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What is Trauma

Trauma is currently defined as a catastrophic event (or series of events) in which individuals have been exposed to situations in which they were personally threatened or witnessed death, physical harm, or sexual violence (Friedman, 2015). In addition to seeing a traumatic event to meet the DMS-5 criteria for trauma leading to PTSD, a direct exposure to actual or threatened serious injury or sexual violations, as well as witnessing or hearing about such events occurring in the lives of a close family member or a close friend, are now included as part of the DSM-5 (Sanderson, 2013). However, this revision does not fully explain the impact of pervasive and repeated physical, sexual, or psychological violations or the habitual unpredictability and lack of control with an attachment relationship such as in child's physical abuse, child sex abuse, domestic abuse, or institutionalization (Sanderson, 2013).


Complex trauma (CT) is a term that refers to a sort of trauma that is more than just a one-time occurrence. Barbieri et al. (2019) define CT as a repeated, prolonged, interpersonal traumatic event. Child abuse and spousal violence are two common causes of CT. It is also evident in those incarcerated, tortured, or subjected to sex trafficking. Complex trauma relates to early-life interpersonal experiences linked to abnormalities in biology, attachment, mood regulation, behavioral control, cognition, and self-concept. CT plays are role in other mental health disorders; in particular, it has been thought to be a significant key factor in understanding borderline personality disorder (BPD) patients' profound issues with self and identity (Luyten, Campbell, & Fonagy, 2020).


One of the most critical distinctions between the two types of traumas is the treatment approach. I think an essential factor to consider is whether the individual is still amidst violence. As therapists, we must first establish safety and trust and determine whether the individual is going back to the environment that led them to treatment. Nieuwenhove & Meganck (2019) add that priority is given to ensuring the patient's wellbeing by focusing on symptom control and the enhancement of emotional, behavioral, and interpersonal abilities. They add that individuals with CT seek therapy for their emotional and interpersonal functioning rather than their PTSD symptoms. One of my first patients with complex trauma was an active-duty female Marine. She was a refugee from Africa whose parents had asked to watch over her siblings if they died escaping. She was only five years old when they fled from her country. Because she was returning to the environment in which she was experiencing trauma, there were many areas of her trauma that she would not process due to her fear of being “too soft to go back.”


This week we celebrate the crucifixion and resurrection of our Savior. We are reminded that “Surely he took up our pain and bore our suffering, yet we considered him punished by God, stricken by him, and afflicted. But he was pierced for our transgressions; he was crushed for our iniquities; the punishment that brought us peace was on him, and by his wounds we are healed (Isaiah 53:4-5, NKJV, 2017). What an amazing grace He gave His life for our pain. Sometimes I wish I could explain to all my clients the gift of healing and salvation. But the Lord has spoken and said that my clients are not ready for solid food, just milk (1 Cor. 3:2, NKJV, 2017).


References


Bartlett, J. D., Griffin, J. L., Spinazzola, J., Fraser, J. G., Noroña, C. R., Bodian, R., Todd, M., Montagna, C., & Barto, B. (2018). The impact of a statewide trauma-informed care initiative in child welfare on the well-being of children and youth with complex trauma. Children and Youth Services Review, 84, 110-117. https://doi.org/10.1016/j.childyouth.2017.11.015


Barbieri, A., Visco-Comandini, F., Alunni Fegatelli, D., Schepisi, C., Russo, V., Calò, F., Dessì, A., Cannella, G., & Stellacci, A. (2019). Complex trauma, PTSD, and complex PTSD in African refugees. European journal of psychotraumatology, 10(1), 1700621. https://doi.org/10.1080/20008198.2019.1700621


Friedman, M. J. (2015). Posttraumatic and acute stress disorders (Sixth ed.). Springer.


King James Bible. (2017). Cambridge University Press. (Original work published 1769)


Luyten, P., Campbell, C., & Fonagy, P. (2020). Borderline personality disorder, complex trauma, and problems with self and identity: A social‐communicative approach. Journal of Personality, 88(1), 88-105. https://doi.org/10.1111/jopy.12483


Sanderson, C. (2013). Counseling skills for working with trauma: Healing from child sexual abuse, sexual violence, and domestic abuse. Jessica Kingsley Publishers.


Van Nieuwenhove, K., & Meganck, R. (2019). Interpersonal features in complex trauma etiology, consequences, and treatment: A literature review. Journal of Aggression, Maltreatment & Trauma, 28(8), 903-928. https://doi.org/10.1080/10926771.2017.1405316

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