This series of articles in September has focused primarily on advocating and supporting someone who has suicidal ideations or has attempted to die by suicide.
As September is National Suicide Awareness Month, we shall continue to address the causes and treatment available to those who are suicidal and their families and friends.
In this article, we shall examine together the link between complex trauma and suicidal ideation, examining closely what both are and how to help someone you love and yourself.
Complex trauma events have been defined as chronic, interpersonal traumas that begin early in life (Cook, Blaustein, Spinazzola, & van der Kolk, 2003) (Wamser-Nanney & Vandenberg, 2013).
Perhaps an easier to understand explanation is as follows:
“Complex trauma describes both children’s exposure to multiple traumatic events—often of an invasive, interpersonal nature—and the wide-ranging, long-term effects of this exposure. These events are severe and pervasive, such as abuse or profound neglect. They usually occur early in life and can disrupt many aspects of the child’s development and the formation of a sense of self. Since these events often occur with a caregiver, they interfere with the child’s ability to form a secure attachment. Many aspects of a child’s healthy physical and mental development rely on this primary source of safety and stability (NCTSN.org)”
Most of us know someone who has experienced complex trauma, people in our lives who have been injured in childhood by the very people who were supposed to care and love them. Early childhood trauma refers to the traumatic experiences of children between the ages of 0-6 (these ages are not set in stone). Children that young cannot verbalize their reactions to threatening events even though many people believe they can protect themselves and “grow out of it.”
Some of these events may be:
- Sexual abuse
- Narcissistic abuse
- Physical abuse
- Emotional abuse
- Witnessing domestic violence
- Natural disasters
- Living in a war zone
- Medically painful procedures
- The loss of a parent/caregiver
Known as adverse childhood experiences, some children who experience them can grow into adults who are plagued by suicidal ideation.
Complex Trauma and Complex Post-Traumatic Stress Disorder
Complex trauma is the basis of complex post-traumatic stress disorder, a problem where people who have survived childhood maltreatment have the following symptoms:
- Losing memories of trauma or reliving them
- Difficulty regulating emotions that often manifest as rage
- Sudden mood swings
- Feeling detached from oneself
- Feeling different from others
- Feeling ashamed
- Feeling guilty
- Difficulty maintaining relationships
- Difficulty trusting others
- Seeking our or becoming a rescuer
- Feeling afraid for no apparent reason
- Having a feeling of always on the alert
- Becoming obsessed with revenge on the perpetrator
- Feeling a loss of spiritual attachment and either ignoring or depending upon religion for self-worth
- Suicidal thoughts or actions
Survivors who deal with complex post-traumatic stress disorder often struggle with chronic suicidal ideation and have experienced repeated suicide attempts. Still, other survivors may have passive suicidality where they do not take their medication, eat, drink sufficient fluids, or self-care items.
Many people living with the after-effects of complex trauma will have periods of no suicidal ideation only to have it come back again later. Because of the tremendous pain involved with dealing with complex trauma, survivors must have a “way out” of the pain and may consider suicide a “safety net,” a way of escape.
Supporting Someone Who Has Experienced Childhood Trauma and is Suicidal
Watching a friend or loved one suffer the aftermath of childhood trauma is hard to do. You wish to help them, and your support is imperative as research has shown that leaning on a loved one has multiple benefits for trauma survivors (Littleton 2010.) While being available for a person experiencing the leftovers from a traumatic childhood seems trivial, it is critical to their recovery.
There are multiple ways to support survivors of childhood maltreatment, including the following examples.
Realize that trauma can resurface repeatedly. To some, it may seem that someone who has survived child abuse should be capable of walking away from their past and live in the now. However, since brain changes occurred when the trauma occurred, it is nearly impossible for emotional flashbacks and reactions to memories of what happened not to resurface.
The way to aid someone who is experiencing resurfaced traumatic memories is to listen without judgment or suggestions. Do not try to “fix” the person; just listen to what they are saying and hold them when needed (see below).
