What Is Complex Trauma?: A Resource Guide For Youth and Those Who Care About Them
What Is Complex Trauma?: A Resource Guide For Youth and Those Who Care About Them
What Is Complex Trauma?: A Resource Guide For Youth and Those Who Care About Them
This project was funded by the Substance Abuse and Mental Health Services Administration (SAMHSA), US Department of Health and Human
Services (HHS). The views, policies, and opinions expressed are those of the authors and do not necessarily reflect those of SAMHSA or HHS.
Resource Guide Developers: Joseph Spinazzola, The Trauma Center at Justice Resource Institute and Suffolk University;
Mandy Habib, Adelphi University; Margaret Blaustein, The Trauma Center at Justice Resource Institute; Angel Knoverek,
Chaddock; Cassandra Kisiel, Northwestern University Feinberg School of Medicine; Bradley Stolbach, University of
Chicago Medicine; Robert Abramovitz, Silberman School of Social Work at Hunter College; Richard Kagan, Training
Programs on Traumatic Stress; Cheryl Lanktree, University of Southern California; and Jenifer Maze, National Center for
Child Traumatic Stress.
Acknowledgments: The authors wish to acknowledge the invaluable feedback and instrumental support of the
NCTSN Youth Taskforce, Kimberly Blackshear, Joshua Arvidson, Matt Kliethermes, Keri Schumacher, Kristine Kinniburgh,
the faculty of the NCTSN Complex Trauma Treatment Network, and the entire membership of the Complex Trauma
Workgroup. The following SAMHSA CMHS NCTSI grants (U79 SM0: 61283, 80037, 61168, 80023, 61443, 61262, 54284,
61254, & 62976) supported this project.
Copyright © 2017, National Center for Child Traumatic Stress on behalf of the authors and the National Child Traumatic
Stress Network. This work was funded by the Substance Abuse and Mental Health Services Administration (SAMHSA),
US Department of Health and Human Services (HHS), which retains for itself and others acting on its behalf a
nonexclusive, irrevocable worldwide license to reproduce, prepare derivative works, and distribute this work by or on
behalf of the Government. All other rights are reserved by the copyright holder(s).
Suggested Citation: Spinazzola, J., Habib, M., Blaustein, M., Knoverek, A., Kisiel, C., Stolbach, B., Abramovitz, R., Kagan, R.,
Lanktree, C., and Maze, J. (2017). What is complex trauma? A resource guide for youth and those who care about them.
Los Angeles, CA, and Durham, NC: National Center for Child Traumatic Stress.
A 12-year old boy had been thinking about all the things he’d experienced in
his life, some good and a bunch of bad. He went to an adult he trusted—his
therapist—and asked if there were any brochures or books he could read on
“Complex Trauma.” Before the therapist could answer, the boy clarified that he
wanted something written specifically for kids, not for adults. The therapist had
nothing.
We developed this Resource Guide for youth who have experienced, or know
someone who has experienced, Complex Trauma. Older youth, adolescents,
and young adults can explore the information in this guide on their own
to help make sense of their experiences and understand themselves
better. Clinicians, caregivers, and other adults can use this guide to have
conversations—sometimes hard, but often freeing—with young adults, teens,
pre-teens (and even some curious 7-9 year olds).
The youth who asked for the written resource on Complex Trauma said he
wished he had better understood what he was going through and why he
reacted the way he did. Once he knew what Complex Trauma was, he started
to make sense of his thoughts, feelings, and behaviors. He felt relieved and—
though he still had some hurdles to get over—he felt hopeful. Now, he added,
he wished there were some materials he could share with a friend going
through similar hard times.
It is our hope that this guide will be such a resource for you. Whatever your
age, and whether you read this on your own, with a friend, a caregiver, or a
professional—this Resource Guide is for you.
Wishing you all the hope, optimism, determination, and support you need to
heal, grow, find people you can trust, and make a better tomorrow.
