Complex trauma is still a relatively new field of psychology. Complex post-traumatic stress disorder (C-PTSD) results from enduring complex trauma.

Complex trauma is ongoing or repeated interpersonal trauma, where the victim is traumatized in captivity, and where there is no perceived way to escape. Ongoing child abuse is captivity abuse because the child cannot escape. Domestic violence is another example. Forced prostitution/sex trafficking is another.

Complex PTSD is a proposed disorder which is different to post-traumatic stress disorder. Many of the issues and symptoms endured by complex trauma survivors are outside of the list of symptoms within the (uncomplicated) PTSD diagnostic criterion. Complex PTSD does acknowledge and validate these added symptoms.

The impact of complex trauma is very different to a one time or short-lived trauma. The effect of repeated/ongoing trauma – caused by people – changes the brain, and also changes the survivor at a core level. It changes the way survivors view the world, other people and themselves in profound ways.

The following are some of the symptoms and impact most felt by complex trauma survivors.

1. Deep Fear Of Trust

People who endure ongoing abuse, particularly from significant people in their lives, develop an intense and understandable fear of trusting people. If the abuse was parents or caregivers, this intensifies. Ongoing trauma wires the brain for fear and distrust. It becomes the way the brain copes with any further potential abuse. Complex trauma survivors often find trusting people very difficult, and it takes little for any trust built to be destroyed. The brain senses issues and this overwhelms the already severely-traumatized brain. This fear of trust is extremely impactful on a survivor’s life. Trust can be learned with support and an understanding of trusting people slowly and carefully.

2. Terminal Aloneness

This is a phrase I used to describe to my counselor — the terribly painful aloneness I have always felt as a complex trauma survivor. Survivors often feel so little connection and trust with people, they remain in a terrible state of aloneness, even when surrounded by people. I described it once as having a glass wall between myself and other people. I can see them, but I cannot connect with them.

Another issue that increases this aloneness is feeling different to other people. Feeling damaged, broken and unable to be like other people can haunt a survivor, increasing the loneliness.

3. Emotion Regulation

Intense emotions are common with complex trauma survivors. It is understandable that ongoing abuse can cause many different and intense emotions. This is normal for complex trauma survivors.

Learning to manage and regulate emotions is vital in being able to manage all the other symptoms.

4. Emotional Flashbacks

Flashbacks are something all PTSD survivors can deal with, and there are three types:

Visual Flashbacks – where your mind is triggered and transported back to the trauma, and you feel as though you are reliving it.

Somatic Flashbacks – where the survivor feels sensations, pain and discomfort in areas of the body, affected by the trauma. This pain/sensations cannot be explained by any other health issues, and are triggered by something that creates the body to “feel” the trauma again.

Emotional Flashbacks – the least known and understood, and yet the type complex trauma survivors can experience the most. These are where emotions from the past are triggered. Often the survivor does not understand these intense emotions are flashbacks, and it appears the survivor is being irrationally emotional. When I learned about emotional flashbacks, it was a huge lightbulb moment of finally understanding why I have intense emotions, when they do not reflect the issue occurring now, but are in fact emotions felt during the trauma, being triggered. But, there is no visual of the trauma – as with visual flashbacks. So, it takes a lot of work to start to understand when experiencing an emotional flashback.

For more info about emotional flashbacks see my article on my website.

5. Hypervigilance About People

Most people with PTSD have hypervigilance, where the person scans the environment for potential risks and likes to have their back to the wall.

But complex trauma survivors often have a deep subconscious need to “work people out.” Since childhood, I have been aware of people’s non-verbal cues; their body language, their tone of voice, their facial expressions. I also subconsciously learn people’s habits and store away what they say. Then if anything occurs that contradicts any of this, it will immediately flag as something potentially dangerous.

This can be exhausting. And it can create a deep skillset of discernment about people. The aim of healing fear-based hyper-vigilance is turning it into non-fear-based discernment.

6. Loss Of Faith

Complex trauma survivors often endure a loss of faith. This can be about people, about the world being good, about religion, and a loss of faith about self.

Complex trauma survivors often view the world as dangerous and people as all potentially abusive, which is understandable when having endured ongoing severe abuse.

Many complex trauma survivors walk away from their religious beliefs. For example, to believe in a good and loving God who allows suffering and heinous abuse to occur can feel like the ultimate betrayal. This is something needing considerable compassion.