Ask Before Holding a Survivor. Although you may feel the need to hug or hold a survivor who is suffering the side-effects of complex trauma, survivors sometimes don’t like being touched, and you could inadvertently cause the situation to become worse.
Survivors who experienced traumatic childhoods may equate touch with pain and will shy away from physical contact. Don’t feel rejected but celebrate the fact that the survivor in your life trusted you enough to say they do not want a hug.
Watch for Suicide Risk Factors. People who survived complex traumatic events are at risk for developing suicidal ideation and actions. However, there are risk factors, including:
- Severe mental health conditions such as depression or anxiety disorders
- Access to lethal means such as firearms and drugs
- Prolonged stress such as bullying, unemployment, or problems in a relationship\
- Exposure to another person’s suicide
- Previous suicide attempts
- Family history of suicide
- History of childhood abuse, neglect, or other trauma
Watch for Suicide Warning Signs. Survivors of complex trauma may exhibit warning signs that tell their friends or loved ones that they are contemplating dying by suicide. These warning signs include:
- The person talks about killing themselves, feeling hopeless, having no reason to live, that they would be better off dead, or of unbearable pain.
- Their behavior may change where they increase their use of alcohol or drugs, withdrawing from activities, isolate themselves, or give away prized possessions.
- The person may exhibit signs of depression, anxiety, irritability, loss of interest, shame, anger, or a sudden mood improvement.
If you notice these warning signs and know they have risk factors, do not hesitate to talk to them directly about your suspicions. Talking about suicide WILL NOT cause the person you love to die by their own hand; indeed, you might open a conversation that saves that person’s life.
Know Where to Turn
When someone is suicidal or knows someone exhibiting signs of suicidal ideation, they need to turn to experts for help.
The first line of defense is your family doctor. Tell them that you are concerned about your loved one or yourself and be honest about suicidal ideations. Your physician will get you the help you need right away, sometimes resorting to entering you into the hospital for observation. While going to the hospital is not ideal, doing so will keep you or your loved one alive while the doctors attempt medications to decrease the anxiety or depression causing the problem.
Your second line of defense is knowing organizations that can help.
The National Suicide Prevention Lifeline (Call or Chat Online). This resource is available 24/7 at the following number:
Contact them whenever you feel worried about someone who may be contemplating dying by suicide.
Crisis Text Line. In our age, more and more people opt to text instead of talking on the phone. The Crisis Text Line is available 24/7, and you can reach them by texting “GO” to 741741.
Ending Our Time Together
Complex trauma is challenging to live within one’s life. The healing process is long and painful, leading some survivors to think they do not wish to live. Advocates can do things to help, and many involve self-education about both complex trauma and suicidal behavior.
By simply being there and listening to what the survivor in your life has to say, you can help them defeat the voices in their mind from the past that are haunting their soul.
Be sure to take good care of yourself while helping your survivor by knowing yourself, your needs, and how to get what you need. Self-advocate to keep yourself from becoming burned out or ill so that you can be there when your loved one needs you without sacrificing yourself.
Please, consider sharing this post on your social media accounts or with family and friends. It could change a life today.
“Don’t compromise yourself. You’re all you’ve got.” Janis Joplin
“Be bold enough to use your voice, brave enough to listen to your heart, and strong enough to live the life you’ve always imagined.” Author Unknown
Littleton, H. L. (2010). The impact of social support and negative disclosure reactions on sexual assault victims: A cross-sectional and longitudinal investigation. Journal of Trauma & Dissociation, 11(2), 210-227.
Wamser‐Nanney, R., & Vandenberg, B. R. (2013). Empirical support for the definition of a complex trauma event in children and adolescents. Journal of traumatic stress, 26(6), 671-678.
CPTSD Foundation Awareness Wristbands
Official CPTSD Foundation wristbands to show the world you support awareness, research, and healing from complex trauma.
