Relational Trauma, Attachment Trauma, and Developmental Trauma in Relation to CPTSD and Health

Complex Post-Traumatic Stress Disorder (CPTSD) is most often associated with trauma that is chronic, repeated, and rooted in relationships. Unlike single-incident trauma (such as a one-off accident or event), CPTSD develops when a person grows up or lives for long periods in environments that feel unsafe, unpredictable, or emotionally overwhelming. Understanding how relational, attachment, and developmental trauma contribute to CPTSD can help make sense of the symptoms many people struggle with for years - emotionally, psychologically, and physically - without having a clear name for them.

Relational trauma: unsafe connections

Relational trauma refers to emotional harm that occurs in the context of important relationships, usually those that should have been sources of care, stability, and protection. This can include experiences such as chronic criticism, shaming, emotional neglect, controlling dynamics, or unpredictable caregiving. Because human beings are wired for connection, the nervous system relies on safe relationships to regulate itself. When those relationships are inconsistent or unsafe, the long-term impact is not simply hurt feelings. The body learns to stay on alert. Stress physiology becomes organized around threat: muscles hold chronic tension, the breath becomes shallow, digestion becomes disrupted, and the immune system shifts into long-term survival mode.

A person may become highly sensitive to rejection, conflict, or change. They might have difficulty with boundaries, trust, or intimacy, not due to any personal flaw, but because their early environment instilled the belief that closeness is dangerous. These patterns may also manifest physically; many people with relational trauma experience chronic muscle tension or pain, headaches or migraines,

gut issues (IBS, nausea, digestive irregularities), sleep difficulties, and autonomic dysregulation (e.g., heart palpitations, dizziness). Indeed, relational trauma lays the foundation for both the emotional and physiological patterns seen in CPTSD: hypervigilance, emotional dysregulation, chronic tension, a sense of threat even in everyday situations, and difficulty truly feeling safe with others.

Attachment trauma: disrupted primary bonds

Attachment trauma is a specific form of relational trauma that occurs in a child’s earliest relationships (often with caregivers) when the need for comfort and protection is not consistently met. This can happen through neglect, parental mental illness, substance misuse, domestic violence, emotional unavailability, or simply caregivers who were too overwhelmed to be responsive.

Early attachment influences the development of the brain's structure and the stress-response system. When caregiving is safe and predictable, children learn that the world is manageable and that others can be depended on. However, when caregiving is confusing, frightening, or absent, the child learns that emotions are unsafe, needs are burdensome, and comfort is unreliable. These initial adaptations frequently develop into lifelong patterns, such as distancing oneself from others, clingy behaviours, shutting down when stressed, or continually being on the lookout for danger.

Attachment trauma also leaves physical traces. Growing up without reliable regulation profoundly affects the parasympathetic nervous system - the system that should help the body recover from stress. Without it, individuals might encounter persistent fatigue, an increased startle response, easily activated fight-or-flight or shutdown reactions, immune problems or frequent illnesses, and trouble relaxing.

In adulthood, attachment trauma often shows up in relationships as fear of abandonment, difficulty trusting others, people-pleasing, emotional overwhelm, or feeling fundamentally too much or not enough. These patterns are nervous system strategies developed in the context of early instability. CPTSD acknowledges the relational and physical damage central to chronic trauma, setting it apart from PTSD, which is triggered by a single event.

Developmental trauma: when stress influences the developing system

Developmental trauma refers to chronic, repeated stress or threat during the formative years of childhood and adolescence. This includes emotional neglect, chaotic households, abuse, exposure to violence, or living with constant unpredictability. Because these experiences occur during critical windows of neurological, emotional, and physical development, they shape how the brain, body, and nervous system learn to respond to the world.

A child exposed to ongoing stress may develop a nervous system biased toward survival modes: fight, flight, freeze (dissociation), or fawn (people-pleasing). Over time, these become default states where the body stays tense, anticipating danger even when there is none. This is why adults with developmental trauma may experience chronic hypervigilance, intense emotional swings, dissociation from the body, or difficulties with self-worth and identity. Physical manifestations might look like fatigue, chronic pain or widespread body tension, autonomic instability (rapid heart rate, swings between agitation and exhaustion), digestive problems, hormonal irregularities, inflammatory conditions, and migraines.

Developmental trauma also disrupts the formation of a stable self. When a child is surviving rather than growing, the ability to explore, take risks, express feelings, and develop a coherent identity is compromised. Many adults with CPTSD describe feeling fragmented, disconnected from their emotions, or unsure who they really are; a direct outcome of early environments where authenticity was unsafe, i.e. ridiculed, shamed or mocked.

