Paper: Accumulated Childhood Trauma and Symptom Complexity

I love when I find full scientific papers for free online!

The Journal of Traumatic Stress has published a paper entitled, Accumulated Childhood Trauma and Symptom Complexity by John Briere [Department of Psychiatry and Behavioral Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA and the National Child Traumatic Stress Network] and Stacey Kaltman and Bonnie L. Green, Department of Psychiatry, Georgetown University Medical School, Washington, DC.

The relationship between accumulated exposure to different types of traumatic events (cumulative trauma) in childhood and the total number of different types of symptomatology reported  (symptom complexity) in adulthood was examined in a sample of 2,453 female university students. There was a linear relationship between the number of trauma types experienced by participants before 18 and symptom complexity. This effect remained even when controlling for specific traumatic events, suggesting a generalized effect of cumulative trauma.

The authors explored the effects of multiple traumas in childhood, using twelve trauma types.  Doing a quick check of my own trauma inventory, I realized that I experienced nine of these trauma types, some of them repeatedly, for years.  It’s no wonder that my symptoms compounded, especially given the added experience of multiple traumas in my adult life.

The clumsy process of my psychological recovery makes a bit more sense to me, especially given the fact that some of the traumas overlap, or are related to each other somehow.  Treating Complex PTSD is already a difficult process, treating Complex PTSD with multiple trauma types is even more challenging.

The authors also provide a conclusion that rape and physical abuse traumas are unique indicators for complex psychological symptoms, which — in my opinion — are further compounded when those traumas occur in a familial setting.

The authors do not provide conclusions on therapy or recovery in this paper.


21 thoughts on “Paper: Accumulated Childhood Trauma and Symptom Complexity

  1. I’m in with seven distinct types. I’d assume therapy having to follow each symptom or set of symptoms where they can be positively related to each other. Other than that, severity of experienced symptoms in reduced life quality might be another aspect of prioritizing. If therapists don’t see that, I’d simply require them to follow this simple scheme. No?

    1. Definitely addressing the most severe symptoms is vital.

      I’m so stubborn that I have rejected outside therapy at almost every turn. That has meant that I manage my own therapy, am my own therapist, however you want to see it. I think that does make it difficult in some ways, but it has also been clumsily effective. I have had to set the priorities for myself.

      Early in 2011, I took a month or so to build a trauma inventory. It was a painful, confronting process, writing each event out on its own index card. That inventory, however, has been a useful tool. The priorities seemed to sort themselves out, but it didn’t lead me to deal with the most hurtful parts of past first. The way it has worked is that the most painful, the deepest issues, were what I dealt with last. That inventory also helped me piece together the narrative of my life, which had been terribly fragmented through disconnected and incomplete memories.

      As for the symptoms that effect the quality of my life, that is an ongoing issue that I have to manage on a daily, sometimes hourly, basis. As I have worked through understanding and recognizing my triggers, some symptoms reduce in frequency or severity, but the underlying foundation of PTSD still exists.

      I’m still hoping to get past it completely or at least regain a greater part of who I am and have the life I want for myself. It will happen.

  2. I think, trusting your own instincts and going with what your heart tells you is an excellent concept! I’m most impressed by this approach. Plus, where formerly unconditional love gets betrayed so badly, trusting anyone becomes a very big challenge. I hence understand your reluctance to undergo formalized therapy and feel you on that one.
    From my own reading up on existing therapies, I get the feeling that finding an “empathic witness” as Alice Miller calls it in her book “The Drama of the Gifted Child” is of paramount importance. Abuse is a crime of crossing borders, borders not only of convenience, but borders of safety. In order to restore as much personal completeness and integrity, the abused/hurt/crossed over parts, the “hurt children” need to be validated in their pain. The pain as such needs to find validation by an empathic witness, someone who’ll go beyond analyzing or offering solutions, but will take the place of a trusted companion who stands up for you. That person was likely not around when the intrusions and violation of safety happened and your own psyche coped by compartmentalizing the emotional responses from those crimes. In order to get in touch with one’s emotional self, according to Miller it is important to let these feelings of profound sadness and possibly rage etc. come forth and be validated as appropriate responses. The idea of healing then revolves around the concept of restoring as much emotional integrity as possible and thus getting to feel a much greater sense of vividness and aliveness than ever before. Maybe not the 100% we could have had or felt, but enough to make life worth experiencing.

