Complex trauma: when it didn’t happen once, but for years

“They never hit me. There wasn’t one big event I could point to. It’s just that every day at five I listened to the door opening, and from the way my father put down his keys I knew whether the evening would be calm or not. Like that for twelve years.”

When people tell stories like this, they often stop at the same question: how can something that wasn’t a “real” event stay with you for so long? They have no accident they can put a date on, no single memory they could work through. They have years. And out of those years came not one fear, but a whole way they learned to be in the world.

Today professionals call this complex trauma. In this post I’d like to explain what it means, how it differs from trauma after a single event, how it shows up in adult life and what helps — and where the limits lie of what talking about it can do.

One accident, or years

When we picture trauma, we often picture a single event: a car crash, an assault, a natural disaster. I described what happens after an event like that in What is trauma: not the event, but what stays in the body. Complex trauma, however, doesn’t arise from a single moment. It arises from repeated experiences that went on for a long time and that could not be escaped.

Two words are key: repeated and no way out. A child cannot leave a family where there is violence or neglect. A woman in a violent relationship often cannot simply walk away — because of the children, money, fear. A child bullied at school for years has to walk back into the same classroom every morning. Being trapped is part of the wound: not only that terrible things happened, but that they kept happening, again and again, whatever you did.

Often this happens in relationships that should have been a source of safety. When the same person is both the one who comforts and the one you fear, a child cannot learn a simple thing: where to turn when things are bad. This split is the subject of Disorganised attachment: when the same person is both comfort and fear.

Where the concept comes from

In 1992 the psychiatrist Judith Herman proposed, in a professional article, that post-traumatic stress disorder as it was then described was too narrow for people who had survived prolonged, repeated trauma — childhood abuse, domestic violence, captivity. She noticed that these people were tormented not only by memories and fear, but also by deep changes in how they experienced themselves, their emotions and other people. She proposed the name complex PTSD.

It took almost three decades for the concept to enter an official classification. The World Health Organization’s International Classification of Diseases, ICD-11, in force since the start of 2022, lists complex post-traumatic stress disorder as a separate diagnosis for the first time. The American manual DSM-5 doesn’t include it — there these difficulties are described differently, which is one reason the concept is still debated among professionals.

It also matters how big the problem is from which complex trauma often grows. In the well-known American study of adverse childhood experiences (ACE), published by Vincent Felitti and colleagues in 1998, more than half of adults reported at least one kind of such experience — from abuse to growing up with a parent with an addiction or mental illness. Among those who had experienced four or more, the risk of depression, alcoholism and attempted suicide was several times higher than among those who had none. The study didn’t measure complex trauma, but it showed how very often repeated hard experiences in childhood pile up on one another.

What is different about complex trauma

ICD-11 describes complex PTSD as two layers. The first is the same as in “ordinary” post-traumatic stress disorder: re-experiencing in the present, avoiding everything that reminds you of the trauma, and a constant sense of threat. The second layer is what sets it apart — difficulties the classification calls disturbances in self-organisation.

These three difficulties shouldn’t be understood as “character flaws”. They are the result of what a child, or an adult who is trapped, learns in order to survive.

Emotions that can’t be regulated. If there was nobody beside you to soothe you, you had nowhere to learn how to soothe yourself. So emotions often arrive as a wave that sweeps you away — or don’t arrive at all, because it was safer not to feel. That second state sometimes deepens into dissociation, a sense of being disconnected from yourself or your surroundings.

A self-image shaped by the wound. A child who is treated badly almost always concludes that it is their own fault. For a child that is less frightening than realising that the adults they depend on are dangerous. This conclusion often survives into adulthood as a deep, quiet shame. There is more on this in Self-image after abuse: when you believe it was your fault.

Relationships in which closeness is both longed for and dangerous. Someone who has learned that people are unpredictable is constantly on the lookout in relationships. They may keep their distance, they may cling, or they may swing between the two. They often repeat patterns they know — not because they want them, but because they are familiar.

How it shows up in adult life

People with complex trauma often seek help for something else entirely. For burnout, because they have always been the one who copes with everything. For relationships that keep ending in a similar way. For anxiety with no clear cause, or for physical complaints that doctors can’t explain. Complex trauma rarely introduces itself by its own name.

Remarkable functioning is common too. Many took on an adult’s role in childhood — looking after brothers and sisters, after a parent’s moods, after the peace of the house. As adults they are reliable, hard-working, adaptable. And exhausted. What it is like when there was never really a childhood is described in The loss of childhood: when you had to grow up too soon.

If the threat was present from the very first years — before the child had words — we speak of a particular form, which I wrote about in Developmental trauma: what happens when safety wasn’t there from the start. Complex trauma, however, isn’t limited to childhood; it can also develop in adulthood, for example in a violent relationship lasting many years.

When the past walks into a present relationship

In relational family therapy, in which I am training, we pay particular attention to how old experiences show up in present relationships. With complex trauma this is often very visible. A conversation between partners might sound something like this (a composite, not a real person):

“I only said I’d be half an hour late. Why are you so quiet?”
“I’m not quiet. It’s fine.”
“You’ve been avoiding me all evening.”
“When you texted that you’d be late, I started tidying. Everything. As if I had to make sure nothing was wrong before you got home.”
“But I’m not angry.”
“I know. My body doesn’t.”

