Complex PTSD: Symptoms, Causes, Treatment, Tips, and Resources (2023)

Complex PTSD can change your whole world, from how you see yourself to how you relate to others. Treatment options are available to help you manage symptoms.

Do others experience the world the way that you do? Lately, you’re not so sure. Maybe you’re having a hard time in your relationships, or you feel a pervasive sense of sadness without knowing why.

You may find it hard to control your emotions, or perhaps you struggle with low self-esteem. You wonder whether it could be post-traumatic stress disorder (PTSD), bipolar disorder, borderline personality disorder, or something else entirely.

You’re probably familiar with PTSD, a condition that can arise after you experience a distinct trauma, like a violent crime or natural disaster. PTSD impacts 1 in 11 people in their lifetime, according to the American Psychiatric Association.

But there’s another type of trauma that’s a bit newer to the world of psychology. It’s often confused with other mental health conditions. It’s called complex post-traumatic stress disorder — a subtype or variant of the classic form of PTSD.

The term “complex PTSD” first emerged in 1992 in Dr. Judith Herman’s book “Trauma and Recovery.” It’s commonly abbreviated as CPTSD or C-PTSD.

CPTSD stems from trauma that occurs as a result of repeated or ongoing traumatic experiences, usually over the course of several months or years.

It often develops as a result of childhood trauma, but it can develop from repeated trauma in adulthood as well.

Currently, CPTSD is not an official diagnosis in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5).

However, it will be included in the International Classification of Diseases, 11th Revision (ICD-11), which is considered the gold standard in diagnostics by the World Health Organization (WHO).

Some research estimates that 3.3% of people in the United States meet the criteria for CPTSD, with women being more than twice as likely as men.

Any kind of trauma sustained over the long term can lead to CPTSD. However, CPTSD is particularly common among those who experienced ongoing trauma during their developmental years — i.e., during childhood.

CPTSD may develop from trauma inflicted by those who were meant to care for or protect you. This could include family members, close family friends, teachers, coaches, or religious leaders.

Here are some examples of what can cause CPTSD:

  • repeated physical or emotional abuse
  • living in a politically unstable or war-torn area
  • ongoing childhood neglect or abandonment
  • long-term sexual abuse, such as human trafficking
  • regular exposure to danger, as encountered by military personnel, police, or first responders
  • family enmeshment or parentification (being a parent to your parent)

Researchers are still trying to figure out why some people develop CPTSD while others do not. So far, your likelihood depends on a few risk factors:

  • family history of depression or anxiety
  • genetic factors, like lower stress tolerance
  • absence of a support network or “safe” connections

In order to be diagnosed with CPTSD (unofficially), you’ll need to have some classic symptoms of PTSD, such as:

  • flashbacks or nightmares
  • dissociation or memory lapses
  • reliving the traumatic experience
  • hyperarousal, or being on “high alert”
  • avoidance of certain people, places, or scenarios
  • dissociation or feeling detached from yourself
  • somatic symptoms, like headache or upset stomach

The other CPTSD symptoms can be grouped into three main categories: negative self-cognition, emotional dysregulation, and interpersonal hardship.

Negative self-cognition

When we’re young, we engage in black and white thinking — this or that, good or bad.

If you experienced prolonged trauma during childhood, you may have had trouble understanding your experience and seeing the person who hurt you as the one at fault. Instead, in order to make sense of things, you may have blamed yourself: “I must be bad, so I deserve this.”

This type of self-perception can continue well into adulthood, even if you’re not aware of it on a conscious level. It manifests as:

  • having low self-esteem
  • feeling a lack of self-worth
  • feeling damaged
  • feeling unworthy
  • feeling guilty or ashamed
  • feeling undeserving of good things

As the mind and body adapt to long-term trauma, it’s natural for the brain to shape your worldview around a traumatic new “normal.” By blaming yourself, it makes it easier to handle the pain.

Emotional dysregulation

Difficulty with controlling emotions is a common symptom of CPTSD, which can lead to a misdiagnosis as a mood disorder. These symptoms include:

  • angry outbursts
  • impulsive behaviors
  • abrupt mood changes
  • high levels of anxiety or worry
  • feeling a chronic lack of safety
  • ongoing sadness or upset mood

Interpersonal hardship

Children who experience trauma may have difficulty trusting others as adults.

You may experience frequent arguments over miscommunications or have emotional outbursts toward those you love. On the other hand, you may self-isolate or avoid interacting with others as a measure of self-protection.

You may also oscillate between wanting to be close to people and wanting to pull away. This dynamic is similar to a fearful-avoidant attachment style in attachment theory, or the push-pull dynamic that emerges in borderline personality disorder, commonly described as, “I hate you, don’t leave me.”

