Complex trauma is a multi-layered and highly complex disorder that affects the child/young person/adult pervasively. A search on the term reveals that it is used to describe a dual complexity. Firstly, the children's exposure to multiple traumatic events and secondly the wide-ranging, long-term effects of this exposure. These events usually occur early in life and can disrupt many aspects of the child's development and the formation of a sense of self as well as the development of trust.
One could ask why is this so important?
NICE guidance on developmental trauma and attachment explains: "Attachment is a type of behaviour displayed by children to draw their primary caregiver towards them at moments of need or distress. Children whose caregivers respond sensitively to their needs at times of distress and fear in infancy and early childhood develop secure attachments to them... Early attachment relations are thought to be crucial for later social relationships and for the development of capacities for emotional and stress regulation, and self-control. Children and young people who have had insecure attachments are more likely to struggle in these areas and to have emotional and behavioural difficulties".
If we think about it, trust only develops when someone feels safe. Safety develops when the child/young person/adult has had their basic life needs met (have food to eat, clean and warm clothes to wear, a roof over their head, financial stability) but also when their emotional and psychological needs are met (they are cared for, nurtured, supported, feel heard and listened, praised for their achievements and encouraged to take responsibility for their mistakes, learn from them and have aspirations to do even better, achieve even higher for themselves and their community).
When a person experiences abuse all of the above is absent...
The traumatized individual often feels unsafe and mistrust develops.
They will refuse to go to school, will have difficulty concentrating and focusing, will feel the need to run away (from home, school, classroom), self-harm, will get into fights, will be isolated, quiet or unable to manage their anger, look lost and emotionally absent, will present sexualised behaviour, will have difficulties sleeping and eating, might develop distorted eating as a form of managing their trauma, will develop unsafe behaviours and might look into the use of substances and drugs as well as alcohol as a way of self-managing. They might be unable to form friendships or any other long lasting relationships and might repeat the trauma they experienced onto someone else or themselves (suicidal ideation).
What helps?
The link below is from NICE guidance. Trauma focused Cognitive Behavioural Therapy
(TF-CBT) is the main approach. There is also a number of other interventions that are worth looking out for such as: Non-violent resistance therapy (NVR), trauma focused DBT, Eye-Movement Desensitisation and Reprocessing (EMDR)
The American Occupational Therapy association gives very useful advice on the role of Occupational Therapy in childhood trauma. Occupational therapy can intervene and support in all levels of intervention (Universal, targeted and specialist). Occupational therapists can offer predictability (which leads to the development of feeling safe) by making activities and routines predictable. They can help children regain control by allowing for choice. They can integrate and pair sensory approaches with cognitive approaches in order to teach children to calm their bodies and minds. They can recommend stress management strategies. They collaborate with their service users to offer them activities that are designed to empower and maximise their independence.
Most importantly, occupational therapists "Provide environments and opportunities intentionally designed to increase a traumatized child’s sense of mastery, connection, and resiliency " (AOTA, 2015). In other words, a child's sense of self and identity is highly supported, encouraged to flourish and develop, using meaningful and purposeful occupations that are highly personalised to meet the individual's needs... Ask an OT today for help and support.
