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People usually think of trauma as an isolated event in a person’s life, which can lead to more or less serious consequences, depending on the level of impact it has on the individual. These can vary according to the age of the individual, genetic variables, the attachment bond, and the social context.

First, what is “trauma”? Simply put, a negative experience can become traumatic when a person (in this case, a child) feels powerless while facing it, and is not able to defend themselves.

Traumatic experiences can occur multiple times in a person’s life, with variable frequency and intensity, leading to far more serious consequences than a single traumatic event would (e.g., the loss of a loved one).

In these cases, when talking about a series of traumas that follow each other, we refer to complex trauma, which occurs in early or crucial stages of development. It is not, therefore, an isolated event that occurs only once, but is the effect of recurrent traumas, which increase in severity over time: one type of trauma can “stratify” on top of another. The repeated traumatic experiences in the life of a child are undoubtedly found in episodes of abuse and mistreatment, which, in turn, generate cumulative trauma.

Mistreatment is defined as “any form of physical and/or affective ill treatment, violence, carelessness or negligent treatment, sexual or other exploitation, involving actual or potential harm to health, to the survival, development or dignity of the child, in the context of a relationship of responsibility, trust or power”. Examples of forms of mistreatment include lack of protection and emotional responsiveness, verbal abuse, sexual and physical abuse by family members or children’s everyday life, up to severe physical and emotional abuse by any adult, serious neglect by parents or guardians, and sexual abuse by any adult or peer.

Research on the consequences of early abuse shows the lasting negative effects on brain development, as the brain is modelled by our life experiences. Mistreatment is a chisel that “shapes” it, so that it habituates to the conflict, at the cost of receiving deep and lasting wounds. Child abuse is not something you can bypass. It is an evil that we must recognize and face if our goal is to do something to combat the uncontrolled cycle of violence.

So, what is the impact of complex trauma on child’s areas of functioning?

The first analyzable domain is attachment. At birth, the role of the stress response system is to perceive discomfort (e.g., hunger, thirst, cold, threat etc.) and then, to take action to promote survival (if hungry, eat; if thirsty, drink…). Newborns are unable to satisfy their needs by themselves, and depend on their caregiver, who becomes the regulator of external stress. The primary caregiver, through consistent responses, nurturing assurance, and responsive and predictable caretaking, provides the neural stimulation needed to build both an adaptable and flexible stress response, and the ability to self-regulate, resulting in the construction of a healthy attachment bond.

If the caregiver is depressed, stressed, drug dependent, inconsistent, or absent, the two crucial neural networks (stress response and relational) develop abnormally. The result is a child that is more vulnerable to future stress and less able to benefit from healthy relational support that can help and buffer future stress or trauma, becoming itself a source of trauma.

In addition, early care relationships provide the relational context in which children develop the first psychological representations of self, other, and self in relation to others. These operational models form the foundation of development skills, including tolerance, curiosity, sense of action and communication. When the child-caregiver relationship is a source of trauma, the attachment relationship is severely compromised.

A second domain impacted by complex trauma is the biological one. Repeated traumas interfere with neurobiological development and the ability to integrate sensory, emotional, and cognitive information into a coherent framework. During childhood, the most rapidly developing brain areas are those responsible for the fundamental characteristics of “executive functioning”, necessary for autonomous functioning and engagement in relationships. Unlike children not traumatized, victims of complex trauma do not have the opportunity to gradually learn to orient themselves in the external and internal environment, failing to develop a gradual shift from the dominance of the right hemisphere (sensation and perception) to the primary dependence on the left hemisphere (language, and long-range planning), and an integration of neural communication across the two cerebral hemispheres.