Symptoms of interpersonal hardship include:

  • frequent conflict
  • communication issues
  • difficulty trusting people
  • breakup/makeup pattern
  • distorted perception of others or trauma bonding
  • relationships that replicate childhood experiences (trauma reenactment)

Dishonesty can also come up in relationships. You may have been forced to lie or conceal your feelings in childhood to stay safe, and now it’s a survival skill that can be difficult to let go of.

PTSD can develop as a result of experiencing or witnessing a distinct traumatic event, like a car accident or violent assault. In 1980, the APA added PTSD as a diagnosis in the third edition of the DSM.

Those who live with PTSD have a heightened fight, flight, or freeze response. This creates an ongoing sense of danger along with other symptoms, like flashbacks or nightmares, even when the danger has long since passed.

CPTSD, on the other hand, comes from trauma that occurs repeatedly. It presents many of the same symptoms as PTSD, but it can also change how you view yourself, how you control your emotions, and how you relate to others.

Since CPTSD isn’t in the DSM-5 yet, it may be hard to get an official diagnosis; your doctor may not be aware that it even exists.

If you’ve experienced symptoms for one month or longer, your doctor may diagnose you with PTSD, a mood disorder, or another trauma-related condition, such as:

  • bipolar disorder
  • borderline personality disorder
  • dissociative identity disorder
  • depersonalization/derealization disorder

A proper diagnosis of CPTSD is important because it impacts the kind of treatment you will receive. While other mental health conditions appear to have similar symptoms, many come from genetic factors (rather than environmental factors), so they’re addressed differently.

If you feel that trauma plays a role in your symptoms, it’s a good idea to reach out to a trauma specialist. Try to find a doctor who understands CPTSD and the multitude of ways it can impact your life.

Complex trauma can be just that — complex. There’s no one-size-fits-all treatment protocol. Consider an integrative approach, with education, psychotherapy (talk therapy), self-care, and medication if suggested.

Research shows that cognitive behavioral therapy (CBT) and eye movement desensitization and reprocessing (EMDR) can be effective for treating symptoms of CPTSD and traditional PTSD.

A number of other trauma approaches are gaining traction as well, particularly for those who live with disassociation, since talking about trauma too soon can actually do more harm than good.

In her book “Healing the Fragmented Selves of Trauma Survivors,” Dr. Janina Fisher draws on a number of therapeutic approaches, including somatic therapies (body-based therapies) and internal family systems, to help trauma survivors find “resolution” in their core self. This replaces negative self-beliefs with compassionate acceptance.

World-renowned trauma expert Bessel van der Kolk is a proponent of rewiring the brain and reestablishing trust in the physical body through practices like yoga. Research shows that yoga can be an effective adjunctive treatment for PTSD.

Note, though, that it might be worth looking for trauma-informed yoga sessions. In these sessions, the yoga instructor will be sensitive to the fact that trauma can be stored in the body, and that certain body movements or motions can trigger emotional reactions. This helps to create a safe space to practice and facilitate healing.

Studies show that dialectical behavior therapy (DBT) can be effective at managing borderline personality disorder (BPD), which has many overlapping symptoms with complex trauma. It centers on mindfulness, acceptance, and distress tolerance.

To compliment your work in talk therapy, consider body-focused self-care, like tai chi, weight lifting, or dancing. Your life experiences may have taught you to turn off your relationship with your body, and these activities can help bring you back into it.

Also, check in with yourself several times a day. Close your eyes and ask your body:

  • What do you need?
  • How can I support you?
  • Where does this feeling live?

It can also be helpful to keep a daily journal about your feelings. Every so often, engage in “self-study” and see if you can recognize any patterns. These insights can be helpful to bring up in therapy.

If you are dealing with flashbacks, try this flashback halting protocol. Along with that, build up a meditation practice and do deep breathing techniques, like box breathing (inhale for a count of 4, hold for 4, exhale for 4, hold for 4, repeat).

No matter what your inner critic says, remember this: You are not broken. You are not a lost cause. You are not alone.

CPTSD is treatable and support is available. You can use the American Psychological Association’s Psychologist Locator to find a therapist who is familiar with trauma. You can also look up support groups near you.

If you’re in a relationship, you may want to consider couple’s therapy for extra support. It can be helpful to have an objective person in the room to help with communication.

