Recognising the Damage

Most survivors of childhood trauma and abuse have had someone say to them, at some time, one or more of these phrases: why do you keep going on about it? Just get over it and move on! Everyone has something bad happen to them, that’s life! Stop being a victim for heaven’s sake!

Such accusations show no understanding of the long-term effect of childhood trauma. When we talk about ‘trauma and abuse’, we are not talking about childhood experiences that fall within the range of ‘distressing, hurtful, humiliating, embarrassing, sorrowful, guilt-making or enfuriating’. These are unfortunate but common feelings experienced during childhood, and each one of these can be experienced without causing trauma.

By definition, experiences that cause a child to become traumatized must include other elements beyond the normal range of emotional ups and downs. In this discussion of the ‘essential issues’ to be addressed in treatment for Complex PTSD / Developmental Trauma Disorder, we will assume a long drawn-out childhood experience of a range of abusive treatments : neglect, emotional abuse, psychological abuse, sexual abuse, physical abuse, abandonment, violence, manipulation and failure to meet basic needs for healthy development.

It is important to understand that many people who were raised in such environments took their lot for granted, not knowing anything different. Their brains were only partly formed, which meant that even if everything had been explained to them, they still would have been incapable of understanding the meaning and implications of their abusive environment. They were part of it, and it was part of them, and the two were inseparable. The damage to the self-esteem or self-image is so deep that self-blame, self-hatred and the perception of one’s badness obscures what should be a logical understanding that you, the child, was blameless.

For many people coming into therapy with such backgrounds, there is little understanding that something else besides their own faulty selves has screwed up their life. It’s not that a woman who has been a child victim of sexual abuse can’t see that she was molested or raped. She knows that, and she knows she’d have preferred it never happened. But SO many other things have happened between then and now, the sense of a continuous link has been lost. By now, most of the problems in her life that she’d like to change seem to be either of her own making or due to the unreasonable behaviour of those around her. And for many or most, there is a pervasive sense of the terribleness of existence without any discernable solution.

In this early phase of therapy, the many, many complaints need to be linked to the many, many consequences of a traumatic upbringing. This process will usually toggle between dealing with present-day problems and gradually linking them to earlier realities. The injuries can be grouped into categories of damage:

Low self esteem, almost no sense of self

No sense of personal power

Inability to feel emotion

Out of control emotional volatility

Disconnectedness from one’s body

Somatic complaints with uncertain causes

Inability to have (successful) (safe) (intimate) relationships

Inability to trust

Inability to feel safe or secure

Inability to have a normal sleep pattern

Anxiety for no apparent reason

Depression for no apparent reason

Inability to have a successful career

Inability to realize one’s potential or talent

Constant recurring dramas and traumas in adult life,

And so on. 

The list could be much longer, but such lists can be found elsewhere. The point here is that any of these difficulties can be explained and clarified within the trauma model. For each person, the order in which they appear will be random, and each issue can be an entry point for psycho-education about PTSD, Complex PTSD and Developmental Trauma Disorder (attachment damage). It may not be necessary or advisable to use those diagnostic terms, rather to word the clarification in a more direct and personal way.

For example:

Client: I don’t believe I am important – I have no right to expect any kindness from others.

Therapist: That was the message you got from your parents, that your needs didn’t matter?

Client: well, yes that’s true. They never seemed to notice I was there, I just had to look after myself mostly.


Client: I can’t feel any anger, even when my friends use me and disrespect me!

Therapist: And when you were young, what happened when you expressed anger?

Client: oh, my dad would beat me really bad. I soon got the message!


Client: I live with this constant sense that disaster is imminent, I can never relax and feel safe. I don’t know why.

Therapist: But your home life was completely insecure. You never knew when the next abuse would happen!

Client: oh, I didn’t think of that . . .


Client: I don’t understand why so many disasters happen in my life! It seems to be one drama after another. I have so much bad luck. There must be something really wrong with me!

Therapist: what you are describing is one of the long-term effects of posttraumatic stress disorder, and is so common with survivors of long-term childhood abuse. Your childhood imprinted a pattern of drama and chaos into your brain, but as well as that, your experiences took away your ability to keep yourself safe, and danger became the pattern that feels most familiar.

Client: do you mean that I seek out what feels familiar? I don’t think I mean to do that!

Therapist: of course you don’t mean to, but living things are deeply programmed to seek the familiar – even when the familiar is not good for them! But once you become aware of this pattern, you’ll have the choice to change it and learn how to keep yourself safe.

Client: yes, that is what I want.



Back to “Essential Issues”

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