Complex Trauma

The term complex trauma generally refers to traumatic stressor events and experiences that occur repeatedly, often escalating in severity as they become more chronic over time. They are typically interpersonal in causation and commission; that is, they are caused by other people. In most cases, they are premeditated and involve violation, intrusion upon, or exploitation of individuals who are usually of lower status or power. Some involve physical violence; others do not. Tragically, when interpersonal trauma occurs between individuals who are related or known to one another and who have ongoing [Page 140]contact and access in a closed setting such as a family, community, religious congregation, or work setting, it is more likely to recur and may go on to become chronic. In contrast, when perpetrated by a stranger (e.g., a robbery, a physical assault, a rape), it is usually a one-time event that occurs suddenly and without warning. As a general rule, trauma that is interpersonal results in more severe reactions than trauma that is impersonal, resulting from an “act of God” or nature or a random event (e.g., a natural disaster or an accident). Such events have no deliberate causation and, although they can certainly have major negative consequences, they do not have the additional distress associated with being deliberately hurt or used by another person and of being betrayed by a known person or intimate.

Different types of complex trauma have been identified. They are not mutually exclusive but can have different trajectories, depending upon the age of the victim when the trauma begins. The first consists of adverse experiences beginning in early childhood leading to developmental trauma. Child abuse of all types—including attachment insecurity and relational trauma, and physical, sexual, emotional abuse, and abandonment or neglect—involving individuals who have significant relationships and roles with major responsibilities for caretaking and protection (i.e., parent-child, sibling, grandparent-child) constitute some of the most commonly identified forms of chronic interpersonal victimization. Other forms of abuse (mostly sexual but involving emotional coercion and sometimes physical violence as well) have recently received more societal attention and include abuse by clergy, teachers, coaches, counselors, and therapists. When abuse occurs chronically and over the course of a child's maturation, it has great potential to alter development starting at the neurobiological level and affecting physiological, psychosexual, personality, and relational capacities. Moreover, a relationship has been found between childhood victimization, especially ongoing sexual abuse, and vulnerability to additional interpersonal victimization across the life span.

Cumulative adversities that constitute another form of complex trauma are faced by many eth-nocultural, religious, political, and sexual minority groups and communities. Some are conditions into which a child is born that are part of the familial and social context, some begin during childhood or adolescence, and others take place later in life. Some are lifelong and cumulative, others more intermittent in occurrence. When they happen to a child who is already subjected to abuse and other interpersonal violence, they tend to result in even greater traumatic exposure (“layered” or “cumulative” trauma) and the likelihood of more impact on development and more compounded reactions. When they begin in adolescence or adulthood, they are likely to have less of an impact on personality development, since major maturational milestones have already been achieved; however, they nevertheless can be highly impactful and interruptive of personal, relational, and other life stability. Such chronic traumatic adversities can include but are not limited

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