What are the effects of relational trauma?

From the Guidelines

Relational trauma can have severe and long-lasting effects on individuals, and the most effective treatment approach is trauma-focused therapy, which can be initiated without a stabilization phase, as evidenced by recent studies 1. The effects of relational trauma can manifest in various psychological, emotional, and physiological symptoms, including difficulty forming and maintaining healthy relationships, trust issues, emotional dysregulation, hypervigilance, and negative self-perception. People who have experienced relational trauma may develop attachment disorders, anxiety, depression, post-traumatic stress disorder (PTSD), or complex PTSD. Some key points to consider in the treatment of relational trauma include:

• The importance of trauma-focused therapy approaches, such as Eye Movement Desensitization and Reprocessing (EMDR), Cognitive Behavioral Therapy (CBT), or Dialectical Behavior Therapy (DBT) 1
• The need for consistent weekly sessions, often requiring 6-12 months of treatment 1
• The importance of building a support network, practicing self-compassion, and establishing healthy boundaries as crucial components of healing
• The fact that relational trauma can alter brain development and function, particularly in areas responsible for stress response and emotional regulation, leading to heightened cortisol levels and an overactive amygdala Recent studies have shown that trauma-focused treatment can be effective for individuals with complex PTSD, and that a stabilization phase may not be necessary before initiating trauma-focused treatment 1. In fact, research has failed to support the view that symptom exacerbations are more common in individuals who receive trauma-focused treatment than in those who do not receive any treatment 1. Additionally, dropout from treatment is most likely due to patient-related reasons, such as travel time, caring for young children, or stressful life events, rather than trauma characteristics 1. Therefore, trauma-focused therapy should be initiated as soon as possible, without a stabilization phase, in order to promote optimal recovery and minimize the risk of symptom exacerbation or dropout 1.

From the Research

Relational Trauma Effects

• Relational trauma can have severe and long-lasting effects on an individual's mental health and well-being, including difficulties in emotional regulation, interpersonal relationships, and shame 2, 3, 4.
• The effects of relational trauma can be complex and multifaceted, involving repeated incidence of maltreatment over an extended period of time, including emotional abuse, physical abuse, sexual abuse, neglect, and witnessing family violence 3.
• Relational trauma can lead to the development of complex post-traumatic stress disorder (cPTSD), a condition characterized by severe difficulties in emotional regulation, interpersonal relationships, and shame 2, 4.
• The treatment of relational trauma often requires a phase-based approach, addressing shame and emotional regulation prior to exposure therapy, and may involve therapies such as trauma-focused cognitive-behavioral therapy (TF-CBT) 4, 5.
• Group therapy can be an effective treatment for relational trauma, providing a safe and supportive environment for individuals to form valued relationships, develop a comprehensive understanding of themselves and their difficulties, and experience compassion from others 4.

Therapeutic Interventions

• Therapeutic interventions for relational trauma may include alliance repair, developing reflective functioning, and motivational enhancement 3.
• TF-CBT has been shown to be a safe, tolerable, and acceptable treatment for interpersonal trauma in transitional-aged youth, with significant improvements in PTSD, anxiety, and depression symptoms 5.
• The treatment of relational trauma may also involve the development of self-compassion and the formation of a "compassionate armour" to protect against further trauma and shame 4.

Prevalence and Classification

• Relational trauma is a common experience, with reports from many countries indicating that various forms of abuse may occur in relationships with adults, usually parents, on whom the child is dependent for many years 2.
• The 11th edition of the International Classification of Diseases (ICD-11) introduces a new diagnosis: complex post-traumatic stress disorder (cPTSD), which is related to relational trauma 2.