The more you learn about CPTSD, the less alone you may feel. Here are some well-known books that can support you on your journey:

Suicide Prevention

CPTSD may increase your risk of self-harm. If you’re considering self-harm or suicide, you’re not alone. Help is available right now:


How do you deal with C-PTSD triggers? ›

Try grounding techniques.
  1. Get to know your triggers add. You might find that certain experiences, situations or people seem to trigger flashbacks or other symptoms. ...
  2. Confide in someone add. ...
  3. Give yourself time add. ...
  4. Try peer support add. ...
  5. Find specialist support add. ...
  6. Look after your physical health add.

What are the main causes of complex PTSD? ›

What causes complex PTSD?
  • childhood abuse, neglect or abandonment.
  • ongoing domestic violence or abuse.
  • repeatedly witnessing violence or abuse.
  • being forced or manipulated into prostitution (trading sex)
  • torture, kidnapping or slavery.
  • being a prisoner of war.

What is the most effective treatment for complex PTSD? ›

Psychotherapy (talk therapy) is the main treatment for complex PTSD. Specifically, this type of psychotherapy is a form of cognitive behavioral therapy (CBT) called trauma-focused CBT. This therapy takes place with a trained, licensed mental health professional, such as a psychologist or psychiatrist.

How do you treat complex PTSD symptoms? ›

If you have complex PTSD, you may be offered therapies used to treat PTSD, such as trauma-focused cognitive behavioural therapy (CBT) or eye movement desensitisation and reprocessing (EMDR). You'll also be offered treatment for other problems you may have, such as depression or alcohol addiction.

How do people with C-PTSD act? ›

People with PTSD have intense, disturbing thoughts and feelings related to their experience that last long after the traumatic event has ended. They may relive the event through flashbacks or nightmares; they may feel sadness, fear or anger; and they may feel detached or estranged from other people.

Does C-PTSD get worse with age? ›

Symptoms may worsen

As people age, their PTSD symptoms may suddenly appear or become worse, causing them to act differently. It may be unsettling to see these changes in a loved one, but it's nothing to fear. Changes are common and treatment can help.

What is the gold standard treatment for complex PTSD? ›

Trauma-focussed cognitive behaviour therapy (TF-CBT) is the recommended treatment, which includes: Prolonged Exposure (PE) Cognitive Processing Therapy (CPT) Eye movement desensitisation and reprocessing (EMDR)

What is the first line treatment for complex PTSD? ›

Trauma-focused psychotherapy as first line – For most adults with PTSD we suggest first-line treatment with a trauma-focused psychotherapy that includes exposure rather than a serotonin reuptake inhibitor (selective serotonin reuptake inhibitor [SSRI] or serotonin-norepinephrine reuptake inhibitor [SNRI]) (Grade 2C).

What happens to the brain with complex PTSD? ›

In a person with PTSD, the prefrontal cortex is underactive and doesn't control the stress response appropriately. Hippocampus. This part of the brain is responsible for memory storage and retrieval. In the case of PTSD, the hippocampus may ineffectively store memories about the trauma.

Why is complex PTSD so hard to treat? ›

In general, trauma disorders can be difficult to treat because a person must work with a therapist to unearth the sources of trauma, and their ability to trust and approach those vulnerabilities is severely compromised. Complex PTSD can take that challenge to another level.

Why is complex PTSD so debilitating? ›

People with C-PTSD struggle to control their emotions, which are often volatile, fear- or anger-based, and often overwhelming and powerful. This can negatively affect their behavior, creating embarrassing situations or causing conflicts in relationships. Extreme isolation and withdrawal.

What happens if complex PTSD is not treated? ›

Untreated PTSD can cause permanent damage to the brain due to the person living in a hyper-aroused state. Patients with PTSD may have a co-occurring mental health issue such as one of the following: Depression. Anxiety disorder.

Does complex PTSD qualify for disability? ›

Complex post-traumatic stress disorder qualifies for SSDI or SSI under the criteria for listings 12.15 or 112.5 trauma and stressor-related disorders.

Can complex PTSD get worse over time? ›

' In some cases, C-PTSD symptoms can have a cumulative effect and can get worse rather than better over time, which is why some C-PTSD sufferers 'manage' for such a long time without help, but they then worsen over time and eventually the symptoms become unmanageable.

What does a C-PTSD episode look like? ›

Symptoms of complex PTSD

dizziness or nausea when remembering the trauma. hyperarousal, which means being in a continual state of high alert. the belief that the world is a dangerous place. a loss of trust in the self or others.

What is it like to live with complex PTSD? ›

Living with Complex PTSD can create intense emotional flashbacks that provide challenges in controlling emotions that may provoke severe depression, suicidal thoughts, or difficulty in managing anger. C-PTSD can also create dissociations, which can be a way the mind copes with intense trauma.

