Symptoms and Treatment of Complex Trauma

Examples of Complex Trauma

Jessie & Jerome: A Complex Trauma Case Vignette

*The following vignette is fictional and is not intended to depict an actual client’s experience.

When Jessie and Jerome wake up in the morning, their first thought is “How am I going to get through this day?” Jessie says this with little emotion and lots of resolve because she always has a plan and is prepared for the worst. After all, that’s how she’s managed to get through life this far.

Alternatively, Jerome poses this morning’s thought to himself with a twinge of hopelessness because he hasn’t felt a sense of agency in his life in a long time, perhaps not ever. Jessie begins to move through her day determinedly, while Jerome does so begrudgingly.

By lunch, they’ve found themselves in one of two headspaces. 

Numb and detached

Jerome has barely registered anything his coworkers or family members have shared with him and he is running on “autopilot” to complete what’s been asked of him. Autopilot for Jerome means working or moving around but not feeling. Who has time to sit around and feel? Autopilot drives him away from connecting with others, and he doesn’t get along with his coworkers or family members because of it.

As a result, Jerome may think of himself as a workaholic, socially awkward, or unfriendly on any given day.

Anxious, driven, and people pleasing

Meanwhile, Jessie has internalized everything she’s heard from those around her and is busy arranging the rest of the day to make everyone’s lives easier. Logically, she thinks if everyone else is happy she will be too. She’s busy being a great employee, a great partner, a great parent, and a great friend.

What she needs can (or should) wait because something or someone else is more important. 

Complex Childhood Trauma Can Lead to Loneliness in Adulthood

Expressing desires, preferences, and personal boundaries has always been tricky for Jerome and Jessie. Where they grew up, managing and thriving in chaos was more important than addressing their own needs or feelings. Naturally, that’s the type of work or home environment they gravitate towards.

By the end of the day, no matter whether they started off determinedly or begrudgingly, Jessie and Jerome can’t recall a single thing that made them happy that day. After a few weeks, months, or years of this, they find it even more difficult to engage meaningfully with other people.

Jessie starts to feel let down all the time even in her closest relationships and Jerome finds it easier and easier to shut people out who “don’t get it” until he feels like he is the loneliest person he knows.

The feelings of rejection, sadness, anger, or frustration that they’ve both been pushing down or away threaten to bubble up at the most inappropriate times. The calm and controlled persona they’ve spent their whole life perfecting is breaking down fast.

Jerome starts to wonder if people in his life would even care if he was gone while Jessie wonders how on earth can she keep going day after day with so much tumult trapped beneath her calm exterior.

They both sign up for therapy relatively certain their issues will be resolved in a few sessions.

Jerome is convinced he’s just working too hard and Jessie is sure that marriage counseling will set her and her partner right back on track. After all, everyone these days has some form of anxiety, depression, or ADHD, right?

If Jessie or Jerome’s daily pattern sounds familiar, you may be facing more than anxiety, depression, or ADHD.

You could be facing complex trauma. 

What is Complex Trauma?

Complex Trauma Definition

Complex trauma is defined as exposure to multiple traumatic experiences combined with the difficulties that arise in surviving these experiences.

Sounds pretty vague, right?

Disentangling Complex Trauma from Presenting Mental Health Conditions 

As the above vignette would indicate, clients don’t normally walk into my therapy office with the awareness that their presenting concerns are symptoms of complex trauma.

Unfortunately, complex trauma has a sneaky way of showing up as a unique constellation of symptoms for each individual, making it difficult to isolate from other mental health diagnoses.

Complex Trauma Symptoms

Symptoms of complex trauma might include:

• depression, burnout, and a lack of focus (Jerome)
• anxiety and hyperfocus (Jessie)
• poor memory
• a history of substance abuse
• a general sense of vigilance and mistrust in others (i.e., always feeling jumpy or “testing” new people and places by surveying before interacting)
• or becoming fatigued more rapidly than someone else no matter how much sleep you’ve gotten.

