Discussions of psychological trauma often begin by describing posttraumatic stress disorder (PTSD), a diagnosis that first appeared in the third edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III) in 1980 to describe the psychological impact of war on combat veterans. However, PTSD only tells part of the story for those traumatized in early childhood. In 2022, the 11th version of the International Classification of Diseases (ICD-11) articulated an additional diagnostic category, complex PTSD (C-PTSD), to describe the psychological impact on individuals who suffer from repeated, prolonged, relationally traumatic events, such as childhood abuse and domestic violence. This diagnosis requires that an individual meet the criteria for PTSD in addition to experiencing disturbances in emotional regulation, identity, and difficulties in relationships. Unlike a single-incident trauma, such as war, rape, or natural disasters, C-PTSD recognizes that early long-term repeated trauma damages a person’s sense of self, their emotional regulation, their ability to form relationships, their values and beliefs about themselves, others, and the world. However, traumatic events may underlie other psychological difficulties and create emotional distress, including (but not limited to) mood and anxiety disorders, dissociative, personality, and substance use disorders. For example, those who experience chronic depression and/or anxiety may be unaware that their suffering stems from how they were treated in childhood—perhaps a harsh and critical parent yelling at or degrading them constantly, or emotional neglect or abandonment. Survivors of traumatic events carry profound wounds and experience an intensity of emotions, but, if they have sufficient support from family and friends and have good coping skills for distress, they can heal with time. With early relational trauma, significant long-term suffering occurs, and individuals can develop a broad set of symptoms, including --chronic and prolonged depression and anxiety --self-destructive behaviors --shame, distrust, and self-blame --difficulties managing intense emotions --memory and attention problems --fear of close relationships --difficulty with sexual intimacy --emotional numbness or dissociation --damaged sense of self --feelings of worthlessness --physical symptoms with no clear medical cause --failure to find meaning or connection --vulnerability to repeated trauma. These symptoms arise from prolonged, dangerous, and unpredictable situations where rules and boundaries are unclear and secrets are kept to preserve the façade of a normally functioning family. Survivors can become exquisitely attuned to their environments. Relationships. Early childhood abuse and neglect have a significant impact on adult relationships. Individuals who have had their trust betrayed by those who should have protected them often feel incapable of trusting or experiencing stability in their personal relationships. They believe that relationships are unsafe, unreliable, and disempowering. Shame, guilt, and dissociation can also undermine or prevent authentic relationships. Avoidance and fear of intimacy lead to withdrawal. Having had their boundaries trampled in childhood, survivors often lack healthy boundaries with others and may learn to tolerate abusive relationships. Early relational trauma has a powerful influence on a person’s ability to feel whole, safe, and deserving of love and connection. Because relational trauma creates isolation, I believe it is only in relationship that we heal. Emotional Regulation. Survivors of relational traumas experience difficulties identifying, controlling, and safely expressing their emotional experiences. Prolonged traumatic stress can make it difficult to know what is safe and what is threatening. Dissociation, emptiness, emotional numbing, and despair can occur, along with difficulties in calming oneself when distressed, fearful, or anxious. Complex trauma can be understood as an ongoing experience of fear without a solution: when caregivers are abusive toward their children, they become both the source and the solution to the child’s fear. The abused child experiences an impossible dilemma: they must remain close to their caregiver, upon whom they depend for survival, while also contending with the intense fear and anxiety caused by the abusive caregiver’s frightening or neglectful behaviors. Self-Identity. Many individuals with complex trauma believe that their symptoms are an immutable part of their personality. Consequently, shame and guilt can make it difficult for them to reach out for help or to cope resourcefully with their ongoing suffering. Rather than recognizing the traumatic origins of their self-beliefs, they view themselves as responsible--as wrong, different, broken, flawed, unlovable. Negative beliefs and thoughts about themselves can feel searingly painful, yet uncontrollable. Those with early childhood trauma often struggle with basic self-care, such as hygiene, eating, exercise, and sleep. At the same time, they may function well in other areas of their lives, such as school or work. This is because relational trauma requires individuals to compartmentalize their suffering to meet developmental milestones—for example, going to school or getting and keeping a job. The symptoms of relational trauma are usually made more evident in adult relationships with family, friends, close associates, and intimate partners. Revictimization. Studies have provided clear evidence that those with complex trauma are at increased risk for repeated harm in adult life. Individuals become distinctly vulnerable to revictimization in many forms, which can include adult rape, domestic abuse, self-inflicted harm, masochistic behaviors, sexual dysfunction, involvement with abusive men, prostitution, and/or substance abuse. And sometimes, they are violated by the people whom they turn to for help.