© The Trauma Initiative

The word “trauma” is often misunderstood.

Normally when we think about the victims of trauma, our minds jump to those who’ve been in affected by extremely negative events – such as terror or racial attacks, sexual and physical abuse, car accidents, natural catastrophes, or warfare. But Post-Traumatic Stress Disorder (PTSD) and its chronic counterpart Complex PTSD (or Complex Trauma) isn’t just exclusive to victims of catastrophic events. In fact, the most common form of trauma happens to young children within the home.

There are millions of children around the world who are growing up in neglectful or violent households, witnesses to tremendous scenes, who feel that they don’t count, that they don’t matter. This has a big impact on how brains develop.  If you are not ‘seen’ as a child or if you are constantly scared, your brain becomes wired to be ‘fear driven;’ to always be set for danger and be on alert.

The legacy of child trauma is serious in New Zealand. Sadly, our diagnostic manuals don’t acknowledge Complex PTSD, instead diagnoses like ADHD, oppositional defiance disorder, conduct disorder, or childhood bipolar disorder get bandied around. But interventions rarely deal with the ‘fear driven’ brain, which is essential for recovery.

Let’s look at the numbers

  • New Zealand has one of the worst records of child abuse in the developed world. Children under five years, and particularly infants and newborns, are most at risk of violence and maltreatment in New Zealand.
  • Oranga Tamariki receives more than 150,000 reports of concern relating to children each year.
  • On average a child dies every five weeks as a result of violence in New Zealand, and children under 12 months old make up much of this statistic. Children under the age of 18 make up 20% of all violent deaths in New Zealand.
  • 20% of girls and 9% of boys in New Zealand report unwanted sexual contact.
  • The cost of child abuse in New Zealand is around 3% of GDP, approximately $6 billion per year.  (Unicef New Zealand)

It’s important to note that PTSD is not limited to child abuse (sexual or physical). New Zealand has a growing list of events a child may experience in his or her lifetime, including:

  • Child neglect.
  • Growing up with domestic violence, a parent affected by drugs and alcohol, mental illness or significant health problem.
  • Divorce.
  • Natural events (earthquakes and flooding).
  • Displacement from homeland (refugees).
  • Sex trafficking.
  • Terrorist attacks.

What are the symptoms of PTSD and Complex PTSD?

There are four types of symptoms that are part of PTSD and some additional symptoms for Complex PTSD as detailed below. Complex PTSD, which develops due to chronic, ongoing trauma, is more likely to occur due to long-term neglect, domestic violence or childhood sexual and/or physical or emotional abuse. Most people who meet the criteria for Complex PTSD also meet the criteria for PTSD.

It is recommended that you seek professional support if a child in your care is struggling with any of these symptoms, especially if symptoms last longer than one month, cause great impairment or distress and/or disrupt his or her ability to function in everyday life.

1. Reliving and re-experiencing the trauma

PTSD: Memories, reoccurring nightmares, persistent unwanted and upsetting thoughts, physical reactivity, vivid flashbacks of the original event can all be a part of PTSD. A child may also encounter triggers in everyday life – whether it be something he or she can see, smell, hear, that brings him or her back to the original event. This can look different for every survivor. A sexual assault survivor might hear the voice of someone who resembles her assailant and find herself reliving the terror of being violated. A domestic violence victim might find herself being triggered by someone raising their voice. Triggers can be seemingly minor or overwhelmingly major, depending on the severity and longevity of the trauma endured.

Complex PTSD: According to trauma therapist Pete Walker, a child may also suffer from emotional flashbacks where he or she ‘regresses’ back into the emotional state of the original event and behaves maladaptively to the situation as a result. Walker states that for people with Complex PTSD, individuals develop four “F” responses when they are triggered by emotional flashbacks: he or she may fight, flee, fawn (seek to please) or freeze. These responses are protective, but they may end up further harming the survivor because the survivor might fail to enforce his or her boundaries or may use excessive force in protecting themselves.

