“The core experience of psychological trauma is disempowerment and disconnection from others.” — Judith Herman

Trauma is less about what happens and more about what happens inside of us when an experience or environment threatens our sense of safety and overwhelms our capacity to cope.

Complex trauma most often emerges from chronic or repeated interpersonal harm that occurs within relationships and environments that were supposed to provide care and protection, and in situations that were inescapable (e.g. developmental, attachment, systemic, institutional, and identity-based traumas).

Effects of complex trauma include:

• Difficulties tolerating and regulating emotions and associated impulsive urges

• Dissociative experiences

• Attention and executive functioning problems

• Negative, contradictory, or disconnected sense of self/identity

• Difficulties trusting others, intense fears of intimacy or abandonment

• Somatic/physical symptoms without medical explanation (e.g. stomach problems, nausea, headaches, joint and muscle pain)

• Changes in meaning, losing faith in pre-established core belief systems, hopelessness

Dissociative responses often begin as survival strategies to cope with overwhelming experiences and environments. They include a wide array of symptoms, ranging from mild to severe and temporary to chronic. Dissociative experiences can feel frightening, difficult to make sense of, and hard to describe in words.

• Alienation or estrangement from your sense of self, your body, or your surroundings: Feeling numb, blank/empty, or “dead inside,” insensitive to physical pain or sensation, sense of usual surroundings or people appearing unfamiliar, unreal or hazy, noises sounding more distant than they are

• Loss of time or memory (past or present): memory feels “foggy” or full of gaps (e.g. you remember 9th and 12th grade, but nothing in between), not knowing what you did for hours or days at a time

• Time distortions: experiences of time moving too fast or too slow, being confused about where you are in space and time

• Intrusions: abrupt changes to mood states, sudden feelings, thoughts, impulses, or behaviors that come “out of the blue,” unexplained physical pain or other sensations that has no medical cause, a sense of being physically controlled by someone else

Chronic irritability or anxiety, depression, mood swings, or feelings of guilt, shame, or unworthiness often reflect a nervous system that has learned to stay on either high alert or shut down/withdraw to cope with real or perceived threats. This can also lead to co-occurring secondary problems, such as using substances to either “upregulate” or “downregulate” mood and energy and isolation and avoidance-related behavior to manage anxiety, depression, or shame.

Both trauma and ADHD can create challenges with executive functioning (EF): a set of interrelated skills and abilities an individual uses to direct themselves toward a goal over time. Difficulties across EF domains include:

• Motivation- difficulties getting started on tasks and/or completing tasks, difficulties sustaining attention or effort on unpleasant or boring tasks

• Self-restraint/impulsivity - saying or doing things without regard to their consequence, poor inhibition or reactivity to events

• Emotion Regulation - quick and intense reaction to events, difficulties self-soothing and refocusing attention away from “trigger,” emotionally reactive in ways that interfere with long-term goals and welfare

• Time Management: difficulties having an accurate sense of time, planning, preparing for deadlines and other goal-directed behavior

• Organization/Problem-Solving: difficulties organizing ones thoughts, actions, and writing, difficulties problem-solving obstacles or making adjustments for unexpected events