It is estimated that more than two- thirds of children in the United States experience at least one traumatic event by the age of 16 [A]. While that is very disconcerting, when children or adolescents experience multiple, recurring traumatic events, and at different stages of development in childhood and adolescence or repeatedly at any age, the impact is even more devastating. 

This is called complex trauma or Complex Post-Traumatic Stress Disorder (CPTSD). Examples include physical, verbal, emotional or sexual abuse, interpersonal violence, and emotional or physical neglect. Children and teens with complex trauma often have negative thoughts, emotions or beliefs about themselves and the world. Read on to learn more about complex trauma and how it affects teens’ mental health.

What is Complex Trauma?

Complex trauma, unlike PTSD which refers usually to single traumatic events, involves prolonged, repeated traumatic experiences and symptoms. Children and teens suffering from complex trauma face many developmental challenges. These include [B] [C]:

Attachment Issues

• Lacking a stable caregiver, teens lack a sense of safety and protection. They may have difficulty trusting and expressing their feelings. And later in life they may have trouble developing close relationships. They may be suspicious and distrusting and socially isolate. They may have difficulty with friendships and other social relationships. They may not be able to see other people’s perspectives on things.

Impacts on the body and brain

• Under constant stress and with their brains in survival mode, even when they don’t have to be, teens may have problems with attention and focus, reasoning or problem-solving.

Health Issues

• Since the body’s stress response systems and immune system may not develop properly under constant dress, teens and then adults may have more physical health problems including substance abuse, obesity, heart disease and cancer. They may complain of body pains that do not have an identifiable cause and have coordination issues.

Emotion Regulation

• Teens may have trouble with regulating their emotions and labeling and expressing feelings. They may fly into a rage easily. They may have difficulty knowing ad describing their internal states and not be good at communicating their wishes and needs

Dissociation

• Teens may have changes in their states of consciousness with amnesia or poor memory about past events and depersonalization. They may appear “spaced-out”

Behavioral Control

• Teens may have poor control of their impulses and engage in self-destructive behavior or aggression towards others. They may have eating and sleep disorders. They may develop an SUD. They may be excessively compliant or rebellious with oppositional behavior. It’s common that they have difficulty understanding and complying with rules. They may reenact their trauma in behavior or play possibly in a sexual or aggressive way.

Cognition

• Teens may have difficulties in paying attention and with executive functioning (reasoning, problem solving and judgment). They likely have difficulty focusing on and completing tasks, planning and anticipating. They may have problems understanding responsibility. They may have learning difficulties, problems with language development and with orientation in time and space.. 

Self-concept

• Teens may lack a continuous, predictable sense of self and have a poor sense of separateness. They may have issues with body image, low self-esteem, shame and guilt.

How Does Trauma Affect Teen Mental Health?

Complex trauma has a variety of effects on teens’ mental health. These change as teens grow older. The most common effects include [B]:

• Challenges with attachment and relationships
• Difficulty regulating emotions and behavior
• Challenges with attention span and other cognitive difficulties
• Dissociation from reality (“spacing out”)
• Overall negative outlook on the world

Short-term Effects

Often these are described as normal reactions to abnormal events. They can last for up to a month after a traumatic event or much longer for prolonged, repeated traumatic events. They can include:

• Fear

• Guilt

• Anger

• Isolation

• Helplessness

• Disbelief

• Emotional numbness

• Sadness

• Confusion

• Flashbacks or persistent memories

• Thoughts about the events

Long-term Events

Sometimes these strong emotions, thoughts and memories can continue over time and even worsen through adolescence and into adulthood. These can be overwhelming for a teen and have damaging impacts on their life, affecting their well-being, relationships, and ability to work and study. Some traumas, especially those in childhood may have effects that only become clear later in life.

There is a strong relationship in the long-term between trauma and poor mental or physical health. Yet, with the right support, in many cases teens can bounce back. This is called resilience and enables the teen to experience positive growth despite the adversity earlier in their life. 

