Hi Caroline,
Cartographic representations are stored in the gdb, so there shouldn't be an issue as far as viewing. I think you may also be able to export as a layer.
I basically created a font that I would have to layer once I got into ArcMap. In my example above the circle, arrows and text are all different characters in the font. I created them using a multi-layer symbol and then converted them to cartographic representations, where I further refined them.
I would suggest that you create the multi layer symbol in Symbol Property Editor and then convert it to a representation.
In this example, I used two simple symbols to create the circles and then my custom font to create the character marker symbol in the center. From there, I would convert the symbols to a representation (right click on the layer in ArcMap).
Representation Editor Screen:
Notice how the symbols are a bit off-centre and mis-aligned.
Here is the finished symbol in the Representation Editor: