1. Attachment – Uncertainty about the reliability and predictability of the world, problems with boundaries, distrust and suspiciousness, social isolation, difficulty attuning to other people’s emotional states and points of view, difficulty with perspective taking and difficulty enlisting other people as allies.
2. Biology – Sensorimotor developmental problems, problems with coordination, balance, body tone, difficulties localizing skin contact, hypersensitivity to physical contact, analgesia, somatization, increased medical problems.
3. Affect or emotional regulation – easily-aroused high-intensity emotions, difficulty with emotional self-regulation, difficulty describing feelings and internal experience, chronic and pervasive depressed mood or sense of emptiness or deadness, chronic suicidal preoccupation, over-inhibition or excessive expression of anger and difficulty communicating wishes and desires.
4. Dissociation – distinct alterations in states of consciousness, amnesia, depersonalization and de-realization and two or more distinct states of consciousness, with impaired memory for state-based events.
5. Behavioral control – poor modulation of impulses, self-destructive behavior, aggressive behavior, sleep disturbances, eating disorders, substance abuse, oppositional behavior, excessive compliance, pathological self-soothing behaviors, difficulty understanding and complying with rules and communication of traumatic past by reenactment in day-to-day behavior or play (sexual, aggressive, etc.).
6. Cognition – difficulties in attention regulation and executive functioning, problems focusing on and completing tasks, difficulty planning and anticipating, learning difficulties, problems with language development, lack of sustained curiosity, problems with processing novel information, problems with object constancy, problems understanding own contribution to what happens to them, problems with orientation in time and space, acoustic and visual perceptual problems, impaired comprehension of complex visual-spatial patterns.
7. Self-concept – lack of a continuous and predictable sense of self, low self-esteem, feelings of shame and guilt, generalized sense of being ineffective in dealing with one’s environment, belief that one has been permanently damaged by the trauma, poor sense of separateness, disturbances of body image and shame and guilt.
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The symptoms and behavioral characteristics of complex trauma have been categorized into seven domains: