Complex Trauma: What it is and what it means for your family

The second session was led by Dr. Arthur Becker-Weidman who I have long admired. I interviewed him once over the phone for my blog. It was really neat to get to finally meet him in person.  His research, books, articles, and work with traumatized children at the Center 4 Family Development is amazing. He uses Dyadic Developmental Psychotherapy in his work and has trained many other therapists to do the same.

His session, Complex Trauma, comes from years of studies on how trauma effects children. He defines complex trauma as the effects from early, chronic maltreatment in a care-giving relationship. It is different than Post Traumatic Stress Disorder which can occur because of trauma at any time in a persons life and from a single event. 

According to the National Adoption Center 52% of adoptable children have attachment disorder symptoms. 50-60% of the children in US foster care who have RAD also have been diagnosed with Bipolar I Disorder.

I asked Dr. Becker-Weidman about the Bipolar Diagnosis and here is his reply:

"I am not sure that is an accurate statistic. The 50-60% is a number stated by Dr. Alsten, who is or was the psychiatrist at the Attachment Center at Evergreen. He has a chapter in the book Handbook of Attachment Interventions.

"While it is true that many children in foster care who meet the DSM-IV-TR criteria for Reactive Attachment Disorder have mood dysregulation problems, are aggressive, and irritable, I am not convinced that they actually have Bipolar I Disorder. I suspect what we are seeing is more the results of Complex Trauma on emotional and behavioral regulation functions and it's effects on the stress-response system. One factor that leads me to think this way is that I do see many children with both DX who are not responding to medication treatment with a mood stabilizer and anti-psychotic medication. The children I see who I believe have Bipolar I Disorder do respond to these medications quite well." Thank you Dr for clearing that up!   In other words children with RAD are often diagnosed with Bipolar because so many of the behaviors are similar.

The domains affected by complex traumas are attachment, biology, emotional regulation, dissociation, behavioral regulation, cognition and self-concept" 
In attachment this can show up as: problems with relational boundaries, lack of trust, social isolation, difficulty attuning with other's emotional states, lack of empathy and lack a secure base. Each of the domains is effected just this dynamically.

Biology:  sensory-motor developmental dysfunction, analgesia, sensory-integration dysfunction, somatization, increased medical problems

Emotional regulation: Poor affect regulation, difficulty identifying and expressing emotions, difficulty identifying and describing internal states, undeveloped reflective function, difficulty communicating needs and wishes

Dissociation: distinct alterations in states of consciousness, amnesia, depersonalization and derealization, discrete states of consciousness with discrete memories, affect and functioning, impaired memory for state-based events, really a defense against overwhelming stress.

Behavioral regulation: difficulty regulating impulses, poos impulse control, self-destructive behavior, excessive risk-taking behavior, aggression, pathological self-soothing behaviors, sleep problems, disturbances of eating, substance abuse, excessive compliance, excessive defiant behavior, problems complying with rules, reenactment of trauma in behavior or play

Cognition: difficulty with regulation attention, difficulty with Executive Functions: planning, judgment initiation, use of materials, self-monitoring, difficulty processing new information, difficulty focusing and completing tasks, difficulty with object constancy (shame="crazy lies"), difficulty planning and anticipating problems with cause-effect thinking, learning lags, difficulty with language development: gap between receptive and expressive communication abilities

Self-concept: fragmented and disconnected autobiographical narrative, poorly developed sense of separateness, disturbed body image, low self-esteem: internal working model of self as unloved/unlovable, not valued/valuable, as "garbage", excessive shame.

I will cover his implications for treatment next time as this is a lot of info.  But you can see how invasive complex trauma has been on our children's lives.  They cannot "Behave" or "shape up". 

Remember just how serious children's illness is, and then have a healing weekend.