PTSD What Is Complex PTSD (C-PTSD)? A stress disorder that may result from repeated, prolonged trauma By Matthew Tull, PhD Matthew Tull, PhD Twitter Matthew Tull, PhD is a professor of psychology at the University of Toledo, specializing in post-traumatic stress disorder. Learn about our editorial process Updated on November 14, 2022 Medically reviewed Verywell Mind articles are reviewed by board-certified physicians and mental healthcare professionals. Medical Reviewers confirm the content is thorough and accurate, reflecting the latest evidence-based research. Content is reviewed before publication and upon substantial updates. Learn more. by Ivy Kwong, LMFT Medically reviewed by Ivy Kwong, LMFT LinkedIn Twitter Ivy Kwong, LMFT, is a psychotherapist specializing in relationships, love and intimacy, trauma and codependency, and AAPI mental health. Learn about our Medical Review Board Print Verywell / Laura Porter Table of Contents View All Table of Contents PTSD vs. C-PTSD Symptoms Diagnosis Causes Treatment How to Cope Complex post-traumatic stress disorder (sometimes called complex PTSD or c-PTSD), is an anxiety condition that involves many of the same symptoms of PTSD along with other symptoms. First recognized as a condition that affects war veterans, post-traumatic stress disorder (PTSD) can be caused by any number of traumatic events, such as a car accident, natural disaster, near-death experience, or other isolated acts of violence or abuse. When the underlying trauma is repeated and ongoing, however, some mental health professionals make a distinction between PTSD and its more intense sibling, complex PTSD (C-PTSD). Complex PTSD has gained attention in the years since it was first described in the late 1980s. However, it is important to note that it is not recognized as a distinct condition in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), the tool that mental health professionals use to diagnose mental health conditions. PTSD vs. C-PTSD Both PTSD and C-PTSD result from the experience of something deeply traumatic and can cause flashbacks, nightmares, and insomnia. Both conditions can also make you feel intensely afraid and unsafe even though the danger has passed. However, despite these similarities, there are characteristics that differentiate C-PTSD from PTSD according to some experts. The main difference between the two disorders is the frequency of the trauma. While PTSD is caused by a single traumatic event, C-PTSD is caused by long-lasting trauma that continues or repeats for months, even years (commonly referred to as "complex trauma"). Unlike PTSD, which can develop regardless of what age you are when the trauma occurred, C-PTSD is typically the result of childhood trauma. When it comes to C-PTSD, the harmful effects of oppression and racism can add layers to complex trauma experienced by individuals. This is further compounded if the justice system is involved. The psychological and developmental impacts of complex trauma early in life are often more severe than a single traumatic experience—so different, in fact, that many experts believe that the PTSD diagnostic criteria don't adequately describe the wide-ranging, long-lasting consequences of C-PTSD. C-PTSD Caused by long-term, repeated trauma Typically arises from childhood experiences Often occurs in those who have endured racism and oppression Usually more severe than PTSD PTSD Caused by a single event Can result from trauma experienced at any age Usually milder than C-PTSD Symptoms of C-PTSD In addition to all of the core symptoms of PTSD—re-experiencing, avoidance, and hyperarousal—C-PTSD symptoms generally also include: Difficulty controlling emotions. It's common for someone suffering from C-PTSD to lose control over their emotions, which can manifest as explosive anger, persistent sadness, depression, and suicidal thoughts. Negative self-view. C-PTSD can cause a person to view themselves in a negative light. They may feel helpless, guilty, or ashamed. They often have a sense of being completely different from other people. Difficulty with relationships. Relationships may suffer due to difficulties trusting others and a negative self-view. A person with C-PTSD may avoid relationships or develop unhealthy relationships because that is what they knew in the past. Detachment from the trauma. A person may disconnect from themselves (depersonalization) and the world around them (derealisation). Some people might even forget their trauma. Loss of a system of meanings. This can include losing one's core beliefs, values, religious faith, or hope in the world and other people. All of these symptoms can be life-altering and cause significant impairment in personal, family, social, educational, occupational, or other important areas of life. Treating the Effects of Childhood Trauma Diagnosis of C-PTSD Although the concept of C-PTSD is longstanding, it is not in the fifth edition of the "Diagnostic and Statistical Manual of Mental Disorders" (DSM-5), and therefore isn't officially recognized by the American Psychiatric Association (APA). Although C-PTSD comes with its own set of symptoms, some believe the condition is too similar to PTSD (and other trauma-related conditions) to warrant a separate diagnosis. As a result, the DSM-5 lumps symptoms of C-PTSD together with PTSD. Many mental health professionals do recognize C-PTSD as a separate condition, because the traditional symptoms of PTSD do not fully capture some of the unique characteristics shown in people who experienced repeat trauma. In 2018, the World Health Organization (WHO) made the decision to include C-PTSD as its own separate diagnosis in the 11th revision of the "International Statistical Classification of Diseases and Related Health Problems" (ICD-11). Because the condition is relatively new and not recognized in the DSM-5, doctors may make a diagnosis of PTSD instead of complex PTSD. Since there is not a specific test to determine the difference between PTSD and C-PTSD, you should keep track of the symptoms you have experienced so that you can describe them to your doctor. Treatment for the two conditions is similar, but you may want to discuss some of your additional symptoms of complex trauma that your doctor or therapist