Complex trauma

Complex trauma

1. Attachment patterns

   • growing up in presence of danger - violent/abusive adult in home.
   • compromised attachment formation -eg mum who uses drugs and is unpredictable, unavailable, or inappropriate
   • emotional abuse- parent who puts down, insults, belittles, blames or accuses the child.

2. Types of trauma

   • Intimate
     • Abuse, neglect, family violence
   • Societal
     • war, community violence, racism, bigotry
   • Unintended illness, injury, loss
   • Prolongued exposure to stress/trauma
     • may include substance abuse, poverty, etc
   • Complex
     • usually relational aspect. over longer period. Disrupts ability to form + maintain healthy relationships

3. Impairments you might see in a child experiencing this

   • attachment, biology (eg somatisation, difficulties localising skin contact), affect regulation, dissociation, behavioural control (eg impulse control, aggression), cognition, self-concept (eg shame and guilt, low self-esteem)

4. shapes behaviours/ cognitions --> shaping schema

   • Schemas: unconditional beliefs/feelings about self in relation to environment. Developed in childhood. rigid + persistent. when problematic, highly negative.
   • Trigger --> schema --> behaviour ---> schema is strengthened.

5. Close link to PD

   • BPD - particularly abuse. 
   • DPD - often from abandonment, neglect.
   • Narcissistic- often from emotional abuse.

6. To help

   • Environment
     • Create + maintain safety and containment. be a prototype for a trusting rel.
   • Source
     • understand origin of problem. normalise this. validate their reaction.
     • understand  their story so you can empathise
   • Comorbidity
     • assess + address potential co-morbid problems. it is the rule, not the exception. common problem: suicidality.
   • Schema therapy
     • identifying + slowly changing schema
   • Dialectical behaviour therapy
     • skills training approach. particularly for BPD and suicide clients. 
   • Stages of recovery
     • Judith Herman: safety, remembrance and mourning, reconnection.  Importance of range of biopsychosocial factors involved. group therapy recommended for normalising in stage 1.
   • Expect rel problems to play out
   • Consistency
     • respect, empathy, boundaries, accountability
   • Avoid vicarious trauma
     • make sure you can debrief + dissociate your feelings. 
   • Refer to clinical psych

7. Risk group: refugees

   • 10.4mill worldwide. often subject to repeated HR violations- in original home, during flight, at camps. UNHCR- every woman in refugee camps in Rwanda had been sexually assaulted or raped.