None of this is a conscious choice. The message about being late set off an old readiness: before he arrives everything must be perfect, or it will be bad. Her partner, who doesn’t know this, feels rejected, and she feels misunderstood — and so the old can get caught in a new cycle. When both understand what is going on, the cycle can be broken. For a couple this is often the first real relief: realising that they aren’t arguing about being late, but about something that was there long before.

What helps

The good news is that complex trauma isn’t destiny. A review of research published in 2019 by Thanos Karatzias and colleagues found that the methods used for post-traumatic stress disorder help here too — trauma-focused cognitive behavioural therapy, exposure and EMDR. It added, though, that there are still few studies looking specifically at people with the complex form.

Most professionals work in phases, as Herman already described them. First safety and stability: outer safety (the violence is no longer present) and inner safety (learning to recognise when you are being flooded and to come back into your window of tolerance). Only then processing of memories. And finally reconnection — with people, with your own wishes, with a life that is more than survival.

Whether the stabilisation phase always has to be long is debated among professionals. Some researchers warn that putting off processing for too long can tell a person that they are too fragile, and that many can manage trauma-focused work sooner than is often assumed. Others stress that for people with severe dissociation or dangerous circumstances, stabilisation is essential. The answer probably depends on the person — and it is a decision the client and a properly trained professional make together.

Where I fit in

I want to be open here. I am not a trauma specialist, and I don’t practise EMDR or the somatic methods that work through bodily sensations, such as Somatic Experiencing or sensorimotor psychotherapy. All of these require specific training. As a therapist in training under supervision in relational family therapy, I work with relationships: with how old patterns repeat in partnerships and families, and with finding new ways of being close.

With complex trauma, the relationship itself is often part of the healing. People who were wounded in relationships also heal in relationships — in the experience that someone is predictable, that you can disagree without being punished, that a relationship can be repaired after a misunderstanding. The research showing that secure attachment can be learned in adulthood too is summarised in Secure attachment can be learned. But when re-experiencing, severe dissociative difficulties or self-harm are in the foreground, you need a professional specifically trained in trauma work, often in cooperation with a psychiatrist. I can help you find the right path.

Exercise: a map of safe points

This exercise doesn’t open up memories. It belongs to the first phase — to starting to gather, deliberately, whatever gives you at least a little safety. With complex trauma this is often harder than it sounds, so take your time.

1. Take a sheet of paper and draw a circle in the middle — that is you, today.
2. Around the circle write down the people with whom your body relaxes at least a little. It may be just one. It may be someone from the past, a teacher or a neighbour. It may be an animal.
3. Add places and things: a bench in the park, a particular blanket, music, a calming smell.
4. Next to each point, write how you feel it in your body. Do your shoulders drop? Does your breathing slow? Warmth in your chest?
5. Choose one point and visit it on purpose this week — call the person, go to the bench, put on the music. Notice what happens.

If nothing comes to mind, that too is important information, not a failure. It just means the map still has to be drawn — and that is something you can do with a professional. The concept describing how the nervous system calms in the presence of another person is explained in the knowledge base under co-regulation.

Where this concept has its limits

Not every hard childhood is complex trauma. Many people grew up in families with tension, criticism or coldness and carry consequences that don’t fit this diagnosis. That doesn’t mean their pain doesn’t count; it only means they need a different lens and perhaps a different kind of help.

You don’t diagnose yourself. Complex PTSD partly overlaps in its symptoms with borderline personality disorder, depression and other conditions; telling them apart is demanding and belongs with a psychiatrist or clinical psychologist. Self-diagnosis online can bring relief, because things get a name — but it can also miss what a person actually needs.

A label is not an identity. The concept of complex trauma is valuable because it explains why things were so hard. But it isn’t the whole person. Many people with long-lasting, severe experiences live full, connected lives. That surviving doesn’t in itself mean strength is set out in “What doesn’t kill you makes you stronger” — why that isn’t true of trauma; that recovery is possible is just as true.

When not to wait. If you are still in a relationship in which you are in danger, the first step is outer safety. In Slovenia the SOS helpline for women and children victims of violence is available on 080 11 55; in an emergency call 112 or the police on 113. If you are thinking about suicide or self-harm, call the crisis line Klic v duševni stiski on 01 520 99 00 in Slovenia (every day from 7 pm to 7 am) or the Samaritans helpline (Zaupni telefon Samarijan) on 116 123 (24 hours a day), or turn to your doctor.

What to remember

• Complex trauma arises from repeated, long-lasting experiences there was no way out of — often in relationships that should have been safe.
• Since 2022 ICD-11 lists it as a separate diagnosis: the PTSD core plus difficulties with emotions, self-image and relationships.
• These difficulties aren’t character flaws, but learned ways of surviving.
• Recovery usually happens in phases: safety, processing, connection — and not in a straight line.
• Diagnosis and treatment are led by a trained professional; a relationship in which you are safe is often an important part of the path.