Complex Trauma

Defining trauma is an individualized process that includes looking at events, experiences, and effects. Best practices explicitly state the importance of an individual's experiences when defining trauma. Therefore, solely utilizing a professional lens for discussion is often inappropriate. The purpose of this chapter is to examine trauma and trauma-informed care through both a professional and personal lens. Research on outcomes for children internationally adopted or living in foster care will be intertwined with personal narrative. Erikson's theory of psychosocial development will be the lens to examine how trauma affects life and learning as children grow and mature. Finally, specific anecdotal strategies will be shared that either provided or negated support on how potentially to navigate public and higher education systems in the United States.

Boarding school syndrome: reconsidered in social context and through the lens of attachment theory

I argue the time has come to expand the now recognised clinical diagnosis of boarding school syndrome to take account of its invisible precursors in the avoidant attachment patterns of British upper-class culture. This elite, comprising less than 1% of the population, has sustained fee-paying boarding “public” schools, and is sustained by them, in a remarkably effective nexus of power and influence. I propose to call this avoidant culture with its severe affective limits and entitled assumptions, “British upper-class complex trauma condition”. Until we can recognise it and understand it as a form of group trauma, we will not be able to deal with its grave incapacity when it comes to empathy with the lives of others. Like Bowlby1, I advocate the abolition of early boarding as a key part of transforming the condition’s psychosocial limitations, which profoundly impact us all.

A Meta-Analysis of Childhood Maltreatment in Relation to Psychopathic Traits

Psychopathy is a personality disorder characterized by a mix of traits belonging to four facets: affective (e.g., callous/lack of empathy), interpersonal (e.g., grandiosity), behavioral instability (e.g., impulsivity, poor behavioral controls), and social deviance (e.g., juvenile delinquency, criminal versatility). Several scholars have argued that early childhood maltreatment impacts the development of psychopathy, although views regarding its role in the four facets differ. We conducted a meta-analysis including 47 studies comprising a total of 349 effect sizes and 12,737 participants, to investigate the association between the four psychopathy facets and four types of child maltreatment: physical abuse, emotional abuse, neglect, and sexual abuse.We found support for a moderate link between overall psychopathy and childhood physical abuse, emotional abuse, and neglect, as well as overall childhood maltreatment. The link between psychopathy and childhood sexual abuse was small, but still significant. These associations were stronger for the behavioral and antisocial facets than for the affective and interpersonal facets of psychopathy, but nearly all associations were significant. Our findings are consistent with recently developed theories on the role of complex trauma in the development of severe personality disorders. Trauma-focused preventive and therapeutic interventions can provide further tests of the trauma-psychopathy hypothesis.

The School Counsellor’s Role in Trauma-Aware Education

It is not unusual for school counsellors to be involved in trauma-aware education practice; however, their role is not uniformly defined in the literature nor consistently applied in professional settings. Trauma-aware education is relatively new but rapidly growing in Australia and beyond. It involves supporting students in a neuroscience-informed manner to address the impacts of complex trauma on their capacities to feel safe, to relate, to emotionally regulate, and to learn. Twenty-six school counsellors completed questionnaires, and eight of those joined focus group discussions to explore the role of school counsellors in trauma-aware practice in Queensland, Australia. Drawing on the voices of practitioners, the present report discusses categories of practice that are prioritised by school counsellors and recommends supports to effectively undertake trauma-aware practice in school settings.

Safety and Efficacy of Collagen-Based Biological Dressings in the Management of Chronic Superficial Skin Wounds in Non-Complex Trauma: A Post-Marketing Surveillance Study

Biological dressings such as collagen and hyaluronic acid represent the main advanced tools that plastic surgeons, dermatologists and vulnologists use today to treat chronic wounds or ulcers that do not tend to heal. These types of dressings are important because they create a moist and physiological interface at the wound level, are of natural origin, easy to use, hypo-allergenic, economical and do not create discomfort for the patient during dressing changes. We treated 128 patients (divided into four groups based on type of dressing) with non-complex superficial chronic wounds in comparison with a traditional dressing (fitostimoline gauze or polyurethane foam). We analyzed wound characteristics, healing time, and operator and patient satisfaction. A significantly higher recovery rate was observed in the “Collagen-coated plates” treatment group compared to Standard Treatment. Additionally, a significantly higher probability of recovery was observed compared to the alternative two experimental devices (Collagen-coated plates + HA and Collagen-based spray). However, the main limitation of the randomization of this study is the presence in the “Collagen-based spray” group of localized wounds, mainly in the fingers and hand. No side effects were reported in relation to the procedures or the experimental products. Collagen may be considered as a valuable therapeutic tool in non-complex chronic wounds by virtue of its low immunogenicity, flexibility and applicability in biocompatible scaffolds, and represents driving force toward enhanced wound care.