Acknowledging complexity in the impacts of sexual victimisation trauma

ACSSA Issues No. 16 – February 2014

Introduction

The adverse impacts of sexual victimisation have been extensively documented, and significant amongst these is the negative impact on the mental health of victim/survivors (Boyd, 2011). Some psychological and behavioural responses to sexual victimisation have been recognised as coping strategies for victim/survivors to deal with traumatic events. The dominant framework through which the mental health responses to trauma are understood and organised has been through a diagnosis of post-traumatic stress disorder (PTSD). However, the diagnostic category of PTSD was developed in response to the symptoms seen in survivors of one-off, or relatively contained events, such as a natural disaster. Many researchers in the fields of psychiatry, traumatology, and social work do not see PTSD as adequately capturing the effects of chronic and/or multiple types of victimisation (Briere & Spinazzola, 2005; Herman, 1992; Higgins & McCabe, 2000). Sometimes the reach of effects can extend beyond mental health and surface as somatic complaints or substance abuse issues. In such instances, it may not be immediately apparent that there is a link to sexual victimisation trauma.

It is a particular type of victimisation that gives rise to complex trauma, usually prolonged or multiple types of interpersonal abuse. It often commences at an early age, thereby affecting emotional development and often the perpetrator is an authoritative figure in the victim's life. The variety of impacts arising from sustained or chronic trauma has resulted in the development of the concept of complex trauma to reflect the varying symptomatology, co-occurring disorders and multiple adverse experiences that combine to impact on victim/survivors of multiple or ongoing and interpersonal traumas such as childhood sexual abuse. The impacts of ongoing trauma can be seen in the links between many social issues and the traumatic experiences of victim/survivors. For example, it is estimated that up to 80% of women seeking treatment for substance abuse disorders have histories of sexual or physical abuse or both (Cohen & Hien, 2006). A history of abuse trauma is also a feature in the lives of many homeless people (Morrison, 2009). The complexity of different needs that people with traumatic abuse backgrounds often have can encompass assistance with social care, such as finding employment or housing, to dealing with a range of psychiatric disorders. The levels and types of service needs involved mean that traumatised people are frequently the highest users of costly care in the health system (Jennings, 2004) and government services. However, these problems are still often treated separately as if they are distinct issues, instead of a complex suite of human responses to trauma.

What has become apparent to services that deal with clients suffering multiple disorders and a complex array of trauma symptoms is that treatment needs are multifaceted and varied. Isolated treatment of trauma symptoms may only impact on one aspect of their needs. An approach to intervention that looks at encompassing the whole cluster of symptoms is more likely to facilitate sustainable improvement (Cohen & Hien, 2006).

This Issues paper aims to provide an overview of complex trauma as a concept for classifying a varying range of symptomatology that is also a pervasive driver of need for many users of human services. The literature reviewed shows that the particular trauma associated with ongoing interpersonal violence, such as sexual violence, has complex impacts and effects that will vary on a case-by-case basis. The term "complex trauma" is used in this paper, not as a diagnostic term but in order to refer to a particular range of symptoms and connected social issues that manifest in many victim/survivors who have experienced early onset, chronic sexual victimisation. Other terms are often used in relation to victim/survivors or service users who experience the significant and particular symptomatology that is being discussed to here. Other terms, such as "complex post-traumatic stress disorder" have developed from the fields of psychology and psychiatry to encompass the complex and varying set of symptoms and social problems, such as substance abuse and vulnerability to re-victimisation, often seen in individuals that have suffered prolonged and repeated trauma experiences often beginning in childhood (Connor & Higgins, 2008a). This Issues paper provides an overview of complex trauma as a response to chronic sexual victimisation and considers what this means for services and service configurations. It will also look at the implications of acknowledging complex trauma for policy responses in health and human service fields.