories for them… Without evidence, corroboration, or the client’s autobiographical memory, no one can say for sure whether a person was or was not abused…. The therapist must start with the patient’s memories (if any are available) and symptoms as they are presented…. The therapist should not set him or herself up as the arbiter of the patient’s reality.” From p. 194
The writers go on to point out that the goal is address symptom reduction and to avoid all suggestion or suppression on the part of the counselor. Lastly, Complex Trauma does not appear in the current DSM but appears widely accepted and is supported by solid research bases.
Is there anything that gives a summary of the current research-based perspective on repressed or false memory? (hoping to cut to the chase)
Phil, Thx! Shucks…now I’ll have to read the book… Helpful to see CC’s support of “evidence, corroboration, or the client’s autobiographical memory.” That is the primary concern. I’ll still argue Courtois is “prolific” though – over 70+ articles since 1980 – 38 as primary author. She’s a real researcher, but my point is that the “popular” crowd used her material – and that of others like Herman, van der Kok,etc – to legitimize their questionable practice.
About E Loftus, if you will indulge me – I am unaware that her research has been discredited, even if her detractors tried to tar and feather her on ethical grounds. She is ranked among the top 50 psychology researchers in the country and has about 500 publications. We can discuss the merits of her research visa-viz Courtois, but the scales tip heavily toward Loftus. It is curious to me that anyone would disapprove of her – but that’s another topic… Appreciate your time, Phil, and enjoy the blog!
Tom, thanks for your response. I agree Courtois is prolific, just not a prolific advocates of recovered memories as you put it. Both Loftus and Herman suffered from those who took material and ran with it. Loftus’ research was used to support the suspicion of all returning forgotten memories. Both sides reject the search for lost memories and I think both sides are open to the reality of some memories coming back after having been put out of one’s consciousness. Further, both sides agree with the malleability. I think the divergence is on how often, whether most recovered memories are implanted, and the amount of suspicion one should have about recovered memories.
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I have PTSD and before I developed it I am positive I already had some form of Complex Trauma from an abusive childhood. The biggest difference for me is is how much harder it is to lead a normal life with PTSD compared to Complex Trauma. If I had only addressed my Complex Trauma and worked through it I may have ended up better off today? Instead I drank to bury it. I isolated and buried myself in workaholism and extreme sports, etc. It amazes me how much real trauma I had to go through to end up where I am now. I functioned fairly well for many years before one incident changed me forever. I wasn’t even aware I had PTSD until I was arrested for an incident of it. I have to be very careful today to recognize the signals of an episode coming so I can avoid snapping in public. I am on Lorazepam and keep a couple pills on me at all times to take when I feel the signs of an upcoming episode. It takes a few minutes to regain composure after I take my emergency pills and I will go somewhere quiet and practice my breathing until it passes. I know now I need to leave the situation and go somewhere quiet and what to do thanks to a wonderful doctor that helped free me. I can now leave my house and work part time which is a miracle. I no longer drink and I have not had an episode in quite a while thanks to knowing my limits and self care. Working the 12 Steps of AA and doing the work, the inside job, and the writing with the support of a group was amazing. I discovered my part in my own undoing and gained the wisdom of how not to repeat it. You have to “face the fear” instead of “F* everything and run”, to overcome it which is the hardest part. Many are not so lucky and are incarcerated or live as a shut in and don’t even know they have Complex Trauma or PTSD. Many will never have the courage to try to face the “Hideous 4 Horseman” or do the work that will free them from the bondage of self. I hope my testimony helps someone to have the faith and hope to get some help. Life is too precious and short to stay stuck.
I’m familiar with Judith Herman’s work. This quote nails it:
“These days, when I teach about complex PTSD, I always begin with the social ecology of prolonged and repeated interpersonal trauma. There are two main points to grasp here. The first is that such trauma is always embedded in a social structure that permits the abuse and exploitation of a subordinate group… The second point is that such trauma is always relational. It takes place when the victim is in a state of captivity, under the control and domination of the perpetrator.”
Now here’s a scenario I haven’t seen her address:
The prolonged and repeated interpersonal trauma is within a marriage.
It’s embedded in the social structure of the conservative church which can dismiss the concerns of an oppressed wife as the “subordinate group.”
The victim *is* in a state of captivity, under the domination of her husband.
And then also under the “control” of church elders, and even counselors, who don’t believe her.
This is me.
Try healing from this by yourself.
P.S. Please consider posting on adult Asperger’s/autism in marriage.