The Difference Between Complex Trauma And Developmental Trauma

[Chava]

And so, if we just take the difference between a survivor of repeated childhood sexual abuse and a survivor of repeated threatened death in combat - I believe there is something distinct in how those two traumas manifest, and would like to see a diagnosis that represented that.

Hermann was partly trying to account for the massive amount of people diagnosed with BPD who had complex trauma histories. I think that's a big difference with child vs adult. Terrible full-system symptoms in either case, but more influence on personality and identity in childhood cases. The problem I have with too easily diagnosing personality disorders is that it seems like a fixed issue (like I am diabetic)...and also too many clinicians do not want to treat BPD. Also, if there is a trauma component, that has to be treated, vs just DBT or other skills. I also see differences between complex trauma and BPD but this is part of it...accounting for the deeper effects on personality and the long-standing self-other patterns, etc.

 

[Chava]

It's really clear that they're focusing on childhood issues, whether simple or complex. Shrug.

You're probably right and I think that came from lack of attention to childhood trauma. Many victims of CSA are still diagnosed BPD instead of CPTSD (or some mix of ADD and other things because it is noted they aren't functioning well in school). It sort of faults them. Not that I don't relate to some very borderline-y behavior myself, but the deal is childhood trauma not some personality or brain disorder that is inherent or genetic or whatever. Maybe for a few, but most borderlines have CPTSD. That research sort of spurred a lot of this on...all the crappy diagnosis. Probably they just needed "PTSD" but the dynamics are pretty gnarly and challenging with some of them, where the defenses against even recognizing trauma or working with a therapist are enough of a battle in themselves.

 

[Friday]

@Chava. Yep. I agree. The problem I see was trying to use complex trauma as the foot in the door, since to loop around to @Ms Spock 's original Q... There's a big difference between complex trauma & developmental trauma. As it's only one type amongst many possible complex traumas.

Lol. I have the old parable about the 3 blind men & the elephant running though my head... An elephant is like a rope! No, no, like a tree trunk! No. You're both wrong. An elephant is like a snake.

 

[Friday]

@joeylittle

That's better than mine! :D I'd have split it like ADHD (my bias obvious ;)), and left ages out of it as I'm eternally grumpy about the old age limits on ADHD (neurology changing on your birthday? Pfui.) and have worked with child soldiers & children in countries in conflict. Some who were very much adult, some who were very much children... At the same age. So, too, children in countries in conflict... And how radically different they are from first world countries, and how similar. Puberty was a pretty good predictor, but puberty happens anywhere from 9-17. Shrug. My mind always goes straight to them whenever I start thinking about this stuff

PTSD (select type)
- Childhood Onset
- Childhood Onset Complex
- Adult Onset
- Adult Onset Complex
- Combined : Contains features of both childhood & adult onset

I also very much like the DTD as you propose it... Very much like ASD Where symptoms are not present in scope or severity to meet a PTSD diagnosis, but may durn well progress (or not).

 

[Chava]

@FridayJones it might be I just don't totally get what you're saying (which happens to me for sure!). So not just lumping both into complex trauma? But then...

There's a big difference between complex trauma & developmental trauma. As it's only one type amongst many possible complex traumas.

I feel confused. But I do like this discussion because neither are a formal diagnosis (not saying DSM is the only standard), but different frameworks...I believe both helpful for their contributions. I think Hermann meant to address complex adult traumas, like continual combat or hostage, but she started from the framework of childhood stuff....and maybe since CPTSD didn't get further attention fast enough it has just been stuck with this Judith Hermann example. There is certainly "complex" trauma at any level.

 

[Friday]

@Chava... I'm going to cheat here and cut /paste from this thread :D

What Is Complex Trauma?

Whilst PTSD requires abnormally traumatic events as diagnostic criterion (and though complex trauma is entangled within that requirement), the PTSD diagnosis fails to concede to the longevity and duration that complex trauma encapsulates. Examples of trauma which fit the criteria for CPTSD include:

• Physical abuse - ongoing, typically administered within a family or by caregiver / Domestic Violence (DV).
• Sexual abuse - ongoing, typically administered within a family or by caregiver / friends of family / DV.
• Imprisonment - prisoner of war / incarceration / forcible confinement for long periods of time.
• Repeated tours in combat.
• Other possibilities."

All of those (and more) are complex trauma.

None of them require being a child. None even require "typical" to have happened / they can all come from different sources.

By, as you say, working within the framework of not just childhood trauma, but childhood developmental trauma perpetuated by a family/caregiver... While they may be exceptional in that focus... When they try to apply that framework to all complex trauma? It doesn't work. Unless you happen to be in their focus group, or close enough to it to get some benefit. Then it's amazing. But if you're not in their focus group? It's really obvious that, at best, you're an afterthought. Just sort of lumped in.

All T-bone steaks grilled medium rare are foods. Vs.
All foods are T-bone steaks grilled medium rare.