Trauma Responses Often Present as Physical Symptoms

Psychological trauma is held in the body over time and presents both as physical and psychological symptoms. Often, clients dismiss physical symptoms of trauma believing instead that their symptoms are related to more recent and routine stressors.

This is why people are less likely to seek therapy for trauma specifically, even if they have each of the symptoms of trauma. 

Complex Trauma Symptoms or General Mental Health Symptoms?

All of the symptoms I’ve described so far might also sound familiar if you’ve ever been diagnosed with ADHD, general anxiety disorder, major depressive disorder, recurrent PTSD, or borderline personality disorder.

These are mental health conditions that complex trauma may “hide” behind. Upon initiating therapy clients will ask for coping strategies to manage what could be considered symptoms of complex trauma. 

So therapy may start with anger or stress management techniques, interpersonal conflict resolution, breathing exercises for anxiety, or expanding self-care.

As complex trauma represents an ongoing pattern of experiences, it’s easy to miss the experience as traumatic.

We adapt to what we know.

And it can be easier to push aside painful memories, or “move on.”

As therapy progresses, we sometimes find that the root underneath a client’s struggle to successfully self-soothe and emotionally regulate is a history of complex childhood trauma and dysregulated attachment.

Experiencing neglectful or abusive caregivers as a child can lead to instability in interpersonal relationships and views of self, poor or nonexistent relationships with family members, and a poor level of self-confidence.

Sometimes a client’s complex childhood trauma can be exacerbated by PTSD experienced later in life, through a client’s occupation or a separate traumatic event that reinforces their ongoing struggle to relate and connect. For example, experiencing life-threatening medical complications delivering a child, serving a deployment in Afghanistan, etc. 

What to Expect: Treatment of Complex Trauma

Complex trauma cannot be effectively treated by a singular drug or pharmaceutical regimen. Antidepressants, anti-anxiety medications, ADHD stimulants, and substance abuse detoxes may alleviate the byproducts of complex trauma. However, it’s only in combination with therapy (group and/or individual) can someone suffering from complex trauma experience and maintain lasting relief from their symptoms.

This is because complex trauma shapes the very fabric of how you view yourself and the world around you. While it is not impossible to confront distorted attitudes and beliefs shaped by traumatic experiences on your own, it is certainly easier and faster to do so with a therapist’s help. Think back to Jessie and Jerome from the vignette. They were convinced upon presenting to therapy that their primary issues of concern were rooted in recent and routine stressors.

Beginning Trauma Therapy

In therapy, Jerome and Jessie could complete reliable scientific assessments administered and interpreted by a professional to identify (or rule out) complex trauma as a potential diagnosis.

Specialized, evidence-based trauma treatment such as somatic experiencing (SE), eye movement desensitization reprocessing (EMDR), and brainspotting can help the body work together with the brain more quickly and effectively than traditional talk therapy to integrate traumatic memories and experiences.

Above all, Jessie and Jerome wouldn’t have to suffer alone anymore.

Therapeutic trauma treatment creates an opportunity for the relationship between the therapist and client alone to serve as a corrective relational experience, confronting prior biases regarding people and their intentions in relationships. Beliefs such as, everyone is out to get me, people only befriend me because they want something from me, etc. 

Integrating and Becoming Whole

Once physiological manifestations of complex trauma start to decrease in intensity and frequency thanks to new or improved coping skills, increased education on complex trauma, and trust in the therapist, the next step in treatment is to integrate the “new” or healed version of the self into the “old” or injured self.

A trauma therapist can help integrate these healed and injured parts of an individual by pointing out when the client is falling back on prior negative coping strategies such as alcohol abuse or self-harm.

One way to do this is to help clients understand how their previous triggers may have evolved since beginning therapy.

A therapist working with complex trauma can also track over time how empowered the client feels in their ability to enhance their own quality of life by engaging in more regular self-care and/or increasing daily pleasurable activities and social interactions.

Jessie and Jerome will know that therapy and any supplemental support/medication is working when they experience increased insight as to their actions and reactions, increased feelings of agency in their interpersonal relationships, and increased self-confidence. All of which indicate the successful integration of their complex trauma into their healed or “new” self.

