The Impact of Complex Trauma

Hello and welcome back to the Thriving After Complex Trauma podcast, where I aim to help you understand complex trauma and how to recover and really thrive in life. In this second episode, I hope to help you learn and understand more about what complex trauma is and the impact it has on our brains, minds and bodies. I'll also cover more about the common symptoms and challenges faced by people who have experienced complex trauma and an overview of how it can develop from childhood and adult traumatic experiences. Please do take care of yourself while listening. If anything feels a bit too much at any point for you, do make sure that you pause or stop, but hopefully it will be helpful for you to understand more about complex trauma, so let's get started. Firstly, I want to briefly clarify what we actually mean by trauma and complex trauma, because there's an unhelpful and untrue message around at the moment, especially on social media, surprisingly enough, that all of us have experienced trauma, and that's an inaccurate and actually potentially quite damaging message, I think. It is true that we really do all experience upsetting and distressing events as part of life, that's unfortunately part of the human experience. However, these things that happen to us are not necessarily traumatic, because when we talk about trauma clinically, we're specifically meaning the huge emotional shock and overwhelm that we experience following a highly threatening event, and that would be something that's scary and dangerous and causes us to feel intense fear, helplessness, terror, and sometimes horror, and that means our emotional and coping systems are overwhelmed at the time of the event. It's this that understandably has a lasting impact on our psychological and physical health, and seriously disrupts our ability to function and cope with life, both at the time and afterwards. And when we're talking about complex trauma, as I explained in the first episode, we're referring to the experience and impact of having repeated events that are traumatic and interpersonal in nature. So the trauma we've experienced is caused by the repeated shocking, scary, hurtful and harmful behaviour of another human. This could be in adult relationships that should have been loving and safe, or more commonly, hurt and harm has been repeatedly caused to us in childhood, often in our closest relationships with our caregivers. So some examples of this are that as a child, we may have been emotionally or physically neglected. So our caregivers have not been there for us in the way that they should to provide us consistent, safeness, kindness and care, or we've not been protected from hurt and harm, or we've been subjected to any kind of child abuse. So that can be physical, emotional, sexual. And unfortunately, that is often by the very adults who should be taking care of us and keeping us safe. It can also happen if you've been sent to a harsh boarding school environment from a young age and had many difficult experiences there. As an adolescent, we may have been exposed to multiple violent or abusive experiences as we start to explore the world beyond our family intake more risks, which can also cause significant harm. And as an adult, we may have been subjected to recurring long term domestic abuse in a relationship. And that can of course take many forms, including emotional and psychological abuse, coercive control, and any physical and sexual violence. And quite often we've been subjected to a number of these over time in an abusive adult relationship. And less common, but very real experiences that cause complex trauma are also having experienced torture, human trafficking, or exploitation, kidnapping, living in a war zone, or being a member of a cult. Most clients I see have been subjected to complex trauma in the context of their romantic or childhood family relationships, and often a combination of both. So that's what I'll focus on at least initially. But these are all clearly extremely traumatic experiences for any human to endure. And I hope you can see that the common theme is the consistent lack of safeness, kindness, and care where there should be, and that there is a power imbalance. So someone is exerting power and control over another human being in a harmful and hurtful way. Now there's obviously a continuum of experiences here. And the symptoms and challenges that people have to deal with do usually correlate with how sustained and significant the trauma that they have been subjected to has been. So while we may have been in a romantic relationship with someone who was emotionally abusive as an adult, so who called us names or belittled us in any way, who shouted at us, dismissed our feelings, that of course is going to have an impact on us and can cause complex trauma itself. But because it's happened to us in an adult body, mind, and brain, we may recover relatively quickly after we've left the relationship and worked through it. However, if we lived in a household where that happened as a child, it will be much more impactful, and it will cause greater damage to our growing minds and bodies and brains. The brain doesn't stop developing and maturing until our mid to late twenties. So again, anything that happens in our childhood or adolescence is of particular importance in terms of complex trauma. So the younger we are and the more significant the trauma that we've been through has been, then the more impact that we tend to see clinically. But let's talk about what happens to our brains and our minds and bodies when we experience a traumatic event, remembering that with complex trauma, this is happening over and over again. So our brains primary job is to look out for threat and danger. That's what it's designed for. It's evolved from our Stone Age ancestors who had to be on constant lookout for danger and threat just to survive. And if they did see something dangerous, their brain would immediately get their body ready for action to deal with the threat. Now we still have this primal survival instinct. And while the brain is of course very complex, there's a group of brain structures we call the limbic system that's