A Guide to Relational Trauma for Healthcare Professionals

## **Complex post-traumatic stress disorder and relational trauma** Relational trauma often overlaps with complex post-traumatic stress disorder (PTSD), especially when it involves repeated trauma or long-term traumatic experiences within a significant relationship. Unlike single-event trauma, complex relational trauma usually develops in environments where trust and safety are consistently broken. a. Alongside flashbacks and hypervigilance, individuals may also struggle with: - **A negative self-image** – Patients often carry poor self-esteem or feelings of worthlessness shaped by past trauma. - **Emotional dysregulation** – Intense mood swings or difficulty calming down after stress are common relational trauma symptoms. - **Dissociation** – Detaching from reality, often as a coping mechanism during traumatic events. - **Relationship difficulties** – Adults who have experienced relational trauma may find it challenging to maintain fulfilling relationships or trust others. It’s important to remember that complex PTSD doesn’t occur in isolation. It is often tied to other mental health conditions such as depression, substance abuse, or borderline personality disorder.

## **Signs and symptoms of relational trauma** Some common signs of relationship trauma include the following: ### **Unwanted recollections** Intrusive, vivid memories of the traumatic event can make patients feel as though they are reliving the experience. These flashbacks are repetitive, unwanted, and deeply distressing. ### **Feelings of fear or distress** Patients may report intense fear, anxiety, or anger when reminded of past trauma. This can lead to avoidance behaviors, particularly in situations, around people, or environments that trigger them. ### **Guilt and shame** Many survivors struggle with poor self-esteem and feelings of isolation. These negative emotions often complicate relationship difficulties, making it harder to build fulfilling relationships. ### **Nightmares** Relational trauma can disturb sleep, causing recurring nightmares or difficulty falling and staying asleep. ### **Trust difficulties** Survivors of childhood trauma or adult relational trauma may find it difficult to trust others, especially in romantic relationships or other significant relationships. ### **Feelings of suspicion** The violation of emotional, physical, or sexual boundaries can leave individuals hypervigilant, constantly scanning for danger in their surroundings and interactions.

## **Causes and risk factors of relational trauma** When relational trauma occurs, it can shape how a person views themselves and others, increasing the risk of long-term difficulties with trust, self-esteem, and emotional regulation. Read on to know more about causes and risk factors: ### **Impact of abuse and neglect** When children face physical abuse, emotional neglect, or sexual abuse, their sense of trust and safety is damaged. Such interpersonal trauma is one of the strongest predictors of relational trauma and can trigger traumatic memories that resurface well into adulthood. These unresolved experiences may contribute to mental disorders like generalized anxiety disorder, depression, or borderline personality disorder, while also raising the likelihood of physical health problems and long-term difficulties with emotional regulation. The World Health Organization (2024) reports that about 70% of people worldwide will experience a potentially traumatic event during their lifetime, but only a minority, around 3.9% develop PTSD. >Still, the risk is much higher when the trauma is relational in nature, such as ongoing abuse or neglect. Still, the risk is much higher when the trauma is relational in nature, such as ongoing abuse or neglect. ### **Experiences of loss or absence** A child may feel abandoned even if a parent remains present. Divorce, death, long work hours, substance abuse, or other barriers to consistent care can prevent children from receiving the emotional support they need. This lack of support often results in persistent feelings of abandonment, emotional numbness, and a weakened stress response, all of which can profoundly impact an individual’s mental health and physical well-being. ### **Blurring of boundaries** Relational trauma can also arise when parents are overly enmeshed in their child’s life. If a parent relies on the child for their own unmet needs or disregards healthy boundaries, the child may feel suffocated and struggle to form a stable sense of self. These trauma responses can lead to unhealthy and toxic relationships in adulthood, often making it difficult to establish healthy coping mechanisms.

## **Relational trauma co-occurring disorders** Relational trauma is rarely an isolated experience. Many individuals who have lived through childhood relational trauma, attachment trauma, or other forms of interpersonal trauma also develop co-occurring disorders that affect both mental and physical well being. Because trauma responses disrupt emotional regulation, survivors are at higher risk of developing complex trauma patterns that contribute to ongoing difficulties in daily life. Common co-occurring conditions include anxiety disorders, such as generalized anxiety disorder, and mood-related mental disorders like depression. In some cases, persistent traumatic memories and emotional neglect can increase the likelihood of borderline personality disorder or other personality disorders, which complicate future relationships and emotional development. Substance abuse is also a frequent concern, as individuals may turn to drugs or alcohol to cope with emotional harm or unresolved emotional scars. Over time, this can worsen both emotional and physical health problems, reinforcing unhealthy relationships and poor self-esteem.

## **Diagnosing relational trauma** Diagnosing relational trauma can be challenging, as trauma occurs in the context of relationships and often leaves emotional scars rather than visible signs. Many patients may not recognize their past trauma as the root cause of their current struggles, instead presenting with symptoms like low self esteem, anxiety, depression, or difficulties in future relationships. These experiences may overlap with other mental health issues, such as borderline personality disorder or complex PTSD, making careful evaluation essential. A thorough assessment typically begins with a detailed patient history, exploring early attachment patterns, experiences of emotional neglect, physical abuse, or other traumatic experiences within significant relationships. Clinicians should pay attention to trauma responses such as emotional numbness, dissociation, or pervasive feelings of mistrust, which can signal underlying attachment trauma or ongoing interpersonal trauma. Validated screening tools, structured interviews, and observation of relational patterns can help in identifying when relational trauma is a key factor.

## **Treating relational trauma in patients** Addressing relational trauma requires a comprehensive approach that focuses on both emotional well being and physical health. Treatment often begins with creating a safe and supportive environment where patients can process their traumatic memories without fear of judgment. >Since trauma occurs within relationships, building trust with a therapist is an important first step toward healing. Effective therapeutic interventions are essential in helping patients manage trauma responses and rebuild their sense of self. Without supportive environments, therapeutic interventions such as eye movement desensitization, dialectical behavior therapy, or support groups, the profound impact of early trauma may continue to influence emotional well-being across trauma populations. These evidence-based strategies can reduce emotional numbness, improve stress response, and encourage healthy coping mechanisms.

## **Conclusion** Relational trauma leaves lasting emotional scars that can influence an individual’s mental health, physical well-being, and ability to form healthy connections in future relationships. When trauma occurs in childhood through abuse, neglect, or disrupted attachments, the effects may resurface later in life as low self-esteem, emotional numbness, or persistent difficulties with trust and emotional regulation. Left unaddressed, these challenges may contribute to other mental disorders or unhealthy relationships.

### **References** World Health Organization. (2024, May 27). Post-traumatic stress disorder. https://www.who.int/news-room/fact-sheets/detail/post-traumatic-stress-disorder Herzog, J. I., & Schmahl, C. (2018). Adverse childhood experiences and the consequences on neurobiological, psychosocial, and somatic conditions across the lifespan. Frontiers in Psychiatry, 9, 420. https://www.frontiersin.org/journals/psychiatry/articles/10.3389/fpsyt.2018.00420/full