What are the four stress responses in C-PTSD? ›

The responses are usually referred to as the 4Fs – Fight, Flight, Freeze, and Fawn and have evolved as a survival mechanism to help us react quickly to life-threatening situations.

Is C-PTSD a serious mental illness? ›

CPTSD is a serious mental health condition that can take some time to treat, and for many people, it's a lifelong condition. However, a combination of therapy and medication can help you manage your symptoms and significantly improve your quality of life.

Do people with C-PTSD need more sleep? ›

Whether or not insomnia is diagnosed, people with PTSD often report less sleep due to problems falling asleep, being restless during the night and waking up earlier than wanted. Even brief periods of sleep loss can affect daily life.

Can people with C-PTSD be good parents? ›

People with PTSD can make wonderful parents, just like anyone else. Something that many people with PTSD may not consider, however, is that once they become parents, their kids could trigger their PTSD.

What mood stabilizer for complex PTSD? ›

The most common medications used for treating the depression and anxiety associated with PTSD belong to a class of antidepressants called selective serotonin reuptake inhibitors, or SSRIs. These medications work by raising levels of the brain chemical serotonin, which regulates mood, appetite, and sleep.

How many sessions of therapy for complex PTSD? ›

This is a form of cognitive behavioural therapy (CBT) specifically adapted for PTSD. NICE recommends that you are offered 8–12 regular sessions of around 60–90 minutes, seeing the same therapist at least once a week.

How to help someone with complex PTSD? ›

Tips for Caring for Someone with Complex PTSD
  1. Avoid Retraumatization. Don't underestimate the danger and intensity of your adult child reliving their original traumatic memories and suffering. ...
  2. Lead with Listening. ...
  3. Discuss the Triggers and Work Together. ...
  4. Learn About the Options for Treatment.
May 9, 2018

How long does therapy take for C-PTSD? ›

Talk therapy treatment for PTSD usually lasts 6 to 12 weeks, but it can last longer. Research shows that support from family and friends can be an important part of recovery. Many types of psychotherapy can help people with PTSD. Some types target the symptoms of PTSD directly.

How do you rewire your brain after trauma? ›

EMDR therapy changes the way a traumatic memory is stored in your brain using eye movements or rhythmic tapping. This allows you to process the trauma so that you can remember the event without reliving it.

What are the long term effects of complex trauma? ›

Children with complex trauma histories may develop chronic or recurrent physical complaints, such as headaches or stomachaches. Adults with histories of trauma in childhood have been shown to have more chronic physical conditions and problems.

What are the physical signs your body is releasing trauma? ›

Some may have a fight-or-flight type of response, which may include muscle tension, heart pounding and sweating because their body "believes it needs to activate," she explains. Others maybe experience a freeze response, which can look like someone who struggles to move or get out of bed.

What is worse than complex PTSD? ›

PTSD results from and extreme trauma such as what happens in a hurricane, earthquake, trauma experienced in war. PTSD is bad enough but DESNOS is even worse than that. DESNOS results from repeated and long term trauma. In other words, the negative experiences are prolonged and repeated.

Do people with complex PTSD not trust anyone? ›

Complex trauma survivors — those with CPTSD — often have a distrust of self and others. They may feel like a burden to people, have shame, and be unable to make choices or have a voice for self. This lack of trust becomes ingrained in who you are; you believe everyone is untrustworthy.

What foods help with complex PTSD? ›

Shift towards more anti-inflammatory foods, such as omega 3-rich fish three times a week, flax seeds, sour cherries and berries, apples, pears, and pomegranate. Choose a plant-based diet. Eat mostly whole grains, nuts, seeds, fruits, and vegetables. Balance your meals with protein and fat.

What vitamins help PTSD? ›

Increase multivitamin and mineral intake

Vitamin D is often called the 'feel good' vitamin, is of particular importance to our wellbeing. A study of PTSD participants found 62.7% were deficient in Vitamin D (7).

What activities help PTSD? ›

Relaxation techniques such as meditation, deep breathing, massage, or yoga can activate the body's relaxation response and ease symptoms of PTSD. Avoid alcohol and drugs. When you're struggling with difficult emotions and traumatic memories, you may be tempted to self-medicate with alcohol or drugs.

What does shutdown dissociation look like? ›

Eye contact is broken, the conversation comes to an abrupt halt, and clients can look frightened, “spacey,” or emotionally shut down. Clients often report feeling disconnected from the environment as well as their body sensations and can no longer accurately gauge the passage of time.

What are the personality changes in C-PTSD? ›

Self-destructive behavior, such as drinking too much or driving too fast. Trouble sleeping. Trouble concentrating. Irritability, angry outbursts or aggressive behavior.

