Understanding Complex Trauma Frightening events can have lasting effects Trauma and Homelessness Team Carswell House Dennistoun Glasgow G31 2HX Tel: 0141 232 0114 Fax: 0141 232 0131 General enquiries email: Pat.Parker@ggc.scot.nhs.uk
The Trauma and Homelessness Team is a Greater Glasgow & Clyde NHS mental health team dedicated to working with adults who have experienced Complex Trauma and are homeless or at risk of becoming homeless. This leaflet is for anyone affected by Complex Trauma. It describes Complex Trauma and will tell you about some difficulties that adults with Complex Trauma may experience and identifies some ways of coping. 2
Definition of trauma: A trauma can be an event or experience that is deeply distressing to someone. Often this can effect the way someone thinks, feels and behaves. It can also cause bodily reactions such as insomnia and tension. In many cases, traumatic events can impact on relationships with others. Examples of traumatic events are below: Death. Road traffic accident. Fire. Rape. Sexual assault. Physical assault. Loss. Witnessing a traumatic event. Natural disaster The types of trauma listed above are single, discrete events that can occur suddenly and without warning. If it is a single, one-off, unexpected event, it is called at TYPE 1 Trauma. 3
Some types of trauma can occur on multiple occasions and over a longer period of time. The person may anticipate what is going to happen but be unable to do anything about it. If the trauma happens on multiple occasions, it is called TYPE 2 Trauma. Many TYPE 2 Traumas can involve people known to us, family members and people who we love. Below are some examples of TYPE 2 Trauma: Domestic violence Childhood abuse (sexual, physical, emotional, neglect) Torture 4
COMPLEX trauma is often defined as long-term, interpersonal abuse, occurring on multiple occasions and often beginning early in life (Herman, 1997). 5
These are the thoughts and feelings of some people who have experienced Complex Trauma: I thought it hadn t affected me but it (the abuse) has changed everything my personality and my relationships with everyone. I try and pretend that I am normal and the same as everyone else but I feel different and no-one understands the fear, the guilt, the shame. I can t cope with the memories. This is why I drink. I feel angry all the time, I don t trust anyone, bad luck follows me wherever I go. 6
How common is Complex Trauma? Complex Trauma is more common than a lot of people think. It is estimated that 80 to 100 percent of people using homeless services in Glasgow have experienced trauma with a high proportion experiencing Complex Trauma. Prevalence rates for child sexual abuse (contact and noncontact) are estimated at around 21% for females and 7% for males. Strathclyde Police Force recorded 23,306 annual incidents of domestic abuse. 7
How does complex trauma affect someone? Complex Trauma can impact on: The way someone feels The way someone thinks The way their body works The way someone behaves 8
Mental Health Consequences of Complex Trauma Post Traumatic Stress Disorder Many people can develop Post Traumatic Stress Disorder. Some of the symptoms include the person having dreams or unwanted pictures or images of the trauma coming into their mind (often called flashbacks). They may feel that the trauma is happening again and experience the same sensations and distress. They may find that they try to avoid all things that are related to the trauma. This may include not talking about the trauma or avoiding people or places that remind them of the trauma. Other symptoms include jumpiness, feeling irritable and difficulties sleeping. Mood Difficulties (anxiety, depression, anger) People who have experienced Complex Trauma often report difficulties in identifying and managing emotions. Traumatic events may produce feelings of fear, loss, abandonment and isolation. These feelings can affect mood. Because trauma is often associated with danger and vulnerability, some people may experience symptoms of anxiety (e.g. shakiness, trembling, tension, palpitations, and dizziness). 9
Self esteem and relationships Our early experiences of care can often affect how we feel about ourselves and impact on the relationships we form with other people. People who experience abuse in what is meant to be a caring relationship can often feel that it is their fault and think badly about themselves. They may also believe that all relationships will be similar and accept this or believe that it is better to be alone. Some people report that experiencing one traumatic event after another can make them feel powerless and helpless and there is no point trying to get help because there is nothing they can do. 10
Ability to cope with emotions Complex Trauma often produces feelings of fear, sadness and despair that can often be difficult to manage and control. Often these feelings start suddenly and become very powerful, often overwhelming. Sometimes people report that the only way they can cope or find any relief is through drugs and alcohol or other forms of self harm. Physical symptoms Complex trauma can affect people physically. This is because traumatic events normally trigger biological reactions. Symptoms may include insomnia, concentration difficulties, muscular aches and pain, tiredness, palpitations, headaches and stomach problems. In some cases people may be diagnosed with physical difficulties, such as Irritable Bowel Syndrome, migraines or pain. 11
Dissociation / Detachment Traumatic events can sometimes be too painful for the mind to accept. Dissociation is the minds attempt to hide the memory and disconnect from the trauma. Although this may have been helpful at the time, some people continue to dissociate when they experience difficulties after the traumatic event. Some people may feel they temporarily lose touch with things that are going on around them (kind of like what happens when you or others daydream) and can even have no memories for a prolonged period of time and/or feeling as though they are outside of their body. 12
Coping with Complex Trauma Coping strategies tend to fall into two categories: unhelpful coping strategies and helpful coping strategies. Unhelpful coping strategies can be helpful in the short-term but aren t healthy long-term solutions and often lead to more difficulties. Some examples of unhelpful coping strategies are below: Unhelpful coping strategies Alcohol and drugs. Taking out feelings on others who don t deserve it. Self harm (e.g. punching / cutting / burning, swallowing dangerous substances, staying in abusive relationships and dangerous situations). Bottling up feelings. 13
Other coping strategies are those which usually take more effort but are really helpful in the long-term. Some examples of helpful coping strategies are below: Helpful coping strategies Accessing and accepting support from others. Expressing needs and emotions honestly. Taking time out. Staying active / building structure and routine When experiencing a flashback or nightmare, it may be helpful for the person to - remind themselves that worst is over and that flashbacks or nightmares are very normal in people who have been traumatised - try and notice what is going on in their present environment (e.g. notice the colours and shapes of the room, listen to different sounds) - take care of themselves (e.g. having a relaxing bath, play soothing music, reading a book, have some quiet time) 14
However, for some people who have experienced Complex Trauma these strategies may not be sufficient and they may benefit from psychological treatment. Psychological Treatment for Complex Treatment Research has shown that it is good for people to talk about their reactions and how they feel about what has happened. Meeting regularly with a trained therapist for psychological treatment can help people reduce symptoms and develop positive ways of coping with painful experiences. It also provides a safe opportunity to process what has happened to them and allow them to make sense of how the trauma has affected them. 15
The Trauma and Homelessness Team is a mental health team for individuals who have experienced complex trauma and are homeless or at risk of homelessness. The team offers a range of talking therapies for treating complex trauma. Remember. Advice, support and treatment are available. Trauma and Homelessness Team Carswell House Dennistoun Glasgow G31 2HX Tel: 0141 232 0114 Fax: 0141 232 0131 General enquiries Email: Pat.Parker@ggc.scot.nhs.uk 16