In defining trauma, the terms abuse, neglect, and complex trauma are often discussed. Abuse refers to any situation in which one person or group, holds power over another (whether due to physical size, prestige, finances, or other real or perceived advantage), and misuses such power in a harmful or malicious way. Abuse has many forms: physical, sexual, emotional, verbal, financial, and even spiritual. Some abusive experiences may qualify someone for a diagnosis of PTSD. Others may be linked to different diagnoses or life problems that we will discuss. For many survivors, abuse involves multiple layers of wounding. For instance, consider Alejandro, a male survivor of sexual abuse. He endured years of sexual abuse at the hands of his local minister, a well-respected member of the community and personal friend to his parents. The pastor would often tell Alejandro that the activities they engaged in were part of "God's plan" for Alejandro's life, and that challenging that plan would put his soul in danger. Diana, a survivor of chronic domestic violence (physical, emotional, verbal, sexual), was similarly manipulated by her partner and came to believe her abuse was the will of God.
Another example of chronic abuse (misuse of power) occurs when mentally ill, elderly, or infirmed people are physically and/or financially dependent on others for their care. Therese is an 80-year-old woman who is no longer able to walk or drive without assistance. Her daughter and son-and-law have become her primary caregivers. Therese has become accustomed to their constant verbal and emotional insults like, "You're just a worthless old lady," and "Why won't you just die already?" Sometimes they hit her when they become frustrated. They also coerce her to give them money, threatening to leave her, or to rot in a sub-par nursing home, if she doesn't given them whatever they want.
While abuse involves actively doing something harmful, its cousin neglect involves passively failing to provide basic care or guidance to dependent persons (children and adults). For instance, Therese's daughter and son-and-law often left her alone at home for weeks at a time without checking on her, or getting her to the store for groceries.
In many cases, abuse and neglect cannot be easily distinguished. Every year the news media reports on horrific cases of childhood abuse. These stories involve children being left to care for themselves, and having their most basic needs ignored (which often happens with children living in alcoholic or addicted homes). While abuse and neglect are often intertwined, there are differences especially for survivors in recovery. Due to its passive nature, neglect is often much more difficult to identify. Therefore, its harm is often more difficult to recognize.
In recent years, the concept of neglect has been expanded to include emotional neglect. Emotional neglect occurs when parents ignore, or are indifferent to their children's emotional needs. These emotional needs include the need to feel valued, worthy of love, and the need to be soothed and comforted during emotional upset. Think of children who grow up in circumstances where they are never held, soothed, and comforted; where no one ever plays with them or takes an interest in them. These children are expected to "just get over it," and they are never taught how to cope with difficult or painful emotions. Continuing with our parallel to physical wounds, this would be analogous to failing to provide basic first aid to a painful and potentially harmful wound. However, emotional neglect does not only apply to children. Many adults in high-conflict or abusive relationships describe feeling emotionally neglected or abandoned by their partner.
Lily provides us another example of neglect. Lily was born into a very wealthy family. Her physical needs were always met. She had a beautiful house, the nicest clothes, the coolest toys, and went to the best schools. She never "wanted" for anything- except the love and attention of her parents. Her father was always working and rarely at home. Her mother was wrapped up in her community work; keeping up with the lifestyle of her peers; and traveling the world for romantic liaisons with other partners. By the age of 13, Lily experienced several depression and behaviors of eating disorders. In typical fashion, her parents did not 'neglect' her medical care. They sent her to the best psychiatrist they could find. However, for Lily, this was just one more example of their non-involvement in her life. For people like Lily and Therese, who have been harmed by neglect, it is rarely a one-time event; but rather, a chronic or steady series of events and experiences. This is often called complex trauma, which is reviewed in the next section.