The Impact of Complex Trauma on the Developing Brain

The Impact of Complex Trauma on the Developing Brain

The Diagnostic and Statistical Manual 3rd Revision (DSM-III) introduced Post-traumatic stress disorder (PTSD) in 1980 (VA.gov | Veterans Affairs, n.d.). Baranowsky and Lauer define PTSD as an anxiety disorder following a traumatic event, clarifying it as a psychological trauma that causes emotional disturbance and distress (2014). While PTSD has gained worldwide recognition, “some clinicians and researchers began to argue that the diagnosis did not fully capture the sequelae of trauma, especially for individuals who had experienced prolonged interpersonal trauma” (VA.gov | Veterans Affairs, n.d., para 2). Prolonged interpersonal traumas include but are not limited to domestic violence or early childhood trauma, such as neglect, physical, emotional, and sexual abuse, or witnessing domestic violence. In 2009, Dr. Bessel Van der Kolk, a trauma expert and author of “The Body Keeps the Score,” proposed the addition of Developmental Trauma Disorder (DTD) in the DSM to encapture the sub-symptoms of complex trauma. Unfortunately, the proposal was rejected (Bremness & Polzin, 2014). Nevertheless, expanding the list of symptoms of complex trauma, clinicians and researchers aim to differentiate between and treat symptoms associated with PTSD and complex PTSD. This article will explore the neurological, physical, emotional, and spiritual implications of complex trauma.

Neurological and Physical Implications

The neurological implications of trauma pertain to developmental changes in the brain and nervous system, primarily white and grey matter and the limbic system while the physical implications involve the sympathetic and parasympathetic nervous systems. The human brain develops during gestation from the bottom up and comprises neurons, cells that transmit messages to one another (Kalat, 2019). Neurons are housed primarily in the brain’s grey, using axons, or long fibers, to send signals to other areas of the brain or body and are located in the brain's white matter. These neurons and axons are vital to developing and maintaining neural networks that facilitate communication between brain areas, resulting in cognitive processes, emotional regulation, and behavioral responses. Grey matter is the brain's outermost layer, called the cortex (Mercandante & Tadi, 2023). According to Mercandante and Tadi, the brain begins developing in utero, increasing in volume through eight years of age, after which it starts to decrease in volume but increase in density. It grows through the proliferation and maturation of the neurons, extending throughout the central nervous system and assisting with motor control, emotions, and memory. Trauma affects the proliferation and maturation of the neurons, initially causing a sharp increase of new neurons and then leading to abnormalities in neuronal migration, development, and integration into neural circuits. White matter is the innermost layer of the brain and develops through myelination, the growth and insulation of axons. Particularly active in childhood and adolescence, white matter growth is substantial during development, crucial for experiential learning (Fields, 2024), and collaborating with grey matter in higher cognitive functions (Filley, 2013). Trauma disrupts white matter growth by impairing myelination and disrupting connectivity between brain regions. Consequently, the brain experiences abnormal structural and functional changes throughout (Kılıç et al., 2024), resulting in physical, emotional, and spiritual implications over the lifespan. Another key area of neurological dysfunction is damage to the limbic system.

Research also shows substantial changes in the limbic system’s structure and function. The limbic system, responsible for emotional processing, works with the sympathetic nervous system (SNS), alerting and preparing the body to respond to threats (Principles of Social Psychology, 2015). The limbic system comprises the amygdala, hypothalamus, hippocampus, and cingulate gyrus (Kalat, 2019). Like a recording device, the limbic system records data in the hippocampus from unpleasant, uncomfortable, or harmful situations, storing it in memory and developing an emergency response system for future use. The amygdala routinely evaluates the environment or situations, looking for fear or danger. Upon sensing fear or threat, the amygdala simulates a smoke detector, alerting the limbic system to override the frontal cortex, where logic and reason are housed, a brain region that is not fully developed until age twenty-five. The cingulate gyrus weighs the potential threat and coordinates with the hypothalamus. If the cingulate gyrus determines the potential threat is too great, it notifies the hypothalamus, sending a message to activate the SNS. When the SNS is activated, the body becomes aroused, increasing breathing and heart rate, pumping oxygen to the muscles and tissue, dilating the pupils for clearer vision, increasing perspiration to keep the body from overheating, and activating the liver to allow higher sugar levels into the bloodstream for energy. The parasympathetic nervous system (PNS), responsible for resting, relaxation, and recovery, is placed on standby until the threat has been extinguished, allowing the body to remain in homeostasis. During homeostasis, the body maintains a stable internal environment (Billman, 2020). In addition to physiological disturbances caused by complex trauma, there are emotional implications as well.

