Complex/Relational Trauma Syndrome


 Areas of Functioning Affected by Prolonged Periods of Traumatic Experience

 Complex or Relational Trauma can arise from prolonged periods of aversive stress usually involving entrapment (psychological or physical), repeated violations of boundaries, betrayal, rejection and confusion marked by a lack of control and helplessness.  Common situations include being bullied, harassment, physical, sexual and emotional/verbal abuse, domestic violence and substance abuse, stalking, threats, separation and loss, unresolved grief and neglect.

  A.   Alterations in Relations with Others

    1. A general feeling of distrust and use of isolation as a defense against hurt, rejection and disapproval
    2. Problems keeping personal boundaries and recognizing the boundaries of others; difficulty attuning to emotional states and perspectives of others
    3. Difficulty asking for help and often a relentless search for a rescuer or savior from the outside
    4. Re-victimization and/or victimizing others
    5. Preoccupations with revenge
    6. Attachment problems- ambivalent, avoidant or disorganized relationships

B.  Biological and Bodily Effects

    1. Hypersensitive and aversion to physical contact, analgesia or under-responsive and need to seek sensations
    2. ANS “set-point” is chronically too high or too low leading to over- coupling [excessive sudden arousal] or under-coupling [excessive inhibition and dissociation] of traumatic experience
    3. Sensorimotor and coordination problems…developmental lags
    4. Somatization and systemic medical problems such as chronic fatigue, digestive problems, spastic colon/irritable bowels, allergies, endocrine problems and other auto-immune disorders
    5. Predisposition to develop PTSD to subsequent traumatic stressors
    6. Poor response to Prolonged Exposure therapy

C.  Alterations in Affect Regulation

    1. Persistent moods of sadness, suicidal thoughts and feelings, explosiveness or greatly inhibited anger, unmodulated sexual behavior, excessive risk taking
    2. Difficulty self-regulating emotions
    3. Difficulty describing feelings, sensations and internal experience
    4. Difficulties communicating wishes and desires

D.  Alterations in Attention and Consciousness

    1. Exaggerated amnesia for or reliving traumatic events
    2. Episodes of dissociation involving derealization and/or depersonalization-or  “under-coupling” of traumatic experience
    3. Impaired memory for state-based events

E.  Difficulties with Behavioral Control

    1. Cutting, self-mutilation and self-destructive behaviors
    2. Excessive self-soothing- binge eating, substance abuse, interpersonal dependencies
    3. Poor impulse modulation with anger and aggression
    4. Extremes of compliance or oppositional behavior
    5. Difficulty understanding and complying with rules
    6. Arousal problems manifest in sleep disturbance, eating disorders and learning problems
    7. Inability to inhibit behavior when aroused

F.  Cognition

    1. Difficulties with sustained attention, attention regulation and executive functioning
    2. Problems focusing, planning, anticipating and completing tasks
    3. Difficulties seeing own role in events that happen to them
    4. Learning, language and orientation in time and space problems
    5. Object constancy problems and visual-spatial pattern difficulties
    6. High levels of competence and interpersonal sensitivity can co-exist with self-hate, lack of self-care and interpersonal cruelty
    7. Poor response to Cognitive Restructuring Behavioral Therapy

G.  Alterations in Self-Perception and Self-Concept

    1. Sense of helplessness, shame, guilt and self-blame
    2. Feeling stigmatized and perceived as difficult from others
    3. Low self-esteem and poor sense of individuation from others
    4. Conviction of being un-loveable and permanently damaged

H.  Alterations in Systems of Meaning

    1. Despair and hopelessness
    2. Loss of previously sustained beliefs
    3. Belief in a foreshortened future

Resource materials: 

Complex Trauma in Children and Adolescents, a White Paper from the National Child Traumatic Stress Network, Complex TraumaTtask Force.  Available on-line at

and  van der Kolk, Bessel.  The Assessment and Treatment of Complex PTSD.  In Traumatic Stress. Rachel Yehuda, ed.  American Psychiatric Press, 2001.


Developed by Ron Doctor, Ph.D.