    I have decided, I have never gone about that part and I have formalized admission to a clinic specializing in trauma therapy later this year. Waiting lag is 6 months minimum. I expect to do a lot of crying and screaming, but both need to be done once in order to become complete.

    Hope, this encourages you to continue the journey. My own response to the book was one of additional devastation at first, but after some time of processing, I realized that’s the best possible remedy. And better than what I’ve been doing so far as far as coping with the past.

    1. I will have to read that book. There was one that I read and re-read at the start of my major breakdown 5 years ago, The Courage to Heal. It triggered a lot of memories, and was a shattering experience that led to psychosis. I don’t feel nearly so vulnerable now that I’m so far through my process.

      I have had some amazing people support me through this, most only for a bit of time. I think it’s hard for others to be too deeply involved, especially when they have to witness the machinations of PTSD. Most people expect a person to grasp a concept, absorb it and move on, but that is difficult when you have this disorder. An issue will come back in many different forms, especially for survivors of abuse. It’s not like we here hit once, sexually manipulated once, belittled or betrayed only once.

      Those that have been most amazing and supportive have been my sons, my darling friends in Holland, my mother and my sister. In fact, my mother has been so valuable to my recovery that I am amazed. She listens to anything I have to say and answers every question I have. (this is new for us)

      I’ve also practiced being my own empathetic witness, to some extent. Given that I have a fractured personality, with several identities that still need to fully come together, I guess I can sort of play around with which ‘me’ is witnessing for some other ‘me’. My identities follow periods of my life, so the grown-up, capable me can listen and empathize and even ‘talk’ with the ‘children’. The PTSD me can cry to the grown-up, capable me about how much has been lost. I think the integration of my personality is going to be the last, most challenging part of this. To achieve that, I have to accept and love each one of me and that takes listening and caring. I don’t know that anyone else could do that for me, even my empathetic witnesses.

      I still need my friends and family to listen to me about the process, not so much about the experiences. I need their empathy most when it comes to the PTSD. Knowing they care is going a long way toward rebuilding my ability to trust.

      Hugs back…KC

      1. The books is called “The Drama of the Gifted Child” by Alice Miller. However, you get to familiarize yourself with the main concepts of her work at his – no longer updated, archived – website:
        In particular the “helping witness” is a key aspect of healing and you seem to have managed to do so with your mother via these migraine-inducing talks at the kitchen table. I can only wish I had gotten this far. I seem kind of hung up on your statement “Sociopaths are completely devoid of feelings for others and incapable of developing them. They are never healed, ever.” It appears to me that my mother – the main perpetrator – was such a sociapath in her more youthful years. Not only with me, but – as you already assumed somewhere else further below in a different reply – with my father, our paternal grandfather (who lived under the same roof), her sister and other family, co-workers, the list goes on. In retrospect I find it amazing so few people put their foot down with her. But a therapist once told me that psychotic people can be very, very smart and she must have always known – or felt – just how far she can push it before things would have backfired in her face. Her youthful her was a dictator, an utterly cruel and at times merciless tyrant and the grown-up in me can’t help but think, people like this should never be permitted to have children of their own. I even fancied a general lawsuit against them, with the goal of destroying their material accomplishments in life, like robbing them of the house they now own and live in. But I also realized that inflicting more damage is the opposite of healing, so I dropped that idea.