In contrast, when an individual has a healthy and well-developed brain, the frontal cortex overrides the limbic system, giving the brain time to interpret information, assess the situation, and determine how to respond using rational thinking and decision-making. The SNS and PNS remain in homeostasis, allowing the individual to function in a healthy and balanced manner. They form secure attachments to others and experience success and satisfaction in school, work, and relationships. Damage to these areas has shown changes in size and an over-aroused response in daily functioning, resulting in various physical and emotional implications. For children exposed to long-term abuse, neglect, malnourishment, or abandonment, cortisol levels remain high, weakening neural connections and leading to neurotoxicity. Neurons damaged by neurotoxicity impair memory, learning, information processing, and executive functions (Kılıç et al., 2024). In their metanalysis of 134 studies on the effects of complex trauma, Kılıç et al. found that children with complex trauma are at higher risk for psychological disorders such as bipolar, borderline personality disorder, and schizophrenia, with three times a higher rate of suicide than those without histories of childhood trauma. Additionally, individuals with complex trauma are often diagnosed with anxiety, depression, ADHD, OCD, and eating disorders, to name a few. Another consequence of complex trauma that the untrained eye cannot see is the issue of emotional and interpersonal difficulties that hinder personal development and societal integration. In severe instances, these individuals are at risk of violence and social isolation, as in the case of mass school shootings, including Columbine and Sandy Hook.

Emotional Implications

When the brain fails to develop correctly, it is unable to filter out unnecessary information, becomes overstimulated, and “in the case of psychological trauma, - it results in feelings of helplessness and a passivity that leads to emotional dissolution, chaos, and rage” (Arnold & Fisch, 2011, p. 3). Consequently, individuals have difficulty regulating emotions, navigating relationships, and learning effective interpersonal skills. One of the primary consequences of trauma is impairments in Bowlby’s concept of attachment styles (Reisz et al., 2018). Attachment determines an individual’s ability to form and maintain close relationships, offering “a secure base from which one can freely explore the world when not in distress as well as a safe haven from which one can seek support, protection, and comfort in times of distress” (Levy et al., 2011, p. 193). Instead, people with complex trauma develop insecure attachment styles more recently classified as anxious and avoidant (Lee & Hankin, 2009). Lee and Hankin describe individuals with anxious attachment as being anxious and fearful of rejection, whereas an avoidant attachment style is characterized by avoidance and discomfort with closeness. Attachment styles influence the behaviors and feelings experienced in close and working relationships, interfering with the individual’s sense of trust, safety, and interpersonal functioning. 

Individuals with anxious attachment styles exhibit excessive neediness and clinging, worry about their partner's commitment, exhibit jealous and possessive behavior, have difficulty with personal boundaries, fear rejection or abandonment, and seek constant reassurance. They experience high anxiety and stress in their relationships, low self-esteem, have a difficult time regulating their emotions, and feel overwhelmed by relationship issues. They may check up on their partner frequently, try to control their partner's actions, sabotage their relationships due to fear, and have difficulty letting go of past relationships. Individuals suffering from avoidant attachment struggle with forming deep connections, being emotionally vulnerable, and getting close to others. They are uncomfortable with physical closeness, emotional sharing, advocating for their needs, are often emotionally unavailable, and tend to push their partners away. They have a fear of commitment and prioritize their need for independence and self-sufficiency, crippling their ability to rely on their partner. They avoid conflict and crucial conversations, neglect issues, and fail to trust their partner with their emotional needs. They appear calm or detached in emotional situations, struggling to show their emotions and believing they are not worthy of love.

For children exposed to long-term abuse, neglect, malnourishment, or abandonment, cortisol levels remain high, weakening neural connections and leading to neurotoxicity. Neurons damaged by neurotoxicity impair cognitive processes, including memory, learning, information processing, and executive functions, and are at higher risk for mental health and psychological disorders such as ADHD, OCD, bipolar, borderline personality disorder, and schizophrenia, with three times a higher rate of suicide than those without histories of childhood trauma.

