How Do Complex Trauma Symptoms Manifest in Older Female Survivors of Intimate Partner Violence?

What you need to know

• Complex post-traumatic stress disorder (CPTSD) symptoms were identified in the narratives of older female survivors of long-term intimate partner violence (IPV).
• Key symptoms included difficulties regulating emotions, negative self-beliefs, challenges managing threat responses, and problems sustaining relationships.
• Understanding these complex trauma responses can help therapists provide more effective, trauma-informed care for IPV survivors.

Understanding Complex Trauma in Intimate Partner Violence Survivors

Intimate partner violence (IPV) is a serious public health issue that can have devastating long-term impacts on survivors’ mental health and well-being. While post-traumatic stress disorder (PTSD) is commonly associated with trauma from IPV, researchers are increasingly recognizing that the effects of prolonged, repeated trauma can be more complex.

This study explored how symptoms of complex post-traumatic stress disorder (CPTSD) manifest in the stories of older women who have survived long-term intimate partner violence. CPTSD extends beyond typical PTSD symptoms to include difficulties with emotional regulation, negative self-concept, and problems in relationships. By examining survivors’ narratives through a complex trauma lens, the researchers aimed to provide insights to help therapists better understand and support this population.

Emotional Regulation Challenges

One of the key themes identified in survivors’ stories was difficulty regulating emotions, particularly anger and self-destructive urges. Many women described intense emotional responses to the abuse they endured, including aggressive thoughts or actions toward their abuser:

“I used to look at him and think I wish you were dead, he used to walk past me, and I’d think die, just leave me in peace,” reported one 63-year-old participant.

Others turned these intense emotions inward, resulting in self-harm and suicidal thoughts:

“I’d attempted to take me own [life] and I think it was the hospital that got them [women’s service] in touch with me, ‘cause they were worried,” shared a 58-year-old survivor.

These emotional regulation challenges align with the CPTSD symptom of “difficulties in affect regulation.” For survivors, extreme emotional responses likely served as coping mechanisms for managing overwhelming trauma. However, they can persist long after leaving an abusive relationship.

Eroded Self-Concept and Beliefs

Another prominent theme was how prolonged abuse impacted survivors’ core beliefs about themselves and relationships. Many women expressed beliefs that normalized abuse or blamed themselves:

“I blame myself for what happened. I mean to me it just seems to never end I feel as if what am I doing wrong in life for people to do these things to me,” said one 53-year-old participant.

Some traced these beliefs to early life experiences or cultural messages that taught them to accept mistreatment:

“The way I was brought up was that once you’re married, you’re married for life…and you do whatever your husband says or does,” explained a 45-year-old survivor.

This erosion of self-determination and tendency toward self-blame are hallmarks of the negative self-concept associated with CPTSD. Survivors internalized abusive messages, impacting their sense of self-worth and agency.

Ongoing Hypervigilance and Threat Response

The research also found that many survivors described ongoing hypervigilance and difficulty managing perceived threats, even long after leaving abusive relationships. This manifested as heightened awareness of potential danger and attempts to minimize risk:

“I started getting a bit like, jittery because then once the kids were out, it was just like me and him and I would be wary of what I was doing or…if I was like washing dishes, like, how much noise I was making,” shared a 45-year-old participant.

Some women also reported dissociative responses when recalling traumatic memories:

“I thought, I can go back and he can batter me head in, I’ll blank him out, and you think of all the other ways of getting round…me head was mashed,” described a 63-year-old survivor.

These persistent threat responses align with both PTSD and CPTSD criteria related to hyperarousal and dissociation. For survivors, these responses likely developed as protective mechanisms but can persist as maladaptive coping strategies.

Relationship Difficulties

The final key theme identified was challenges forming and maintaining relationships. Many survivors described an inability to trust others and a tendency to conceal their experiences:

“I don’t trust my friends,” stated a 51-year-old participant simply.

Others felt compelled to hide their abuse out of shame or fear of judgment:

“I thought they are not going to believe what I say and plus…I was embarrassed, I was ashamed of what he was making me do,” shared a 52-year-old survivor.

This struggle to sustain relationships and reluctance to be vulnerable with others is another hallmark of CPTSD. For survivors, past betrayals and prolonged isolation can make forming new connections extremely challenging.

Implications for Therapy

Understanding how complex trauma symptoms manifest in IPV survivors’ stories has important implications for therapeutic practice. The researchers emphasize several key considerations for clinicians working with this population:

1. Recognize that behaviors like emotional dysregulation, self-blame, and relationship avoidance may stem from complex trauma rather than other mental health conditions.

2. Create a safe, trusting therapeutic relationship, as survivors may struggle with attachment and vulnerability.

3. Use trauma-informed approaches that validate survivors’ experiences and emphasize “what happened to you” rather than “what’s wrong with you.”

4. Be prepared for dissociation, hypervigilance, and other trauma responses to emerge in therapy.

5. Take a holistic approach to treatment that addresses cognitive, emotional, physiological, and interpersonal impacts of prolonged trauma.

6. Understand that healing from complex trauma takes time and may require longer-term therapy to address deeply ingrained beliefs and coping strategies.

By viewing survivors’ experiences through a complex trauma lens, therapists can provide more compassionate, effective care tailored to the unique needs of those healing from prolonged intimate partner violence.

Conclusions

• Older female survivors of long-term IPV often exhibit symptoms of complex post-traumatic stress disorder in their narratives of abuse and its aftermath.
• Key CPTSD symptoms found include emotional dysregulation, negative self-concept, persistent threat responses, and relationship difficulties.
• Understanding these complex trauma presentations can help therapists provide more targeted, trauma-informed care for IPV survivors.
• Further research is needed to explore complex trauma in diverse populations of IPV survivors and develop tailored treatment approaches.