        In writing and contemplating all this, I might have had a helping witness in a former therapist. If so – and I’m not sure, if he truly lived up to this, but if he did, then the helping witness had no lasting or profound effect on me. Which leaves room for two conclusions: Either something else is going on, which I haven’t identified yet, or … my healing has already progressed farther than I am aware of. Hm. Might have to ponder that… 🙂

  3. I’m happy for you you should have this support, Kelly. I will be honest: It is hard for me to read these lines and realize, how I lack everything you describe as far as support for coming around. It’s a devastating place to be in and I’ve been in that place for six years with only temporary progress in between as I seem to realize now.

    In regards to your process, I think you’re doing it all perfectly. I couldn’t imagine a better process, if you labelled and sold it at Walmart’s… 😉 So congrats for having come this far and wish you lots of love all around and success with the continued process. Oh and: I’m sorry for having been a little inconsiderate/insensitive with my second reply. In going over it now, I find it to sound awfully cold bordering on intrusive and that may have been on account of probably still being shook up by that incident I experienced a few days ago. Actually… I think, I’ve thoroughly reached the end of the last fiber of a broken rope in me. But don’t let that alarm you, please. I have proven to be like superglue when it comes to hanging on…

    1. I’ve been at that point too, Wes. In fact, quite recently I had another bout of major hopelessness and suicidality. I just had to ride it out.

      And don’t worry for a minute that I took anything you said the wrong way. Not at all. I think it’s great that you express what you’re thinking and feeling, even if the expression comes out unbidden, it’s better to let it come out. You learn from it. You should have seen the mess I was (and sort of still am). I’m just stubborn and I sense a good foundation of stubbornness in you. Hold on to that, that’s the little core of life in you that just won’t let go. It’s that core of hope that keeps you looking for your answers.

      I don’t always use my support system. Sometimes I just sit and wallow in sad, bad thoughts and starve myself for a few days. They don’t always know I’m doing it because I am so inconsistent in my communication. I don’t call everyday, so they don’t know when I’m not doing well.

      What can you do to build a better support system for you? I’m happy to be part of it from all the way over here 🙂

    1. Ah… that’s different.

      I will say this… bringing certain people into my recovery, like my mother, was extremely difficult. I had blamed her my entire life for letting my father abuse me. We had some migraine-inducing, tear-filled discussions at her kitchen table the last couple of years. The naked honesty that we’ve come to is beyond what I ever thought I could achieve… or cope with. I had to lead her through it though. I had to help her open up to me, to share things that no one would really want to share, and I had to do it very gently. I think we’ve both healed from it.

      All of the other canned therapies that people talk about cannot compare with being able to sit down and have a blatantly honest discussion about the abuse, with the ones who were there. By this I mean the ones who could/should have been protectors and rescuers.

      I have never had an honest discussion with my father about the abuse. My mother came to the table, but he never did. We have talked about it, but every time he used it as an opening to talk about himself. He was never able to see it from my perspective and he never will. Sociopaths are completely devoid of feelings for others and incapable of developing them. They are never healed, ever.

      But we can be.

  4. “What can you do to build a better support system for you? I’m happy to be part of it from all the way over here ” You are, Kelly. Having found your blog and with you sharing your journey is by far the most valuable resource I have come across in recent years. And learning the various recurring phases and stages as part of the process from a trustworthy as well as competent, intelligent and empathetic individual like yourself has already proven to make up for many of the previous – and failed at that – therapeutic situations many times over. Hearing from you that riding it out is the thing to do helps a lot plus having learnt a success story of overcoming the condition from someone else last night. So saying, I lack support isn’t an accurate perception I now find. Frustration from needing to pull myself up time and time again sometimes gets the better part of me. Sorry ’bout that 🙂 And thank you for sharing your journey and most valuable insights. You’re doing a great “job” with that. Again, I expect the book to “clear the shelves” with success!

  5. I hear you. “I have never had an honest discussion with my father about the abuse. My mother came to the table, but he never did. We have talked about it, but every time he used it as an opening to talk about himself. He was never able to see it from my perspective and he never will. Sociopaths are completely devoid of feelings for others and incapable of developing them. They are never healed, ever.”