Recipes provided...Works amazing if you're a T-Bone. Can work pretty durn well to grill a pork chop. Not so great if you're ice cream.

((If you're ice cream? You're left floundering. Okay, try the opposite of what is provided. First, um, don't use fire? Cause that went badly. Okay. Perhaps also not massaging it with salt and herbs and seasonings, before not putting it in the fire. Or maybe? If we use different seasonings? Um. Maybe spinach? No. Hot sauce? They recommend those. No. (Oh. My brain hurts.) Strawberries? Oh hey that works. Okay, now what? They season then put on the grill. Crap. That doesn't work. Where do I cook my ice cream? (Why is this so freaking difficult??? ) Meanwhile, everyone is talking about how amazing they are for complex trauma. Well.... For a very specific -if common- type of complex trauma. Great for meats. Not so great for fruit, veg, dairy. As one is constantly having to reverse engineer, fail, turn the problem inside out, fail, throw the book at the wall (Hey! Success ;)))

Not meaning to pick on Herman specifically. If you pick up just about any book on complex trauma. It's roughly 90% childhood abuse perpetuated by family or caregiver, a chapter on combat, and a paragraph or three to each of the other forms of complex trauma. And the childhood framework? Is prevalent in everything from workbooks to proposed additions to the DSMV.

 

[Tinyflame]

I'm sorry I can't read all of the longest posts, but I would suspect that some of the largest impact comes from whether a child feels like they have an identity in place before traumas occur. Notwithstanding all the other developmental milestones, I think the advantage an adult may have is a point of reference to go back to. Not to say that that the absence of such is sufficient to indicate developmental trauma, but the presence of such trauma (& it's after-effects) surely would impact on how one is to process traumas as an adult, even if the causative factor was primarily complex traumas in adulthood, wouldn't you think? I've heard it said (regardless of ptsd or not) that the core wounds everyone experiences that impact most greatly on their lives are from the age of 7 or less.

 

[Chava]

Not meaning to pick on Herman specifically. If you pick up just about any book on complex trauma. It's roughly 90% childhood abuse perpetuated by family or caregiver, a chapter on combat, and a paragraph or three to each of the other forms of complex trauma.

First, I always enjoy food metaphors around dinner time. Gimme a steak emoji!! I honestly haven't read a lot on complex trauma aside from Herman's book and bits here and there on the internet. The childhood bit is probably the starting point. It's many years in captivity for victims of abuse, but also perhaps easier to research since the pool is bigger than, say, adult hostages. Or if we get into adult multiple traumas there are too many variables. It's not less horrible, it's just harder for people to write about and feel like they have any authority on yet. ???

@Junebug I've been reading more about the impact of early childhood trauma and it is sort of depressing...mostly because our whole foundation is set. Our brain develops in these early years, for better or for worse. But I hope with more research and more access to appropriate therapies, people can still feel hopeful to change some things (recent research on neuroplasticity seems hopeful too, somewhat along these lines). CBT is great for many reasons, but CBT and other forms of talk therapy are limited in working with early or preverbal trauma stuff. We're just sort of figuring this all out.

I have one adult trauma that, if it comes to mind, I want to destroy myself (I never talk about it...I just want to die). I've been able to contain that or work through it somewhat...not that it totally leaves. But the early childhood ones are probably the ones that make me feel like I'm dying, immobilized when I'm not, and completely alien. They are just very different. I wouldn't even say child vs adult matters in these cases, more the nature of the traumas (I have similar feelings of self-destruction related to some early stuff, very specific...the content is similar and that seems to be the common theme for some of my symptoms). I don't know where the hell I'm going with this...

 

[Tinyflame]

Totally follow you @Chava with that (& yes I'm for steak too. :tup: :hungry: ). Seriously though, I've found the same thing. I believe part of the difficulty processing the adult traumas may come from the way the brain has tied the emotions or experiences to the childhood ones. I do believe in neuro-plasticity. If anything, I do think that the repeated involuntary intrusive thoughts, nightmares & FB's (perhaps a consequence of the thoughts themselves) 'encourage' our brains to virtually default to more of the same. In that regard, forging new neural pathways & developing those may be beneficial- such as body-focused techniques, & right-brain (primarily non-linguistic) activities. As well as anything that decreases cortisol production (whether it be diet, exercise, etc, because without that the others are nearly impossible).

Perhaps talking though is critical; as you said you can't speak of the one, (I understand. :( :hug: )

 

[Chava]

I believe part of the difficulty processing the adult traumas may come from the way the brain has tied the emotions or experiences to the childhood ones.

YES! Oh, if I could only yell "yes" louder here...

 

[Tinyflame]

Hee- I hear you from Canada! ;) :)

Thank YOU @Chava. :hug:

 

[ms spock]

Thanks everyone. I am reading along and trying to understand.