How Trauma is Acquired: Simple Versus Complex Trauma

Simple or Single Incident Trauma

Textbook PTSD

Most people associate PTSD with some kind of single episode that was overwhelming and life threatening. Such overwhelmingly stressful events include being the victim of an assault or kidnapping, or surviving an immediately life threatening event such as a hurricane, motor vehicle accident or being exposed to war or genocide. Even hospital related trauma such as a pregnancy/birth trauma or surgical trauma can result in post-traumatic stress disorder (PTSD).

Complex or Developmental Trauma

Adverse Childhood Experiences

The 1997 landmark study the Adverse Childhood Experiences (ACE) study by Kaiser Permanente and the Centers for Disease Control, researchers identified strong, graded relationships between exposure to childhood traumatic stressors and numerous negative health behaviors and outcomes, health care utilization and overall health status later in life. For example, persons who had experienced four or more categories of childhood exposure, compared to those who had experienced none, had 4- to 12-fold increased health risks for alcoholism, drug abuse, depression, and suicide attempt. If you have developmental trauma, the truth is you’re going to be at risk for almost any kind of physical health, mental health, social health problem. Recognizing this fact is the basis of what’s known as “trauma informed care.”

Early childhood experiences wire children’s brains “differently” when they’re raised in a chaotic or violent environment. “Don’t ask ‘What’s wrong with you?’ Ask, ‘What happened to you?’”

Definition of Trauma

Trauma is in an event that overwhelms the central nervous system and changes the way you remember and react. It’s something that happens to your central nervous system and to your mind and makes you incapable of assimilating or integrating the experience into your life.

Bessel van der Kolk is a researcher and psychiatrist studying and treating post-traumatic stress since the 1970s. His work focuses on the interaction of attachment, neurobiology, and developmental aspects of trauma’s effects on people.

Attachment Styles and Trauma

Early relationships with caregivers determine how we form attachments with people. The Strange situation is a procedure devised by Mary Ainsworth in the 1970s to observe how confident or secure a child responds to behavior of their parent or caregiver. In the video you can see reactions of the child when their mother leaves the room. 

Attachment styles range from secure attachment (seen in 70% of the children observed), where the baby or toddler shows a moderate amount of concern and will engage with another caregiver when her parent leaves the room. Ambivalent attachment (15%) and avoidant attachment (15%) response are evident where the baby shows indifference or is unconsolable when the mother leaves the room. In 1990 an addition attachment style was identified, disorganized attachment, where the baby can appear either indifferent or agitated. This was evident in less than 4% of babies tested.

Attachment styles are determined by around 17 months and shapes how we respond to stress. Securely attached children tend to be more resilient and optimistic. Other attachment styles impair resilience and contribute to negative effects of stress, PTSD and trauma symptoms.