very important to consider when we're looking at trauma. And what we know so far is that the components of the limbic system are concerned with our emotions, behaviors and instincts, especially those linked to our survival and importantly, including our emotional memory. And within the limbic system, there's a little small almond shaped structure called the amygdala. And it's responsible for processing fear and threat. So it acts as an alarm bell for danger. The amygdala senses the threat, pushes the alarm bell and triggers our stress response to kick in. And that sets off a series of effects that prepare us to deal with the danger. So it pushes us into survival mode, where we're in a heightened state of arousal, ready to instinctively deal with the threat. So very importantly, it shuts off the prefrontal cortex, which is the thinking part of the brain, because we have to act quickly and automatically to deal with the danger. Our nervous system gets flooded with stress hormones. So adrenaline cortisol, and that's readying our bodies to fight to run away or to hide. So the fight flight freeze response that you will have heard of. And it causes physiological changes like increased heart rate, rapid breathing and muscle tension. And again, we've all experienced that. Now in the moment, remember, we're acting automatically to overwhelming threat. There is no voluntary control at all here. And once our amygdalas pick up that there is a threat and mobilizes on nervous system, we are all going to have a fight flight freeze or fawn or submit response. Or we'll dissociate and zone out if the danger is extremely overwhelming and sustained. So let's look at each of these briefly. Fight means that we'll become frustrated, aggressive and want to shout out and hit back. So we're trying to gain some kind of power and control. A flight response is when we want to escape the situation. So our bodies get ready to run away and we usually have very strong feelings of anxiety and shallow breathing and we can feel trapped. But if we can't escape or fight back, and we're subjected to constant overwhelming threat, so especially as children, then fight and flight are often not viable options. And it's probably more likely that we go into a freeze or a fawn response, or we'll dissociate and completely disconnect from the experience. So a freeze response is common, where we've experienced an overwhelming amount of fear and panic. And it feels like we're in near paralysis. So we're very stuck and immobile, we're effectively frozen in place, and we tend to see that a lot with certain types of traumatic experience. For example, childhood abuse, sexual traumas and domestic violence situations. We can also often have freeze responses when we're reminded of past trauma. A fawn response is also very common with complex trauma when we're faced with a controlling, more powerful and harmful other person, because we submit and we try to appease them, staying as small and insignificant as possible to try and reduce the threat and not come to more harm. And again, especially you can understand that if a child is faced with a scary adult, if any of us are faced with a scary adult, then that can be an automatic response, especially if we can't get away. And if we have severe and ongoing threat, we can have more than one defense response at any time during a traumatic event, which can be very confusing as well. So we can want to fight, but be unable to because we are frozen, for example. And if we're subjected to repeated and totally overwhelming trauma, we have no option but to dissociate. It's a protective coping mechanism where we disconnect from what's happening to us in order to survive. And I'll be talking much more about dissociation in later episodes because it can be so confusing for people to understand and can continue long after the immediate threat is over. We can sometimes as adults as well be very judgmental about how we've responded to threats in the past. So the key point to really remember here is that these are automatic survival responses coming from the limbic system. This is the survival part of our brain and our nervous system is responding to an overwhelming threat. It's the threat that's the issue, not our response. Now our brain and our threat system are designed to protect us from danger as a priority, but then they're also designed to relax back into safety once the threat has been dealt with, or we realize that it's not actually a threat. However, if the threat persists or it's incredibly intense and overwhelming, our survival system is not able to do this. We can't relax back down to safety, which creates an overactive stress response, and we can effectively become stuck in an overactivated hyperarous state. So if we're experiencing hurt and harm repeatedly in our homes where we really should feel safest, it's very difficult for our nervous system to perceive that we are safe and to return to a regulated state. And that means that the stress response can then become chronic and never switching off and our minds and brains and bodies can become stuck in survival mode. And of course if this happens in childhood, when the brain is undergoing incredible growth and development and we're most sensitive and receptive to our experiences, the impact is much more significant and long-lasting. So let's talk a little now about the impact of having a survival response that's stuck in this overactivated state and the symptoms and the challenges that we see clinically with complex trauma. So a very common symptom of an overactive threat response is hypervigilance, which is a constant state of heightened awareness. So that means we're constantly scanning for possible danger and threats to our safety and it makes it really difficult to feel safe and to relax. So we're in a hyperarous state a lot of the time, which brings with it a lot of anxiety and often feelings of panic. And our bodies are repeatedly being flooded with stress hormones, so we can feel a great deal of tension in our muscles, have a rapid heart rate and suffer with digestive issues because the body is constantly readying itself to deal with the danger. And if this continues, the brain and