Spiritual Implications

Trauma has several spiritual implications including questioning beliefs, feeling disconnected, feeling abandoned or punished, a sense of emptiness, or result in religious trauma. These individuals may become more religious or abandon the idea of God and spirituality altogether. They may ask how a loving God can allow bad things to happen, questioning their beliefs and values. Traumatized individuals may feel disconnected from themselves, others, and the world around them. They may experience religious shaming in which they feel abandoned or punished by their higher power, contributing to low self-esteem. Religious trauma may result in compulsive perfectionism, compromised self-worth, and self-hatred. On the one hand, religious coping can be used positively, providing a sense of safety and internal protection, meaning, purpose, connection, and hope. On the other hand, believers might be inclined to see their trauma as a demonic event and perceive their atrocities as God’s failure to intervene and protect them (Daniel, 2017). Unfortunately, more often than not, “Trauma injuries create developmental ruptures in a survivor’s sense of spirituality” (Van Deusen et al., 2015, p. 37). A theologian and psychologist, Fowler proposed a six-stage faith development theory. The first four stages, including a pre-stage from birth to two years old, describe the cognitive processes of faith development through 18 years of age (Handout 1: Stages of Faith Development, n.d.). Suppose children experience trauma in the first four stages. In that case, the result is a distorted connection between themselves and their caregivers, a confused sense of faith that is confusing and punishing, an unhealthy need for secrecy, and a sign of a punishing God, furthering religious cognitive distortions. During these stages of development, the adolescent is at significant risk of rebellious and high-risk behaviors.

Treatment of Developmental Trauma

Treating developmental trauma typically begins with treating diagnoses that are a derivative of developmental trauma, such as anxiety, depression, ADHD, and other mental health conditions. One could argue these are not mental health conditions but instead brain health conditions. While medications offer a temporary solution, they do not provide the structural changes necessary for sustainability once the medication is stopped. Those who use medication to treat issues that arise from developmental trauma are at risk of side effects and lifelong dependence with no guarantee of the highest quality of life. To get to the root cause of issues that arise from developmental trauma, treating the brain should be at the core of treating developmental trauma. Until the brain is rewired, the cognitive, emotional, and behavioral consequences of developmental trauma are likely to repeat themselves due to the limbic system's attempt to protect the individual, as previously discussed. While cognitive behavioral therapy (CBT), dialectic behavioral therapy (DBT), and psychotherapy help educate the client on different improvement methods, techniques, and strategies, the individual may not fully engage in these treatment suggestions if the brain cannot integrate and process information effectively. Therefore, this article proposes the use of neurofeedback in treating developmental trauma.

Neurofeedback retrains the brain by changing the electrical frequency that transmits information between brain regions. Feedback is received through the audio and visual cortex and administered through a computer, coaching the brain toward regulation and the body toward homeostasis. Individuals wear sensors on their scalp, transmitting a signal from the sensors to the computer. The computer detects a deviation in activity and offers suggestions to the brain using electromagnetic pulses. The brain decides what to do with the information. In most cases, the brain tries the suggestion and continues to take in more suggestions upon being rewarded. Each time the brain is rewarded, it works harder to receive the rewards using audio or visual stimulation. The results are sustainable once the information has been encoded in the brain. Exceptions can occur. Some brains are resistant to change, environmental stressors, medications, and physical illnesses can slow or impede change, and clients who ingest mind-altering substances are likely to experience little to no change or regression once neurofeedback is stopped. Individuals may also develop an aversion to drugs, alcohol, or medication as the brain changes, resulting in more severe side effects with continued use. In a study of children ages 6-13 with severe histories of abuse and neglect who had not benefitted from other types of therapy, researchers found that 24 sessions of neurofeedback reduced their symptoms associated with PTSD (Rogel et al., 2020). 

