The Posttraumatic Stress Disorder (PTSD) diagnosis was introduced in 1980 and was the first to explain psychiatric disorders as stemming from an external influence, rather than originating in an inherent biological weakness. It is a unique diagnosis because it emphasizes and includes the originating event - in addition to the symptoms - within its criteria.
Complex trauma goes beyond the PTSD diagnosis to address psychiatric disorders that result from exposure to chronic and repetitive trauma occurring at developmentally crucial stages. It is considered a diagnosis that explains “arrested development” that results in alterations in how the individual functions. Though not implemented in recent publication of the DSM it is referred to - in clinical circles and for the purposes of research and development - as Complex PTSD and/or Disorders of Extreme Stress - Not Otherwise Specified (DES-NOS).
Complex PTSD is understood as resulting from traumatic stressors occurring at developmentally important times such as early childhood and adolescents; and are committed by an important person in the individual’s life such as a parent, nanny, and childcare or healthcare provider. When these violations occur within relationships that should provide safety, significance, and belonging it undermines the individual's natural ability to develop in a healthy way.
Complex trauma can also develop later in life. Though not a focus of this blog post, here is a brief explanation of how. Whereas chronic childhood trauma derails the personality development of the individual, chronic adulthood trauma has the potential to damage the already formed personality of the individual. The events typically overwhelm the individual’s established sense of self, identity, relationship and security. These types of traumas include, but are not limited to, combat, chronic homelessness, poverty, inescapable community violence, persecution, human trafficking, refugee displacement, and torture.
With regard to childhood chronic trauma it is important to take a discuss what development was like for the child. Instead of focusing on normal developmental milestones (attunement, attention, learning, social cooperation, etc.) the child was preoccupied with their survival. The result is the development of a pervasive pattern of negative beliefs about self, others and the world that are based on the assumption that they need to focus solely on survival. The beliefs develop into patterns that become the means by which the individual organizes their life. The survival response leads to a disconnection between body and mind that often manifests in impulsive behavior, drug and alcohol use, unsafe sexual behavior, dissociation, and eating disorders.
Children are naturally ego-centric for many years of their development This is appropriate and necessary to normal development. Through this lens they understand how they affect their environment. A child learns how they effect their environment simply by interacting with their toys. For example, stacking up wooden blocks and then knocking them down provides them information about how they can affect change in their environment. It is an essential building block to initiate and support later stages of development related to social connectedness, responsibility, and building autonomy as individuals. The trouble with this, however, is that when trauma is present during these stages they apply their ego-centrism to interpret events in an attempt to understand why things are happening. Though understandable it is clearly a narrow-minded interpretation that leads to faulty conclusions that inform the individual about who they are. That is why it is so essential that children are provided adequate explanation to things that are going on in their lives. The old adage “children should be seen and not heard” is detrimental to assisting healthy development in the midst of adverse circumstances.
Keep in mind that adverse circumstances for children can be divorce of parents, pervasive fighting between caregivers, a chronic sickness of a sibling, a childhood surgery, and bullying; all events that fall outside the parameters of the stand alone PTSD diagnosis. Many people are flying under the radar for a diagnosis connected to trauma for this reason. Instead these individuals typically have a list of other diagnoses that are attempting to explain the singular, although not officially recognized (at the moment), diagnosis of Complex PTSD.
Having a list of diagnoses can be taxing and overwhelming. In cases where individual’s have a history etched with complexity it can be helpful to reduce the overwhelming burden that multiple diagnoses have on the individual by increasing their understanding of Complex PTSD and how it it may apply to them. Certainly there are many cases when a list of diagnoses is sufficient in providing an accurate depiction of an individual’s symptoms. It is, however, important to keep in mind that while the current diagnostic system does it’s best to provide a clear picture of symptoms, it is flawed and therefore may miss the point - especially in cases when an individual’s history is more accurately reflected in the definition of complex trauma.
If you’re interested in learning more about how we can help you with symptoms associated with PTSD and Complex PTSD and/or Complex Trauma, please contact us here.
We are located at 13911 Ridgedale Drive, Suite 320, Minnetonka, MN 55305
The information in this blog post was adapted from a literature review that was completed by Jessie M. Doughty in 2016, at Adler Graduate School in Minnesota. The title of the literature review is: “Treating Complex Trauma Using EMDR and Concepts from Individual Psychology.”