Youth grow up in lots of different kinds of families and neighborhoods. When things go as they
should they have grown ups in their lives who look out for them, show them love, and help them
grow up to be healthy and strong. However, sometimes the grown ups who children and adolescents
are supposed to be able to count on to help and protect them say or do really mean or hurtful things,
or just aren’t able to take care of them.
Life experiences matter—good, bad, and everything in between. As we grow up, both the things that
happen and those that don’t happen affect us. Some youth don’t think what happens really matters.
How about you? Some people think children and adolescents are supposed to get over what happens
to them even if it’s something really horrible. But for many youth, things keep bothering them long
after they happened.
Adults have a lot of names for these kinds of things: stress, tragedy, adversity, and trauma. None of
these words really capture the difference between what it’s like to deal with one or a couple of bad
things that happened, versus living with lots of terrible things happening all the time.
Sometimes, things are bad in a way that hurts young people on the inside, where no one can see,
like when grown ups, older siblings, or peers are constantly saying terrible things about them,
threatening them, or getting mad and blaming them for things that are not their fault. Some youth
live in scary neighborhoods where it never feels safe outside their home.
It can be really hard when bad stuff starts to pile up. Many children and adolescents feel like there’s
no one around to fix things, and no one in their corner. They can feel afraid, sad, or mad a lot of the
time, or blame themselves for what’s going wrong. It can also be hard to trust people when you
never know if someone is going to let you down, disappear, or attack you all of a sudden. If you feel
like people don’t care about you, you might start thinking you deserve the bad things that happen.
Instead of feeling loved and special, you might not feel good about yourself. You might feel like
you’re really different from other people and like you don’t fit in, especially if you see others having
good times with their families and having grown ups they can count on. It might feel like you’ll
never be good at anything no matter how hard you try, and you want to just give up.
It can feel really hopeless.
When youth feel like this, it usually doesn’t get better on its own. Sound complicated? You bet.
That’s why it’s called Complex Trauma.
Complex Trauma can affect people in lots of different ways. Children and adolescents with Complex
Trauma often have negative thoughts, emotions, or beliefs about themselves or the world. They
might have uncomfortable feelings in their bodies from living with constant stress. Living a traumatic
life can make it hard for young people to have healthy relationships or imagine a good future.
Even when bad stuff happened in early childhood and was supposed to be “over” years ago, the
effects of Complex Trauma can last a really long time. This can be confusing and upsetting for teens
and even young adults who still feel hopeless, unhappy, stuck, lost, or unsafe even though everything
is supposed to be better and different now. This can create a lot of pressure and shame, especially
when adults start to get impatient, frustrated, or blame youth for not trying hard enough to change.
The important thing to remember here is that this is exactly how Complex Trauma works. Just as an
earthquake can cause deep foundation cracks that are the hidden cause of a building’s instability
even decades later, Complex Trauma can disrupt healthy development and is often the unseen cause
of many problems and difficulties youth face years later that are not obviously connected to early
childhood experiences.
A Liar, a Sneak, a Suck-Up, a … Spaced Out, Distracted, Nothing at all. I don’t notice when I
Hypocrite, a Coward, a Bully. Numb. cut or hurt myself.
… Scared of myself and what I can’t make eye contact with most
… Stupid, School is not for me.
happens when I lose control. people.
I have to . . .
… Like I don’t care anymore what I can’t deal with people standing too
Be Perfect, Fool Everyone,
happens to me or anyone else. close to me or wanting to touch me.
Convince Them to Love Me.
I don’t understand why everyone Nobody wants me. I’m never going to become
treats me this way. Nobody likes me. anything.
I shut everyone out. I just want to I don’t see a future for myself. I’ll be
Everything I touch gets ruined.
be left alone. dead or in jail by the time I’m 25.
I can’t get my thoughts to stop Relationships aren’t worth it: Happiness is for other people, not
spinning. I get lost in my head. there’s always too much drama. me.
I don’t understand why I do some Everyone I care about dies, I’ll never have a job. I’ll never be
of the things I do. Sometimes I just betrays me or leaves. I hurt a success. I’ll never be good at
lose it. everyone I love. anything.
