Developmental Traumas are experiences that involve 13 “Is”: Intentional Interpersonal acts which are Inescapable and cause Injury that is potentially Irreparable, which occur in a manner that is highly Intimate, Intrusive, and Invasive of the body and the self, often involving Imminent Threat, the totality of which results in deformations of Identity (including the capacity to Integrate One’s Identity and Experience and Maintain One’s Integrity) and disrupting Interpersonal Capacity for Intimate and Other Relationships.

The first two “I’s” are intentional interpersonal acts that violate the rights and integrity of others with the intent of meeting a particular need (e.g., among others, domination, power, sex, affection, sadism) of the perpetrator, i.e., the “evil that men [and women] do.” When people harm other people, it constitutes a desecration of the basic social contract, a willful disregard for and disrespect of the safety, dignity, integrity, and well-being of other human beings. In addition to creating fear in relation to the perpetrator(s) (which can result in the PTSD symptoms of intrusive re-experiencing, numbing, avoidance, and hypervigilance), such acts raise existential issues and call into question whether anyone can be trusted, whether there is any hope for the future, and whether there is something fundamentally damaged or defective about the survivor that made them the target or victim of the trauma and possibly its cause (Herman, 1992). Many CT survivors describe themselves, their existence, or their worlds as being a void. Moreover, when harm is perpetrated by individuals or institutions that should safeguard the welfare and rights of victim/survivors, this betrayal exacerbates the original betrayal involved in the trauma, causing additional fear and demoralization that can lead to a sense of shame and profound disconnection and alienation from self and others (Smith & Freyd, 2014).

When traumatic experiences actually are, or seem to be, inescapable, the sense of being entrapped and helpless can lead to a combination of conditioned defeat and learned helplessness in both children and adults (Hammack, Cooper, & Lezak, 2012). In extreme cases such as when political or ethnic violence involves subjecting children (Gadeberg, Montgomery, Frederiksen, & Norredam, 2017) or adults (McDonnell, Robjant, & Katona, 2013) to captivity or torture, victims understandably can feel morally and mentally defeated and helpless to protect themselves, loved ones, and their community and institutions. Tragically, the core features of captivity and torture are not limited to those public forms of violence, but also can occur in more disguised ways as a result of child abuse and domestic or intimate partner violence, and in single or repeated episodes of sexual assault, sexual harassment, or kidnapping. Much like the response of animals to inescapable danger when escape from a predator is impossible, human victims often go beyond the initial physiological fight or flight defensive response and move into a state of freeze and collapse (also known as “tonic immobility,” the body and mind shutting down (Bovin et al., 2014, p. 721). This response, which appears to be an automatic self-protective reaction that occurs without conscious intent, ironically can later cause the victim to feel chronically guilty and ashamed for not having been better at fighting back or self-protection (Bovin et al., 2014), feelings that potentially set the stage for severe or complex PTSD symptoms.

The irreparable injury that is caused by intentional and inescapable acts of harm and personal intrusion primarily is psychological and spiritual (Walker, Courtois, & Aten, 2015), although certainly it causes considerable physiological damage as well. Moral injury initially was thought to occur when a survivor committed acts in traumatic events that violated  personal values, but also has been found to be associated with being violated psychologically and spiritually by other person(s) (Hoffman, Liddell, Bryant, & Nickerson, 2018). Moral injury sustained as a result of one’s own or others’ actions often leads to severe anger and depression as well as PTSD, but when injury results from the actions of others (i.e., especially when they involve betrayal of some sort and violate the terms of a relationship or an agreed-to duty or responsibility), the PTSD symptoms are often the most severe and complex. Moral injury caused by others’ acts also tends to be associated with a sense of having been not only harmed but essentially damaged in ways that seem irreparable, and this can lead to severe problems with feeling disillusioned with and alienated from others, alienated from self grossly defective, deserving of mistreatment and lack of assistance. Dissociation, self-harm, multiples forms of addiction, and suicidality can occur in response to these feelings (Ford & Gomez, 2015).

Although intentional, inescapable, and irreparably injurious acts occur either in public or in private, in either case they are intimate, intrusive, and invasive since they violate the survivor’s physical, psychological, and spiritual integrity and boundaries. Because complex trauma is the opposite of safe, respectful, mutual, and self-determined intimate encounters or relationships, it calls into question the safety, sanctity, and even the very possibility of being a unique and integrated individual who can be intimately involved with other human beings. When experiences involve psychological or physical (or both) domination, oppression, and intrusion, the sense of subjugation and exploitation intensifies the survivor’s sense of inescapable and irreparable injury, often identified as self-alienation that occurs in conjunction with problems of self-integration. This, in turn, leads to estrangement and withdrawal from contact with others, identified as other-alienation and involving profound mistrust (see Chapter 24).

The result of developmental trauma is a set of automatic survival adaptations that carry a heavy cost:  severely dysregulated emotions and actions, depression, panic and other anxiety conditions and disorders, anger and rage, addiction, disorders of eating or sexual involvement, psychosomatic or autoimmune illness, borderline personality disorder, psychosis, or suicidality. These are the cardinal features and adaptations—not disorders but complex stress reactions—of the DTDs.