What Is Complex PTSD?

Teenage girl hugging a pillow and sitting in a chair

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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, called complex PTSD (C-PTSD).

C-PTSD vs. PTSD

Although PTSD and C-PTSD are two similar conditions, they are triggered in different ways, each coming with its own range of symptoms.

C-PTSD

  • Result of severe, repetitive trauma over the course of months or years

  • Mostly seen in whose trauma occurred in childhood

  • Severe symptoms that impair everyday functioning

  • Treatment involves multiple therapeutic sessions for a longer time

PTSD

  • Triggered by a brief one-time event

  • Can develop at any age

  • Symptoms range from mild to severe

  • Treatment involves short-term counseling and drug therapy

This trauma interrupts their psychological and neurologic development. Affects how they learn who they are as individuals, understand the world around them, and form relationships.

C-PTSD Symptoms

In addition to all of the core symptoms of PTSDre-experiencing, avoidance, and hyperarousal—C-PTSD symptoms generally include:

  • Emotional regulation difficulties. It's common for someone suffering from C-PTSD to lose control over their emotions. This can manifest as explosive anger, persistent sadness, depression, and suicidal thoughts.
  • A 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.
  • Relationship issues. Relationships may suffer due to difficulties trusting others and because of 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 things that have happened to them.
  • 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.

If you are having suicidal thoughts, contact the National Suicide Prevention Lifeline at 1-800-273-8255 for support and assistance from a trained counselor. If you or a loved one are in immediate danger, call 911. 

For more mental health resources, see our National Helpline Database.

All of these symptoms can be life-altering and cause significant impairment in personal, family, social, educational, occupational, or other important areas of functioning.

Causes

In most cases, C-PTSD is related to events that occurred and persisted through childhood, but it is possible to develop the disorder as an adult. These events are often are long-lasting and involve some form of physical or emotional abuse. Examples of situations 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

There is an ongoing debate among mental health professionals and researchers regarding whether C-PTSD should have its own diagnosis. Although C-PTSD comes with its own set of symptoms, there are many who believe they are too similar to PTSD (and other trauma-related conditions) to warrant a separate diagnosis.

It is because of this overlap, that C-PTSD doesn't have its own diagnosis in the Diagnostic and Statistical Manual of Mental Disorders (DSM); instead, it is lumped together with PTSD. Even so, many mental health professionals believe C-PTSD should have its own diagnosis, separate from PTSD.

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

Despite the complexity and severity of the disorder, C-PTSD can be treated with many of the same strategies as PTSD.

Psychotherapy

C-PTSD requires complex and sequenced treatment, which involves multiple components that target different symptoms. But as experts continue to study C-PTSD, there is research that supports a unique phase-oriented trauma therapy. This treatment approach entails three phases:

  1. Stabilize: Building emotional regulation and distress tolerance skills
  2. Process: Reviewing traumatic memories under the care of a trained mental health professional
  3. Reconnect: Transitioning out of therapy and rebuilding a sense of self-esteem and security

Eye movement desensitization and reprocessing (EMDR)

Another emerging treatment for C-PTSD is EMDR. Unlike most forms of psychotherapy that focus on the disturbing emotions and symptoms that result from traumatic experiences, EMDR focuses more on the memory itself.

During EMDR therapy sessions, you'll briefly focus on a traumatic memory while your therapist—this is not something you should DIY— directs your eye movements. Over time, this process is supposed to reduce and eliminate the negative feelings associated with the traumatic memory.

Though EMDR is controversial, it is recognized as an effective form of treatment for trauma by the American Psychiatric Association, the World Health Organization, and the Department of Defense.

Medication

At times, it may be necessary to use medications to provide relief from C-PTSD symptoms, such as anxiety or depression.

A doctor may prescribe one of the following antidepressants for C-PTSD:

These medicines work best when combined 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.

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