    In my case, roles are reversed with my mother being the perpetraitor (although not sexually) and my father being the one to let it happen. After a major panic attack that had me pass out and suffer a chin laceration as well as concussion in October 2009, I’ve made an all resolved attempt at “getting through” to them. Prior to that, there was a period of some 2 years, where I shut them out of my life completely, even threatened a lawsuit on them should they disrespect my unilateral no talking “policy”. After the panic attack – which lasted for several hours that had me hyperventilate the entire time and brought about the worst fears of annihilation to happen any second (an emotional analogy for physical death, I guess, maybe a flashback, too) – I woke up the next morning feeling emotionally regressed to a four year old. It was the most bizarre thing I’d ever experienced. I felt alone and helpless all over again. In my despair I first tried to get someone at the hospital to talk and that calmed me down a little. I then called my sister, who encouraged me to resume talking to family. I did, we both broke down and I thought I had opened a door. After being released from hospital, my father came to stay one night upon my request. I then spent another few days at home by myself, after which I went to visit them at home, resolved on using the opened door. I stayed for about a week and the full scope and range of physical discomfort was back at full throttle, although I had an entire flat/floor to myself. There were long walks and talks both inside the home and outside, with each parent individually and both together. After that, I resumed therapy with a therapist who knew about the book I refer to above and confirmed to me that the book was a prominent part of his work. I also briefed him to the effect of reassuring me he wouldn’t put me in the victim’s place all over again, which he o.k.’ed to me. I also requested him to address the abuse that had been going on instead of focussing too hard on my first weeks of being quarantined at the pediatric hospital.

    There was a number of individual sessions, after which he suggested to bring in family – which I very reluctantly agreed to. Sure enough, upon the second session or so, I’d find myself put in the place of the victim again. Right after that session I expressed my feelings of being let down by him and that we had agreed on something different, to which he more or less shrugged his shoulders and resorted to a place of saying I might choose to consider a different therapist then (in retrospect, I should sue his lousy, indifferent ass from here to Kingdom Come, for crying out loud…).

    To cut this long story short: I realized that instead of opening a door to recovery, I opened a door to perpetuated abuse and find myself in an impossible situation of having accepted help in other areas from them, while at the same time needing to realize what you said above: “Sociopaths are completely devoid of feelings for others and incapable of developing them. ” – the sociopath being my mother in this case (and not only with me, b.t.w. – it never ceases to amaze me, how apparently noone had put their foot down with her. Maybe she’s more deeply troubled herself than I had ever assumed…). Which makes – or made – one thing devastatingly clear to me: I can forget about making her or my father the empathetic witness. They cooperated in very sick ways as far as abusing me (and my sister, but who was better capable of drawing a line and also removing herself from the immediate scene sooner than I. Also, she was never as much “in the spotlight” and the center of all family attention as was I – for better or worse, rather worse).

    Anyway. I will need an empathetic witness from somewhere else in order to get over this hump, or else the injured parts will never be quiet and always act up on me sooner or later… This all feels like an epic nightmare to me, more along the lines of a curse.

    “But we can be.” I’m sure about you, yes. And I’ve met someone last night in my country, who shared their story of as much recovery as possible with me. I still believe I can to that place, i.e. a 60% or above chance of recovery to some perceived 80-90% of what I could have been. I am fairly clear, though, that I’ll never be like other people when it comes to close relationships. And I’ve begun to wonder, what else was out there for me, if not that. Oh boy… 😉

    1. Have you ever thought of your father as a victim? A victim of your mother’s abuse, or someone else’s before her?

      My mother was abused as a child and abused by my father, more emotional abuse but still quite devastating for her. I had to separate the ideal I had in my head of what a mother should have done for me and accept what my mother was able to do for me. At the time, she couldn’t help. I still stubbornly (like a kid) did not want to forgive her, but I needed to. Accepting her as she is has been a vital part of accepting me for who I am.

