It's 9:40 p.m. on a Monday night. The kids are finally down and the last invoice went out an hour ago. You're standing at the kitchen counter eating peanut butter crackers and drinking a glass of red, because even though you made dinner, you forgot to eat it before it got cold. When your husband asks if you're okay, you shrug him off and tell him you're just tired. Which is true. You've been tired since about 2008.

Somewhere in the past year, there's been a question nagging at you. Is something wrong with me? It's not like anything's on fire. It's more like a pit in the bottom of your stomach that you can't trace back to anything.

For example:

You wake up with your jaw aching.
A raised voice in the next room puts you on high alert before your brain can decide whether it matters.
And don't forget the apology that comes out of your mouth before you even know what you did.

If someone suggested trauma, you'd probably just shrug it off. Trauma is what happens to other people. Your childhood had food on the table and two parents at every recital. If anything, your mom still brags that you were the easy one.

There's no way you could have trauma, let alone complex trauma… right?

Middle Class woman in red shirt who looks "fine." — Centre for Ageing Better @Unsplash

What complex trauma actually is

Most people picture trauma as one terrible moment, like a car wreck or a phone call at 2 a.m. Those moments are real, and they can leave real damage.

Complex trauma has a different shape. It comes from harm that repeats over months or years, usually inside a relationship you depended on and couldn't leave. For most women I see, that relationship was with a parent.

The harm didn't arrive as a single event, it was something that happened so often, your nervous system learned to just deal with it.

Even the diagnostic manuals don't fully agree on this. The World Health Organization lists complex PTSD as its own diagnosis. In the DSM, the manual most American clinicians trained on, it still doesn't have a separate listing. That gap is one reason so many women go years without hearing the term, even from therapists.

Complex trauma isn't only about what happened to you.

It's also about what didn't.

Maybe nobody noticed you were struggling, because you got so good at looking fine. Why would you yell "fire" when you learned from a young age that no one was coming?

Like when your parents' divorce got explained once, in the Sonic drive-thru, and never came up again.

Or when you were eleven and knew from the sound of your mom's keys whether to stay in your room, and nobody ever wondered why you spent so much time in there.

Or when your dad was the soft place, but he traveled four nights a week, so you learned to save everything up for Fridays.

Or when you threw up before the piano recital, and the whole ride home was about the notes that you messed up.

A child can get through a hard moment when someone helps her make sense of it afterward. What wears her down is the hard moment followed by silence, over and over, until she learns to handle everything alone. And then she grows up, and everyone calls her the strong one.

Why you might not think you have it

"Other people had it so much worse."

That may be true. It's also beside the point. Trauma isn't a contest, and your nervous system doesn't grade on a curve. It responded to what you lived through at the age you lived through it. Comparison is usually the first thing a woman reaches for when she gets close to her own story, because the truth is, your own story is uncomfortable as hell. Why would you want to face a truth when ignoring it has kept you safe for most of your life?

Ranking your pain is just one more way to make yourself small so nobody has to deal with you. Sound familiar?

Nobody hit you.

Or they did, rarely, and it was always followed by a normal Tuesday. Much of complex trauma is quiet. It looks like a mother whose warmth rose and fell with your report card, or a house where you checked the mood in the kitchen before you took off your shoes. Nothing about it would make the news. It still taught you how safe it was to need anything.

Your life looks fine. Better than fine.

You built a business, and you're also the one who remembers the dentist appointments and teacher appreciation week. From the outside, it looks like proof you're okay.

The part nobody tells you is that competence is one hell of a hiding place. If love at home tracked performance, getting very good at things was the smartest move a kid could make. It worked. The trouble is you never learned when to stop.

One parent was safe.

Having one steady, loving parent is a gift, and it can also make everything harder to name. How could it have been that bad if your dad was so good to you? Both things are true at once. The safe parent didn't cancel out the unsafe one. Often his gentleness is what shows you, in hindsight, how much was missing everywhere else. Which might be why you've spent years defending your mom by pointing at your dad.

You're the one everyone calls.

You can tell your husband is irritated from the way he sets down his keys. Before a client emails to cancel, you already know. That kind of attunement probably feels like personality. For many women it began as a job, handed over early, in a house where someone needed to track the emotional weather. It rarely occurs to anyone that a child of nine shouldn't have had to do that for the 45-year-olds in the room.

What it can look like now

Complex trauma in adult women rarely looks like flashbacks. More often it lives in ordinary places.

In your marriage, it might be the anger that comes out of nowhere and scares you, especially because you love him.

Rest only happens after everyone else is taken care of, which means it mostly doesn't happen. At work, it's often the belief, never said out loud, that you're only worth what you produced today. And in your body, it can be the headache you took ibuprofen for three days running without asking why.

These patterns got you through. But are they still working, or are they why you're eating peanut butter crackers at the counter at 9:40 on a Monday night?

A few questions to sit with

This isn't a quiz or a diagnosis. It's a place to be honest with yourself.

When you picture yourself as a kid having a hard day, who comes to mind as the person you'd go to? Is anyone there?
What happens in your body when someone you love is disappointed in you?
Do you know how to stop working without first feeling like you earned it?
If a friend's daughter described your childhood as hers, would you call it fine?

Pay attention to how these landed.

How to treat complex trauma

You don't need more coping skills. You already cope better than anyone you know, and that's part of the problem. This is how I have treated complex trauma, especially with women that struggle with self-worth, high-functioning anxiety, and feeling as though they abandon themselves in their relationships.

The thing about complex trauma is that your relationships with people often get built on a premise of fear.

What if they leave me? What if I'm not good enough? What if I show up as myself and they don't like me?

During therapy, if the therapist isn't careful, it can end up being a place where things play out much like they did in your childhood, or still do in your adult life. So it's really important to create an environment where trust and safety are built as this is the foundation for relational and trauma-informed therapy.

What that looks like in the therapy room with me:

Before we start, you'll know the ground rules: what I'll ask of you and what you can expect from me.
We will not begin with the worst thing that's ever happened to you. First, you get to find out whether I'm someone you can trust.
When we talk about your parents, I'll call what they did harmful. What you do with that is always your call.
If I get something wrong, you can tell me. Instead of getting defensive or going quiet, I'll own my part and we'll repair it.

The HOCI Model, or Healing Our Core Issues Model is a modality that I use for treating development and relational trauma, sometimes known as complex trauma.

If you want to learn more about the HOCI model, please go here.

EMDR therapy can be useful as well. Both of these modalities are helpful in integrating what happened to you in your nervous system as well as give you permission to tell your story.

Sarah Hill MS LPC

**If you're in Oklahoma**
I'm a licensed professional counselor in the Oklahoma City area, and I work with women across Oklahoma who are tired of ignoring their own needs to please others.
Your needs were never too much. There was just never enough room for you.
There's room for you here.
Schedule a free 20-minute consult call today.

What Is Complex Trauma in Women? (And Why You Might Not Think You Have It)