This is the domain of complex post-traumatic stress disorder (C-PTSD), a world in which the mind tries to survive amid the ruins of devastating experiences.
How C-PTSD arises: a cry for help from the soul
Complex trauma, or complex post-traumatic stress disorder, is a term that arose from the need to recognise the many-sidedness and severity of certain traumatic experiences that are not fully covered by the standard definitions of PTSD. The story of Madelon, a young woman struggling with the shadows of her past, shows the devastating impact that prolonged and repeated trauma can have on the soul.
Madelon’s world is one of dissociation, a defence mechanism in which she disconnects herself from the pain, resulting in emotional numbness and estrangement from herself and her surroundings. The somatic echoes of her trauma, the headaches, stomach aches and chronic pain, are the silent scream of her body, a constant reminder of the fear and vigilance that pervade her daily life. The voices she hears are an echo of the tormentors who once beset her.
More than PTSD
The recognition of C-PTSD as a distinct and complex form of trauma is an essential step in understanding and treating people who have been through prolonged, repeated traumatic experiences. These experiences often go beyond a single event and include situations such as long-term abuse, war violence or captivity. This form of trauma not only affects emotional wellbeing, it also has a profound effect on a person’s identity and relationships with others.
The struggle for recognition: a journey through time
The road to recognition of complex trauma has been long and bumpy, often hindered by outdated views and the strict categorisation of mental health problems. Even so, the voices of experts by experience and forward-looking professionals have shed light on the importance of a broad and inclusive approach to trauma. It is a struggle that continues, but is slowly being won.
Complex trauma and psychosis susceptibility
One of the most telling insights in the study of complex trauma is its deep connection with psychosis susceptibility later in life. Research increasingly shows that people who went through prolonged and repeated traumatic experiences in childhood or adolescence have an increased risk of developing psychotic experiences, including hearing voices. This phenomenon, often surrounded by stigma and misunderstanding, is prominent in people who struggle with complex trauma.
Hearing voices can be a direct expression of unprocessed trauma that has settled deep in the unconscious. These voices can vary in character and intensity, but they often act as an echo of the past, reflecting the traumatic experiences and the emotions that go with them, such as fear, guilt and shame. For some people the voices can even take the form of their abusers, so that the traumatic events are relived again and again, a cycle that is extremely hard to break.
A trauma-informed approach
This insight underlines the importance of a trauma-informed approach in the treatment of psychosis susceptibility. Recognising complex trauma as a fundamental factor in the development of psychotic experiences offers a crucial perspective for therapists and care workers. It enables them to look beyond the symptoms and to address the underlying traumas that form the core of the psychotic experience. This approach requires a thorough understanding of the dynamics of complex trauma, and also a commitment to creating a safe and supportive therapeutic environment in which people can explore and process their traumatic experiences.
Recognising the relationship between complex trauma and psychosis susceptibility is a step forward in destigmatising psychotic experiences, and it offers hope to those who are looking for recovery. It is a reminder of the complexity of the human psyche and of the resilience needed to overcome the shadows of the past and to walk a path towards recovery.
Guidelines for recovery: a path of hope
The development of guidelines such as those of Blue Knot in Australia, and the advice of the Dutch advisory group on early childhood trauma, mark a turning point in how we approach complex trauma. These guidelines stress the importance of safety, of recognising the impact of trauma on body and mind, and of an individual and holistic approach to treatment.
The challenges of treatment
Treating complex trauma is far from simple. Traditional talking therapies and EMDR often fall short in addressing the deep-rooted effects of prolonged trauma. There is growing recognition of approaches that see body and mind as one whole, and that use innovative therapies such as the Comprehensive Resource Model (CRM) and other body-oriented methods.
The importance of the journey: beyond the destination
For those who struggle with complex trauma, the path to recovery is often long and full of uncertainty. It is a journey that takes courage, patience and resilience, and one that can lead to a place of understanding, recovery and, in the end, peace. In the search for recovery and understanding, we need the courage to embrace the complexity of human distress. Complex trauma is a reminder of our vulnerability, and also of our remarkable resilience.
Do you need help now?
PsychosisNet offers information. We do not offer a chat, a helpline or crisis support. If you or someone else is in immediate danger, call the emergency number in your country. If you are thinking about suicide, or you need to talk to someone now, see Need help now? for helplines by country.
Prof. dr. Jim van Os, Chair Division Neuroscience, Utrecht University Medical Centre. 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’. In 2026 he published 'Wat psychisch lijden is'.
Want to read more?
Blogs by Jim van Os can be read here
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