body simply cannot cope and we can go into a hypoarous state. And when we're in a hypoarous state, we shut down, we disconnect and feel numb. And when we have complex trauma, we can swing between these two extremes. So we can find ourselves either being too activated and hyperaroused and then alternatively being very shut down and hyperaroused. And many people also experience feeling too much or too little. So we may feel very intense and dysregulating emotions, which we really struggle to regulate. So very frightened, we might feel intense guilt, we often feel an awful lot of shame, we may feel very lonely, and we may feel extremely angry and irritable. Or we might just feel very numb and not really feel anything at all. So our mood regulation systems do not work well after trauma and we can really struggle to feel regulated. We can have a persistent low mood and irritability and anxiety, which of course impact our behaviour and our relationships, not least with ourselves. Complex trauma can profoundly affect how we see ourselves. We can feel like we've lost our sense of self and who we are as people and our place in the world. We can be really tormented by very negative thoughts and beliefs about ourselves. We can feel broken, damaged, bad and worthless in some inexplicable way. And we can also find that we're not able to plan for the future or take care of ourselves in really quite basic ways. This impact on our sense of self can be especially true if significant complex trauma has happened in our younger lives. So we may feel that we've never really had a true sense of ourselves and who we are, or that our sense of self is very fragile and unstable. And sometimes we can quite early on construct a false self as a coping mechanism. And some people can also experience a fragmentation of the self where parts of us can feel very separate, with some parts becoming stuck developmentally at the time that the trauma happened to us and other parts developing very strong protective functions. And this is a bit of a complex topic so I'll talk more about that in future episodes, particularly when we're talking about dissociation. But the key point here is really that complex trauma can significantly impact how we see ourselves and our sense of self. It impacts our behaviour and how we relate to others and the world around us. We see everything through a very negative threat focus lens because our threat pathways are over activated and those involving safety and trust under activated. And we really can have our ability to trust and be intimate with other people seriously damaged, which is very understandable when you think about the fact that with complex trauma we've been hurt and harmed badly by other humans. So it's naturally very hard to trust other humans again, even though we might know at some level that there are safe and kind people in the world. And the interpersonal nature of the traumas unfortunately very often leave behind a really harmful legacy of guilt and self-blame and shame for what has happened to us rather than correctly attributing the blame and the shame to the abuser. And there are many reasons for this that I'll start to tackle probably in the next episode that will focus on childhood development of complex trauma. But for now just know that taking on self-blame is very very common and so is a harsh critical internal voice that can endure long afterwards that tells us that we're bad, wrong, not worthy of good things and are the harmful messages. This of course then adds to the intense emotional suffering, causes us to feel even worse about ourselves and can often lead to more social withdrawal and isolation. Perhaps we tell ourselves that we prefer being at home and by ourselves because that keeps us safe from the dangerous world or sometimes that other people are safer without us around. And feeling this awful about ourselves and having these very difficult internal experiences often leads to reckless and harmful behaviour because we're trying to get away from our thoughts, our feelings, our difficult memories. So we may abuse substances like alcohol and drugs, we may distract ourselves with endless scrolling, video games, workaholism, over exercising, anything really to escape from the difficult internal feelings and there are lots of avoidance behaviours that we see. And some of the most challenging and frightening internal experiences that people naturally try to avoid are the intrusive flashbacks that can occur, which involve reliving some or all of the traumatic event as if it's happening in the present and these tend to come in as feeling and body memories and that's really because unprocessed trauma memories are stored differently in the brain than normal narrative memories because we were so frightened and emotionally overwhelmed at the time. It means that trauma memories hold on to their emotional charge and fragments of the memory are very easily triggered by almost anything in the present. So it can be people, it can be places, noises, smells, even feelings. So the brain picks up the triggers, so the amygdala again, picks up the trigger as an immediate threat and floods us with the sudden intense emotional reactions and body sensations of experiencing the trauma which of course can be really frightening. You might remember earlier I said that the amygdala shuts off the prefrontal cortex of the thinking part of the brain when we experience trauma. So that makes it incredibly hard to think or talk when we're in a flashback. But the limbic system hangs onto the emotional parts of the memory and that's the intense emotions, the body sensations, the fragments and that's what we re-experience when we are triggered and that can cause us understandably to want to avoid anything that might trigger a flashback. So I hope you can see why it's really important to know and recognize that we're being triggered when we've experienced trauma and to get to know what might trigger us. Not so that we can avoid it but to be able to manage it once we know how to. And this of course can be really challenging with complex trauma because we have been hurt and harmed in close relationships or often in our homes then we're very