When Trauma Won’t Quit: Understanding Complex PTSD


The current accepted diagnosis for experiencing a single traumatic life event is posttraumatic stress (PTSD). In diagnosing posttraumatic stress, clinicians must see that the person experienced a traumatic life event in which they were involved in or witnessed events where death or serious injury was threatened or there was a threat to physical integrity of self or others (D’Andrea, Ford, Bradley, Spinazzola, & van der Kolk, 2012). But trauma can be more complicated than that.

Discussed in the clinical research is another form of posttraumatic stress, appropriately called complex posttraumatic stress. Herman (1992) defines complex PTSD as “typically the result of exposure to repeated or prolonged instances or multiple forms of interpersonal trauma, often occurring under circumstances where escape is not possible due to physical, psychological, maturational, family/environmental, or social constraints.”

So what are some of the situations in which someone is exposed to interpersonal trauma, and what are the short- and long-term consequences of someone experiencing this kind of trauma? Felitti, et al. (1998) describes several abuses and household dysfunctions by parents or other adults in the home in which interpersonal trauma can occur. These include:


  • Psychological abuse: Repeated insults, negative comments, and swearing directed at the victim.
  • Physical abuse: When a parent or some other adult in the household repeatedly pushes, grabs, slaps, or hits the victim, and marks are often left.
  • Sexual abuse: When a parent or some other adult in the household repeatedly touches, fondles, or grabs the victim in a sexual way. When a child is forced to have intercourse with a parent or adult.

Household Dysfunctions

  • Substance abuse: When a parent or other adult in the home can be described as having a problem with drugs or alcohol.
  • Mental health issues: When a parent or other adult in the house can be described as having depression or another serious mental condition.
  • Mother treated violently: When the mother in the household is physically abused. The mother is repeatedly pushed, grabbed, and slapped, and it is witnessed by the victim.
  • Criminal behavior in the household: When someone in the home participates in an illegal activity or is arrested and sent to prison.
  • Bullying, neglect, betrayal: If a person is bullied, neglected, or betrayed by a loved one, this can cause interpersonal trauma (D’Andrea, et al., 2012).

When a person experiences any of the above, there can be many adverse effects. Studies show children who are repeatedly exposed to these abuses may experience severe coexisting problems with emotion regulation, impulse control, attention, and cognition, as well as interpersonal relationships and negative self-attributions (D’Andrea, et al., 2012).

Despite evidence to suggest interpersonal trauma results in complex posttraumatic stress and has both short- and long-term adverse health outcomes, the mental health community is still struggling to develop a diagnosis to capture this exposure and condition.

One of the most cited studies on this subject found that the more times a child was exposed to these abuses, the greater the likelihood they experienced severe health problems in adulthood. The study found a strong relationship between the number of adverse childhood exposures and the following conditions: heart disease, cancer, chronic bronchitis or emphysema, history of hepatitis or jaundice, skeletal fractures, and poor self-rated health (Felitti, et al., 1998).

In addition, parents who have experienced trauma and do not seek treatment can unknowingly externalize their trauma and pass it on to their child’s developing personality, a process known as transgenerational transmission (Shulevitz, 2014).

Because of the impact interpersonal trauma can have on health and well-being, seeking treatment is critical. Effective treatments for exposure to interpersonal trauma may include:

  • Prolonged exposure therapy: This treatment is supported by over 20 years of research and is highly effective for treating chronic posttraumatic stress and associated symptoms. The goal of exposure therapy is to address traumatic memories and triggers. The therapist works with the person to address these elements gradually so a tolerance to the memory is built over time (Foa, Hernbree, and Rothbaum, 2007).
  • Eye movement desensitization and reprocessing: Otherwise known as EMDR, this treatment is also supported by over 20 years of research. By engaging the brain in dual attention stimulus (DAS) and left-to-right brain stimulation, the goal of this approach is for the person to access the memory; recall specific aspects of the memory; and reprocess the memory so it is stored in an adaptive form. The clinician helps the person to see the event in a different way—perhaps a source of strength or something that took courage to survive (Shapiro, 2001).
  • Cognitive behavioral therapy: CBT is an approach that targets automatic negative thoughts and core beliefs about the self. People who experience interpersonal trauma often have more negative beliefs and attributions about themselves that are not true (D’Andrea, et al. 2012). Using exercises such as thought records and data logs, the clinician helps the person to examine their thoughts and understand they might be unbalanced. By finding evidence for and against their negative thoughts, the person is able to create alternative and more balanced thought patterns about themselves (Greenberger and Padesky, 1995).

Despite evidence to suggest interpersonal trauma results in complex posttraumatic stress and has both short- and long-term adverse health outcomes, the mental health community is still struggling to develop a diagnosis to capture this exposure and condition. Several task forces have been created to address the need for a consensus on how to diagnose and treat people affected by interpersonal trauma. Until then, complex posttraumatic stress will remain a notable omission from the Diagnostic and Statistical Manual of Mental Disorders (DSM).

If you or a loved one has been exposed to any of the above-mentioned abuses, seek help from a licensed and trained mental health professional.


  1. D’Andrea, W., Ford, J., Stalback, B., Spinazzola, J., & van der Kolk, B. (2012). Understanding interpersonal trauma in children: Why we need a developmentally appropriate trauma diagnosis. American Journal of Orthopsychiatry 82(2) 187-200. Retrieved from http://www.traumacenter.org/research/ajop_why_we_need_a_complex_trauma_dx.pdf
  2. Felitti, V., Anda, R., Nordenberg, D., Williamson, D., Spitz, A., Edwards, V., … Marks, J. S. (1998). Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults. American Journal of Preventive Medicine 14 (4) 245-258. Retrieved from http://www.ajpmonline.org/article/S0749-3797(98)00017-8/pdf
  3. Foa, E., Hernbree, E., & Rothbaum, B. O. (2007). Prolonged exposure therapy for PTSD: Emotional processing of traumatic experiences: Therapist guide. New York, NY: Oxford University Press.
  4. Greenberger, D., & Padesky, C. (1995). Mind over mood: Change how you feel by changing the way you think.New York, NY: The Guilford Press.
  5. Herman, J.L. (1992). Trauma and recovery: The aftermath of violence from domestic violence to political terrorism. New York, NY: Basic Books.
  6. Shapiro, F. (2001). Eye movement desensitization and reprocessing: Basic principles, protocols and procedures(2nd)New York, NY: The Guilford Press.
  7. Shulevitz, J. (2014, November 16). The science of suffering: Kids are inheriting their parents’ trauma. Can science stop it? Retrieved from https://newrepublic.com/article/120144/trauma-genetic-scientists-say-parents-are-passing-ptsd-kids

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  1. I was diagnosed with depression, PTSD, and dissacociative disorder several years ago. Thank you for all this information, it is so helpful and describes all the craziness that I experience on a daily basis. I am learning how to be ok without the approval of others which was really just me doing any and everything to be sure I didn’t offend anyone and make sure everyone was ok but me. Of course it has lead to a number of painful incidents because it’s impossible to make everyone happy.

    • Thanks for getting in touch and your generous comment. I really appreciate it. I am delighted the article has been helpful to you. It sounds like you have been through a lot over the years and on an ongoing basis. I to have Dissociative disorder so know how difficult that is to live with. As you say it’s impossible to make everyone happy. You have to look after yourself as no one is going to do it for you. It’s not selfishness, it’s called survival!!! All the best for the future Erin

I would love to hear from you so please leave a comment. All feedback is much appreciated. Thank you. Erin

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