How these forms of trauma come together in CPTSD

Relational, attachment, and developmental trauma are deeply interconnected, often occurring together and reinforcing one another. Relational trauma teaches the body that other people are unpredictable or unsafe. Attachment trauma disrupts the formation of secure internal templates for trust, comfort, and emotional regulation. Developmental trauma shapes the nervous system itself, influencing stress sensitivity, emotional responses, bodily physiology, and the formation of identity.

When these wounds accumulate, they create the core patterns of CPTSD: ongoing emotional dysregulation, chronic shame or a deeply negative self-concept, difficulties forming or maintaining relationships, and heightened vigilance for rejection or danger. Many individuals go through phases of dissociation or emotional numbing, along with difficulties in trusting others or even themselves. There may be a persistent sense of threat, a feeling of being on edge without clear cause, and a sense of loneliness or disconnection from others.

These emotional and relational struggles are often accompanied by significant physical consequences.

Chronic pain, digestive problems, sleep disturbances, fatigue, headaches or migraines, autonomic instability, heightened vulnerability to stress, and inflammatory or stress-related conditions are all common manifestations of a nervous system shaped by long-term threat. Indeed, CPTSD is an adaptive response to environments where safety was uncertain or unavailable, and where the body learned to survive in the best ways it could.

Healing: rebuilding safety in the present

Recovery from CPTSD is entirely possible, but because the wounds are relational, the healing often needs to be relational as well. Trauma-informed, attachment-focused therapy offers a consistent, empathetic relationship in which emotions are acknowledged with understanding rather than fear, shame, or rejection. Gradually, this consistent presence helps the nervous system learn safety, regulate more effectively, and trust connection in ways that may not have been possible earlier in life.

Healing developmental trauma also means reconnecting with the body and cultivating a kinder, more compassionate relationship with it. It involves learning emotional skills that were never taught, challenging old survival beliefs such as “I don’t matter” or “My needs are a burden,” and seeking out relationships that are supportive rather than punitive. There is often an in-depth process of exploring identity and self-worth beyond trauma, alongside building internal stability, self-compassion, and greater emotional resilience.

As safety is restored to the nervous system (and this takes time), the body frequently undergoes changes: muscles relax, digestion stabilizes, sleep becomes more rejuvenating, and physical reactivity slowly reduces. The aim is not to erase the past but to expand the capacity to live in the present, with more calm, more connection, and a growing sense of being safe enough in one’s own body and in the world.

If this is something you’ve been affected by, please leave a comment below. If there’s something important you’d like to add, please do so. I'd love to hear from you.

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Dr. Ingela Thuné-Boyle is a licensed Practitioner Health Psychologist and a Doctor in Behavioural Medicine who specializes in improving the quality of life of people struggling with long-term health problems, chronic pain and trauma. She runs a private online (telehealth) practice at www.ingelathuneboyle.com. You can find out more about her background [here], and more about her approach to therapy [here].

📩 Contact: For therapy or other enquiries, you can contact her at info@ingelathuneboyle.com.

Frequently Asked Questions (FAQs)

What does a health psychologist do?

A health psychologist supports the emotional and relational impact of chronic illness and pain. Long-term health challenges often affect identity, daily life, and relationships. Therapy offers a space to understand these shifts, build resilience, and find meaning while living alongside illness.

Can psychology really help with chronic illness or pain?

Yes. Therapy can reduce stress, strengthen coping, and help you process the grief, fear, and uncertainty that illness often brings. It also addresses various traumas so you can rebuild safety, trust, and connection with your body and with others.

Is online therapy effective for chronic illness and pain?

Yes. Research shows online therapy is often as effective as in-person work. It can be especially supportive when fatigue, mobility limits, or fluctuating symptoms make travel hard. Sessions meet you where you are, offering comfort and continuity.

How do I know if therapy is right for me?

If you’re feeling emotionally overwhelmed, stuck, disconnected, or unsure how to navigate life with a chronic condition, therapy may help. A health psychologist can support you in making sense of these experiences, strengthening your internal resources, and finding steadier ground in the midst of change.

Please note: Advice given in this blog is not meant to take the place of therapy or any other professional advice. The opinions and views offered by the author is not intended to treat or diagnose, nor is it intended to replace the treatment and care that you may be receiving from a licensed physician or mental health provider. The author is not responsible for the outcome or results following their information and advice on this blog.