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c-PTSD, much more than PTSD.  During our online consultation we get a lot of questions from people who ask us when trauma is considered ‘complex’. A good reason to write a blog about complex trauma and complex post-traumatic stress disorder (c-PTSD).

It’s hard to imagine, but in the depth of the human psyche lies a complex network of memories, emotions, and experiences. For some of us, this network is a maze of traumas so complicated and deeply intertwined that finding a way through it poses a lifelong challenge. This challenge is a characteristic of Complex Post-Traumatic Stress Disorder (c-PTSD), a condition that makes the psyche try to survive amidst the ruins of devastating experiences.

The emergence of c-PTSD: the soul’s cry for help

Complex trauma, or Complex Post-Traumatic Stress Disorder is a term that arose from the necessity to recognize the versatility and severity of certain traumatic experiences that aren’t completely contained by the standard definition of PTSD. Madelon’s story (Madelon is a woman who struggles with the shadows of her past), shows the devastating impact that long-term and repeated trauma can have on the soul.

Madelon’s world is a world of dissociation; a coping mechanism she uses to detach herself from her pain, which results in an emotional anesthetic, and an alienation of herself and her environment. The somatic echoes of her trauma – the headache, stomachache, and chronic pain – are a silent cry of her body, a constant reminder of the fear and vigilance that infiltrates her daily life. The voices she hears are an echo of the tormentors that besieged her in the past.

More than PTSS

The recognition of c-PTSD as a unique and complex form of trauma is a crucial step in understanding and treating those who have dealt with long-term and repeated traumatic experiences. These experiences often go beyond a one-off experience and include situations like long-term abuse, war violence, or imprisonment. This form of trauma doesn’t just affect the emotional well-being, but has a profound effect on someone’s identity and interpersonal relationships as well.

The struggle for recognition: a journey through time

The road to recognizing complex trauma has been long and bumpy, often hindered by outdated views and the strict categorisation of mental disorders. Nevertheless, the voices of ‘experience experts’ and progressive professionals have shed light on the importance of a broad and inclusive approach to trauma. It’s a battle that continues but is gradually being won.

Complex trauma and sensitivity to psychosis

One of the most revelatory insights into the study of complex trauma is the discovery of its deep connection with sensitivity to psychosis later on in life. Research increasingly shows that people who experienced repeated and prolonged trauma in their youth or adolescence are at a higher risk of developing psychotic symptoms, including hearing voices. This phenomenon, often surrounded by stigma and misunderstanding, is a prominent occurrence in individuals who struggle with complex trauma.

Hearing voices can be a direct expression of the unresolved trauma that is deeply rooted in the subconsciousness. These voices can vary in character and intensity, but often serve as an echo of the past, that reflects the traumatic experiences and the associated emotions like fear, guilt, and shame. For some people, these voices can take the form of their abusers, which causes the traumatic events to be experienced over and over; a cycle that is extremely hard to break.

This revelation stresses the importance

of an approach that takes trauma into consideration when treating sensitivity to psychosis. Recognizing the part of complex trauma as a fundamental factor in developing psychotic symptoms offers a vital perspective to therapists and healthcare professionals. It enables them to look beyond the symptoms and tackle the underlying traumas that are at the core of the psychotic experiences. This approach doesn’t just require a deep understanding of the dynamic of complex trauma, but a dedication to create a safe and supporting therapeutic environment in which individuals can explore and process their traumatic experiences.

The recognition of the connection between complex trauma and sensitivity to psychosis is a major step in the de-stigmatization of psychotic experiences and provides hope to those who are seeking recovery. It’s a reminder of the complexity of the human psyche and the resilience that is necessary to conquer the shadows of the past find the road to recovery.

Guidelines for recovery: a pathway of hope

The development of guidelines like those of ‘Blue Knot’ (a foundation that provides information and support to anyone who struggles with complex trauma), and the advice of the advisory group that specialises in early-childhood trauma in the Netherlands, mark a turning point in how we approach complex trauma. These guidelines emphasise the importance of safety, recognition of the impact of trauma on body and mind, and the urgency of an individual and holistic approach to treatment.

The challenges of the treatment

Treating complex trauma is by no means simple. Traditional talk therapies and EMDR (Eye Movement Desensitization and Reprocessing, a therapy that involves revisiting and reprocessing traumatic memories) fall short in dealing with the deeply rooted effects of long-term trauma. There’s a growing recognition of approaches that consider the body and mind as a whole, and that use innovative therapies like the Comprehensive Recourse Model (a therapy that focuses on mind and body, and affects nervous system) and other therapies that focus on the body.

The importance of the journey: past the destination

For those who are struggling with complex trauma, the road is often long and full of uncertainties. It is a journey that requires courage, patience, and resilience, but also one that promises to lead to understanding, recovery, and ultimately, piece. In the search for recovery and understanding, we must find the courage to embrace the complexity of human suffering. Complex trauma is a reminder of our vulnerability, but also of our incredible resilience.

Translated from Dutch by SGM Taplin

Prof. dr. Jim van OsChair Division Neuroscience, Utrecht University Medical Centre. Jim is also Visiting Professor of Psychiatric Epidemiology at the Institute of Psychiatry in London. Jim works at the interface of ‘hard’ brain science, health services research, art and subjective experiences of people with ‘lived experience’ in mental healthcare. 

Jim has been appearing on the Thomson-Reuter Web of Science list of ‘most influential scientific minds of our time’ since 2014. In 2014 he published his book ‘Beyond DSM-5‘, and in 2016 the book ‘Good Mental Health Care’. 

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