Post-Traumatic Stress Disorder (PTSD) & Complex Trauma

In the context of brain function, trauma can be defined as any event or experience that changes your vision of yourself and your place in the world. It may occur as the result of one single event, or it could build up gradually due to a threatening or lonely environment.
The imprint of trauma exists in our society in epidemic proportions; from war and its victims, to victims of sexual, physical, and emotional abuse. As everyone with trauma knows, when brain activity is altered by traumatic events it can be a heavy burden to carry. What may have served us as a necessary self-preservation response in the past seldom serves us in the present.
In order to receive an official Post-Traumatic Stress Disorder (PTSD) diagnosis, the DSM-5 states that there must have been exposed to actual or threatened death, serious injury or sexual violence. This includes:
  • Directly experiencing the traumatic event(s)
  • Witnessing , in person, the event(s) as it occurred to others
  • Learning that the traumatic event(s) occurred to a close family member or close friend
  • Experiencing repeated or extreme exposure to aversive details of the traumatic event(s)
Symptoms of PTSD
Everyone suffering PTSD experiences different symptoms at various levels, regardless of the nature of the traumatic event(s) being exposed. The symptoms can appear immediately after the event, or many years after.
The DSM-5 identifies four different types of symptoms for two age groups; children 6 years and youngsters and adults, adolescents, and children older than 6 years. The symptoms are all associated with the traumatic event(s) and begin or worsen after the traumatic event(s) occurred.
The symptoms for adults, adolescents, and children older than 6 years include:
Intrusion symptoms, such as:
  • Recurrent, involuntary, and intrusive distressing memories of the traumatic event
  • Recurrent distressing dreams in which the content and/or affect of the dream are related to the traumatic event(s)
  • Dissociative reactions (flashbacks) in which the individual feels or acts as if the traumatic event(s) were recurring
  • Intense or prolonged psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event(s)
Persistent avoidance of stimuli, including:
  • Avoidance of or efforts to avoid distressing memories, thoughts or feelings about or closely associated with the traumatic event
  • Avoidance of or efforts to avoid external reminders (e.g. people, places) that arouse distressing memories, thoughts, or feelings about or closely associated with the traumatic event(s)
Negative alterations in cognitions and mood, such as:
  • Inability to remember an important aspect of the traumatic event(s)
  • Persistent and exaggerated negative beliefs or expectations about oneself, others, or the world
  • Persistent distorted cognitions about the cause or consequences of the traumatic event(s) that lead the individual to blame himself/herself or others
  • Persistent negative emotional state (e.g., fear, horror, anger, guilt, or shame)
  • Markedly diminished interest or participation in significant activities
  • Feelings of detachment or estrangement from others
  • Persistent inability to experience positive emotions
Marked alterations in arousal and reactivity, including
  • Irritable behaviour and angry outbursts expressed as verbal or physical aggression toward people or objects
  • Reckless or self-destructive behaviour
  • Hypervigilance Exaggerated startle response
  • Problems with concentration
  • Sleep disturbance
It’s quite normal to experience some of these symptoms when you are exposed to a traumatic event, but usually they subside. When they continue for more than a month a PTSD diagnosis may be made.
Treatment for PTSD
The most effective treatment for PTSD should help the individual come to terms with the trauma and is usually conventionally treated through talk therapy or psychotherapy. Another technique that has become popular in recent years is known as Eye Movement Desensitisation and Reprocessing (EMDR), which involves moving the eyes from side to side whilst reliving the trauma. Sometimes antidepressant medication will be prescribed to help relieve some of the symptoms, but it is acknowledged that they will not address the root causes of PTSD.
What is Complex PTSD (C-PTSD)?
Complex PTSD, also known as Developmental Trauma Disorder, is usually interpersonal (occurs between people), and involves ‘being or feeling’ trapped. It is often planned, extreme, ongoing and/or repeated. Complex trauma generally leads to more severe, persistent and extreme impacts than single incident trauma. It impacts tend to be cumulative.
People react to threat or danger with a system comprised of biological, cognitive and behavioural responses. The biological responses involve a cascade of interdependent neurochemical changes in different parts of the brain and body. These, in turn, influence thinking and behaviour.
Normally, following the perception of threat or danger, the body’s neurochemistry returns back to normal. In post-traumatic stress disorder (PTSD), the neurochemical responses outlive the original threat and inhibit the system’s ability to return to normal.
In people with complex trauma, research suggests that repeated exposure to traumatic events early in development not only inhibits the neural system’s ability to return to normal but changes the system to appear like one that is always anticipating or responding to trauma.
For this reason, people who have experienced complex trauma may display symptoms including poor concentration, poor attention and poor decision-making and judgement. They may also appear highly reactive and respond to threat even if it is not present. Their behaviour may be aggressive in response, or they may take flight or simply freeze.
In this way, complex trauma translates into a range of social, emotional, behavioural and interpersonal difficulties that can be life-long. The associated personal, social and economic costs are high.

Neurofeedback in the treatment of trauma
The objective with neurofeedback training for trauma is the same as that for psychotherapy or EMDR – to come to terms with the trauma. The difference is that neurofeedback offers a way to do this without having to talk about uncomfortable feelings or reliving them. It works at a deep subconscious level, breaking the cycle of trauma and post-traumatic stress.
Four studies have been completed looking at the effectiveness of neurofeedback for trauma in adults.  One study has been completed with children. These studies all suggest that neurofeedback is a very promising approach to treatment. This is especially important because existing treatments have limited effectiveness for many individuals with trauma.
How does neurofeedback help alleviate trauma?
Neurofeedback trains the brain to produce a calm state, as well as regulate the stress response. The specific areas of the brain affected by trauma can also be targeted and trained to produce healthier patterns.
Frequently, the first sign of improvement is better sleep quality. Then other symptoms begin to improve, and it is often possible to significantly reduce medications. After sufficient training, a person with trauma can maintain a calm state on his or her own. When they have reached this stable state, neurofeedback treatments can be decreased until no further training is necessary.
Symptoms of trauma that can be trained
  • Sleep difficulties
  • Exaggerated response when startled
  • Lack of concentration
  • Lack of trust
  • Irritability and/or angry outbursts
  • Restricted range of emotions
  • Loss of memory for important parts of the traumatic experience(s)
  • Lack of interest in significant activities
  • Isolation
  • Feeling detached from others
  • Sense of doom
  • Nightmares and or recurrent dreams of the event(s)
  • Recurrent distressing images, thoughts, feelings, or perceptions of past trauma
  • Flashbacks
  • Hypervigilance, being always on guard
  • Numbness
  • Disassociation