What are some unusual signs of C-PTSD? ›

C-PTSD overlaps with PTSD, but it also has some unique symptoms, such as dissociation and negative self-image. Your response to trauma won't always look the same as someone else's. Your experiences — and how long or how often you went through them — can all impact trauma symptoms later in life.

How hard is it to live with complex PTSD? ›

When your brain is wired for fear and distrust, it's difficult to be comfortable with anyone. Living with complex PTSD can trigger intense emotional flashbacks, making it difficult to control emotions, leading to severe depression, suicidal thoughts, or difficulty managing anger.

How much money do you get for PTSD disability? ›

Depending on the severity, a veteran's diagnosis of PTSD is eligible for VA disability rating of 100% ($3,621.95/month), 70% ($1,663.06/month), 50% ($1,041.82/month), 30% ($508.05/month), 10% ($165.92/month), or 0% (no payment).
VA Disability Ratings for PTSD.
RatingMonthly amount
5 more rows
Oct 12, 2021

How severe is complex PTSD? ›

Those with complex PTSD often experience intense emotions, which are sometimes inappropriate. Besides anger and sadness, they may feel like they're living in a dream. They may have trouble feeling happy. Relationship problems.

What not to say to someone with C-PTSD? ›

10 Things Not To Say To Someone With CPTSD
  • It wasn't that bad, was it?
  • That happened in the past, why are you still upset?
  • Calm down.
  • You're overreacting. It's been years now. Get over it.
  • You're too much right now.
  • What's wrong with you?
  • I don't believe anything you're saying.
  • You are crazy. You are dramatic.

How do you release anger from C-PTSD? ›

  1. Remember: It's about the process. ...
  2. Own it. ...
  3. Be persistent. ...
  4. Acknowledge your anger and hurt. ...
  5. Say the words out loud. ...
  6. Remember when you were offered forgiveness.
Apr 10, 2021

What happens if C-PTSD goes untreated? ›

If left untreated, complex PTSD can become life-threatening. It raises the risk of developing anxiety, depression, addictive behavior, self-harm, and suicidal thoughts. Chronic pain, fatigue, and changes in eating and sleeping patterns are all possible physical health problems.

Does C-PTSD count as a disability? ›

Also, since people living with complex post-traumatic stress disorder qualify for a diagnosis of post-traumatic stress disorder, the Social Security Administration will consider them disabled.

What happens to the brain in C-PTSD? ›

Proven structural changes include enlargement of the amygdala, the alarm center of the brain, and shrinkage of the hippocampus, a brain area critical to remembering the story of what happened during a traumatic experience. Functional changes alter activity of certain brain regions.

What are the 5 W's for PTSD? ›

Here are some things you may not have known about Post Traumatic Stress Disorder in the form of the good old fashioned Five W's: who, what, where, when, and why.

What are the two most common types of precipitating traumas in PTSD? ›

Kinds of traumatic events

The most common events leading to the development of PTSD include: Combat exposure. Childhood physical abuse.

What medications are used to treat complex PTSD? ›

What are the best medications to treat PTSD?
  • Sertraline (Zoloft) is FDA-approved for treating PTSD, and it's one of the most common medications prescribed for this condition. ...
  • Paroxetine (Paxil) is the only other FDA-approved medication for PTSD. ...
  • Fluoxetine (Prozac) is used off-label for treating PTSD.
Jul 6, 2021

What happens when you yell at someone with PTSD? ›

Such an interaction could likely cause stress. And yelling can be a trigger for PTSD. However, if you do not have PTSD, making this comment can be insensitive to those with the condition. According to the U.S. Department of Veterans Affairs National Center for PTSD, PTSD is a disorder in the DSM-5.

Can you overcome C-PTSD? ›

Complex post-traumatic stress disorder is entirely treatable with the right combination of compassion, patience, and trust. Someone can work to disempower the trauma that cripples them and practice positive coping skills in the context of well-rounded support and guidance.


Top Articles
Latest Posts
Article information

Author: Carmelo Roob

Last Updated: 15/11/2023

Views: 5649

Rating: 4.4 / 5 (45 voted)

Reviews: 84% of readers found this page helpful

Author information

Name: Carmelo Roob

Birthday: 1995-01-09

Address: Apt. 915 481 Sipes Cliff, New Gonzalobury, CO 80176

Phone: +6773780339780

Job: Sales Executive

Hobby: Gaming, Jogging, Rugby, Video gaming, Handball, Ice skating, Web surfing

Introduction: My name is Carmelo Roob, I am a modern, handsome, delightful, comfortable, attractive, vast, good person who loves writing and wants to share my knowledge and understanding with you.