Everything about trauma

What is Complex Trauma? What are the differences to a classic post-traumatic stress disorder? How do I recognize trauma? What are the symptoms of post-trauma disorder?

You can find answers to these and many other questions here. In order to face the disease, it is helpful to understand it. On this and the following pages you will get an insight into various aspects of post-traumatic stress disorder.

What is a Complex Trauma?

What is trauma-related disorder?

Complex trauma in war veterans

Trauma as a result of sexual abuse and childhood experiences of violence

What is Complex Trauma?

When a person is confronted with death, serious injury, or sexual violence and feels helpless and alone in the process, trauma can result. If this maximum psychological stress persists over a longer period of time or if traumatizing events occur again and again, a complex trauma can arise.

You can read here what exactly a complex post-traumatic stress disorder (cPTSD) is, what symptoms it shows up and what you can do if you or someone around you suffers from a complex trauma.

How does a complex trauma arise?

Traumas are strong psychological shocks caused by short or long lasting, overwhelming events that pose a threat to the life or physical integrity of the person concerned. The threat does not have to affect you yourself. The trauma can also be triggered by direct experience of such events or their occurrence with close friends or family.

If several traumatic individual results come together and the further traumatic event cannot be predicted, a complex trauma occurs in 8-15% of all traumatized people. In most cases, such trauma arises from first-hand experience of war as a civilian, rape, or sexual abuse.

Although such experiences would cause deep despair in almost everyone, studies show that only 1-4% of people in Germany who have such traumatic experiences develop post-traumatic stress disorder or CPTBS. The rest of those affected develop resilience or psychological resilience through coping strategies.

However, even those who do not develop post-traumatic disorder often suffer from other mental disorders for which traumatic experiences are risk factors. The more often a trauma is repeated, the more likely it is that a complex trauma (building block effect) will occur.

The difference to post-traumatic stress disorder

Better known and researched to date than complex trauma is post-traumatic stress disorder (PTSD). It was examined primarily in connection with war returnees. PTSD has many of the same symptoms as the complex trauma, including an unwanted attachment to the trauma that haunts the traumatized with images, sounds, and memories.

Furthermore, PTSD manifests itself in the avoidance of anything that could trigger the trauma and often associated with social withdrawal. In addition, the arousal threshold of the autonomic nervous system falls due to the traumatic experiences, which leads to a general increase in arousal. All stimuli from the body are intensified and those affected suffer from frequent overstimulation and can sleep poorly even at night.

In complex trauma, these symptoms are also accompanied by pronounced affect regulation disorders, which can be expressed through persistent irritability, negative self-perception and relationship disorders.

Symptoms of complex trauma

  • Reliving the trauma in the here and now
  • Avoidance of triggering / numbing
  • social withdrawal and relationship disorders
  • Increase in arousal and the associated overstimulation, sleep disorders, etc.
  • Affect regulation disorders
  • negative self-awareness

What can I do?

If you are suffering from a complex trauma yourself, you can seek support from a psychotherapist for treatment. The symptoms of a complex trauma can be alleviated by methods of trauma-specific psychotherapy. Studies of PTSD have also shown that social support plays a big role in coping with trauma. Not only the family atmosphere, but also recognition, compassion and understanding in the social environment help those affected to live with their trauma.

Increasingly evidence-based health care, in which patient-oriented decisions are made on the basis of the symptoms present, ensures that the clinical picture of the complex trauma is now becoming increasingly well known. This gives those affected the social acceptance and support they need.

In order to defend yourself against violent criminals (also with regard to emotional or financial violence), please see the “Find support” page in the menu.


PTSD and Complex PTSD: ICD-11 updates on the concepts of measurement in the UK, USA, Germany, and Lithuania . (2017). DOI: 10.1080 / 20008198.2017.1418103

Hecker & Maercker: Complex post-traumatic stress disorder according to ICD-11 . (2015).

What is trauma-related disorder?

Once a taboo topic and laughed at as a weakness, trauma is now increasingly moving into the social and scientific focus. And rightly so! According to estimates, around 26% of men and 18% of women in Germany suffer from trauma, in the USA it is as much as 61% and 51%, respectively. Not all of them also experience post-traumatic stress disorder, but at least 4% of men and 12% of women suffer from post-traumatic stress disorder. So it is time we all learned more about this disease in the midst of society!

