Complex trauma

Annotations:

• Unpredictable + chronic exposure to multiple forms of violence  + other potentially traumatic stressors, in context of attachment behavioural systems  that are unable to provide protection, care and comfort. Focus on cumulative trauma and developmental context rather than on discrete episodes.

1. Attachment patterns

   Annotations:

   • 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
   1. Intimate

      Annotations:

      • Abuse, neglect, family violence
   2. Societal

      Annotations:

      • war, community violence, racism, bigotry
   3. Unintended illness, injury, loss
   4. Prolongued exposure to stress/trauma

      Annotations:

      • may include substance abuse, poverty, etc
   5. Complex

      Annotations:

      • usually relational aspect. over longer period. Disrupts ability to form + maintain healthy relationships
3. Impairments you might see in a child experiencing this

   Annotations:

   • 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

   Annotations:

   • 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

   Annotations:

   • BPD - particularly abuse. 
   • DPD - often from abandonment, neglect.
   • Narcissistic- often from emotional abuse.
6. To help
   1. Environment

      Annotations:

      • Create + maintain safety and containment. be a prototype for a trusting rel.
   2. Source

      Annotations:

      • understand origin of problem. normalise this. validate their reaction.
      • understand  their story so you can empathise
   3. Comorbidity

      Annotations:

      • assess + address potential co-morbid problems. it is the rule, not the exception. common problem: suicidality.
   4. Schema therapy

      Annotations:

      • identifying + slowly changing schema
   5. Dialectical behaviour therapy

      Annotations:

      • skills training approach. particularly for BPD and suicide clients. 
   6. Stages of recovery

      Annotations:

      • Judith Herman: safety, remembrance and mourning, reconnection.  Importance of range of biopsychosocial factors involved. group therapy recommended for normalising in stage 1.
   7. Expect rel problems to play out
   8. Consistency

      Annotations:

      • respect, empathy, boundaries, accountability
   9. Avoid vicarious trauma

      Annotations:

      • make sure you can debrief + dissociate your feelings. 
   10. Refer to clinical psych
7. Risk group: refugees

   Annotations:

   • 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.