      Like you I am always going to struggle in close relationships, but right now the most important relationship I am building is with myself. All that other stuff can come later. I do still have times when all I want is someone to just hug me.

      1. Yes, I have. Quite frankly, I believe the two have had a most unhealthy relationship/marriage of co-dependency themselves and I had begun to address this in the family therapy sessions. Interestingly, my father said something to the effect of “she wouldn’t let go of me”, referring to my mother during the time they met. I can only reiterate the therapist’s crass incompetence by letting this key phrase go unaddressed and resorting to this pediatric clinic crap. (of course, the clinic stands for initial trauma, but still – I had urged him to address abuse this time around and maybe address the clinic thing and trauma as a secondary aspect, one we could deal with later. But no …).

        I hear you in regard to “I had to separate the ideal I had in my head of what a mother should have done for me and accept what my mother was able to do for me. ” I’ve tried that, too, most noteably during that crucial time post-panic attack in 2009. I think, I’ve grown enough to embrace that idea and sentiment. And in replying to may “getting through” speech she replies something along the lines “that’s horrific, I can’t begin to wrap my mind around that”, referring to the pain I endured from her. And that was that! It didn’t go any further than that and I thought it to be more promising to leave the rest to the therapeutic setting (although personally, I’d have rather gone about the whole thing in similar ways than you have, i.e. migraine-inducing, painful, but honest and clear-cut, unmistakeable cutting to the chase between perpetrator – or co-dependent perpetrator). The bottomline is: At some point, I need to be given the opportunity to meet at eye’s level with them. If not, there is no point in extending a “relationship” that is more of an expression of Stockholm Syndrome than anything else, see?

        And in regards to the inpatient care: Yes, I’m tremendously fear-ridden as to that one, as it IS a triggering situation. However, I may have to understand that it’s a “take it or leave it” kind-of situation on account of the limitations my health insurance plan brings about. I will continue to investigate the possibility of ongoing, long-term outpatient care, but the odds are not exactly in my favor there. 😉

        Thanks for taking an interest. Yes, you nailed! Sometimes a simple hug would work miracles… *sigh* 🙂

  6. P.S. I think I was fairly clear about the process of “bringing them in” would have become very tough. I never shied away from that. But now, with the full realization that it will NEVER happen… I’m just lost. It brings me back to saying what I said a couple of days ago, that in agreeing to formalized inpatient care is more or less checking off items of an inner checklist of possible remedies. The thing I’m most scared of is to experience another therapeutic let down. I am not sure, I can cope with that again should it occur.

    1. I think the inpatient could be good. The one thing that I would perhaps caution about is the triggers that come merely from being in hospital. I’m curious about what you mentioned about regressing to the 4 year old in pediatric hospital. Were you injured or ill as a child? I’m curious because I was. At 6 months I was starving, so I was hospitalized. At 11, I was in a serious bicycle accident and hospitalized again. I completely disassociate when I am in hospital, I’m just not there. The traumatic experiences we had as children, especially if no real emotional support was given, can be unhealed wounds we carry for years, decades. I spoke with other family members about what they remembered, as well as talking it through with my mother.

      The regression is a bit of what I referred to in an earlier reply. I have a fragmented personality, but basically I think that means that under certain conditions I regress to a certain age. When I went through the psychosis in ’08, I went wayyyyyy back. I regressed to a very young child and have spent the last 4 years or so ‘growing up’ again. I basically followed the emotional stages of my life all over again. I’m just crossing over from disturbed teenager to frustrated, ambitious twenty-something. The most curious thing is that I saw my ex-husband go through the very same thing: regression and re-tracing his emotional life… after a near-fatal car crash with head injuries. The phenomenon seems to be a normal course of healing the brain and mind.

