Over the last 30 years, significant advances have occurred in understanding complex trauma—repeated, ongoing, and often extreme interpersonal violence, abuse, and neglect occurring at any life stage or over multiple stages. Experiences of past trauma affect more than 1 in 4 Australian adults, with unresolved complex trauma representing a significant public health challenge affecting both mental and physical health into adulthood. Trauma-informed medical practice means engaging with patients in ways that acknowledge possible unresolved trauma experiences and avoid compounding prior trauma.
Historical Development
In the 1990s, complex trauma was little understood and often misidentified or misdiagnosed. In 1995, Adults Surviving Child Abuse (ASCA)—the forerunner to Blue Knot Foundation—was established to give voice to child sexual abuse survivors. The 2000s brought growing recognition of complex trauma and survivors’ challenges managing emotions, dissociating, and struggling in relationships. In 2012, Blue Knot released landmark practice guidelines on treating complex trauma. The 2013 Royal Commission into Institutional Responses to Child Sexual Abuse heralded public discourse around child sexual abuse and complex trauma. In 2018, Blue Knot Foundation released “Talking about Trauma: Guide to Conversations, Screening and Treatment for Primary Health Care Providers.”
Recognition and Policy Implementation
The 2020s have seen greater acceptance of complex trauma and trauma-informed practice, with growing trauma-informed peer workforces and survivor-led training. In 2021, the ICD-11 formally included Complex PTSD, approximating a description of complex trauma impacts, although the DSM-5 still does not include it. Trauma-informed practice has become more common in mental health, child protection, domestic and family violence, and disability sectors, with emphasis on “nothing about us without us” principles. Medical settings can be triggering for traumatized people, and doctors serve as key contact points for patients with unresolved trauma presenting with diverse health issues—anxiety, depression, alcohol misuse, eating disorders, irritable bowel, cardiovascular disease, and chronic pain.
This article is an AI-assisted summary. All facts and figures are drawn from the original report: https://insightplus.mja.com.au/2025/43/complex-trauma-and-trauma-informed-care-over-30-years/