Conclusion

Complex trauma is a psychological trauma caused by prolonged exposure to interpersonal trauma(s), which results in problems with affect regulation, diminished self-beliefs, and difficulty sustaining relationships and developing or feeling a closeness to others (UK Trauma Council, 2023). Neurologically, the brain undergoes structural and functional changes that cause disrupted communication between neural networks, resulting in physical, emotional, and spiritual development problems. Individuals with complex trauma have difficulty maintaining homeostasis, are often diagnosed with mental health and personality disorders, and pose a significant risk in rebellious, violent, and high-risk behaviors. They may have difficulty believing in God or enter into extreme ideologies on spirituality, seeing God as punishing and abandoning. The implications for society are far-reaching. By identifying and addressing the neurological consequences of complex trauma early on, clinicians, doctors, and neurologists have the opportunity to change the trajectory of these individuals. Some methods for treating complex trauma include CBT, DBT, psychotherapy, and neurofeedback, to name a few. While talk therapy provides an educational approach, allowing individuals to vent their traumas, they can also cause the brain to relive experiences. Neurofeedback helps the brain rewire, giving it the resources and tools necessary for emotional processing and understanding, eventually allowing the individual to develop a more whole self and move toward adulting. However, more research is needed to determine which methods are best at proactively addressing the consequences of complex trauma and are dependent on each individual's circumstances.

References

Arnold, C., & Fisch, R. (2011). The impact of complex trauma on development. [Jason Aronson].

Baranowsky, A., & Lauer, T. (2012). What is PTSD? : 3 steps to healing trauma. Traumatology Institute.

Billman G. E. (2020). Homeostasis: The underappreciated and far too often ignored central organizing principle of physiology. Frontiers in physiology, 11, 200. https://doi.org/10.3389/fphys.2020.00200

Bremness, A., & Polzin, W. (2014). Commentary: Developmental trauma disorder: A missed opportunity in DSM V. Journal of the Canadian Academy of Child and Adolescent Psychiatry, 23(2), 142–145.

Daniel, T. (2017). Grief as a Mystical Journey: Fowler’s Stages of Faith Development and Their Relation to Post-Traumatic Growth. The Journal of Pastoral Care & Counseling, 71(4), 220–229. https://doi.org/10.1177/1542305017741858

Fields, R. D. (2024, February 20). White matter matters. Scientific American. https://www.scientificamerican.com/article/white-matter-matters/#:~:text=A%20higher%20development%20of%20white,correlates%20directly%20with%20higher%20IQ.

Filley, C. M. (2013). The behavioral neurology of white matter (2nd ed.). Oxford University Press.

Handout 1: Stages of Faith Development. (n.d.). UUA.org. https://www.uua.org/re/tapestry/youth/wholeness/workshop2/handout1-stages-faith-development

Kalat, J. W. (2019). Biological Psychology. Cengage Learning, Inc.

Kılıç, B. S. S. P., Saltoğlu, S., & Erdoğdu, E. (2024). Effects of early psychological trauma on limbic system structure and function. Psikiyatride Güncel Yaklaşımlar/Psikiyatride Güncel Yaklaşımlar, 16(4), 691–706. https://doi.org/10.18863/pgy.1356857

Lee, A., & Hankin, B. L. (2009). Insecure attachment, dysfunctional attitudes, and low self-esteem predicting prospective symptoms of depression and anxiety during adolescence. Journal of clinical child and adolescent psychology: the official journal for the Society of Clinical Child and Adolescent Psychology, American Psychological Association, Division 53, 38(2), 219–231. https://doi.org/10.1080/15374410802698396

Mercadante AA, Tadi P. Neuroanatomy, Gray Matter. [Updated 2023 Jul 24]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK553239/

Principles of Social Psychology. (2015). University of Minnesota Libraries Publishing.

Reisz, S., Duschinsky, R., & Siegel, D. J. (2018). Disorganized attachment and defense: exploring John Bowlby's unpublished reflections. Attachment & human development, 20(2), 107–134. https://doi.org/10.1080/14616734.2017.1380055

Rogel A, Loomis AM, Hamlin E, Hodgdon H, Spinazzola J, van der Kolk B. The impact of neurofeedback training on children with developmental trauma: A randomized controlled study. Psychol Trauma. 2020 Nov;12(8):918-929. doi: 10.1037/tra0000648. Epub 2020 Jul 13. PMID: 32658503. 

VA.gov | Veterans Affairs. (n.d.). https://www.ptsd.va.gov/professional/treat/essentials/complex_ptsd.asp

Van Deusen, S., Courtois, C. A., Aten, J. D., Courtois, C. A., Walker, D. F., Aten, J. D., Walker, D. F., & Courtois, C. A. (2015). Spirituality, religion, and complex developmental trauma. In Spiritually Oriented Psychotherapy for Trauma (pp. 29–54). American Psychological Association. https://doi.org/10.1037/14500-003