      1. You nailed it! The inpatient situation is a potential major trigger, which is the main reason for my unwillingness so far to commit myself earlier following my becoming disabled in 2008.
        About the emotional regression: The number 4 was an more or less arbitrary pick on my part, seeing as I factored conscious memory in and that I had a retraumatizing hospital situation at age four, when I underwent throat surgery and – again – had to spend the night prior and following the operation separated from bio family. When nurses initiated the anesthetic process by putting a sleep gas mask over my face, I fought for my life and the last conscious thought before passing out was “They are determined to kill you.” My denial and dissociation is so pronounced, I don’t feel anything when writing these lines. It feels as if I was talking about someone else. But yes, hospital equals retriggered trauma for me and as a matter of fact, I have been turning down inpatient care with my condition on account of it as well as refused to undergo other minor throat surgery last year, where the submandibular gland should have gotten removed.

        The initial trauma happened only at only a few weeks into my life: I was born slightly undersized and underweighed, wasn’t breast fed and instead fed with formula, which – unfortunately – I wasn’t able to keep down (some 42 years later, a doctor finds I’ve been dairy intolerant all along. Not lactose-intolerant, for there is medication. No, it’s the dairy proteine in my case, which also rules out goat-milk or products coming from the latter). Anyway, I had too little weight and started to lose weight, so the local pediatrician suggested they take me to the clinic about one hour away by car. Getting a second opinion was probably not a common thing to do at that time or they were too concerned or something, so they went with that suggestion. The clinic, however, was run in a way that equals quarantine. They could only visit once a week for an hour or so, and didn’t get to come in and hold me, but only wave and speak through a glass pane, while the nurse would hold me up to it. By inducing mild trances and allowing my mind to drift back, some very distinct images – memories? – appear along with memories of painful and intrusive tests, like e.g. two spinal taps, getting artificially fed for weeks and other non-comforting experiences. The leading pediatrician though was a mild-mannered, kind man with lots of love for his work and his little patients. But I’m pretty sure I must have felt the brutal threat to my life and the emotional impact non-stop and my young mind must have hung on to this one hour once a week, which probably signalled the green light on getting to live on. I have allowed myself for these feelings to come forth a few times, and let’s just say that they induced meltdowns of unexpected, unparalleled intensity. I did that alone and haven’t talked about those – not that I can remember.

        I find it interesting you should mention psychosis. I’m almost certain that at some point in early 2011, I spiralled into a bout of – undiagnosed – psychosis. I gather this from my tolerance level of any kind of disturbance to have come to zero and at some point, I was close to inflicting physical injury on my then-neighbour and myself. The stress was unbearable!! I confided some of what I was going through in him and tried to negotiate a mutual mindfulness situation. I soon had to find he exploited me in that regard and understood mindfulness to be largely unilateral – or maybe his own journey was to learn to express himself or whatever. Anyway, it got to the point where I couldn’t be sure of my own rigid impulse control any more and I began scouting other lodging situations. And much like you, I think, I’ve similarly been on a journey of growing up again altogether. Wow – the similarities ARE striking!

        Going to take a walk now, fingers crossed I don’t run into the delusional, paranoid lunatic again. Or if I do that his mindset today won’t take me for a triggering threat. Jeez… of all things, that’s the last one I needed. It’s almost hilarious, isn’t it? 🙂

        Thanks for taking an interest and offering support! If I was there in person, I’d gladly give you that hug!!

  7. Sorry for typos and incomplete sentences. Naturally and apparently, speaking about these things gets me emotional and when I get like this, the focus of my awareness isn’t on correct grammar or building nicely strung-together sentences. Hope, you were able to fill in the gaps and make sense nonetheless… 🙂

  8. P.P.S. I am still positive you – or dare I say ‘we’? – are on to something here. I don’t believe the recovery process has ever been done or documented in this way – not that I’d be aware of. But then… I wasn’t aware of your blog, either… 🙂 (B.t.w.: Did you ever go and see “Precious”? I couldn’t bring myself to doing so. But apparently it’s another survivor’s story that made it on the silver screen…

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