Frequently Asked Questions About Complex Trauma

• What’s the difference between complex trauma and chronic PTSD?

The criteria for meeting a diagnosis of chronic PTSD include facing isolated episodes of trauma frequently. This can but does not necessarily include direct abuse/neglect. Think first responders and military personnel.

Their PTSD develops in adulthood (unrelated to childhood and attachment) and creates a similar set of symptoms described in the vignette. Comparatively, complex trauma manifests primarily as interpersonal difficulties and ineffective efforts to regulate emotions stemming from prolonged abuse or neglect over the course of critical developmental milestones.

Although some of the same symptoms from the PTSD diagnosis bleed over into a complex trauma diagnosis (e.g., nightmares, avoidance behaviors, pervasive feelings of negativity) they are not the same condition. 

• How is my history of complex trauma different from (or the same as) my typical trauma response (e.g., fight, flight, freeze, or fawn)? Some of the examples in the vignette sound like flight or fawn to me. 

A trauma response occurs upon the introduction of the stressful stimulus. You may have developed a routine trauma response as a result of complex trauma (e.g., fight response to being abused by caregivers or older siblings) but a diagnosis of complex trauma includes more than just your reaction to traumatic events. See the answer to question #1 for more clarification. 

• If all these symptoms combine in unique ways for every person, how do I know I’m suffering from complex trauma? 

A mental health professional can help you rule out inappropriate diagnoses during the course of your treatment. Some assessments (administered and interpreted by a mental health professional) might also provide clarity as to whether or not complex trauma is the root of your symptoms. These include (but are not limited to) the ComplexTQ, Adverse Childhood Experiences (ACE) questionnaire, and the Complex Trauma Exposure Assessment.

Providing a comprehensive history to your provider will allow them to most accurately reach the diagnosis that best captures your presentation of symptoms. 

• What if I have comorbid diagnoses (e.g., depression & anxiety or ADHD and borderline personality disorder) but my therapist has never told me complex trauma is the reason I have these disorders? Am I being treated correctly?

Complex trauma is capable of presenting like several combinations of comorbid mental health diagnoses. It is possible your therapist sees complex trauma as the underlying string tying everything together, or perhaps not. I would encourage you to have a conversation with your therapist about your diagnoses, why you believe/don’t believe your symptoms qualify as complex trauma, and how that relates to your treatment trajectory and therapy goals. 

• I’ve been diagnosed with ADHD but not complex trauma and the vignette really speaks to my lived experience. Should I be worried I have unmanaged complex trauma?

Poor focus, poor memory, and poor impulse control are all symptoms that align with both ADHD and a history of complex trauma. If you are unsure or afraid you have unmanaged complex trauma that is “disguised” as ADHD, I would encourage you to reflect on your ability to foster secure interpersonal attachments throughout your life.

If you feel like your ADHD symptoms impact your ability to form and maintain meaningful relationships and coincide with several of the other symptoms described above, then it is not impossible you could be struggling with complex trauma.

Please note as well that ADHD and autism spectrum disorder are often comorbid mental health disorders that might create difficulty building or maintaining meaningful interpersonal relationships, but these two diagnoses do not necessarily overlap with complex trauma. If you have or believe you have autism spectrum disorder, ADHD, and complex trauma, please consult your mental health provider to help clarify the symptoms of each separate condition and how they relate to your treatment. 

Find a Complex Trauma Therapist in Houston

If you’re ready to find healing that goes to the root of your symptoms, reach out to work with a trained trauma therapist. Trauma therapy works by combining both top-down, ie., talk therapy, approaches with bottom-up approaches, ie., healing at the deeper, physical level, to help you find relief. Trauma therapy can help you feel safe in your body while changing some of the negative thought patterns and beliefs developed from traumatic experiences.

About the Author

Jennifer Oates is a trauma therapist at Eddins Counseling Group. She helps individuals and couples overcome complex trauma, the symptoms associated with trauma, and its impact on relationships. Jennifer incorporates Brainspotting and trauma-informed therapy to help you find relief and pursue the life you deserve.

Schedule an appointment with Jennifer.