Langberg: Understanding Complex Childhood Trauma and Treatment

Diane Langberg gives a lecture on Complex Trauma, or childhood trauma, which really is childhood experiences of abuse, neglect, betrayal and isolation. She provides an explanation of what complex trauma is, how different it is from — and how it is related to–  PTSD.

Below is the video of Langberg’s lecture.

I have sketched down notes on this lecture so for quick reviewing of the content, and against the possibility that the video becomes no longer available.

CPTSD: Complex Posttraumatic Stress Disorder and Child Abuse

While PTSD is a typical response to a single stressor in adulthood, Complex posttraumatic Stress Disorder ( CPTSD ) is the result of childhood experience of abuse.

 

Complex Posttraumatic Stress Disorder CPTSD occurs in neither ICD nor DSM, but it has been proposed for over two decades (p.190). Adult victims of CPTSD suffer lifelong effects of emotional and physical instability of varying degrees of severity, making them also vulnerable in the face of stressful life situations.

Consequences of CPTSD:

Another name proposed for this disorder is “developmental trauma disorder.” CPTSD compromises an individual’s identity, self-worth, and personality; emotional regulation and self-regulation; and ability to relate to others and engage in intimacy.

Individuals can experience ongoing despair, lack of meaning, and a crisis of spirituality.

 

Children are Victims of CPTSD

While PTSD is an atypical response in traumatized adults, developmental trauma may be a very common (and thus the typical) response in traumatized children. Such trauma often goes unrecognized, is misunderstood or denied, or is misdiagnosed by many who assess and treat children.

Children are, due to their immaturity and helplessness, are more prone to being traumatized than adults.  They are also easy targets for narcissistic abuse.

Types of Abuse in CPTSD

CPTSD is generally associated with a history of chronic neglect, trauma, and abuse over the course of childhood. Neglect in early childhood compromises secure attachment and tends to result in avoidant or resistant/ambivalent attachment—or, most severely, toward the disorganized/disoriented attachment style that leads to significant dissociative pathology.

This neglect sets the stage for trauma in early childhood, which further interferes with normal affective maturation and the verbalization of feelings, leading to anhedonia, alexithymia, and intolerance of affective expression. Children and adolescents are more prone to dissociate than are adults.

Experience of Betrayal

Dissociation is especially linked to betrayal trauma—the neglect that allows for, or passively tolerate, more active trauma.

In the face of continued betrayal trauma, dissociation is the child’s best life-saving strategy.

The Bystander Parent

Repeated trauma in childhood involves a perpetrator and victim, but also a parent who permits the trauma to occur; is uninvolved, oblivious, and neglectful; or else is paralyzed by fear into inaction. Patient and therapist may find themselves playing any of these roles and their opposites.

Psychotherapeutic Treatment of CPTSD

When a client comes to therapy, it is often not apparent that he/she suffers CPTSD. Adult clients visit therapy for an array of symptoms that include (but not exclusively) depressive, anxiety, obsessive-compulsive, posttraumatic, dissociative, somatoform, eating, sleep-wake, sexual, gender, impulse-control, substance and non-substance dependency disorders and personality disorders.
There is a danger that therapists who are not aware of CPTSD overlook childhood experiences and spend too much focus on the diagnosed symptom.
If the therapist were to treat the trauma of CPTSD itself, this treatment if successful can ameliorate all the symptoms. This requires that the childhood abuse experiences be recounted and worked through.

The Therapeutic Process

It is common that the patient who has CPTSD will not be able to recollect the events of abuse. If he/she did, he/she may not be able to experience the feelings associated with the time. This is because of the dissociation of the child who was in the situation. Freud explains that what the client does not remember, he acts out. It is important for the therapist to be observant to the repeated behavior of the client in the interaction with the therapist.

The trauma and neglect of CPTSD are essentially relational, and so the therapeutic relationship itself becomes the principal vehicle of change. How the therapist feels, thinks, and acts depends on what aspect of the neglect/trauma drama is being played out with the patient (p.191).

Dealing with childhood trauma is a complicated process in therapy. There may a degree of enactment in the transference and this can be confusing. What is really necessary is a sound therapeutic alliance based on trust. Within the transference relationship, the client a therapist experience the client’s enactments and attitudes towards the abusing parent, the bystander parent and the client as victim and perpetrator. For this reason, the therapist has to be alert to the phenomenology and the here-and-now of what unfolds in the therapy sessions.

Bibliography

Lingiardi, Vittorio. Psychodynamic Diagnostic Manual, Second Edition (Page 192). The Guilford Press. Kindle Edition.

 

How to Ask a Patient about Childhood Trauma History: Dr. Bessel van der Kolk

In this lecture Bessel van der Kolk speaks about his work with patients with childhood trauma. Here is a snippet of this video on how to get from a patient information about his/her trauma history. The topic of childhood trauma is not easy to bring up. Oftentimes the patient doesn’t recall the traumatic event(s). Sometimes these events are not acknowledged as trauma by the patient. Even if someone has encountered trauma and has memory  the event, there may still exist emotional difficulty in relating the event to a professional.

Van der Kolk provides us here with a way of interviewing the client @ 10:20 :

  1. Ask about demographics: where do you live? who lives with you? who does the cooking? who does the dishes? who do you talk to when you come home at night? When you need help/ when you are sick, who can you turn to? when you feel bereft and upset, who do you talk to? These questions give a picture of a person’s interconnectedness.
  2. Ask about the person’s current health (e.g. sleeping patterns).
  3. Family of origin demographics: how about when you were little? who loved you? who was affectionate to you? who saw you as a special little kid? was there anyone in your family who you felt safe with growing up? (*Hear van der Kolk’s comment on this question @ 12:30) who made the rules and enforced rules at home? how did your parents solve their disagreement?
  4. Childhood caretaker and separation.
  5. Other questions @ 31:30 : can we assume that life was good growing up? was anybody in your life a drug addict or alcoholic?

“You really cannot understand anyone with Borderline Personality Disorder unless you understand the terror they grew up in.” Bessel van der Kolk

Childhood trauma and BPD are correlated in findings. 87% of studied subjects with BPD had histories of severe childhood abuse and/or neglect — prior to age 7.  Other personality disorders do not have significant correlations with childhood trauma.

Slide @ 17:05 shows correlation between childhood physical abuse, sexual abuse, neglect and the symptoms of suicide ideas, suicidal attempts, cutting, bingeing and anorexia.

Neglect and ability to feel safe are found to be factors that determine the likelihood in which the patient can feel safe and be helped during therapy.

Full video is here:

Why do we need to find out about traumatic childhood experiences in therapy? Besel van der Kolk explains this @ 44:40, the importance of revisiting the traumatizing events.

@ 45:20 he explains the neuro-biological consequence of trauma.