Complex Trauma (DESNOS): what it is, characteristics and causes

People often face stressful situations that put us on alert. Most are events that are part of daily life, so that the activation response is punctual and does not carry a major impact on our functioning and mental health. Contrary to what is usually believed, this type of stress is necessary in moderate doses, since it allows us to respond effectively to the demands of the environment.

However, there are times when we can face extraordinary scenarios that impact us very intensely. Sometimes we run into sudden, unexpected and uncontrollable events that endanger our physical and / or psychological integrity. This can cause us to feel overwhelmed by our emotions to the point of being unable to respond to the situation adaptively. In these cases, it is possible that we could suffer a psychic trauma.

Traumatic experiences in our life

Living an experience of great emotional intensity is not always linked to the development of a traumaSince most individuals have a capacity for resilience that allows them to rebuild themselves naturally over time. Thus, many authors consider that what is traumatic is not the episode itself, but the effect it generates on the person who experiences it.

In other words, the same event can have very different psychological consequences in some individuals or others. Just as there are individuals capable of recovering, there are also people who after this type of experience develop a psychopathological disorder, one of the most common being Post-Traumatic Stress Disorder (PTSD). Although trauma can appear at any age, it is known that women are more vulnerable to it than men.

On some occasions, people do not face an isolated traumatic event, but are exposed to the traumatic event in a prolonged, repeated and extensive way. In these cases, a very serious phenomenon known as complex PTSD occurs, also known as DESNOS for its acronym in English (Disorder of Extreme Stress not otherwise Specified).

At the moment, DESNOS is not a disorder officially included in the international classifications. However, complex trauma can be observed in clinical reality in survivors of wars and concentration camps, victims of sects, victims of all kinds of violence and abuse, and in children who have suffered traumatic experiences from their first years of life. In general, the risk of developing complex trauma will be greater in those who have suffered early, prolonged and interpersonal trauma.

DESNOS was first described in 1992 by author Judith Herman. Since then, the study of this phenomenon has grown and with it the knowledge about its nature and characteristics. If you want to know more about complex trauma, keep reading, because in this article we will delve into what it is, its characteristics and causes.

What is Complex Trauma (DESNOS)?

Complex trauma, also known as complex PTSD or DESNOS, is a disorder that results from prolonged, repeated and intense exposure to traumatic events. The official classifications still do not include this category, but it constitutes an observable clinical reality in many patients who have suffered very serious traumatic experiences.

Although the probability of developing a trauma depends, among other factors, on the resilience of each individual, it is known that the appearance of DESNOS is more likely when the traumatic experiences have been early, prolonged and have had an interpersonal nature (for example, being sexually abused by another person may be more conducive to complex trauma than having experienced a natural catastrophe). Complex trauma is usually observed in victims of all kinds of violence and abuse and also in those individuals who have experienced wars, genocides or kidnappings.

What are the characteristics of Complex Trauma (DESNOS)?

This psychopathological picture has a series of defining characteristics:

• There is a difficulty in being able to regulate emotions. This can lead to sudden mood swings and episodes of rage or anger.
• The person appears disconnected from the present moment, being able to appear absent. In the most severe cases, dissociative states can occur that lead the individual to lose the continuity and connection of their thoughts, memories, actions and even their own identity.
• Loss of the ability to function on a day-to-day basis, as feelings (shame, guilt, stigma…) can become very overwhelming.
• There may appear a concern about separating from the aggressor despite the damage, as well as a feeling of gratitude and even assimilation of their beliefs as if they were their own. This is especially common in cases of child sexual abuse or gender-based violence, where the trauma occurs within the framework of a relationship of attachment and dependence.
• Inability to establish healthy relationships with other people. It is common for isolation and distrust of others to occur, as this provides a sense of protection against the damage that they can cause. In some cases, he can relate to others by adopting a victim role, waiting to be rescued.
• Lack of hope regarding the future and inability to find meaning in one's life.

What are the causes of Complex Trauma (DESNOS)?

Complex trauma occurs as a consequence of exposure to a repeated and prolonged traumatic event over time. It is known that the probability of suffering from this disorder increases in some specific situations:

• When the trauma has happened in the early stages of development: Early traumas have a very strong impact that marks the entire subsequent trajectory of the person. The experiences we have in the first years of life are closely related to bonding and attachment. When the figure of care fails to provide protection and security to the child, it creates a cognitive representation of what it may or may not expect from its figure of care, developing an insecure style of attachment that will shape their future bonding relationships.

• When the trauma is prolonged in time: DESNOS is more common in those cases in which the trauma has been a chronic situation and not an isolated event. The person has lived in a traumatizing reality for a long time, which leaves consequences much more severe than those typical of simple PTSD.

• When the trauma is interpersonal in nature: Complex trauma is more frequent in those cases in which the trauma has been a consequence of the action of another person. Here we can include all types of violence and abuse, where an aggressor (often emotionally linked to the victim) is the one who executes the damage. When the person responsible for the traumatic situation is someone from the environment, feelings of ambivalence may appear, alternating the approach with the distancing of the aggressor. This confusion of emotions and feelings can be totally devastating for the victim.

In addition to risk factors, the good news is that there are also protective factors that reduce the likelihood of DESNOS appearing with their presence. Among them it is worth highlighting:

• Self esteem: People with better self-esteem have a lower risk of developing complex trauma, as they can cope with the effects of trauma.
• Self-efficacy: People who are able to work towards their goals and objectives are often less likely to develop complex trauma.
• Existence of protective adults and social support: People can suffer very painful and traumatic episodes in our lives, but recovery is always easier when we are surrounded by people who support and love us. Especially important is to have protective adults in childhood who provide security to the victim despite what has happened. For example, the recovery of a girl victim of sexual abuse will not be the same if her mother believes and supports her as if she does not.
• Resilience: The most resilient people are those with the ability to recover from setbacks, the stress and negative events without sequelae. Those who are more resilient are less at risk of developing complex trauma.

Conclusions.

In this article we have delved into what complex trauma is, what its causes and characteristics are. This type of disorder is not yet officially recognized by international guidelines., but it is an observable clinical reality. Complex trauma appears in those people who have been exposed to prolonged traumatic events, especially when these have started in the first years of their life.

Complex trauma receives its name because its severity far exceeds that of simple PTSD, which is one that occurs due to the experience of a specific traumatic situation. Complex trauma is the result not of an isolated episode, but of a traumatic reality as a whole that has persisted for a long time, usually years.

People with complex trauma can feel disconnected from reality, absent, and very emotionally unstable. In addition, they may be unable to function properly in their day-to-day lives, finding it difficult to relate in a healthy way with other people. It is also frequent that a deep hopelessness appears with respect to the future, reaching the point of not finding meaning in one's life. Fortunately, some protective factors can prevent complex trauma from appearing, such as self-esteem, resilience, social support, or self-efficacy.