**⏺️ With:** [[Attunement]], [[Attachment]] **\#️⃣ Tags:** #Trauma #Relational #Developmental > **🌱 Planted:** Tue 01 April 2025 --- When we're born, our brains and nervous systems are still developing and very sensitive. We're entirely dependent on our caregivers not only for our physical survival, but also for our emotional and psychological development too. [[Object Relations]] shows us how important our early relationships are to our forming sense of self. But what happens when there's a failure in our early [[Holding Environment]] and our [[Developmental Needs]] are left unmet? That's how developmental and complex trauma trauma forms. It's not from a single overwhelming event, like in [[Big T Trauma]], but rather from repeated patterns of relational disruption and attachment failure in our early developmental years. And the effects of this runs deep. It impacts our biology and physiology, our capacity for connection, our fundamental sense of who we are, our way of being and [[Attunement|Attuning]] to the world, and our ability to lead fulfilling, enjoyable lives. # Developmental vs Complex Trauma Developmental trauma refers to relational and emotional trauma which occurs in childhood in response to attachment and environmental failure. Complex trauma (also known as Complex P-TSD or C-PTSD) is a broader umbrella term which includes developmental trauma, but also includes the repeated relational and traumatic events which occur later in life as a result of developmental trauma. Both focus on the the impact of ongoing, repeated, relational trauma on the development of the self and the capacity for regulation and relationships. > [!info] > Here in The Book, we primarily refer to developmental or complex trauma's impact on our development, way of being and capacity to lead an enriched life. For that reason, The Book will be using developmental trauma and complex trauma interchangeably. # Origins and Diagnosis Our understanding of trauma and it's impact has evolved massively over the past few decades. The trauma field has been (and still kind of is in some ways) primarily focused on PTSD i.e. [[Big T Trauma is about significant, shocking events that are overwhelming and often life-threatening|Big T Trauma]]. Figures in the trauma field started to recognise that the PTSD diagnosis didn't capture the experiences of certain people who seemed to be relatively safe today in their adult lives, but were still experiencing PTSD symptoms from prolonged and repeated relational trauma during childhood. In 1992, Judith Herman, a psychiatrist who helped launch the field of trauma studies, was the first person to introduce this distinction where she defined the concept of complex trauma in her book "Trauma and Recovery". > [!quote] From [[Healing Collective Trauma by Thomas Hübl|Healing Collective Trauma by Thomas Hübl]] > *In her work, Herman delineates between two classes: Type 1 traumas, which designate single-incident traumas or one-time events of significant impact with core and observable effects, and Type 2 traumas, which describe incidents of ongoing and repetitive trauma and may include occurrences such as a chronic, long-term experience of childhood abuse and neglect or a protracted history of domestic violence. Herman called Type 2 trauma and its effects “complex trauma,” and in Trauma and Recovery, she proposed its diagnostic classification as “complex post-traumatic stress disorder,” or C-PTSD, outlining the ways that long-term consequences of complex trauma are both similar to and different from those experienced by sufferers of PTSD.* From 1995-1997, the Adverse Childhood Experiences study (ACEs) sampled over 17,000 people to study the effects of complex trauma. The data from the study revealed there is a significant relationship between the number of "adverse experiences" someone goes through in their childhood and negative health outcomes later in life. It found that more adverse childhood experiences someone had, the higher their prevalence for diabetes, stroke, heart disease, cancer and other illnesses like autoimmune disease [^1] [^2]. You can take the ACEs questionnaire [here](https://www.acesaware.org/wp-content/uploads/2022/07/ACE-Questionnaire-for-Adults-Identified-English-rev.7.26.22.pdf). Later and building upon Herman's work, Bessel van der Kolk developed the concept of Developmental Trauma Disorder (DTD) to be recognised as a formal diagnostic category in the DSM-5 to recognise the distinct presentation of trauma symptoms in children with histories of complex trauma. DTD sadly and unfortunately didn't make it into the DSM-5, despite the evidence and backing. Not all progress had been lost though, because in 2018 the World Health Organisation officially included [Complex PTSD in the ICD-11](https://icd.who.int/browse/2025-01/mms/en#585833559) (International Classification of Diseases 11th Revision) which became effective in 2022. This is great news because it means complex trauma (and developmental trauma by extension) are now officially