Trauma

Difficult or frightening experiences can stay with us long after they are over. That might show up as intrusive memories or flashbacks, disturbed sleep, feeling constantly on edge, being easily startled, avoiding reminders of what happened, or a sense of being cut off from people and from yourself.

When a collection of these symptoms persists together and starts to interfere with daily life, it is known as post-traumatic stress disorder, or PTSD. PTSD typically involves four clusters of difficulty: re-experiencing the event through flashbacks or nightmares; avoiding anything that brings it back; changes in mood and thinking, such as guilt, numbness or a loss of interest in things that used to matter; and feeling hypervigilant or on edge much of the time. Not everyone who goes through something traumatic develops PTSD, but for those who do, it is a well-understood condition and it responds well to treatment.

Therapy for trauma begins gently, with time spent understanding what happened and how it is affecting you now, and making sure you feel steady enough to do the work. The approach with the strongest evidence is trauma-focused CBT, recommended by NICE for PTSD. The pace is decided together and guided by what feels manageable for you.

Trauma work is not about reliving the worst moments for their own sake. It is about helping the memory settle so that it loses its grip on the present.

Complex PTSD

For some people, trauma was not a single event but something that happened repeatedly, often over a long period and usually in a context where escape was difficult. This might include childhood abuse or neglect, domestic violence, or prolonged exposure to threatening or unpredictable environments. Where that is the case, the picture is often more complex than single-incident PTSD.

Complex PTSD, recognised in the ICD-11, shares the core features of PTSD but also involves significant difficulties in three additional areas: regulating emotions, which can feel intense and difficult to manage; how we see ourselves, often with deep feelings of shame, guilt, or worthlessness; and relationships with others, which can feel unsafe or hard to sustain. These additional features make sense as adaptations to circumstances where they were needed, even if they cause considerable difficulty in the present.

Complex PTSD does respond to treatment. Therapy tends to be more gradual and places significant emphasis on building stability and a sense of safety before moving into processing traumatic material directly. It is careful, collaborative work, and the pace is set by what feels manageable rather than by an external timetable.