Understanding Complex Trauma Child Sexual Abuse



Date of Publication
April, 2011

Children who have been sexually abused have often experienced an entire series of traumatic events, from multiple victimizations to seriously disrupted relationships with their parents. These children's experiences can't be described with the traditional posttraumatic stress disorder (PTSD) label; their fundamental ways of interacting with the world and sometimes even their biological functions are changed because of the chronic, pervasive stress to which they have been exposed at this vulnerable time of life. It is critical to understand that complex trauma has a developmental impact in many realms of a child's life.

Alexandra Cook, Joseph Spinazzola, Bessel van der Kolk and others have identified seven domains of impairment in children affected by complex trauma:

  • attachment,
  • biology,
  • affect regulation,
  • dissociation,
  • behavioral control,
  • cognition, and
  • self-concept.

In other words, almost every aspect of a child's life can be damaged by complex trauma.

The research on effective treatment for complex trauma in children is still preliminary. Healing factors that have been identified as critical include

  • safety,
  • self-regulation,
  • self-reflective information processing,
  • traumatic experiences integration,
  • relational engagement, and
  • positive affect enhancement.

In addition, it is clear that supporting consistent positive engagement by family members is one of the most powerful healing strategies.

Best practice with this population typically involves adoption of a systems approach to intervention and use of multiple intervention modalities. This may include individual, family and group psychotherapy, parent training, and milieu-based intervention. Often, this means working with child protective services, the court system, the schools, and social service agencies.

—Cook et al., 2005

While working with these children and teens is challenging, understanding how complex trauma can affect so many facets of their lives can provide a pathway to healing the trauma of sexual abuse.

    Resources on Other Websites

    • Cook, A., Spinazzola, J., Ford, J., Lanktree, C., Blaustein, M., Cloitre, M., . . . van der Kolk, B. (2005). Complex trauma in children and adolescents. Psychiatric Annals 35(5), 390-398.
    • Complex Trauma in Children and Adolescents
      This White Paper from the NCTSN Complex Trauma Task Force is an excellent, in-depth overview of this topic.
    • Complex Trauma Video
      A YouTube video by the Spokane County Community Network, this explains complex trauma in simple terms, focused on the educational impact for children. Would be useful to share with advocates who work with children.
    • Complex Trauma in Early Childhood
      A clear outline of the topic from the American Academy of Experts in Traumatic Stress