recognised, although it doesn't help in countries like the United States or Australia which rely on the DSM-5 for diagnosis. This means for now, developmental and complex trauma can't be recognised for people living in these countries which comes with a whole host of impacts to personal health, the mental health field and society at large, not to mention increases (perhaps even guarantees) the susceptibility of misdiagnosis (see [[The issue of misdiagnosis]]). Given it's been recognised in the ICD-11, the possibility of it being added in the DSM (Diagnostic and Statistical Manual of Mental Disorders) in the near future has increased significantly. # Seven Domains of Impairment Seven domains have been identified which describe the behavioural characteristics of children who have been exposed to chronic traumatic stress in their developmental years: ![[The seven domains of impairment.webp]][^3] 1. **[[Attachment]]** — A child's sense of self and understanding of others develops from the earliest bond with their primary caregiver (the mother or mothering equivalent). When these bonds are traumatic, the child's ability to know themselves, regulate their emotions, tolerate stress, trust others and form healthy relationships becomes compromised. 2. **Biology** — Children who face chronic, ongoing trauma in their developmental years see an impact to their brain and body function and health as a result. Imbalances in the brain can affect sensory processing, coordination and body connection/awareness, and the chronic impact of stress can lead to higher risk of somatic symptoms and autoimmune diseases. 3. **Affect Regulation** — Complex Trauma impairs Affect Regulation, which is the capacity for someone to modulate their emotional states and stress to adaptively meet the demands of their environments. This can show up as mood swings, outsized reactions to stressors, the inability to identify internal and emotional states (see: [Alexithymia](https://en.wikipedia.org/wiki/Alexithymia)) and difficulty communicating needs to others. 4. **[[Dissociation|Dissociation]]** — Children who face overwhelming [[Trauma is not the event, it's our internal experience|Trauma]] in their developmental years have to rely on primitive defences to keep themselves safe. Dissociation helps to keep painful memories and feelings out of conscious awareness, though it often leads to amnesia, [[Publish/Elements/Dictionary/Repression|Repression]] and depersonalisation. The reflex to detach, while protective, can lead to further body and self disconnection later in life. 5. **Behavioural Regulation** — Complex Trauma makes it difficult to regulate emotions due to the disruption to [[Nervous System]] and brain development. This behaviour can look self-destructive as traumatic events are reenacted, or it can look like rigid routines which effect regulation, sleep and relationships. 6. **Cognition** — Disruption to brain development and function leads to impacted cognition. Many who have experienced Complex Trauma find difficulty regulating attention, reasoning and overall executive function (judgement, planning, initiating and completing tasks). 7. **Self-Concept** — The experience of Complex Trauma during a child's formative years hinders the healthy formation of their [[Self-Concept]] as well as the [[Ego Development|development of their ego]]. These children (and later adults) struggle with a sense of shame, guilt, a sense of defectiveness, low self-worth, and cohesive autobiographical narrative. # Signs and Symptoms Aside from the more official seven domains of impairment, these are also some common signs and symptoms of developmental and complex trauma: - [[Emotional Flashbacks]] - A fundamental [[Dissociation|Dissociation]] and split between the mind and the body leading to disconnection from the bodily [[The way we experience ourselves is through the Felt Sense|Felt Sense]], its needs and its innate wisdom. - An inability to **just be**. [[Trauma fractures our capacity for being]]. - A relentless need to prove our worth, perfectionism, workaholism, coupled with self-consciousness, self-judgement and self-criticism from the [[Narcissistic Wounding]] that is developed as a result. - Dysregulation of the [[Nervous System]] leading to all kinds of symptoms like overwhelm, sleep disturbances, digestive issues, and anxiety. - Feeling unsafe in objectively safe situations or potentially gravitating toward unsafe situations that feel familiar due to "faulty neuroception". - Hypervigilance where there's a heightened reactivity to stimuli (sounds, smell, lighting, touch) in the environment. - Issues recognising one's boundaries [[Boundaries]], and struggles implementing or keeping them in place. - Development of insecure [[Attachment]] patterns which persist into adulthood and affect both intimate and casual relationships. - Challenges with identity due to an incoherent [[Self-Concept|Our sense of self unfolds intersubjectively, not separately]]. - Unconsciously seeking out people or situations which