7. Profoundly Hurt Inner Child

Childhood complex trauma survivors, often have a very hurt inner child that continues on to affect the survivor in adulthood. When a child’s emotional needs are not met and a child is repeatedly hurt and abused, this deeply and profoundly affects the child’s development. A survivor will often continue on subconsciously wanting those unmet childhood needs in adulthood. Looking for safety, protection, being cherished and loved can often be normal unmet needs in childhood, and the survivor searches for these in other adults. This can be where survivors search for mother and father figures. Transference issues in counseling can occur and this is normal for childhood abuse survivors.

Inner child healing can be healing for childhood abuse survivors. It is where the survivor begins to meet the needs of their hurt and wounded child, themselves. I have further info about this on my website.

8. Helplessness and Toxic Shame

Due to enduring ongoing or repeated abuse, the survivor can develop a sense of hopelessness — that nothing will ever be OK. They can feel so profoundly damaged, they see no hope for anything to get better. When faced with long periods of abuse, it does feel like there is no hope of anything changing. And even when the abuse or trauma stops, the survivor can continue on having these deep core level beliefs of hopelessness. This is intensified by the terribly life-impacting symptoms of complex PTSD that keep the survivor stuck with the trauma, with little hope of this easing.

Toxic shame is a common issue survivors of complex trauma endure. Often the perpetrators of the abuse make the survivor feel they deserved it, or they were the reason for it. Often survivors are made to feel they don’t deserve to be treated any better.

Sexual abuse can create a whole added layer of toxic shame, which requires very specific and compassionate therapy, if this is accessible. Often, sexual abuse survivors who are repeatedly enduring this heinous abuse can develop feelings of being dirty, damaged and disgusting when their bodies are violated in this way.

9. Repeated Search For A Rescuer

Subconsciously looking for someone to rescue them is something many survivors understandably think about during the ongoing trauma and this can continue on after the trauma has ceased. The survivor can feel helpless and yearn for someone to come and rescue them from the pain they feel and want them to make their lives better. This sadly often leads to the survivor seeking out the wrong types of people and being re-traumatized repeatedly.

10. Dissociation

When enduring ongoing abuse, the brain can utilize dissociation as a coping method. This can be from daydreaming to more life-impacting forms of dissociation such as dissociative identity disorder (DID). This is particularly experienced by child abuse survivors, who are emotionally unable to cope with trauma in the same way an adult can.

For more information about the different types of dissociation, see my website.

11. Persistent Sadness and Being Suicidal

Complex trauma survivors often experience ongoing states of sadness and severe depression. Mood disorders are often co-morbid with complex PTSD.

Complex trauma survivors are high risk for suicidal thoughts, suicide ideation and being actively suicidal. Suicide ideation can become a way of coping, where the survivor feels like they have a way to end the severe pain if it becomes any worse. Often the deep emotional pain survivors feel, can feel unbearable. This is when survivors are at risk of developing suicidal thoughts.

For more information about suicidal issues, see my website.

12. Muscle Armoring

Many complex trauma survivors, who have experienced ongoing abuse, develop body hyper-vigilance. This is where the body is continually tensed, as though the body is “braced” for potential trauma. This leads to pain issues as the muscles are being overworked. Chronic pain and other issues related such as chronic fatigue and fibromyalgia can result. Massage, guided muscle relaxation and other ways to manage this can help.

All of these issues are very normal for complex trauma survivors. Enduring complex trauma is not a normal life experience, and therefore the consequences it creates are different, yet very normal for what they have experienced and endured.

Not every survivor will endure all these, and there are other symptoms that can be endured. I always suggest trauma-informed counseling if that is accessible. There are medications available to help with symptoms such as anxiety and depression.

There are also many self-help strategies to manage the symptoms and help heal. Many of these are listed on my website.

Lastly, I advise that empathy, gentleness and compassion are required for complex trauma survivors.

— Lilly Hope Lucario (Severe and multiple complex trauma survivor).

If you or someone you know needs help, visit our suicide prevention resources page.

If you need support right now, call the National Suicide Prevention Lifeline at 1-800-273-8255, the Trevor Project at 1-866-488-7386 or text “HOME” to 741-741. Head here for a list of crisis centers around the world.

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Thinkstock photo via AntonioGuillem