The official CPTSD Foundation wristbands were designed by our Executive Director, Athena Moberg, to promote healing and awareness benefits all survivors. We hope you’ll consider purchasing one for yourself and perhaps one for a family member, friend, or other safe people who could help raise awareness for complex trauma research and healing.
Each purchase of $12 helps fund our scholarship program, which provides access to our programs and resources to survivors in need.
As always, if you or a loved one live in the despair and isolation that comes with complex post-traumatic stress disorder, please, come to us for help. CPTSD Foundation offers a wide range of services, including:
- Daily Calls
- The Healing Book Club
- Support Groups
- Our Blog
- The Trauma-Informed Newsletter
- Daily Encouragement Texts
All our services are reasonably priced, and some are even free. So, to gain more insight into how complex post-traumatic stress disorder is altering your life and how you can overcome it, sign-up; we will be glad to help you. If you cannot afford to pay, go to www.cptsdfoundation.org/scholarship to apply for aid. We only wish to serve you.
My name is Shirley Davis and I am a freelance writer with over 40-years- experience writing short stories and poetry. Living as I do among the corn and bean fields of Illinois (USA), working from home using the Internet has become the best way to communicate with the world. My interests are wide and varied. I love any kind of science and read several research papers per week to satisfy my curiosity. I have earned an Associate Degree in Psychology and enjoy writing books on the subjects that most interest me.
This is a very important essay with a hugely significant message. Childhood maltreatment trauma can damage belief in one’s self and a sense of self worth in foundational ways. Thus folks who have experienced this trauma easily can easily slip into suicidal thought patterns.This discussion offers basic and excellent information, support and strategies to cope, survive, get beyond this vulnerable existential state.
It is important for therapists to recognize an existing severe defect in suicide reporting. For generations epidemiological and clinical understanding of mental illness has been constrained by the symptom complexes defined in the Diagnostic and Statistical Manual of the American Psychiatric Association (DSM). The DSM-5 attends to child maltreatment trauma only at the end of the volume after defining the accepted diagnostic categories for various mental illnesses based on symptom complexes. On page 715, there is a brief section called “Other Conditions That May Be as Focus of Clinical Attention.” Here it states that the conditions listed there merely affect mental disorders; they are not mental disorders themselves; and they cannot be treated as mental disorders. Thus designated by the DSM-5 coding system, they are not reimbursable by insurance companies. Conditions relegated to this section include Child Physical Abuse, Child Sexual Abuse, Parent-Child Relational Problems, Child Affected by Parental Relationship Distress, Child Psychological Abuse, Spousal Violence, and others. Although the ICD-10 recognizes these categories, the USA depends on the outdated DSM system, thus the presence of any of these conditions is rarely specifically coded in an American child’s clinical medical record. Thus American records cannot be validly curated into the standard ICD-10 format. This presents a major problem to clinicians who study and treat the effects of child abuse trauma and associated morbidities, not to mention suicide prevention efforts. For instance, in most pre-covid, baseline studies of suicide, the presence or absence of child maltreatment trauma is simply not mentioned. It is commonly thought that the loneliness and pressure cooker family environment created by covid-19 markedly increased the incidence and prevalence of child maltreatment and suicide. It is important to know how much of the observed increase in suicides is associated with child maltreatment trauma and potentially its differential impact in specific sub-populations. But there is no data! We do not know because of the outdated and inadequate coding system promulgated by the American Psychiatric Association.
This is deeply important work. People keep telling me to “get over it” … It’s heartbreaking. Im.judged. I am insulted daily. How can we help get this information out there?