How does trauma arise?

When people experience extreme stressful situations in which their own safety or that of their loved ones is threatened and they feel fearful and helpless, they can develop trauma. Our natural coping strategies cannot always cope with such an extreme situation and are overwhelmed. Such trauma has various after-effects.

Forms of trauma-related disorder

Psychological secondary illnesses that can be traced back to trauma are summarized under the term trauma-related disorder. These often only occur within the first six months after the experience or sometimes even later.

The best-known trauma-related disorder is probably post-traumatic stress disorder (PTSD). In addition, depression, burn-out, addictions, dissociative and personality disorders or anxiety and eating disorders are also among the after-effects of trauma.

Those affected suffer from depression, sadness or persistent tiredness and listlessness. Other symptoms include a loss of memory of a certain period of life or the splitting of the personality into different parts that can lead a life of their own. The symptoms naturally depend on the type of sequelae and differ from case to case.

Post-trauma disorders also have physical consequences. Dissociative disorders can lead to a loss of control over certain parts of the body. Addictions often have serious health consequences depending on the addictive substance. Eating disorders often result in severe weight loss and can even be fatal.

Depending on the type of trauma, this also has the corresponding consequential disorder. Statistics show that the likelihood of PTSD as a result of trauma, for example, in the case of rape or a war experience, is highest at around 38%. After a fire or a natural disaster, however, only 4.5% of those affected suffer a trauma-related disorder.

Risk and protective factors

Not every person who goes through a traumatizing experience has to suffer from a trauma-related disorder. According to studies, there are various risk factors that can be used to determine the likelihood of such a disease. On the other hand, this data can also be used to read possible protective factors that protect people from experiencing secondary trauma disorders after shocking events.

In general, age and gender seem to play a role in relation to risk. While children and adolescents have the greatest risk of suffering from secondary trauma disorders, it is comparatively low in young adults and middle-aged people. In old age, the risk increases again. In general, more women than men suffer from disorders as a result of trauma.

Discrimination and racism, to which people of color are often exposed in everyday life, can also promote the development of secondary trauma disorders. This is a major problem, especially for people seeking asylum in Germany, and psychologists are therefore calling for the needs of traumatized people to be given special consideration in asylum procedures in order not to aggravate existing trauma.

So-called protective factors that can reduce the likelihood of such a disorder include strengthening previous experience, security and support from the social environment. Social recognition and solid mental health prior to the experience can also have a positive impact.

Although we cannot prevent trauma and its sequelae, a happy, loving and safe childhood can lay the foundation for stable mental health for life. Those who weren’t allowed to enjoy this can still make up for a lot with stable social contacts, because this network holds us up when we go through difficult times.


Maercker & Augsburger: The post-traumatic stress disorder. (2019).


Complex trauma in war veterans

Unfortunately, post-traumatic stress disorder and complex trauma were not yet discovered and described when Europe was full of traumatized people after World War II. Many still know the stories of fathers and grandfathers who came back from the war and never again became the happy, loving people their families knew them to be. Even today people experience complex trauma during war. We describe here how these look and can be treated in the meantime.

What is Complex Trauma?

Complex trauma can arise when a person is exposed to persistent psychological stress from persistent experiences of violence, serious injuries or a particularly drastic confrontation with death. These experiences of extraordinary threat cannot, of course, only take place in war situations. Other events can also lead to complex trauma. Examples could be political imprisonment or repeated sexual violence and child abuse.

Affected people have symptoms such as reverberation memories in which they relive the trauma in the here and now and are often haunted by the stressful memories in their dreams. In situations that resemble or are related to the stress, they get into inner distress and often try to avoid such situations at all costs. This is often accompanied by social withdrawal and dysfunctional relationships.

In contrast to the better known post-traumatic stress disorder, the traumatizing situation in a complex trauma lasts for a longer period of time. The resulting symptoms are also different.

Complex traumas in war situations

If you look at the development of complex traumas, it quickly becomes clear that they can arise especially in crisis situations with their extreme stress. In this context, complex trauma was also examined for the first time. Among other things, the work with war returnees from the world wars and Vietnam war veterans led to the original development of the concept.

