Complex trauma: when it wasn't one event

When people think of trauma, they usually picture a single event: an accident, an assault, a sudden loss. That is the classic picture of PTSD, and it is often treated with a focused piece of work on one memory. But for many people, what still affects them wasn't one event. It was a series of experiences, or something that went on over a long period, and its effects are spread more widely through their life.

This is what is usually meant by complex trauma: trauma that goes beyond a single event or a straightforward case of PTSD.

What it can look like

Complex trauma doesn't always involve experiences that would look dramatic from the outside. It can come from:

• Several frightening or distressing events at different points in life
• Growing up in a home that was unpredictable, highly critical or emotionally unsafe
• Prolonged bullying, at school or at work
• A long period of feeling under threat, humiliated or powerless

What these have in common is repetition. Instead of one memory that replays, there are many related memories, often linked by the same feelings and the same conclusions about yourself.

How it differs from single-event PTSD

With a single traumatic event, the main difficulty is usually the memory itself: flashbacks, nightmares, avoiding reminders. Complex trauma can involve those too, but people more often notice its effects in how they see themselves and the world:

• A persistent sense of not being good enough, or of being somehow different from other people
• Shame that seems out of proportion to anything you have done
• Constant alertness to other people's moods, criticism or disapproval
• Finding it hard to relax, to trust, or to believe that things will be alright
• Strong reactions to situations that echo the past, which can feel confusing in the moment

Many people with this kind of history don't come to therapy saying "I have trauma". They come because of anxiety, perfectionism or a sense that something has always been slightly wrong. The link to the past only becomes clear once we look at what keeps their current difficulties going.

Shame and self-worth

Shame often sits at the centre of complex trauma. When difficult experiences are repeated, particularly early in life, people tend to make sense of them by concluding that the problem must be them. That conclusion can persist long after the circumstances have changed, and quietly shape how they approach work, relationships and themselves.

There is a strong overlap here with what CBT calls the "bottom line" in low self-esteem: a settled belief about yourself that feels like fact. Part of the work is recognising where that belief came from, and that it was a way of making sense of what was happening at the time, not an accurate verdict.

Why one memory can affect many others

Memories aren't stored in isolation. Experiences that share the same feelings, beliefs or sensations are linked together, so a present-day situation can activate a whole network of related memories at once. That is one reason why the effects of complex trauma feel so broad, and also why treatment doesn't need to work through every single memory. Processing the key memories in a network often changes how the related ones feel too. I explain this in more detail in How EMDR therapy works.

How treatment works

Complex trauma is treated with the same evidence-based approaches as PTSD, trauma-focused CBT and EMDR, but the work usually takes longer and involves more groundwork. In broad terms:

• Understanding the pattern. Mapping how past experiences connect to what you are struggling with now, and identifying the memories and beliefs that carry the most weight.
• Processing the key memories. Using trauma-focused CBT or EMDR to work through the experiences that are driving current difficulties.
• Updating the beliefs. Revising the conclusions you drew about yourself at the time, and building confidence in a more accurate view.

If intrusive memories or flashbacks are part of the picture, my article on why traumatic memories feel like they're happening now explains why they behave the way they do.

In my practice

I work with adults who are managing their day-to-day lives, often very capably, but who are carrying the weight of experiences that haven't been processed. The work is structured and paced, and I won't ask you to go into anything before you are ready. If, at assessment, I think a different kind of service would suit you better, I'll say so and explain why. You can read more about my approach on my trauma and PTSD therapy page.

Guy Klein

BABCP-accredited CBT therapist and EMDR Europe accredited practitioner, in clinical practice since 2015. Guy works with adults online and in Queen's Park, North West London, with a particular focus on OCD, anxiety and trauma. More about Guy