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What is Trauma?

Historically, trauma referred to physical injuries and the experience connected to receiving them. It is now recognised that even in the absence of physical harm trauma can be experience psychologically. Examples of a traumatic event include things like:
   • A sexual or physical assault
   • A car accident
   • A natural disaster such as an earthquake
   • A terrorist attack

Experiencing traumatic events is often deeply distressing and unexpected, leaving us feeling overwhelmed and out of control. For some people this shock is psychologically traumatic leaving us with symptoms such as:
   • Nightmares, flashbacks and invasive memories
   • Avoiding reminders of the event, for example avoiding car journeys if you had a car accident
   • Feeling on edge, angry or irritable

All these symptoms are normal responses to trauma and can ease over time. If they continue or worsen for more than a few months, it might be time to seek support in case Post Traumatic Stress Disorder (PTSD) has developed.


Types of Trauma

Trauma can occur as a single event this is often referred to as a Type 1 trauma, or as a multiple event, referred to as a Type 2 trauma. Type 2 traumas can be further split into Type 2B, where multiple trauma occur to individuals with relatively stable backgrounds and sufficient resources to separate events; or Type 2B traumas where the individual is unable to separate multiple events. This can be further separated into Type 2B(R) where an individual has sufficient stability to develop resources though resilience impaired, and Type 2B(NR) where an individual never develops resources.


Complex Trauma or Complex PTSD

Complex trauma describes a child's exposure to multiple traumatic events of an interpersonal nature. The traumatic events often involve prolonged and repeated experiences of a sexual or physical nature. Repeated betrayal of trust can lead to dissociation, alterations of self and PTSD. Long-term abuse can cause difficulties in relatedness and identity.

Single traumas, such as car accidents are often referred to as simple or Type 1 traumas. Some people experience prolonged multiple traumas over their lifetime, perhaps beginning in childhood. They can include:
   • Child neglect
   • Torture
   • Physical, emotional or sexual abuse
   • Domestic violence

This type of trauma can be particularly damaging because they are caused by people rather than events. The people involved are often people we live and trust or those in authority who we do not expect to hurt us. This can cause us to feel confused, trapped and unable to escape. These types of trauma are referred to as complex trauma. Symptoms include:
   • Relationship difficulties
   • Struggle to manage overwhelming feelings
   • Struggle with sense of self (self-concept).

All of these symptoms are normal human responses to abnormal situations that were intolerable and can lead to complex post-traumatic stress disorder (c-PTSD).


Causes of Complex Trauma

All infants and children have basic needs generally provided by their parents or primary caregivers. These include food, shelter and clothing. Children also need their psychological needs to be met. These include:
   • Being loved and cared for
   • Feeling safe from harm
   • Able to explore and meet other people

The experience of our psychological needs being met as children help us provide these things for ourselves in adulthood. If some of our experience is neglectful or negative this can cause us difficulties in relationships with others and ourselves later in life. As we depend on our caregivers to survive children can be left confused and too frightened to tell others. Our experience is normalised, and we can even believe we deserve to be treated badly. Children often blame themselves and grow into adults who hold a great deal of shame.

Complex trauma can also develop later in life, perhaps because of domestic violence in the home, human trafficking or even torture. Similar to multiple traumas in childhood and adult can begin to change the way they think and feel about themselves in response to their difficult experiences.

Stress is present in everyone's lives to some extent, being late for the bus or receiving a poor work appraisal is not pleasant for anyone, but for those who have experienced complex trauma day to day stress can feel unmanageable. It can feel impossible to manage a job or relationships. Trauma affects us all differently, it can affect how we think, feel and behave. It is common to feel worthless, bad or a failure because the people around us have told us or made us feel. Often people with traumatic backgrounds experience a deep sense of shame. We might change how we behave to fit in with what we think those around us want, leaving us unsure who we really are.

If we grow up in environments where adults support and encourage us in a caring predictable way, we learn that even difficult emotions are usually temporary and manageable. If we become too distressed, we know we have people around who will help us. If this support has not been available or not been consistent, we do not learn how to manage our emotions. Anger, self-harm or addictions might develop as ways to cope. We can become numb inside or disconnected from our emotions as they are too difficult to bear. We might dissociate, that is cut off from ourselves in response to stress.


Dissociation

We all dissociate sometimes, perhaps you took a journey from A to B and do not recall all of the journey. Sometimes dissociation is more problematic. Our sense of self, our thoughts, feelings and memories can become disconnected, so it becomes hard to access memories or feel grounded in our identity. This might be caused by trauma where we have disconnected from the situation in order to survive. There are five types of dissociation.


   • Depersonalisation
Perhaps you feel as if your body is disconnected from you or does not feel quite right. Maybe you look at your hand, aware you are seeing it but somehow it does not seem to be yours. This is known as depersonalisation. You might even feel as if you are observing yourself, almost as if you are watching a movie but it is you you are watching.

   • Derealisation
Similar to depersonalisation, except it is the world around you that might feel unreal. Perhaps colours, shape or sizes in the world around feel dreamlike, for example you might feel as if you are walking through a busy shopping centre but none of the people around you seem quite real, as if you are walking through a virtual reality game.

   • Amnesia
Some memories might feel missing or incomplete. Perhaps you do not remember how you got to work, or what you have been doing all day. Important information about periods of your life might feel as if they are missing but cant be explained by ordinary forgetfulness.

   • Identificvation Confusion
You may struggle to understand who you are and be confused about your life.

   • Identity Alteration
You might feel as if you are one person at home, another at work and yet another with your friends. It might feel as though you are not sure which 'you' is the real you, especially if each of these identities feels very different.


Trauma and Relationships

If we have been hurt and harmed in the past we can find it difficult to trust others, perhaps pushing people away if they come too close leaving us confused and frustrated. We might attack others because we feel they are about to attack us. Difficulties connecting with others is a common symptom of complex trauma. Therapy can provide a safe space to learn to trust.




Bibliography
Terr, L.C. (1994) Unchained Memories. New York: Basic Books.
Rothschild, B (2000) The Body Remembers: The Psychology of Trauma and Trauma Treatment. New York: Norton
Herman,J.L (1992) Trauma and Recovery. New York: Basic Books
Sanderson, C (2012) Counselling Skills for Working with Trauma. London: Jessica Kingsley
Van Der Kolk (2015) The Body Keeps the Score. New York: Penguin