may also need to address. C-PTSD also can share signs and symptoms with borderline personality disorder (BPD). Although BPD doesn't always have its roots in trauma, this is often the case. In fact, some researchers and psychologists advocate for putting BPD under the umbrella of C-PTSD in future editions of the DSM to acknowledge the link to trauma, foster a better understanding of BPD, and help people with BPD face less stigma. Causes of C-PTSD C-PTSD is believed to be caused by severe, repetitive abuse over a long period of time. The abuse often occurs at vulnerable times in a person's life—such as early childhood or adolescence—and can create lifelong challenges. Traumatic stress can have a number of effects on the brain. Research suggests that trauma is associated with lasting changes in key areas of the brain including the amygdala, hippocampus, and prefrontal cortex. The types of long-term traumatic events that can cause C-PTSD include: Child abuse, neglect, or abandonment Domestic violence Genocide Childhood soldiering Torture Slavery In these types of events, a victim is under the control of another person and does not have the ability to easily escape. Causes and Risk Factors of PTSD Treatment of C-PTSD Because the DSM-5 does not currently provide specific diagnostic criteria for C-PTSD, it’s possible to be diagnosed with PTSD when C-PTSD may be a more accurate assessment of your symptoms. Despite the complexity and severity of the disorder, C-PTSD can be treated with many of the same strategies as PTSD, including: Medications Medications may help reduce symptoms of C-PTSD, such as anxiety or depression. They are especially helpful when used in combination with psychotherapy. Antidepressants are often used to treat complex PTSD, including Prozac (fluoxetine), Paxil (paroxetine), and Zoloft (sertraline). Psychotherapy Psychotherapy for C-PTSD focuses on identifying traumatic memories and negative thought patterns, replacing them with more realistic and positive ones, and learning to cope more adaptively to the impact of your trauma. One type of psychotherapy that may be used to treat both PTSD and complex PTSD is known as eye movement desensitization and reprocessing (EMDR). This approach uses eye movements guided by the therapist to process and reframe traumatic memories. Over time, this process is supposed to reduce the negative feelings associated with the traumatic memory. How PTSD Is Treated Coping With C-PTSD Treatments for complex PTSD can take time, so it is important to find ways to manage and cope with the symptoms of the condition. Some strategies that may help you manage your recovery: Find support: Like PTSD, complex PTSD often leads people to withdraw from friends and family. However, having a strong social support network is important for mental well-being. When you are feeling overwhelmed, angry, anxious, or fearful, reach out to a trusted friend or family member. Practice mindfulness: Complex PTSD can lead to feelings of stress, anxiety, and depression. Mindfulness is a strategy that can help you become more aware of what you are feeling in the moment and combat feelings of distress. This practice involves learning ways to focus on the present moment. Write down your thoughts: Research has found that writing in a journal can be helpful in managing PTSD symptoms and decreases symptoms of flashbacks, intrusive thoughts, and nightmares. In terms of treatment, a journal can also be a great way to track symptoms that you can later discuss with your therapist. Support groups and self-help books can also be helpful when dealing with complex PTSD. Helpful book titles include "The Body Keeps Score" by Bessel van der Kolk, MD, and "Complex PTSD: From Surviving to Thriving" by Pete Walker. A Word From Verywell If you or someone you care about has been exposed to repeated trauma and are struggling to cope, it's important to seek help from a therapist who is familiar with PTSD. In addition to asking your primary care physician for a referral, there are many online resources that can help you find mental health providers in your area who treat PTSD. If you or a loved one are struggling with PTSD, contact the Substance Abuse and Mental Health Services Administration (SAMHSA) National Helpline at 1-800-662-4357 for information on support and treatment facilities in your area. For more mental health resources, see our National Helpline Database. Coping With PTSD 13 Sources Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy. Herman JL. Complex PTSD: A syndrome in survivors of prolonged and repeated trauma. J Trauma Stress. 1992;5(3):377-391. doi:10.1002/jts.2490050305 Kirkinis K, Pieterse A, Martin C, Agiliga A, Brownell A. Racism, racial discrimination, and trauma: a systematic review of the social science literature. 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J EMDR Prac Res. 2009;3(4):264-278. doi:10.1891/1933-3126.96.36.1994 Ullrich PM, Lutgendorf SK. Journaling about stressful events: Effects of cognitive processing and emotional expression. Ann Behav Med. 2002;24(3):244-50. doi:10.1207/S15324796ABM2403_10 Additional Reading American Psychological Association, Guideline Development Panel for the Treatment of PTSD in Adults. Clinical practice guideline for the treatment of posttraumatic stress disorder (PTSD) in adults. Published February 24, 2017. Cloitre M, Courtois CA, Charuvastra A, Carapezza R, Stolbach BC, Green BL. Treatment of complex PTSD: Results of the ISTSS expert clinician survey on best practices. J Trauma Stress. 2011;24(6):615-627. doi:10.1002/jts.20697 Cloitre M, Garvert DW, Weiss B, Carlson EB, Bryant RA. Distinguishing PTSD, complex PTSD, and corderline personality disorder: A latent class analysis. Eur J Psychotraumatol. 2014;5. doi:10.3402/ejpt.v5.25097 By Matthew Tull, PhD Matthew Tull, PhD is a professor of psychology at the University of Toledo, specializing in post-traumatic stress disorder. See Our Editorial Process Meet Our Review Board Share Feedback Was this page helpful? Thanks for your feedback! What is your feedback? Other Helpful Report an Error Submit Speak to a Therapist for PTSD Advertiser Disclosure × The offers that appear in this table are from partnerships from which Verywell Mind receives compensation.