Signs of chronic trauma (often complex PTSD) involve re-experiencing (flashbacks, nightmares), avoidance (people, places, thoughts), negative mood/cognition (numbness, guilt, detachment, loss of interest, negative beliefs), and hyperarousal (irritability, hypervigilance, sleep/concentration issues, being easily startled). Physical signs include chronic pain, sleep problems, and increased substance use, while relational issues often involve difficulty trusting and maintaining stable relationships.
Chronic trauma refers to trauma that has occurred following a series of events (unlike acute trauma, which refers to trauma following a single event). These events have happened multiple times, and include experiences such as: Prolonged child abuse. Prolonged exposure to war and combat.
Complex PTSD and emotional flashbacks
If you have complex PTSD you may be particularly likely to experience what some people call an 'emotional flashback', in which you have intense feelings that you originally felt during the trauma, such as fear, shame, sadness or despair.
Delayed responses to trauma can include persistent fatigue, sleep disorders, nightmares, fear of recurrence, anxiety focused on flashbacks, depression, and avoidance of emotions, sensations, or activities that are associated with the trauma, even remotely. Exhibit 1.3-1 outlines some common reactions.
While CPTSD is often associated with chronic trauma in childhood, adults who experience chronic trauma can also develop the condition.
Pete Walker's “Complex Trauma: From Surviving to Thriving,” explores the four F's of complex trauma, fight, flight, freeze, and fawn, to help survivors understand their coping mechanisms and reactions, and begin to work towards actions that may better serve them in their life and relationships.
Unhealed trauma often appears as chronic people-pleasing, relationship struggles, anxiety, self-destructive coping, or persistent shame and emptiness. Trauma rewires the hippocampus, amygdala, and prefrontal cortex, affecting memory, emotion regulation, decision-making, and social interactions.
Symptoms of Unhealed Trauma
You may feel like you're living through it all over again. Triggers can include sights, sounds, smells, or thoughts that remind you of the traumatic event in some way. Some PTSD triggers are obvious, such as seeing a news report of an assault.
Symptoms of complex PTSD
feelings of worthlessness, shame and guilt. problems controlling your emotions. finding it hard to feel connected with other people. relationship problems, like having trouble keeping friends and partners.
Complex PTSD (C-PTSD) involves classic PTSD symptoms plus additional difficulties, often described around 17 key areas, including severe emotional dysregulation (anger, hopelessness), distorted self-perception (shame, worthlessness), relationship problems (trust issues, isolation), dissociation (feeling unreal), and somatic issues (chronic pain, fatigue), alongside core PTSD symptoms like flashbacks, nightmares, hypervigilance, and avoidance.
A comprehensive review of the litera- ture on complex trauma suggests seven primary domains of impairment ob- served in exposed children: attachment, biology, affect regulation, dissociation (ie, alterations in consciousness), behav- ioral regulation, cognition, and self-con- cept.
Complex posttraumatic stress disorder (CPTSD) is currently a diagnosis listed in the International Clarification of Diseases 11th Revision (ICD-11) but not in the Diagnostic and Statistical Manual 5th Revision (DSM-5 ).
10 Tips on How to Heal from Trauma
There are cognitive, emotional, physical and behavioral signs of chronic stress. “Not all four of these categories of symptoms are necessarily going to show up in one person,” Sinha says.
PTSD often comes from a single, shattering event while CPTSD usually grows out of repeated trauma, especially in situations where escape wasn't possible. Both involve three main symptom clusters: Intrusive memories or flashbacks. Avoidance of trauma reminders.
Trauma Response (The 4 F's – Fight, Flight, Freeze, and Fawn)
Changes in arousal and reactivity: People with PTSD may describe being irritable and having angry outbursts, behaving recklessly or in a self-destructive way, being overly watchful of their surroundings in a suspecting way, being easily startled, or having problems concentrating or sleeping.
A PTSD flashback is when you vividly re-experience a past traumatic incident. In other words, you feel like you're actually reliving the experience. Flashbacks can happen suddenly and unexpectedly, and make you feel scared, anxious, or sad.
Trauma Signs and Symptoms
The 10 ACEs of childhood trauma are:
Symptoms of unprocessed trauma frequently emerge as: Physical symptoms: heart palpitations, sweating, or shaking. Emotional symptoms: panic, feeling trapped or terrified. Psychological symptoms: avoidance of situations that trigger the trauma.
Jonice Webb, (reference at end) describes a range of symptoms of childhood emotional neglect in adulthood:
In univariate analyses, all 5 forms of childhood trauma in this study (ie, witnessing violence, physical neglect, emotional abuse, physical abuse, sexual abuse) demonstrated statistically significant relationships with the number of different aggressive behaviors reported in adulthood.
These feelings affect how they relate to others. They may feel like they are letting down their guard if they get close to someone else and trust them. This is not to say a survivor never feels a strong bond of love or friendship. However, a close relationship can also feel scary or dangerous to a trauma survivor.