A recent concept that calls for an integrative approach

In this article, We will present the concept of complex trauma, We show its interest in the psychotherapeutic treatment of the problems of violence on the side of both the authors and the victims. We also stress the need for an approach that integrates the synchronic and diachronic dimensions so that the repetition of the same scenario of life and the transmission of the curse from one generation to the next can cease.

Complex trauma is a concept that began to emerge in the 1990s. It is also sometimes referred to as Developmental trauma disorder*, which accentuates the impact of a repetition of events or traumatic situations on the building of the individual’s personality. Post-traumatic stress disorder (PTSD) occurs when the injury is due to a single event (uncontrollable, extremely negative, unpredictable, sudden). The therapeutic approach is very different in both cases.

Various forms of abuse in childhood are likely to generate complex trauma  :

  • physical attacks (educational violence) ;
  • sexual assault (incestuous parent, pedophile entourage) ;
  • psychological violence (devalorizations, emotional blackmail, perverse intergenerational coalition, etc.)
  • exposure to domestic violence ;
  • abandonment, betrayal, manipulation ;
  • emotional neglect, emotional deficiencies.

In fact, these situations confront the child with extremely intense affections that overwhelm him: rage, terror, shame… These kinds of assaults are usually recurrent and occur over a prolonged period of time.

The child is trapped by his powerlessness to escape these conditions of life, by his loyalty, his feelings of guilt, his fear of breaking up the family if he confides in others… His capacity is overstretched and he also finds no resources outside, which invalidates the establishment of sufficient internal security, essential to the processes of psycho-affective maturation.

The consequences are multiple and persist into adulthood  :

Complex Trauma-1

  • poor emotional regulation (explosions, emotional blunting, eating disorders, self-harm, generalized anxiety) ;
  • the distorted vision of the world lived as dangerous or, on the contrary, as an idealized elsewhere, often lived alternately as one and the other ;
  • relationship disorders (abusive, victimary or paradoxical regime) ;
  • profound narcissistic attacks declined on an inflationary mode (domination, overvaluation of self…) or in a hemorrhagic mode (submission, hyper-conformism, undervaluation of self, shame and guilt not denied…) ;
  • psychosomatic disorders.

Indeed, any situation with some similarities to this past – and this is happening at the unconscious level – is likely to reactivate emotions encysted in the psyche but separated from representations that would differentiate the present from the bad memories. The person, himself, does not explain the intensity of his reaction, which after the fact seems disproportionate to him.

On the other hand, in some cases, there is a blunted affects, as if nothing were affecting them anymore. Others use anti-thought strategies such as bulimia, scarification, and taking Toxics to keep painful emotions at a distance… It also happens that after having been on the alert for so long, in the anxious expectation of new aggression, the state of stress has become permanent.

The cleavage of oneself and others is a defense mechanism that predominates at an early stage of psycho-affective development, but that subsists when the environment of the child is not adapted to its needs. The result is a partition of the world into good and bad and an image of oneself in all or nothing. It is white or black, without shade, without tolerance for imperfection, incompleteness.

Children come into life without directions for use. Imitation is the most basic way to learn. They follow their parents. The model favored by a girl is usually her mother and by a boy is her father. But the child does not only encode parental behaviors toward him or her, he or she also encodes how his or her parents form a couple, and how they behave toward each other.

Thus, if the relationship patterns of the adults in charge of the child are unhealthy, the marks of the child are distorted and the future adult is in danger of reproducing the trauma. The situations of violence committed (identification with the aggressor) and therefore of violence suffered (massive inhibition of aggression, yet also in the service of self-defense).

From this infantile experience, the adult who has not examined his faults (to discover also the richness as well) keeps a wound that is not healed, that is constantly oozing or that opens up to the slightest indiscretion. The child interprets the fact that he was not loved or that he was not loved as the consequence of a defect which he would bear and which he must hide in order to be loved.

self-dishonor

He confronts existence by carrying around that self-dishonor. Denied, it gives rise to narcissistic over-compensations whose grandiloquent ideas of self are one of the most burlesque manifestations. Not denied, it is particularly visible during depressive decompensations and can lead to suicide.

This fundamental flaw can also give rise to the feeling of being a bad person, whose search for punishments aims to appease feelings of guilt, whose undesirable behaviours are a desperate attempt to be accepted towards and against everything, reassurance that must be constantly rediscovered because it never takes on the value of reparation. The complementary dimension of the resulting problems is well understood.

When situations or traumatic events are too much in daily routine, the multiple sufferings and anxieties generated are caught in the mesh of the familiar landscape and end up blending into the mass and/or body. They become almost invisible and indescribable. It is not uncommon that only a few memories remain in consciousness. There are now only a few facts more striking than the whole that goes beyond. Yet they are only the tip of a gigantic iceberg.

In light of this brief summary, it is understood that the diagnosis of PTSD (post-traumatic stress disorder) is very inadequate to account for the interpersonal, family and chronic nature of abuse. In view of its impact, which goes far beyond the symptoms of intrusion (nightmares, flashbacks), avoidance and hyper-vigilance – characteristic of PTSD. it is also understood that a complex trauma can lead to a personality disorder with its intrapsychic and interactional components.

The perturbations of complex trauma are enormous. They range from schooling to working life, from neighborly relations to strong affective relations, from conjugality to parenthood, etc. The whole path of life is diverted. Untreated, a complex trauma traces a highway to the compulsion of repetition.

The work in psychotherapy makes it possible to mourn the parents who did not have to finally accept the history as it was, to dismantle the inheritance received in order to sort out the parental contributions so as to rediscover the aspects of self that had been forgotten, erased, hidden and rejected.

In adulthood, a complex trauma frequently affects the style of attachment between parent and child. Following the work of Mary Ainsworth there are different types: secure, anxious-avoidant, ambivalent, and disorganized. Secure attachment is the fruit of parents who are a reassuring base from which the child gradually dares to explore the world. Their responses to his requests are quite fast, warm, consistent and predictable.

The tuning of the parents to the emotional state of the child is fair enough for himself to feel understood and effectively contained. The dialogues allow him to make sense of his experiences and gradually to learn to manage his own emotions and to take account of others. Briefly, avoidant, ambivalent and disorganized attachments are respectively the result of disengaged, entangled families.

The characteristics of a disorganized attachment are intrapersonal and interpersonal difficulties, revealed by a loss of empathy, distrust of others, identification with the aggressor or over-victimization (supra), social isolation, relational instability, fragility in dealing with the distancing of others… The major consequence is deregulation of affections, with significant emotional vulnerability and poor control of emotions that is either insufficient or excessive.

It should be noted that in this context, it is not possible to help a child suffering without also caring for his or her parents, or the one who is willing to get involved, without taking into account the place of the symptom in the family dynamics, subsystems (the couple, the siblings, etc.). Of course, there are contraindications to marital or family psychotherapy that we will not explain in this article. Family psychotherapy allows, through narrative narratives in the presence of… to transmit a story instead of a trauma.

Treatment of complex trauma, therefore, requires integration of the synchronic and diachronic approaches, otherwise, it is incomplete and the risk of relapse is high.

 

* Complex TPSR, considered for inclusion in the new DSM version, DSM 5

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