Relationships
Thoughts
Difficult
What I may do to get through it or cope How it can cause problems for me
situation
Pay really close attention to what others feel or I put the needs of others ahead of my own. Sometimes
want and try hard to make sure they are happy. others use this to take advantage of me.
Physical
Learn to fight really well and always be ready to I get into a lot of fights. I think others want to fight me even
Violence or
fight. when they really don’t.
Abuse
Learn not to feel pain so I can “take it” and just Sometimes I can’t feel anything at all—
wait for it to be over. painful or good feelings.
I flirt a lot and try to get others to have sex with me. I use
Learn to use my sexuality to try to control what
sex to get friends or approval. At times, people this to take
will happen with others.
advantage of me.
I hug people I’ve just met. When I make a new friend, I want
Learn to use affection or physical contact to
to touch and hug and tell them I love them a lot. Sometimes
comfort myself and try to get people to love and
people start to avoid me or complain, and I get in trouble
care for me.
with adults for having “bad boundaries.”
Get whatever I can when it is available and hold I get in trouble because I steal, sometimes even when I
on to it. don’t need or want to.
Develop ways to keep myself from feeling lonely, I have a hard time making friends or relating to people.
Neglect like watching a lot of TV, reading, playing video People sometimes think I’m
games. Do things by myself a lot. “weird” or “different.”
Develop “imaginary friends” to comfort me when I sometimes have trouble separating my “imaginary” world
I’m hurt or upset. from the “real” world.
Eat as much as possible. I eat too much or when I’m not hungry.
Learn to be tough. Don’t let anything get to me, I have a hard time trusting people. I’m alone in this world
but if it does, keep it to myself. and can only count on me.
Emotional
Work really hard to please and take care of other
Abuse Others take advantage of me, and I feel like I don’t matter.
people, instead of myself.
Pay close attention to what upsets others and try I believe I’ll never be good enough. I try too hard. Other
hard not to upset them. people use me.
Give up and stop trying to be good. I try to I do things that I know are wrong and get myself into trouble
become the person I’ve been told I am. a lot.
Use drugs or alcohol to not feel or to I sometimes do things that I later regret, or I don’t do things
feel better. I’m supposed to do.
I try to keep people safe but cannot. I try to help and care
for people but end up failing and letting them down. I get
Take on the responsibility to care for or protect a
blamed when things go wrong. I am attacked and pushed
parent, a sibling, or a friend.
away when I try to keep the people I care about from
making bad choices.
*These are examples of what some youth do and some of the reasons they say that they do them. For you, the
reasons might be different or you might have other ways of dealing with bad things that happen. Or you might see
yourself in some of these examples even if your situation is different. While these coping strategies can cause
problems, they show up in many youth who have lived through Complex Trauma, and they were often part of what
helped someone to survive trauma.
1. Increasing Safety
Being “safe” means having enough protection so that—for the most part—there is no immediate
physical danger around. Being “safe” also includes emotional safety: that the people around you
won’t say mean things to you or do things that make you feel bad about yourself. You can learn
strategies to help you feel physically and emotionally safer. The important thing is to know is that
things can be better. It might take a while, but it IS possible to feel safe enough so that you can
focus on living your life the way that you want.
Things that could help:
There are ways to increase safety in your life and in your relationships. You may have experienced
Complex Trauma for so long that you feel like it will never change. By talking to people you trust—
maybe a teacher, therapist, coach, mentor, religious leader, relative, peer mentor, or good friend—
you can learn ways to feel safe/be safe:
► Learn how to recognize unsafe situations. Identify and practice “exit” strategies—ways to
leave these situations safely.
► Learn whom you can trust. Decide who will give you the best guidance if you are in an
unsafe situation (at home, with friends, in your neighborhood, or school) and need to
reach out for help. No one has to figure this out alone.
► Take a close look at all of your relationships. How do you know if someone is safe? Keep
in mind that violence and abuse is not always physical—if someone repeatedly hurts you
emotionally, you are in an unsafe relationship.