Exposure to complex trauma at a young age can change how the brain develops. This may negatively impact the ability to learn. High amounts of stress at a young age can also increase risk-taking behaviors in the teen years and early adulthood. This can lead to poor physical health later in life.

Does Complex Trauma Cause Substance Abuse in Teens?

As a response to complex trauma, teens are particularly susceptible to developing a substance use disorder (SUD) with alcohol or drugs. This is often an attempt to block out the emotional pain of trauma. However, not everyone who experiences trauma will develop an addiction. Factors that contribute to the risk of developing a substance use disorder include [D]:

• Genetics
• Environment
• Family history of addiction
• Severity of trauma
• Childhood adversity
• History of past drug use 

People with a history of childhood physical or sexual abuse have a 74% and 73% greater risk of developing an SUD in their lifetime. And those who are the victim of or who witness violence have an increased risk of SUD. Parental divorce and conflict, loss of a parent or poor family relationships can also be a contributing factor.

Healing from Complex Trauma During Substance Abuse Recovery

It’s highly recommended to treat the underlying trauma issues together with SUD issues as they are usually highly interrelated. Complex trauma is best treated with experienced trauma-informed therapists.

Trauma-Informed Substance Abuse Treatment for Teens

There are a number of evidence-based therapy approaches which are successful in treating dual diagnosis teens suffering from both complex trauma and SUD. These are best done in a residential treatment center, typically for stays of 30-90 days. Building a teen’s secure attachment to trusted adults is at the core of any treatment for complex trauma.

Therapies include:

• Cognitive Behavioral Therapy (CBT): Focuses on efforts to change thinking patterns by learning to recognize distortions in thinking patterns and adjust them, As well it focuses on helping teens gain a better understanding of the behavior and motivation of others and using problem-solving skills to cope with difficult situations.  In addition teens will develop greater self-confidence.

As well, CBT involves efforts to help teens change their behavior patterns by facing their fears instead of avoiding them, using role play to improve ways of handling problematic situations with others and learning to relax and calm mind and body

• Motivational Interviewing (MI): A therapy with a guiding style of communication that is designed to empower teens to change by drawing out their own meaning, importance and capacity for change. It’s based on a respectful and curious way of being with people that facilitates the natural process of change and honors the teen’s autonomy.

• Trauma-focused Cognitive Behavioral Therapy (TF-CBT): Is a variant of CBT but specifically with a trauma-focused approach. It has been proven effective for youth in treating complex trauma. It’s a structured, short-term treatment model that effectively improves a range of trauma-related outcomes in 8-25 sessions with the teen and caregiver.

• Attachment, Self-regulation and Competence (ARC): Is a framework for working with youth and families who have experienced complex trauma. ARC identifies three core domains which are frequently impacted among traumatized youth and which are relevant to future resiliency. These are attachment, self-regulation and competency. 

Attachment focuses on strengthening the caregiver system. Regulation focuses on cultivating youth awareness and skill in identifying, understanding, tolerating and managing internal emotional experience. Competence focuses on key factors associated with resilience by increasing choice and empowerment and identifying and exploring key aspects of the self and identity.

A very helpful resource, written especially for teens and their caregivers, is by The National Child Traumatic Stress Network (NCTSN) What is Complex Trauma? A Resource Guide for Youth and Those Who Care About Them.

Florida Teen Addiction Treatment 

At Lotus Behavioral Health our focus is on renewing and restoring wholeness for teens and their families. Our addiction treatment programs are designed to support teens and their families with the tools they need to recover from substance abuse & co-occurring mental health disorders such as complex trauma. We provide supervised care at our Florida residential treatment center or flexible outpatient services to meet teens and their families at all stages of recovery.

Sources

[A] The Family Institute. Understanding the Effects of Complex Trauma in Youth

[B] Sheldon-Dean, H. 2024.  What Is Complex Trauma? Child Mind Institute. The National Child Traumatic Stress Network (NCTSN). 

[C] Cook, A. et al. 2005. Complex Trauma in Children and Adolescents. Psychiatric Annals 35.5. Complextrauma.org

[D] National Institute on Drug Addiction (NIDA). 2024, February 6. Trauma and Stress.