likely to be triggered by close relationships and in our homes. So one of the first things we obviously do in therapy when someone's experiencing flashbacks is to try to help people understand what's going on and help them to manage and reduce them. So I'll create an episode with practical tips on how to manage them. And for now I'll include some links in the show notes to more information. And unfortunately alongside flashbacks people often experience nightmares too as the brain is trying to process the fragmented trauma memory while we sleep. These nightmares are normal but can be very frightening and people can understandably not want to go to sleep if they happen consistently. So sleep disturbances are very common owing to nightmares but also the fact that we're in a constant state of over activation which makes it very hard to relax and sleep. So trauma can be the underlying cause of chronic insomnia or middle of the night or very early waking and this can understandably make it even more difficult to function in many aspects of our lives. We all know that if we don't get enough sleep we feel a lot worse psychologically and also physically. And physical symptoms are very common too with complex trauma. There's growing research evidence that trauma is stored in our bodies and then manifests in physical ways which leads to many different physical symptoms and conditions like chronic pain, digestive issues, headaches, muscle tension and an elevated heart rate. And these physical symptoms are resulting from the biological changes that are happening when we are in a chronically over activated stress response. And of course if we're experiencing flashbacks then we're having the intense physical sensations triggered and our bodies flooded with stress hormones over and over again. Though it's really no wonder there's this strong link between complex trauma and physical ill health which thankfully is increasingly being recognized but there's still a long way to go. So I hope that gives you an overview and a greater understanding of the many psychological and physical symptoms that can happen if we've experienced complex trauma. These can all be very difficult and distressing of course but if we can start to understand that they are simply symptoms of the traumatic experiences that have happened to us then it's a really good first step in managing them and reducing them. And it's absolutely possible to live a life free from symptoms. However unfortunately many people struggle for too long by themselves or perhaps they've sought help but have been misdiagnosed with other psychological conditions that don't quite hit the mark and therefore treatment has not been effective. Often clients have been to therapy already but it's not been helpful because if complex trauma is not identified as the underlying cause there is a limit to how well some therapies can help. And in some cases they can cause more harm than good. So I'll definitely be talking more about effective treatments that have strong clinical evidence in later episodes. But the truth unfortunately is still that complex trauma is too often missed by clinicians in many healthcare settings even though we know that it's linked to many psychological issues. So that includes depressive anxiety and panic disorders, self-harm addictive and compulsive behaviors, personality disorders which are actually hugely misdiagnosed when complex trauma is often the underlying issue and dissociative disorders which are caused by complex trauma but are very often misdiagnosed as something else or not diagnosed early enough across many healthcare settings. Thankfully we do now have the diagnosis of complex PTSD but again it is often missed. And even if people are not given a diagnostic label or they're able to manage and function fairly well in their lives this is often because they have learned to hide their symptoms and the distress that they experience in their inner world. But we might see clues in their behavior and their coping strategies though. So we may see people overworking, over exercising, having issues around food or misusing alcohol and drugs or compulsive shopping. They may be behaving in confusing or reckless or self-destructive ways at times like driving recklessly, engaging in very dangerous sports or harmful sexual activity or self-harming as they are seeking to escape from the overwhelming intense emotional pain and symptoms. And although these are really understandable coping mechanisms in the end of course they can add to our problems making us feel even worse about ourselves and causing difficulties in our relationships. And the symptoms and challenges of complex trauma of course significantly impact our relationships with others. I'll be talking more about this in the next few episodes because relationships are such an important area for us to understand for recovery. And hopefully you can already see that as the trauma we experienced happened in relationships if we can understand more about the impact of this it can really help to improve our relationships. So I'll start by talking about childhood relationships primarily because our childhood upbringing impacts us all and forms who we are as adults. And this is usually especially important if we're experiencing symptoms of complex trauma even if this has mostly been as a result of abusive relationships in adulthood. I'll cover more about why the roots of complex trauma usually lie in childhood in the next episode. And also why we tend to repeat patterns of our childhood relationships in adulthood. And I'll also talk a little bit more about what children need from parents and caregivers to give them the very best start in life. So if that's of interest to you or a loved one do tune in for that. But meanwhile I hope this episode has helped you to understand more about complex trauma and what happens specifically in our brains and our bodies and our minds when we experience a traumatic event and more about some of the symptoms that we see with complex trauma. I'll put some good links in the show notes as well for some more free sources of information. So goodbye for now. Thanks for listening I'm sending you my very best wishes.