Briere & Scott (2015)
What the research suggests
Briere and Scott define complex trauma as exposure to multiple, often prolonged or extended traumatic experiences over time. A central argument of the review is that cumulative trauma can matter in at least two related ways: it can increase vulnerability to developing PTSD in response to later events, and it can be associated with a wider range of psychological difficulties than PTSD alone.
The authors describe this broader presentation as symptom complexity. Across the literature they review, repeated trauma exposure is associated with difficulties involving affect regulation, relationships and attachment, identity, distorted beliefs about oneself and others, somatization, dissociation, substance use, and self-injurious behavior. Importantly, they distinguish the history of complex trauma from any single diagnostic outcome. They also acknowledge continuing debate about whether these patterns constitute a distinct syndrome or dimensions of difficulty that vary depending on the type, accumulation, and developmental timing of traumatic experiences.
That complexity carries into treatment. Rather than proposing a single “complex trauma treatment,” the authors review approaches addressing different parts of the presentation: trauma-focused cognitive and exposure work, affect-regulation and coping-skills training, relational approaches, and multi-target treatments such as DBT and STAIR. Their broader argument is that treatment may need to address several interacting domains rather than assuming that processing traumatic memories alone will resolve the entire clinical presentation.
Why I care
What I find particularly useful here is the distinction between complex trauma and complex outcomes. Repeated trauma does not automatically produce one recognizable syndrome. Instead, different experiences occurring at different points in development may shape different psychological systems.
That makes complex trauma much more useful to me as a way of thinking about formulation than as another diagnostic label. Someone may have learned to disconnect from emotion, anticipate danger, protect against rejection, control their environment, avoid vulnerability, or regulate overwhelming states in ways that made sense in the circumstances in which those patterns developed.
The original circumstances can change while the pattern remains.
How it connects to my clinical thinking
This connects directly to my interest in the difference between symptoms and the patterns organizing them.
Someone may arrive in therapy with anxiety, depression, emotional reactivity, dissociation, relationship difficulties, avoidance, shame, substance use, or several of these at once. Those concerns deserve to be understood and treated directly. But when several apparently separate problems coexist, I also want to ask whether there is a larger pattern connecting them.
Trauma is one possible hypothesis.
That shifts my attention from only asking, “How do we reduce this symptom?” toward also asking, “What is this response doing? What circumstances made it useful? And are those circumstances still present?”
I also appreciate that the treatment discussion reflects this same logic. If trauma has affected emotional regulation, relationships, beliefs, coping, and responses to threat, then trauma treatment may need to work across those systems. Processing traumatic memories can be important without becoming synonymous with trauma treatment itself.
What it doesn’t establish
This is a narrative review, not a systematic review or meta-analysis, and it was published in 2015. It synthesizes a substantial existing literature, but it does not establish a single causal pathway from cumulative trauma to the different outcomes it describes.
The difficulties associated with complex trauma are also not specific to trauma. Emotional dysregulation, dissociation, depression, anxiety, interpersonal difficulties, identity disturbance, and maladaptive coping can develop through multiple pathways. Their presence therefore cannot be used as evidence that trauma must be their origin.
The authors themselves preserve an uncertainty that I think is important: whether the patterns associated with complex trauma constitute a distinct syndrome or are better understood as dimensions of difficulty shaped by the nature and developmental timing of different traumatic experiences. Complex trauma can therefore be a useful hypothesis for understanding how a person’s difficulties fit together without becoming an explanation imposed on every complicated presentation.