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Trauma & Complex Trauma

By: Courtney Walraven, MSW, LCSW-S

Trauma has several similarities with complex trauma. The diagnostic criteria according to the DSM-5 is the same for symptoms present in traumatic symptoms from a single incident and the symptoms present from complex trauma (American Psychiatric Association, 2013). Trauma is a reaction to experiencing or witnessing a life-threatening event, and it can be a single incident or repeated incidents (Sanderson, 2013). Sanderson (2013) continued to explain the difference between trauma to complex trauma. Complex trauma is a result of a series of traumatic events that typically involve repeated violations (e.g., sexual abuse, coercion, neglect) over an extended period of time. Trauma survivors usually know the perpetrator, and this adds additional layers of complication when healing from the trauma. For victims of child sexual abuse, the CDC reported 91% of child sexual abuse perpetrators are a family member or are known and trusted by the family (Center for Disease Control and Prevention, 2022). Sanderson (2013) explained how challenging life can be for children who experience abuse from a trusted caregiver (e.g., parent, family friend, babysitter). As a result of the constant confusion and restorying that children must develop to survive, boundaries, self-worth, self-respect, and many other developmental functions are undeveloped or dysfunctional (Sanderson, 2013; Blaustein & Kinniburgh, 2019).

Traumatic experiences are stored in the memory network including images, thoughts, body sensations and other senses (Chu, 2011). Chu (2011) stated the emotional impact associated with the events increases the likelihood of remembering the event. Clients who witness a trauma happening to another person (e.g., witnessing a car wreck) may still consider it traumatic depending on the emotional connection to the event. In contrast, experiencing torture, manipulation, and abuse directly would certainly result in an emotional response. Regarding the impact of traumatic events on survivors of any trauma, the emotional intensity experienced during the event will impact the recovery from the event. This is seen in the development of diagnoses following trauma. Clients who have a history of traumatic experiences are more likely to develop PTSD (Wilson & Keane, 2004). Trauma-informed therapies should be applied to all traumatic events. Sanderson (2013) encouraged trauma therapists to consider the longevity required to treat complex trauma survivors before accepting them as clients. Overall, the same core concepts used to treat any client can be applied with trauma survivors. Increased awareness of boundaries and attachments as they apply to complex trauma survivors will help the clinician avoid burnout and uphold ethical practice (Sanderson, 2013).

Complex trauma can include repeated and prolonged dysfunctional relationship attachment (Sanderson, 2013). Humiliation, violation of trust, chronic instability in the emotions of a trusted caregiver, and threats to physical and psychological safety can all contribute to the development of complex trauma. Survivors of complex trauma are more likely to develop personality changes and dysfunctional attachments in the long term (Sanderson, 2013). Although males are twice as likely to experience a traumatic event in their lifetimes, women are 50% more likely to be diagnosed with PTSD (Wilson & Keane, 2004). References:

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.).

Blaustein, M. E. & Kinniburgh, K. M. (2019). Treating traumatic stress in children and adolescents (2nd ed.). Guilford Press.

Centers for Disease Control and Prevention. (2022, April 6). Fast Facts: Preventing child abuse & neglect, violence prevention injury center. Retrieved April 27, 2023, from

Chu, J. A. (2011). Rebuilding shattered lives: Treating complex PTSD and dissociative disorders. (2nd ed.) John Wiley & Sons.

Sanderson, C. (2013). Counseling skills for working with trauma: Healing from child sexual abuse, sexual violence, and domestic abuse. Jessica Kingsley Publishers.

Wilson, J.P., & Keane, T.M. (eds.). (2004). Assessing psychological trauma and PTSD (2nd ed.). Guilford Press.

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