Adverse psychological reactions to traumatic experience can range from acute reactions, such as acute stress reaction/disorder, grief reactions or brief psychotic disorders, to a range of chronic disorders such as major depression, agoraphobia, alcohol and/or substance misuse, panic disorder, specific phobias (e.g., travel phobia), PTSD, Complex PTSD, eating disorders, adjustment disorders and a range of major dissociative or somatisation disorders. If major reactions to one traumatic event can occur in adults with fully developed cortical centres for emotion regulation, there should be no surprise that chronic, invasive, life-threatening, dignity-defiling abuse in early life leads to a wide spectrum of clinical presentations and long-term consequences including self-mutilation and/or suicidal thoughts.
Trauma complexity, i.e., the experience of a number of different types of PTEs, correlates with the occurrence of an increased diversity of symptoms beyond the core PTSD criteria. These symptoms typically comprise difficulties with emotional regulation, interpersonal difficulties, dissociation, substance misuse and suicidality (Cloitre, 2015), recognisable as the symptoms that most clinicians working with traumatised individuals would consider the symptoms (added to core PTSD symptoms clusters) comprising Complex PTSD. In particular, childhood complex trauma is a notable adversity. Although both adults and children experiencing complex trauma are more likely to have symptom complexity, the much stronger predictor was found to be cumulative complex trauma in childhood (Cloitre et al., 2009).
The more complex reactions to PTEs and attachment disruption develop in individuals who have suffered neglect from birth onwards with poverty, lack of love, lack of stimulation in their childhood environment; physical, sexual and emotional abuse; and further traumatisation from health and social services when their dysregulated behaviour brings them to the attention of the relevant care providers. The most extreme complex trauma disorder, dissociative identity disorder (DID) will frequently fail to be recognised as such, and even the most highly motivated patient will struggle to access appropriate services in some geographical areas. The guidelines for the treatment of DID prepared by the International Society for the Study of Trauma and Dissociation (ISSTD; Chu et al., 2011) note that presentations often are a mix of dissociative and PTSD symptoms with a number of apparently “non-trauma” co-morbidities such as depression, anxiety, somatoform, substance abuse and eating disorders. Treatment of these conditions with no recognition of the relevance of the underlying trauma history and its genesis of, for example, a major dissociative disorder will fail to promote recovery, and the patient will then be seen as treatment-resistant or suffering from a personality disorder. Individuals will likely be treated with pharmacological cocktails that fail to provide more than intermittent symptomatic relief.
Animal models suggest that the capacity for positive affect is impaired by repeatedly negative affective experiences, modelled in stimulation of the midbrain PAG (periaqueductal grey) (Wright & Panksepp, 2011). The profoundly negative impact of long-term neglect, non-recognition of needs, lack of affection and subtle humiliation must similarly impair the human ability to experience joy, love and happiness. If this is construed as a clinical syndrome of major depression, it is no surprise when it fails to respond fully to the latest antidepressant drugs. A study of the treatment of depression by Nemeroff et al. (2003) nevertheless found that those participants with a history of childhood loss, deprivation or abuse required psychotherapy in addition to medication, with medication alone being considerably less effective. Clearly, without targeting the effects of childhood experience of trauma, no matter how low-grade it may appear to the therapist, treatment will not result in the full resolution of the negative affect state or the restoration of the capacity for joy and happiness.
(Excerpted from) The Comprehensive Resource Model: Effective Therapeutic Techniques for the Healing of Complex Trauma, written by Lisa Schwarz, Frank Corrigan, Alastair Hull and Rajiv Raju, published by Routledge, 2017