Complex trauma isn't a single traumatic event that happened once. It's what occurs when you've lived through ongoing, inescapable harm—often starting in childhood or within relationships that were supposed to be safe. Sometimes this harm comes from systems that were meant to protect you: families, schools, churches, or other institutions.

When safety, trust, and connection are consistently absent, it changes how your brain and body work. It affects how you see yourself, your sense of who you are, how you manage emotions, connect with others, focus, remember things, and make sense of your world. Sometimes this includes addiction, which is often a normal part of how people adapt to survive unbearable circumstances.

In the ICD-11 (the World Health Organization's International Classification of Diseases, 11th edition), both PTSD and Complex PTSD are recognized as distinct diagnoses. However, it's important to note that the United States is currently still using ICD-10 and has not yet adopted ICD-11, so Complex PTSD is not yet an official diagnosis in the U.S. diagnostic system.

In ICD-11, Complex PTSD is characterized as a variant of PTSD with additional and more severe symptoms that typically arise from prolonged or multiple traumatic experiences.

PTSD includes three core symptom clusters:

• Re-experiencing the trauma in the present (intrusive memories, flashbacks, nightmares)

• Avoidance of trauma reminders

• A heightened sense of current threat (hypervigilance, heightened startle response)

Complex PTSD includes all the PTSD symptoms plus three additional "Disturbances in Self-Organization" (DSO):

• Emotional dysregulation: Difficulty managing emotions, feeling overwhelmed or numb

• Negative self-concept: Persistent feelings of worthlessness, shame, or being fundamentally damaged

• Interpersonal difficulties: Struggles with trust, connection, and maintaining relationships

CPTSD is commonly associated with greater exposure to multiple interpersonal traumas earlier in life and exhibits higher functional impairment compared to PTSD. The trauma that leads to CPTSD often occurs in situations where escape was impossible—such as childhood abuse, prolonged domestic violence, captivity, or other ongoing harmful situations within relationships or systems that were supposed to be safe.

Complex trauma can affect nearly every aspect of life. Ford and Courtois (2016) identify a comprehensive range of potential effects that may include:

Emotional and mood-related:

• Extreme mood shifts between emotional extremes or cycling between heightened arousal and severe shutdown

• Chronic low self-esteem and self-loathing

• Persistent feelings of shame, guilt, and unresolved grief

• Difficulty tolerating or recovering from even mild emotional distress

Relational patterns:

• Social isolation, feeling alienated or detached from others

• Fear of intimacy and relationships, or excessive dependency and compliance with others' wishes

• Dysfunctional relationships that may be emotionally or physically harmful, exploitative, or involve revictimization

• Persistent suspicion and mistrust of others, leading to social problems

• Insecure attachment styles (ambivalent, dismissive, dependent, conflicted, anxious, fearful, or disorganized)

Behavioral responses:

• Addictions (including substances, relationships, and sexual contact)

• Compulsions such as eating disorders, overwork, hoarding, gambling, or excessive spending

• Self-injury or suicidality

• Impulsivity, high-risk behaviors, or uncontrolled anger toward self or others

Sense of self:

• Dissociation, depersonalization, derealization, and loss of personal continuity and awareness

• Feelings of hopelessness, despair, or being viewed by others as "abnormal"

• Self-blame and self-condemnation

• Pervasive feelings of helplessness and ineffectiveness

Cognitive and processing difficulties:

• Problems with attention, focus, and completing tasks

• Difficulty discussing personal events and life history

• A sense of being an "imposter" despite performing well

Physical health:

• Medical conditions that don't respond to treatment

• Chronic autoimmune disorders

• Chronic pain

Trauma-specific responses:

• Intrusive reexperiencing and physiological hyperarousal

• Emotional numbing and avoidance of trauma reminders

Meaning and belief systems:

• Alienation from or rejection of spirituality and spiritual/religious beliefs

• Pervasive feelings of hopelessness about ever being understood or able to be viewed as "normal"

Yes. I am in-network with OHP Open Card and take these insurance options in Oregon and Washington: United Healthcare (UMR, UBH, OPTUM), Aetna, Regence Blue Cross Blue Shield, First Choice Health, Kaiser, PacificSource.

There is no single definition of dissociation, but one way to define it is "a disruption in the usually integrated functions of consciousness, memory, identity, or perception of the environment" (American Psychiatric Association, 2000, p. 519). In more everyday terms, it's a survival response where your mind creates distance from overwhelming experiences, emotions, or physical sensations. It's one of the most creative and protective things your brain can do when something feels unbearable.

When dissociation becomes more severe, it can involve a significant failure in how different aspects of your experience come together and make sense as a whole (Jones, 2001; Ogawa, Sroufe, Weinfield, Carlson, & Egeland, 1997). This might affect how memories connect, how you experience your sense of self, or how you perceive what's happening around you.

Dissociation might feel like:

• Being disconnected from your body or watching yourself from outside

• Losing time or having gaps in your memory

• Feeling unreal, foggy, or like you're moving through life on autopilot

• Parts of yourself that feel separate or in conflict with each other

• Numbness or feeling emotionally flat when you "should" feel something

• Difficulty integrating memories, emotions, and experiences into a coherent sense of who you are

Sessions are typically 45-60 minutes via phone or video through an electronic health record platform. In each session we collaborate. Much of what I do is responsive to the moment.