Understanding Long Term Trauma (Complex Post-Traumatic Stress Disorder)

In an earlier post on how all trauma is not the same, I talk about how single incident trauma and repeated trauma impact people differently. A single incident of trauma catches us off guard and breaks through our defenses. But when trauma is repeated as it is in child abuse, domestic violence, gang violence, or war, then we don’t wait to get ‘caught off guard’ -- we unconsciously, yet wisely, build a system of defenses against being overwhelmed and getting caught off-guard again. Building defenses to survive and experience the repeated trauma conserves our energy for survival. Instead of getting flooded with emotion—with terror, fear, and all the responses to it—we build walls, moats and methods of escape. We go numb, we feel nothing, and we do whatever we have to in order to maintain our distance from ourselves and others.

Most forms of treatment for trauma focus on what I would call the first form of trauma: What did happen. These are the events that you may have a clear memory of, the actions or words of violence, abuse or neglect. Treatment often consists of telling your story and focusing on coping strategies for managing the aftereffects of the trauma: flashbacks and startle response.

But in repeated or long term trauma, ‘What happened’ is only one part of the trauma. If trauma gets repeated, a second form of trauma occurs. This second form of repeated trauma is the systems of psychological and physiological defense that one constructs to survive the trauma. People change themselves to survive trauma. The responses to trauma are no longer ‘symptoms’ but instead these protective responses get incorporated into your personality—into the way you function.

These protective behaviors, beliefs and attitudes not only become how you are the in the world—they are your main defense against feeling the terror of trauma again. While most people have some difficulty with change, or giving up some aspect of themselves that helps them cope, for survivors of repeated trauma, when they lose the ability to use the defense that they feel keeps them safe, they are often thrust into either an emotional or physical flashback—they will panic and experience the feelings that accompanied the original trauma.

In the psychology literature there is a distinction made between a ‘state’—a short term experience, like anxiety about big exam, and ‘trait’ –something that is an enduring part of your personality, like being a generally anxious person, even when there is no event to trigger the anxiety. In short term trauma, the symptoms that one uses to cope can be temporary. These short term solutions that you used to protect yourself might actually be described as a defensive state. For example, during a hurricane, you might put plywood sheets over your windows to brace against the wind and water. The plywood is a temporary fix: you can choose to put it up and take it down at will. In situations of long term trauma the coping strategy is better described as a defensive trait; the protective response becomes a core of your personality. Instead of choosing how to respond, you have basically one, fixed, protective response. This is the body and brain’s genius of efficiency at work. Your body and brain can’t manage the repeated high energy responses to each particular trauma—the responses just become too much. Rather, the body and brain find a way to use their energy and resources more efficiently.

Rather than use something temporary like plywood, in long term trauma the metaphorical equivalent of protecting yourself from the hurricane would be covering the front of your house with brick and cement up to the roofline. True, you’d protect yourself from the hurricane and water wouldn’t get in. But, neither would air or sunlight. And, your wall has no flexibility—it can’t be easily removed. In protecting yourself from repeated trauma you do protect yourself from the things that are most frightening, but you also end up cutting yourself off from the things that you also most need.

This is why healing from repeated or long term trauma is not a one-size-fits-all situation. Everyone constructs different walls to survive their trauma. It is also why many of the treatments for trauma reduce intrusive symptoms like flashbacks or anxiety, but they don't seem to help the problems many trauma survivors face in terms of difficulty in relationships or managing mood. The walls built to survive the trauma were genius, they were effective, they were strong. And you can't just knock them down because they are woven into who you are. This is why healing from repeated trauma is often a long term project: you need to slowly take down the bricks and let light in. But the good news is that healing is possible.

Other websites/Resources for Complex Post-Traumatic Stress Disorder: 

© Gretchen L. Schmelzer, PhD 2014

All trauma is not the same

We talk about and treat trauma as one thing. As if it were like other diseases that we believe to have one origin or one set of symptoms. But psychological trauma is not one thing. When a traumatic event happens once, as in a car accident or a gunshot wound, the normal system of psychological defenses is temporarily overwhelmed. Like water breaking through a levee during a great flood, your body is flooded with adrenaline in such large amounts that the system actually builds new receptors to take in that extra adrenaline.⁠1

When the adrenaline levels recede, the extra receptors create an ultra-sensitive environment where the smallest amount of adrenaline is immediately picked up by the brain and nervous system—producing what is known as the ‘startle response.’ In short term trauma, the system is overwhelmed, and the effect is an over-sensitized system. It is as if the body becomes allergic to anything that might remind itself of the trauma—any loud noise, any fast motion. The psychological and physical after effects of a one time trauma, if they persist for at least a month, are diagnostically called post-traumatic stress disorder (PTSD).

PTSD is defined by a set of symptoms: startle response, flashbacks, nightmares, hypervigilance, difficulty eating, difficulty sleeping, difficulty concentrating, or persistent avoidance of anything that reminds the person of the traumatic event.⁠2 PTSD sometimes describes the aftereffects of short term trauma, but something it never seems to capture is the full picture of long term trauma. A soldier in Edward Tick’s War and the Soul states, “PTSD is a “name drained of both poetry and blame.” The soldier he quotes prefers soldier’s heart because it is a ‘disorder of warriors, not men and women who were weak and cowardly but….who followed orders and who at a young age put their feelings aside and performed unimaginable tasks…PTSD is a disorder of a good warrior.⁠3 A strong reaction to trauma is the normal response, and frequency and duration of trauma is the single greatest predictor of PTSD symptoms. 

A single terrifying event can be traumatic. How then can we understand the experience of multiple terrifying events? A car accident that lasts only 45 seconds can trigger all the symptoms of PTSD and require significant psychological treatment. So, what happens when trauma gets repeated relentlessly? What happens when it is not one frightening event, but a frightening event every night for years? When there is a one-time trauma, the system gets caught ‘off guard’ and overwhelmed. But imagine how exhausting it would be to get ‘caught off-guard’ and overwhelmed every night for most of a childhood, or ten years of war? For better or worse, the human body and brain are designed for efficiency and survival. And survival means finding the most efficient and protective way to cope.

    Understanding healing from trauma means respecting and honoring the ways we learned to cope—the ways we learned to protect ourselves. These were crucial and brilliant strategies that got us through the worst and gave us the chance to be in the position we are now—in a position to heal from it. Take some time today to reflect on the protections that you used to survive. Reflect on them and thank them for their loyal service to you.

© Gretchen L. Schmelzer, PhD 2014

1 Amy Banks, Stone Center Writing.


3 Eward Tick War and the Soul. p. 100. 

The Missing Picture

For better or worse there is almost never a picture of the trauma you experienced. If trauma is unspeakable, it is also certainly, often ‘unshowable’ or invisible. It is hard to get the words out, the descriptions out even to describe an image—let alone find a tangible image. Soldiers do not come home from war with photos of battles. They send photos home, like my great uncle did, of young faces in uniforms too big, standing in front of recognizable landmarks in Europe. Some of these black and white photos are in pastures, or in front of village fountains. All of them are mundane. Men smiling. In this case, only the photos returned home. My great uncle did not.