2. Managing Feelings
Complex Trauma can lead to confusing emotions and feelings in your body. No one wants to feel
numb, checked-out, scared, sad, hurt, angry, or tense all the time. Learning to safely and effectively
manage your emotions, your energy level, and your behavior, gives you choices and more control
over your life.
Things that could help:
► Learn to recognize your trauma reminders, your personal “triggers.” Sometimes we get really
upset over things that seem small to other people. Sometimes we don’t even know why we’re
so upset and people think we’re “overreacting.” When that happens, it usually means we’ve
been reminded of something that happened in the past. Learn to know the things that remind/
trigger you (for example, the way a grown-up talks to you or the way another youth looks at
you).
► Identify your feelings. Figure out what you’re feeling and where you’re feeling it. For example,
when you’re mad, does your heart beat really fast? When you’re nervous, do you feel it in your
stomach? Your body often sends you messages about how you’re feeling. By tuning into your
“body messages,” you can identify and then change the feelings you’re having in your body so
that you don’t always have feel so tense, nervous, or “amped up.”
► Practice communicating your feelings to a caring friend or trusted adult in a way that they can
“hear” you and want to help you. When you are hurt, avoid holding everything in or attacking or
blaming a person you care about. Let people know what reminded/triggered your response so
that they understand why you’re so upset.
► Find ways to “let go” of hurtful feelings or thoughts, or to express feelings in ways that provide
relief. Try journaling, drawing, listening to music, slow breathing, yoga, or exercise.
► Try out new coping skills to see which ones help. Which ones work best for which feelings?
Which ones work best when you have lots of energy? When you have low energy? When you are
thinking really negatively about yourself? When you are feeling spacey or fuzzy?
5. Making Sense of the Past, Figuring Out Who You Are Now, and
Taking a Lead Role in Shaping Your Future
When people live through a lot of bad stuff and not enough good stuff, they learn to react first,
think later, and focus on survival. Over time, this can become a habit and feel like the only way
to live. People can forget all about their wishes, goals, and dreams. Young people who have
experienced Complex Trauma may not get a chance to develop goals; often, the only future they
can imagine is more of the same bad stuff or no future at all. They can, however, learn to envision
a better future, to feel more powerful, to think through difficult situations, and to make good
decisions that solve problems and improve their lives.
Things that could help:
► Learn to understand and cope with your emotions. Don’t just get rid of your feelings, but take
control over them. You want to be able to size up a situation, future out your choices, and make
a good decision—instead of making things worse by acting on impulse. Every situation you
face, even one that seems impossible, actually presents several solutions, including the choice
to do nothing or walk away. It can be hard to know which choice is the right one. While it takes
courage to ask for help, you may feel much better after seeking guidance from adults or friends
who have earned your trust.
► Explore who you are, what matters to you, and what you want to be in the future. Examine
your interests (what you do well, what makes you happy), your opinions, and discover what
holds meaning for you. Try to understand what experiences in your life, good and bad, have
influenced the person you have become so far. The more you know about yourself and why you
do and feel the things you do, the more power you have to change things in your life.
► Make a list of your goals and work with adults you trust to map out “steps” to work toward them.
Identifying your goals can help you make decisions that are right for you.
► Explore your experiences with someone you trust at a pace that feels right for you. You might
identify something that frightens or upsets you and figure out why your reactions probably
make sense—or made sense given your history—even if they get in your way. Learning to
manage your responses to reminders of things in the past takes time and usually requires
support from someone who helps you feel safe.
Increasing
Safety
Managing
Feelings
Building Healthy
Relationships
Increasing
Stengths &
Positive Feelings
Making Sense of
the Past
Building a Strong
Identity
Planning a
Brighter Future
Some of the Complex Trauma therapies to look into and ask more about include:
While not specifically designed for complex trauma, TF-CBT (Trauma-Focused Cognitive Behavioral
Therapy) and CPP (Child-Parent Psychotherapy) have also been utilized effectively to reduce PTSD
and related difficulties in select samples and treatment settings for children and adolescents
impacted by complex trauma. Please consult with a certified trainer for guidance on how to adapt
TF-CBT or CPP for complexly traumatized populations.