What Is Complex Trauma and How Does It Develop?

Trauma, the kind you’ve likely heard of, can develop after a distinct traumatic experience. It occurs when the brain and body are so overwhelmed that they have a hard time easing out of “fight, flight, or freeze” mode and coming back into a relaxed state.

Trauma may refer to a single incident, while complex trauma refers to a series of traumatic events that take place over a long period of time, like months or years.

First introduced in the 1990s by Judith Lewis Herman, PhD, complex trauma has a lot in common with the classic symptoms of PTSD, such as:

• feeling anxious
• having flashbacks
• avoiding circumstances that remind you of the traumatic events

In addition, complex trauma can:

• distort your sense of self
• make it difficult to control your emotions
• cause relationships challenges

When you experience a traumatic event, it activates the limbic system in the brain. This “fire alarm” shuts down all nonessential systems (rest, digestion, sleep) and floods your body with stress hormones, like cortisol, so you can prepare for fight, flight, or freeze.

Once the danger passes, your parasympathetic nervous system provides inner calm, otherwise known as your “rest and digest” mode.

At this point, normal cognitive function returns, and you can go back to your day with relatively few side effects, perhaps only feeling a little jittery for a while, or a bit on edge.

But for people who live with complex trauma, this balance doesn’t quite return all the way.

The limbic system stays engaged most of the time. It’s a coping mechanism to try and stay safe in the face of ongoing adversity. It’s an experience of constantly being in survival mode, or on edge.

Over time, it becomes a “new normal” for the brain and body.

In his book, “The Body Keeps the Score,” trauma expert Bessel van der Kolk, MD, describes how trauma literally becomes trapped in the body and the brain rewires itself. These lasting effects create symptoms of complex trauma.

This bodily state of your nervous system being on “high alert” can affect your thoughts, actions, and relationships.

Some symptoms of complex trauma include:

• flashbacks
• lapses in memory
• difficulty regulating emotions
• hyperarousal, or being “on alert”
• dissociation or lapses in memory
• depersonalization or derealization
• sleep disturbances or nightmares
• struggling in interpersonal relationships
• low self-esteem or negative self-perception
• avoiding people, places, or scenarios that upset you

Somatic (bodily) symptoms, like unexplained headaches or an upset stomach, are also common with complex trauma. Since the body is under chronic stress, it can lower your immune system and lead to a range of chronic health conditions.

Complex trauma can arise in any situation where you feel an ongoing sense of fear, horror, helplessness, or powerlessness over an extended period of time, with the perceived or actual inability to escape.

It usually stems from trauma you experienced in childhood, though it can develop from trauma in adulthood as well.

Some possible causes of complex trauma include:

• sexual abuse or incest
• ongoing physical or emotional abuse
• chronic neglect or abandonment
• medical abuse or medical trauma
• torture or being held captive
• enmeshment or engulfment trauma
• parentification (children taking on adult rules)
• human trafficking
• genocide campaigns
• living in a war zone or area of civil unrest

Everyone’s story is unique — and so is their trauma. What works for one person may not work for another.

Also, keep in mind that what works at one point in time may not work later on down the line.

The great news is, as more is uncovered about complex trauma, more trauma treatment therapies are emerging as well. The goal of each treatment option is to provide a corrective emotional experience for healing.

Here are some effective therapies for complex trauma:

• Cognitive behavioral therapy (CBT). In this form of therapy, you explore the relationship between your thoughts, feelings, and behaviors. Once you become aware of the connections, you may be able to change your actions.
• Eye Movement Desensitization and Reprocessing (EMDR). With this treatment, you’re guided with gentle tapping (or tones) to reprocess traumatic events and form new beliefs around them.
• Internal family systems (IFS). With this approach, you learn how to integrate the different parts of your personality into one whole “Self” to reprocess traumatic events in a way that can no longer harm you.
• Somatic (body) therapies. Since trauma lives in the limbic area of the brain and not the frontal cortex (the part of the brain that talks in therapy), somatic therapies or body-centered therapies can teach your body that it does not have to be prepared for trauma all the time.
• Dialectical behavioral therapy (DBT). This approach can be effective for people who live with borderline personality disorder (BPD), which has many overlapping symptoms with complex trauma. In this treatment approach, you learn mindfulness, radical self-acceptance, and distress tolerance.

There’s also a link between complex trauma and substance use as a way to cope with symptoms. If you’d like to cut back on using drugs or drinking alcohol, support is available.

Look for a local 12-step program, like Alcoholics Anonymous (AA) or Narcotics Anonymous (NA), or SMART Recovery.

Here are some additional resources for support:

• Substance Abuse and Mental Health Services Administration (SAMHSA)
• National Council on Alcoholism and Drug Dependence
• National Institute on Alcohol Abuse and Alcoholism

Recovery from complex trauma can be a gradual process. But having a range of tools and self-care strategies can make the process a whole lot easier.

It’s a good idea to keep a few deep breathing exercises up your sleeve for those tough moments. This is a direct way to let your body know that you’re safe. Try these:

• 4-7-8 breathing: Inhale for 4 seconds, hold for 7 seconds, exhale for 8 seconds.
• Box breathing: Inhale for 4 seconds, hold for 4 seconds, exhale for 4 seconds, hold for 4 seconds.
• Alternate nostril breathing: Place your right thumb over your right nostril. Inhale and exhale eight times through your left nostril. Repeat on the other side.

A consistent mindfulness practice can help too. A 2018 study involving veterans with PTSD found that a regular meditation practice can reduce symptoms of trauma. Yoga has shown similar results, showing that both can be an effective complement to talk therapy.

It might help to access trauma-informed yoga sessions, where the yoga instructor is aware that trauma can be stored in the body, and that some body movements can trigger emotional reactions. They can help you navigate these reactions in a healing way.

Here are some lifestyle adjustments that can make complex trauma more manageable:

• do tai chi or dance
• journal your feelings
• spend time in nature
• eat a nutritious, balanced diet
• sleep around 8 hours a night
• “shake off” tough emotions by literally shaking your arms or your body to release tension
• talk through your triggers with loved ones
• practice progressive relaxation techniques
• exercise five times a week, even if only a few minutes a day
• try using the flashback halting protocol to manage flashbacks

Complex trauma may feel like it’s taking over your life. Perhaps you feel alone in your experience, wondering if it will ever feel like less of a big deal.

Two thoughts: You’re not alone, and it will get better.

One of the best things you can do is to continue to educate yourself about complex trauma. You may be able to find a healing book club or support group in your area.

You can also join one online, like this one through the C-PTSD Foundation.

Here are some books to add to your reading list:

• “The Body Keeps the Score” by Bessel van der Kolk, MD
• “Healing the Fragmented Selves of Trauma Survivors: Overcoming Internal Self-Alienation” by Janina Fisher, PhD
• “Trauma & Recovery” by Judith Lewis Herman, MD
• “The Complex PTSD Workbook” by Arielle Schwartz, PhD
• “Waking the Tiger” by Peter Levine, PhD
• “Trauma and the Body” by Pat Ogden, PhD
• “The Body Heals Itself” by Emily Francis
• “What Happened to You? Conversations on Trauma, Resilience, and Healing” by Bruce D. Perry, MD, PhD, and Oprah Winfrey

Also, here’s a great TED Talk on how childhood trauma affects health over a lifetime.

Finally, know that you will get through this. You’ve survived 100% of your worst days so far and, just like the other tough times, this will pass too.

You’re stronger than you know.