What Is Complex PTSD?

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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 severe and repetitive, however, some mental health professionals make a distinction between PTSD and another form known as complex PTSD (C-PTSD).


While PTSD can develop in response to short-term exposure to a single traumatic event, C-PTSD only occurs when someone has experienced severe, repetitive trauma over a long period of time.

The Diagnostic and Statistical Manual of Mental Disorders (DSM) has recognized PTSD as a diagnosis since it's third edition, but C-PTSD is not yet mentioned as a separate disorder. Even so, many mental health professionals have started to distinguish between the two conditions. In 2018, the World Health Organization 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).


According to the ICD-11, in addition to experiencing all of the core symptoms of PTSD, people with C-PTSD may also experience:

  • Difficulty Controlling Emotions:
    • You may experience an emotional flashback. This is when you have intense feelings that you originally felt during the trauma, such as fear, shame, or sadness. You may also experience severe depression, thoughts of suicide, or have difficulty controlling your anger.
  • Detachment from Trauma (Dissociation):
    • Dissociation is the mind's way of coping with an intensely traumatic experience. Those who experience dissociation may feel detached from their surroundings, their actions, and their body. They may experience gaps in their memory surrounding the original trauma or an everyday task that reminds them of the trauma they experienced.
  • Changes in Self-Perception
    • Complex PTSD can cause a person to view themselves in a negative light. This negative self-image can include feeling as if they are different from other people and feelings of helplessness, guilt, or shame.
  • Preoccupation With Perpetrator
    • It is not uncommon for people with C-PTSD to become fixated on their abuser. This can include becoming obsessed with the abuser, dissecting their relationship with the abuser, and becoming preoccupied with revenge.
  • Difficulty with Personal Relationships
    • Someone with C-PTSD may develop unhealthy relationships because they find it difficult to interact with and trust others. Note that this is unique from borderline personality disorder (BPD) in that a person with C-PTSD often alienates themselves, as opposed to people with BPD who engage in unstable relationships that are often volatile.
  • Changes in Beliefs
    • People exposed to chronic or repeated traumatic events may lose faith in humanity and previously held beliefs.


The traumatic events connected to C-PTSD are long-lasting and generally involve some form of physical or emotional captivity. Some examples of ongoing trauma 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.


Despite the complexity and severity of the disorder, C-PTSD can be treated with many of the same strategies as PTSD. But as experts continue to study C-PTSD, there is scientific research that supports a unique phase-based treatment approach. This treatment approach entails three phases:

  1. Reducing symptoms (i.e., through the use of medication) and improving self-management skills
  2. Reviewing and processing traumatic memories
  3. Transitioning out of therapy and engaging in community life

C-PTSD can be a debilitating condition, but there are effective therapies available to address the chronicity and complexity of a person's past trauma. 

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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Article Sources

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  1. Hyland P, Shevlin M, Fyvie C, Karatzias T. Posttraumatic Stress Disorder and Complex Posttraumatic Stress Disorder in DSM-5 and ICD-11: Clinical and Behavioral Correlates. J Trauma Stress. 2018;31(2):174-180. doi:10.1002/jts.22272

  2. 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

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