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Dr. Spinazzola is executive director, The Trauma Center, Justice Resource Institute, and National Center on Family Homelessness, Boston, MA, and research associate, Division of Psychiatry, Boston University School of Medicine, Boston. Dr. Ford is associate professor, Department of Psychiatry, University of Connecticut Health Center, Farmington CT, and research and evaluation dirctor, Yale/University of Connecticut Child Violent Trauma Center. Dr. Zucker is research associate and postdoctoral fellow, The Trauma Center. Dr. van der Kolk is professor of psychiatry, Boston University Medical School, Boston; clinical director, The Trauma Center; and co-director, National Child Traumatic Stress Network Community Program, Boston. Dr. Silva is associate research professor, medical psychiatry, Duke University Medical Center and Duke Clinical Research Institute, Durham, NC. Dr. Smith is research associate, The Trauma Center. Dr. Blaustein is director of training and education, The Trauma Center, Justice Resource Institute, and National Center on Family Homelessness, and research associate, Division of Psychiatry, Boston University School of Medicine.
The term complex trauma refers to a dual problem of exposure and adaptation. 1,2 Complex trauma exposure is the experience of multiple or chronic and prolonged, developmentally adverse traumatic events, most often of an interpersonal nature (eg, sexual or physical abuse, war, community violence) and early-life onset. These exposures often occur within the child's caregiving system and include physical, emotional, and educational neglect and child maltreatment beginning in early childhood (Cook et al., see page 390). 2
According to the National Child Abuse and Neglect Data System developed by the Children's Bureau of the US Department of Health and Human Services (DHHS), 903,000 cases of child maltreatment were substantiated in the United States in 2001 - and this number is thought to be an underestimate. 1 The Third National Incidence Study of Child Abuse and Neglect, 2 an epidemiological study, estimated the incidence of children at risk of harm through abuse and neglect to be 2,815,600 in 1993. Considering that complex trauma may take many other forms in addition to maltreatment (eg, chronic exposure to community violence, loss of a primary caregiver in early childhood), it is undeniable that child complex trauma is a prevalent public health problem.
A growing body of research has clearly substantiated that complex trauma exposure leads to chronic problems across multiple domains of self-regulation: affective,...