Post-traumatic impairment of attachment and neurobiological integrity can also lead to serious problems with emotional regulation. This encompasses the accurate identification of internal emotional experiences, which requires the ability to differentiate emotional states, interpret them, and apply appropriate labels (e.g., “happy”, “scared”). Children who experience violence develop an “un-regulated” emotionality: in some cases, they cannot respond synchronously to the activation connected to an event (emotional coercion). Others, however, experience all emotions to the maximum of their intensity (emotional explosiveness). This is because young children who experience complex trauma risk not developing the intellectual skills necessary to modulate emotions in response to stress, since they have lived continuous experiences of emotional unavailability. In fact, following the identification of an emotional state, a child must be able to express emotions safely and modulate or adjust the internal experience.

Victimization has been shown to be associated with the development of behavioral problems, such as aggressive behavior and oppositional provocative disorder. Under stress, the analytical abilities of abused and neglected children tend to disintegrate, leaving them with a cognitive, emotional, and behavioral disorganization and making them prone to react with great anger and discomfort, due to lack of protection, feelings of confusion, and lack of care. Such attitudes affect a number of functions of the traumatized child, including automatic behavioral reactions (such as avoidance), attempts to acquire a sense of mastery or control, and attempts to avoid intolerable levels of emotional excitement.

Overall, complex trauma in children compromises safe attachments, personal integrity, and, ultimately, self-regulation, constituting a threat not only for physical survival, but also for psychological survival, for the development of the Self, and for the ability to regulate emotions and behavior.

But what consequences does complex trauma have on the individual?

The main consequence is the development of post-traumatic stress disorder (PTSD). In children as in adults, PTSD manifests itself through a wide variety of symptoms, including difficulties in affective regulation (depersonalization, negative emotional state, anger, depression, anxiety), difficulty in maintaining attention levels and arousal (flashbacks, persistent negative thoughts), and in behavior (anxious, provocative or obsessive behavior, victimization of self and of others).

Other consequences are: somatization disorders, cardiovascular, metabolic, gastrointestinal, and immunological disorders; self-regulation, anxiety, and affective disorders; addiction, aggression,  social impotence, and eating disorders; sexual disorders in adolescence and adulthood; victimization; compulsive or ritualized behavior and phobias; sleep disorders (nightmares, fear of sleeping, or sleeping alone); excessive concern for the safety of family or loved ones; perceptual distortions (sounds and physical sensations); difficulty in remembering events or information, mood swings, sudden episodes of paralysis (“frozen vigilance”). 

In conclusion, complex trauma impacts specific domains of the individual and has far more “complex” consequences than a singular traumatic experience. It impacts the development of a positive vision of self and others, which is linked to stress regulation, emotional response, behavior, and is related to disorders of the nervous system.

Child maltreatment is the main cause of a long chain of traumatic experiences that can shape the whole personality of an individual, by affecting child development, leaving tragic wounds in the self. With a specific treatment, the negative vision of self that is caused by complex trauma can be improved, helping children to re-create a positive vision of the world and other people, and mitigating their reactions of stress and hyperarousal.

Di Lisa Nespoli


Ardino, V., “Post traumatic stress disorder in development”, Milan, 2014.

Cook, A., et al. “Complex trauma.” Psychiatric annals 35.5 (2005): 390-398.

Courtois, C. A., “Complex trauma, complex reactions: Assessment and treatment.” Psychotherapy: Theory, research, practice, training 41.4 (2004): 412.

Radford, L., et al. “Child abuse and neglect in the UK today.” (2011).

Teicher, M. H., “Scars that won’t heal: The neurobiology of child abuse.” Scientific American 286.3 (2002): 68-75.

Teicher MH, Andersen SL, Polcari A, Anderson CM, Navalta CP. Developmental neurobiology of childhood stress and trauma. Psychiatr Clin North Am. 2002;25(2):397-426.

Van der Kolk, B., “The body keeps the score”, New York, 2015

van der Kolk B., Roth S., Pelcovitz D., Sunday S, Spinazzola. Disorders of extreme stress: the empirical foundation of complex adaptation to trauma. J Trauma Stress Disor Treat . In press.


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