recreate the dynamics of early traumatic relationships (repetition compulsion). - Chronic disease, inflammation or general health issues that may be connected to the body holding onto unresolved trauma. # The Issue of Misdiagnosis Since Complex Trauma falls outside of the diagnostic scope for post-traumatic stress disorder (PTSD) in the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition), it is essentially undiagnosable (at least officially). This presents the issue of misdiagnosis where children who were exposed to repeated traumatic events and [[Nervous System]] stress are often incorrectly diagnosed with multiple separate conditions like ADHD, BPD, OCD, Anxiety Disorder, or other chronic illnesses like autoimmune disease, heart disease or cancer [^4] [^5] [^6] [^7]. > [!quote] Renowned traumatologist John Briere said: > “If we could somehow end child abuse and neglect, the eight hundred pages of DSM (and the need for the easier explanations such as DSM-IV Made Easy: The Clinician’s Guide to Diagnosis) would be shrunk to a pamphlet in two generations.” The traditional medical system operates within a paradigm of separation—there are specialists for every body part and organ, but no one who is capable of zooming out to view the person as a whole and interconnected being. Further, these diagnoses completely miss the recognition of the early developmental events that may have contributed to the genesis of the symptoms in the first place. All of this only serves to fuel The Issue of Recognition, which then only serves to reinforce the invalidation and neglect these children experienced during their early developmental years, which sadly, perpetuates their trauma and exacerbates their health ailments, leading to the reinforcement of the belief they are innately and inherently bad, defective and deficient. # The Issue of Recognition Just by looking at how difficult it has been for developmental or complex trauma to be included in official diagnosis structures, we can see there's clearly an issue around recognition. Why is there an issue around recognition? That question penetrates the very fabric of that our westernised, capitalistic society runs upon. Given that [[Collective Trauma]], there's implications that spiral up the chain from the micro to the macro. To keep it simple for now though, if we focus on understanding the human nature behind why there is this difficulty... I personally believe it all comes back to: 1. [[Separation Paradigm]], which permeates our current mode of consciousness and fuels much of our modern, western, [[Achievement Society|achievement based society]]. 2. [[Lab/01 Incubator/Sleeping/Repression]], which is both a human protective strategy and term I use for our magnificent human protective ability to find different ways to circumvent feeling pain. And why don't we want to see the truth? Because the truth hurts! Seeing the truth would mean many implications for many people. Think about how many parents out there would need to come to terms with the fact that their parenting, way of being and way of treating their children has fundamentally caused significant damage to them. And that's just an example of an implication at the micro-familial level. Much of our modern capitalistic society hinges on the collective denial of our wounds and trauma. We thrive on the need to keep moving, producing, achieving and consuming—anything to prevent us from turning inward to face the reality and pain of our inner worlds. This collective and unconscious avoidance creates a culture where we all have to put on masks get by, presenting ourselves as whole, productive, and always positive. Yet beneath the surface, the pain of our unprocessed and unresolved trauma shapes our way of being, the way we treat others, and the way our institutions and fundamental society is structured. # See Also - [[Attachment]] - [[Trauma]] - [[Lab/01 Incubator/Sleeping/Repression]] - [[Boundaries]] - [[Emotions]] - [[Individuation]] - [[Narcissistic Wounding]] - [[Understanding Traumatic Invalidation|Traumatic Invalidation]] # Library - [[Healing Developmental Trauma by Laurence Heller & Aline LaPierre]] - [[The Practical Guide for Healing Developmental Trauma by Laurence Heller PhD Brad J Kammer LMFT]] [^1]: [[The Effect of Multiple Adverse Childhood Experiences on Health]] [^2]: [Cumulative Childhood Stress and Autoimmune Diseases in Adults - PMC](https://pmc.ncbi.nlm.nih.gov/articles/PMC3318917/#:~:text=First%20hospitalizations%20for%20any%20autoimmune,05) [^3]: [[Complex Trauma in Children and Adolescents]] [^4]: [[Complex Trauma in Children and Adolescents]] [^5]: [Pete Walker, M.A. Psychotherapy](https://pete-walker.com/fAQsComplexPTSD.html) [^6]: [About the CDC-Kaiser ACE Study |Violence Prevention|Injury Center|CDC](https://www.cdc.gov/violenceprevention/aces/about.html) [^7]: [Cumulative Childhood Stress and Autoimmune Diseases in Adults - PMC](https://pmc.ncbi.nlm.nih.gov/articles/PMC3318917/#:~:text=First%20hospitalizations%20for%20any%20autoimmune,05)