Until then, complex trauma had been dismissed as weakness or “pension neurosis” and those affected were referred to as “war tremors”. It was not until 1980 that post-traumatic stress disorder was recognized as a diagnosis, followed by complex trauma.

Situations in wars in which complex trauma can arise include captivity and hostage, torture, escape and repeated (sexual) violence. Not only those who have experienced violence can suffer trauma in these situations. Those who use violence (often under duress) can also develop trauma. People who are neither involved as victims nor as violent perpetrators but witnessed the violence can also develop indirect trauma.

People with complex trauma

It is estimated that 5-10% of the population suffer from post-traumatic stress disorder or complex trauma. So it is not so unlikely that you have someone in your family or circle of acquaintances who is struggling with it. Although war trauma is widely viewed as a male disease, studies have shown that women in similar situations are twice as likely to develop complex trauma.

Although we often have stereotypes from US films and series in mind when it comes to this topic, many people in Germany also suffer from complex trauma. In addition to soldiers from the German Armed Forces, who fortunately often receive psychological support during their war missions, this can primarily be people who have fled their homes. Because of their situation, lack of information and the language barrier in the country of arrival, these people unfortunately often receive far too little support in dealing with their trauma.

Research has shown that understanding and support from the environment are of great importance in complex trauma. Treatment with methods of trauma-specific psychotherapy can also help those affected.


Hecker & Maercker: Complex post-traumatic stress disorder according to ICD-11 . (2015).

Roestel & Kersting: Simple and Complex Post-Traumatic Stress Disorders. (2008).

Trauma as a result of sexual abuse and childhood experiences of violence

What forms of violence do children experience?

In a 2011 study, around 13% of the adolescents and adults surveyed stated that they had been victims of sexual abuse in childhood. In addition to physical sexual abuse, children can also be victims of sexual assault on the Internet or exhibitionism.

Not only sexual abuse, but also other forms of violence can leave lasting damage to the psyche of children. According to the survey, around 22% of children worldwide are exposed to physical violence. But neglect can also be perceived as traumatic by children.

In fact, neglect is one of the most common forms of childhood abuse and has similar mental health consequences as physical and sexual violence. In a study, 16% of those questioned stated that they had been physically neglected in their childhood, 18% suffered emotional neglect.

Emotional violence, which includes, for example, bullying by peers, but also humiliation, racist or misogynistic comments by parents, family members, teachers, trainers or strangers, is unfortunately common. It has so far been difficult to quantify and the consequences for the mental health of children have not yet been adequately researched.

In many cases, children are not directly exposed to violence, but experience it as witnesses, for example in the family circle. They hear or see violent confrontations between their parents or get involved in trying to protectively intervene. This form of child violence can also have serious consequences.

Consequences of Experiencing Sexual Violence in Childhood

Every person and every child deals differently with extreme experiences such as experiencing sexualised violence, but also experiencing other forms of violence or neglect. The consequences also differ depending on the duration of the experience. If an experience takes place repeatedly or over a long period of time, this can lead to different consequences for the child concerned. The effects are also different depending on the gender.

In general, however, people have a high risk of secondary trauma disorders due to experiences of violence, especially in childhood. In the context of childhood violence, post-traumatic stress disorder and complex trauma have not yet achieved sufficient awareness as a diagnosis. Nevertheless, these long-term effects often occur in those affected. Often they then get a number of different diagnoses such as depressive, anxiety or panic disorders.

Alert signals for childhood trauma

  • Avoidance behavior: those affected try to avoid situations that are reminiscent of what they have experienced
  • social withdrawal
  • in some cases reluctance to and avoidance of sport and physical exertion (fast breathing and accelerated heartbeat also occur during trauma)
  • Reverberation memories during the day, but also in dreams, resulting in insomnia
  • increased arousal and excessive vigilance
  • Irritability and frightfulness
  • emotional numbness and mental absence

What can I do?

Anyone who knows several of these symptoms, which usually appear weeks or months after the actual experience, from themselves or from people in their own vicinity, can get help. For professional support in dealing with trauma, one should turn to a psychologist. There are different contact persons depending on the age of the person concerned. Specially trained child and adolescent psychologists with knowledge of trauma therapy can help with minors.


Haan, Deegner & Landolt. Childhood Violence and Its Consequences. (2019).

Vasic et al. Persistent childhood sexual abuse and long-term developmental consequences. (2015).