Find a therapist Search articles

Complex posttraumatic stress disorder (c-PTSD): Symptoms, causes, and treatments

Reviewed by Robert Bogenberger, PhD

A concept featuring a brain experiencing stress or trauma responses.

What Is Complex PTSD?

Many people are familiar with posttraumatic stress disorder (PTSD). PTSD is often associated with isolated acts of trauma, such as a near death experience or violence, but even more common with repeated exposure to such events. Complex PTSD represents a more severe form of PTSD—it typically develops after prolonged trauma and is more common in those who have experienced repeated, continuous trauma over months or even years. Children exposed to prolonged trauma, particularly if from caregivers, are most vulnerable to complex PTSD.

Complex PTSD (c-PTSD) is a relatively new discovery—prior to its first mention in the late 1980s, it was originally known as “shell shock,” and predominantly linked with soldiers returning from the Vietnam war. It should be noted that the Diagnostic and Statistical Manual of Mental Disorders (DSM) does not currently recognize c-PTSD as a distinct condition from PTSD.

Complex PTSD vs. PTSD

Both PTSD and c-PTSD are the result of trauma—often those diagnosed with either of these mental health conditions experience flashbacks, nightmares, and insomnia. Both cause fear and anxiety and are often triggered by the memory of previous traumatic events. However, there is one key difference. 

The principal difference between the two is the trauma itself which causes these two conditions to develop. While PTSD often develops from a standalone traumatic event, complex trauma develops when the trauma occurs over a sustained period of time. The symptoms tend to be more extreme and coupled with a negative self-view and detachment from the trauma. 

In many cases, complex posttraumatic stress disorder comes from childhood trauma, while PTSD can develop at any age. However, domestic abuse or living in a war-torn state can also cause c-PTSD to develop.

Complex PTSD Symptoms

Complex posttraumatic stress disorder often displays similar symptoms to Borderline Personality Disorder (BPD). As complex PTSD is a relatively new discovery, not all doctors are aware of it and, consequently, some people are given a BPD diagnosis when their symptoms more closely fit complex PTSD. 

The way c-PTSD displays itself is similar to PTSD, but with a couple of additional symptoms that can be more extreme than those of PTSD. They vary from person-to-person, however, the below are all common to both PTSD and c-PTSD:

  • Potentially Harmful Behavior – often those with the mental illness might turn to self-harm, alcohol misuse or drug abuse.
  • Re-experiencing – the most recognizable symptom of PTSD is flashbacks, unwanted, intrusive memories or nightmares. These are often caused by triggers—and are likely to leave the patient feeling great distress and confusion. 
  • Physical Symptoms – PTSD can often manifest physical symptoms, too, such as headaches, dizziness, chest pains, stomach aches and anxiety attacks.
  • Hyperarousal – this occurs when a high state of anxiety occurs, which may display itself through increased blood pressure, and rapid heart rate.

The below are typical symptoms of those with c-PTSD:

  • Negative Self-View – often people feel ashamed, guilty, and helpless after long lasting trauma. This can continue well after the abuse has stopped.
  • Loss of Systems of Meanings – often those with c-PTSD lose faith in their religion or beliefs especially if they experience depersonalization and derealization. 
  • Abuser Perception – trauma survivors are often still in some form of complicated relationship  with their abuser. 
  • Detachment from trauma – depersonalization and derealization from the trauma and the world around them are common symptoms. They may feel outside their own body, or that what’s happening around them isn’t real.
  • Difficulty controlling emotion – often people suffering with c-PTSD can find emotional regulation difficult. This  may be expressed through explosive anger, continual sadness, depression, and suicidal thoughts.
  • Lack of trust – due to their past experiences, those with complex posttraumatic stress disorder often  find it hard to trust people. Relationships suffer and patients find themselves in unhealthy relationships that repeat those in the past. 

The symptoms of complex posttraumatic stress disorder are not fixed. An individual may experience depersonalization and depression at one time and then shift to a period of emotional outbursts, anger, and suicidal thought at another.

Causes of c-PTSD

As mentioned, complex PTSD is typically caused by long-term physical, emotional or sexual abuse. Some examples of traumatic events that might cause this mental health condition to arise include:

  • Child abuse, neglect or abandonment 
  • Continuous domestic abuse
  • Being a prisoner of war
  • Living in a war-torn area for a long time 
  • Kidnapping, enslavement, or torture
  • Forced into sex work

The symptoms are often more severe if the survivor of trauma has experienced discrimination— whether this be due to race, gender, sexuality, or more. It is thought someone is more likely to develop complex PTSD if:

  • They first experienced trauma from a young age
  • The perpetrator was someone close to them e.g. a parent or partner 
  • The trauma took place over a long period of time
  • The person was alone when the trauma took place
  • There is still contact with the person responsible for the trauma 
  • The person has multiple traumas

Treatment for c-PTSD

As the DSM does not recognize c-PTSD as a distinct condition from PTSD, treatment is still being developed. Professionals tend to offer those with the condition medication, psychotherapy, and eye movement desensitization & reprocessing (EMDR).  C-PTSD also has the effect of disrupting mind-body connections and physical interventions such as yoga, dance, or Tai Chi can be a vital element of the recovery process.


Psychotherapy, or talking therapy, is often the first thing that springs to mind when people think +therapy”—this is because it’s a proven method which has successful results for most mental health conditions. Within talking therapy, a therapist may offer cognitive behavioral therapy (CBT) or dialectical behavioral therapy (DBT)—these help replace negative thoughts with positive ones, while dealing with self-harm and suicidal thoughts respectively.


A combination of psychotherapy and medication are often the most effective treatments for complex PTSD. Antidepressants can work well in easing some of the symptoms—so many find themselves taking medication long term alongside therapy. 

Doctors are likely to prescribe the following:

  • Paroxetine (Paxil)
  • Fluoxetine (Prozac)
  • Sertraline (Zoloft)


A therapist will work closely with the patient to reprocess memories that are causing flashbacks or intrusive feelings and thoughts, helping patients to process those “stuck,” vivid memories. By using eye movement, a therapist can help the patient to desensitize the trauma they feel—resulting in the memories no longer causing such a strong reaction. 

For PTSD, this can be a very effective treatment, which can often help a patient suffering with PTSD in a number of sessions—while a patient with complex PTSD is likely to need more sessions, and more thorough approach to the process. 

At, we pride ourselves on our extensive therapist network who will be able to help with processing trauma, long lasting or otherwise. Check out our directory of trauma therapists—and let one of our expert team help you today.

About the author

The editorial team at works with the world’s leading clinical experts to bring you accessible, insightful information about mental health topics and trends.

Related articles

An exhausted medical worker sits and puts her hand to her head

What is posttraumatic stress disorder (PTSD)?

PTSD can develop after a person experiences or witnesses trauma. Find out how...

A woman looking down toward the ground.

Trauma: Types, stages, effects, and treatments

Most people will experience at least one trauma in their lifetime. Learn more...

See more