2. Avoidance of situations that trigger memories

PTSD: A child will go to great lengths to avoid anything that might potentially trigger memories or feelings associated with the traumatic events. If he or she experienced sexual abuse, it may include going to bed or avoiding situations where any form of physical contact might arise. This avoidance can include trying to avoid trauma-related thoughts, too; your child may constantly be on the go (i.e. unable to sit still and enjoy quiet) so he or she doesn’t have to face any thoughts relating to the traumatic experience.

Complex PTSD: Throughout your child’s life, he or she may go to excessive lengths to avoid abandonment and resort to people-pleasing or “fawning” behavior. This might result in he or she having trouble setting boundaries with others and, as an adult, becoming enmeshed in codependent relationships. Alternatively, he or she may quickly move to fight of fight, due to being hypersensitive to disapproval and micro-signals of abandonment.

3. Skewed belief systems and negative perceptions

PTSD: There is a shift in a person’s belief systems and self-perception after traumatic events. He or she might suffer from low self-esteem, depression, excessive ruminations, negative self-talk, memory loss related to the trauma, decreased interest in activities previously enjoyed and a heightened sense of self-blame.

Complex PTSD: For individuals who experience severe verbal, emotional, physical or sexual maltreatment at a young age, often his or her model of the external world becomes internalized. In other words, negative expectations of what adults have to offer are developed in the child’s internal world, influencing his or her internal working model. The child has a core belief that they are bad and unlovable, and world is dangerous and unreliable. This often prevents children from taking risks or pursuing goals, can lead to a sense of learned helplessness, and as adults they may mimic the voices of any abusers, especially toxic parents.

4. Hyperarousal and hypervigilance

PTSD: Survivors develop an excessive sense of alarm concerning their surroundings. This may include a heightened startle reaction, increased irritability or aggression, engaging in risky behavior, and difficulty concentrating or sleeping.

Complex PTSD: Survivors with Complex PTSD often have a narrow window of tolerance, veering quickly out of the window at the slightest trigger. They struggle with emotional regulation and may engage in self-harm, develop substance abuse addictions, and have a hard time trusting themselves and their intuition. They may have a deep mistrust of others but also a heightened attunement to changes in their environment as well as a hyper-focus on changes in micro-expressions, shifts in tone of voice or gestures in others.

Is there treatment for PTSD and Complex PTSD?

The good news is trauma can be resolved. In fact, Peter Levine, tells us, “I believe not only that trauma is curable, but that the healing process can be a catalyst for profound awakening.” But do note, there is no ‘one-size-fits-all’ solution.

Traditionally, PTSD treatment has favoured medication and/or a top-down therapeutic approach, which looks at how the mind is interpreting information. One of the most popular methods is Cognitive Behavioral Therapy (CBT). However, the top-down approach has limitations. It’s like saying: What happened doesn’t really matter—only changing your thoughts does. Pay no attention to how your body feels or the memories left living inside of it. Let’s just think about it differently. Let’s think ourselves out of it.

Today, many psychotherapists are moving towards a bottom-up approach to treating PTSD. That is observing body sensations, which often hold the key to unresolved (or unintegrated) traumas. Psychiatrist Bessel van der Kolk explains: “When you’re traumatized, you’re afraid of what you’re feeling, because your feeling is always terror, or fear or helplessness. Body-based techniques help you to feel what’s happening in your body, and to breathe into it and not run away from it. So, you learn to befriend your experience.” One of the most effective bottom-up treatments is Eye-Movement Desensitization and Reprocessing (EMDR), which involves processing the trauma by following a back-and-forth eye movement or vibrating paddles. Somatic Experiencing, an alternative therapy created by Peter Levine that facilitates the completion of protective impulses that get trapped in the body, is seeing good results. As is neurofeedback.

Other techniques include physical methods: Yoga, dance, martial arts, reiki, or any kind of intense exercise. All of these help to heal the nervous system and integrate awareness of the self and environment through movement.

When it comes to Complex PTSD, however, recovery is much longer process and a range of therapies may be required. What is crucial is to find a professional who has specialized knowledge and experience in treating trauma, specifically Complex PTSD (that is, given it differs from PTSD). Grieving the losses associated with the trauma or traumas experienced is an essential part of the journey.

For more information and assistance, contact PTSD Help. https://ptsdhelp.co.nz/