[Towards an integrative understanding of complex trauma]

Area of Science:

• Psychiatry and Neuroscience
• Psychotraumatology
• Developmental Psychology

Background:

• The World Health Organization (WHO) advocates for integrating adversity history into health assessments.
• Understanding complex trauma mechanisms is incomplete, spanning neurobiological, psychological, and relational domains.
• Existing knowledge gaps hinder a comprehensive vision of complex trauma's impact.

Purpose of the Study:

• To synthesize key scientific literature on complex trauma.
• To propose a more global and comprehensive understanding of complex trauma.
• To analyze clinical forms of complex trauma in relation to stress, cognition, and attachment.

Main Methods:

• Literature review synthesizing neurobiology of chronic stress, cognitive-emotional disorders, and attachment theory.
• Analysis of four key dimensions in the psycho-traumatic equation: adversity factors, onset circumstances, vulnerabilities, and environmental resources.
• Examination of borderline personality disorder as a model for complex trauma pathophysiology.

Main Results:

• Complex trauma pathophysiology involves early experiences, self-alterations, and affective regulation disorders.
• Borderline personality disorder serves as a model for a two-stage pathophysiology influenced by prior psychobiological changes.
• Four dimensions (adversity, onset, vulnerability, support) are critical in complex trauma.

Conclusions:

• Complex trauma requires a shift from symptom-focused to a dual synchronic/diachronic approach, integrating patient history.
• A systemic vision encompassing the individual and their environment is crucial for understanding trauma.
• Complex trauma challenges traditional psychiatric disorder definitions, particularly personality disorders.