Most people are now aware that when someone witnesses or experiences a traumatic event they can develop disorders of extreme stress such as Post Traumatic Stress Disorder (PTSD) or Acute Stress Disorder.
But what if the trauma is more complex – ie the trauma involves interpersonal victimisation, is of long duration and involves multiple traumatic events?
The Effects of Complex Trauma
Clinical trauma presentations of victims of car accidents and natural disasters tend to be quite different from those who have experienced abuse, deprivation and/or neglect at the hands of their caregivers. It also appears the age at which the trauma occurred makes a difference, with trauma impacting psychological, biological and social maturation and shaping future adaptation patterns.
The symptom constellation associated with this kind of complex trauma, diagnosed as Disorders of Extreme Stress Not Otherwise Specified (DESNOS) by the lead researchers in the field, has been identified in numerous research studies.
Disorders of Extreme Stress Not Otherwise Specified (DESNOS)
The research has identified six areas of functioning that are impacted by complex trauma:
- Regulation of affect and impulses: Tendency to overreact to minor stresses, become easily overwhelmed, have trouble calming themselves, trouble expressing or modulating anger, suicidal preoccupation and heightened risk-taking;
- Attention or consciousness: Amnesia, transient dissociative episodes and depersonalisation;
- Self-perception: Negative views of the self as being helpless, ineffectual, damaged and undesirable to others;
- Relations with others: Histories of numerous and varied dysfunctional relationships;
- Somatization: Suffering from persistent medical complaints that often defy medical explanation or intervention;
- Systems of meaning: Viewing the world through a dark lens, no longer believing that life makes sense or has a purpose.
People who meet the criteria for DESNOS usually have histories of interpersonal victimisation, multiple traumatic events, and/or traumatic exposure of extended duration. Sometimes, they may not have had discrete traumatic experiences but may have lived for many years with chronic exposure to unsound environments.
However, a history of chronic traumatisation does not always lead to development of DESNOS symptoms. So what makes the difference?
Research suggests that trauma may have the strongest impact when its onset occurs during early childhood or adolescence, and becomes less widely damaging with later onset. The impact of extreme stress on the physiology of the brain and body may make the individual more prone to various psychological disorders such as depression, PTSD, other anxiety disorders, substance abuse, and somatization disorder as a response to stressors later in life.
Recovery from Complex Trauma
The treatment of DESNOS is different to the treatment of other trauma related disorders such as PTSD. Experts in the field have conceptualised the treatment of DESNOS as incorporating three phases:
- Stabilisation – addressing areas of affect dysregulation, alteration in consciousness, and disturbances in self-perception;
- Processing and grieving of traumatic memories – traumatic experiences are explored and integrated into a coherent life narrative, building the clients self-perception and his/her ability to be in relationships with others;
- Reconnection/reintegration with the world – focusing on present day issues, reconnecting with peers, exploring meaningful work, pleasurable activities and constructive relationships.
If you think that you – or somebody you know – maybe be struggling after experiencing complex trauma – I encourage you to make an appointment with me.
Greta Neilsen is a Loganholme psychologist, experienced in the treatment of depression and anxiety in adults of all ages. She endeavours to provide her clients with a safe space to understand the challenges they face, as they develop ways to overcome their difficulties.
To make an appointment with Loganholme Psychologist Greta Neilsen, please call (07) 3067 9129 or you can book online today.
- Bryer, J. B., Nelson, B. A., Miller, J.B., Krol, P. A. (1987). Childhood sexual and physical abuse as factors in adult psychiatric illness. Am J Psychiatry,144, 1426–1430.
- Carmen, E. H., & Reiker, P. P., Mills, T. (1984). Victims of violence and psychiatric illness. Am J Psychiatry, 141, 378–379.
- Chu, J. A., & Dill, D. (1989). Dissociative symptoms in relation to childhood physical and sexual abuse. Am J Psychiatry, 148, 50–54.
- Herman, J. L. (1992). Complex PTSD: A syndrome in survivors of prolonged and repeated trauma. J Trauma Stress, 5, 377–391.
- Herman, J. L., Perry, J. C., & van der Kolk, B. A. (1989). Childhood trauma in borderline personality disorder. Am J Psychiatry, 22, 231–237.
- Kroll, J., Habenicht, M., Mackenzie, T., Yang, M. (1989). Depression and posttraumatic stress disorder among Southeast Asian refugees. Am J Psychiatry, 146, 1592–1597.
- Pelcovitz, D., van der Kolk, B. A., Roth S, et al. (1997). Development of a criteria set and a structured interview for disorder of extreme stress (SIDES). J Trauma Stress, 10, 3–16.
- van der Kolk, B. A. (1985). Adolescent vulnerability to posttraumatic stress. Psychiatry, 48, 365–370.
- van der Kolk, B. A., Pelcovitz, D., Roth, S. H., et al. (1996). Dissociation, somatization, and affect dysregulation: The complexity of adaptation to trauma. Am J Psychiatry, 153, 83–93.