You can do like we did and start a blog or you can look around for organizations that deal with suicide and suicidal ideations. Thank you very much for your kind message. Shirley
I am a man, age 48, who has been unemployed for almost 3 years after a job demotion (with no reason given to me) led to a complete mental breakdown and to the resurgence of the same depressive and anxious symptoms that plagued my childhood. I was exposed to an entire childhood of a mother with extreme mood swings and when she was on the bad end, everything resulted in screaming and insults. Dad was passive, endured the same abuse, and never spoke up for himself or for me. I was exposed to Catholic teachings that everyone is born a sinner and is unworthy in the eyes of God. (I long ago became an atheist.). I was exposed to 13 long years of K-12 emotional and physical assaults at the hands of my peers on a near daily basis. — Since becoming unemployed I have tried several different medications and therapists – currently I am not in therapy as I have been extremely upset with how the mental health care that I have received (which took almost a year of being on a wait list to even get) was handled. I found myself being disbelieved by doctors since I am college educated and stayed in the same career for over two decades (a career that I desperately hated every single day). — I know that I need a lot of help BUT the fear of medical bills coming from being hospitalized keeps me from seeking help. I am married and my husband is wonderful – but his salary barely pays the bills. Anything more than a $20 copay for a visit is truly financial hardship. I would like to think that my fear over impossibly high costs for inpatient trauma programs are unfounded – but from what I have been able to gather from endless research (caused by ruminative thought patterns), it is quite common for folks with mental illness to be involuntarily committed only to be met with tens of thousands or more dollars in debt due to medical costs ranging upwards of $1000 a day for in-patient care. No one except for the truly wealthy could ever afford this. I am sharing this only because I believe that every single article that appears that encourages in-patient treatment should also recognize the fact that it is beyond the financial means of most people.
I am so sorry to hear your story. I hope you are able to find help. Have you considered applying for Medicaid in your state? Since you have a limited income, you may get help paying for your medical bills including a therapist. Some hospitals have programs to pay your medical bills. A local mental health center will offer a spend down. I encourage people to seek inpatient help because it is vital to list it as an option. I hope you feel better soon. Shirley
Dear friend – Larry I am pleased that this discussion prompted you to open up and write about your circumstances. You are blessed to have your husband’s support. I am prompted to speak to you as a physician (40 years in family practice). You can take my advice/observations or just pass on them. Consider the following:
(1) Being able to specify your distress and its dynamics is a healthy start. This is more painful than repressing all thoughts of these adversities, but it is good progress toward liberation in my opinion. You are stronger than you think.
(2) Since this was a column about trauma and suicide, if are having thoughts of suicide call 988 today. Full stop.
(3) I do not know where you are located, but most towns and cities have low cost agencies that can provide support. They probably have waiting lists but look them up (try the United Way or 988) for names and get on some waiting lists.
(4) Self-help toward resilience, may be beneficial and you can find many resources on PACESConnection.com. Search the site and you will many techniques for strengthening your resolve and learn which kind of therapies you might want to search out.
(5) If you are still unemployed, get working again or develop some way to be out and expressive everyday, so you can be you and not just sitting around.
I am 68 years old and my struggle with CPTSD has lasted a lifetime. Ten years of physical and emotional child abuse at the hands of my father has hamstrung my ability to life a full, happy life. I have had insomnia, depression, anxiety and uncontrolled rage since I was a very young child. It has worn me down to a shell of a person. It has aged me prematurely and will lead to premature death. It’s a miracle I did not die from substance abuse or suicide years ago. I get furious when I think how much better my life would have been and would be had I had a childhood without chronic violence. I would not drive a crappy old car and I would not have had low-paying jobs my whole life. It drives me crazy that my extreme suffering could have been prevented and that most people did not have their spirit beaten out of them in childhood.
Mike I am so sorry. However it is most valuable that you put your cry into words. First, you are still alive. Hooray! There are years left when you can unwind, enjoy and thrive. Therapy works. If Shirley is not available to help, there will be someone near you with the capacity to get you on your feet. Opening up and verbalizing the ball and chain you have been carrying around has already taken you down the right path and the road to recovery lies ahead. To as a doctor I see the very way you phrase your anguish means you are smart and have the resources to heal. Be brave. Seek help. Now is the time for life to get better!