An Overview of Complex PTSD

In This Article

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).

Teenage girl hugging a pillow and sitting in a chair
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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.

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.

Symptoms

In addition to all of the core symptoms of PTSDre-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.

Causes

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.

The types of long-term traumatic events that can cause C-PTSD include:

In these types of events, a victim is under the control of another person and does not have the ability to easily escape.

Diagnosis

While the concept of C-PTSD is long-standing, 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, there are some who 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.

However, there are many mental health professionals who do recognize C-PTSD as a separate condition because the traditional symptoms of PTSD fail to 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).

Treatment

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.

  • Psychotherapy for C-PTSD focuses on identifying traumatic memories and negative thought patterns and replacing them with more realistic and positive ones and learning to cope more adaptively to the impact of your trauma.
  • Eye movement desensitization and reprocessing (EMDR) 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.
  • Medications may help reduce symptoms of C-PTSD, such as anxiety or depression. They are especially helpful when used in combination with psychotherapy.

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.

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