Complex posttraumatic stress disorder (c-PTSD)

Written by

therapist.com team

Last updated: 04/05/2024

Share this article

Share article

Share this article on Facebook Share this article on Twitter Share this article on LinkedIn Share this article on Messenger Share this article in email Copy the link to this article Print this article

What is complex PTSD?

Many people are familiar with posttraumatic stress disorder (PTSD). This condition can develop in response to traumatic experiences like violence, accidents, bullying, or abuse, and it’s especially common after repeated trauma.

Complex PTSD (or c-PTSD) is a form of the disorder that has several additional characteristics beyond those of standard PTSD. It typically develops after prolonged trauma, and it’s more common if someone experiences trauma repeatedly over an extended time. Children exposed to ongoing trauma, particularly if it’s caused by a caregiver, are especially vulnerable.

C-PTSD is a relatively new concept, first proposed in the 1980s by psychiatrist and professor Judith Herman, MD.¹ It’s worth noting that the American Psychiatric Association’s current diagnostic manual, the DSM-5, doesn’t yet recognize c-PTSD as a diagnosable condition. However, the World Health Organization does recognize c-PTSD in the latest version of its International Disease Classification (ICD-11), which was published in 2019 and came into effect in 2022.²

Complex PTSD vs. PTSD

Both PTSD and c-PTSD result from trauma. Each condition causes fear and anxiety that’s often triggered by the memory of previous traumatic events. People diagnosed with either condition may experience flashbacks, nightmares, or insomnia.

Often,  c-PTSD and PTSD are distinguished by the kind of trauma that caused each condition to develop. While PTSD can develop from a single, standalone traumatic event (as well as from prolonged trauma), complex PTSD generally develops when trauma happens repeatedly over a sustained period.³

People with c-PTSD tend to have extreme symptoms of PTSD and also have difficulty regulating their emotions, view themselves negatively, and struggle to maintain healthy relationships.⁴

Complex PTSD symptoms

PTSD and c-PTSD share many common symptoms, including:

• Reexperiencing: One of PTSD’s most recognizable symptoms is flashbacks—unwanted, intrusive events in which a person relives their trauma. Flashbacks are often triggered by reminders of the trauma, and they can cause intense distress and confusion. Reexperiencing can also take the form of recurring dreams or memories.⁵
• Hyperarousal (or “hypervigilance”): Both disorders can cause people to feel on guard all the time. It may cause someone to feel constantly under threat or startle easily.⁶ This may result in insomnia, irritability, anxiety, increased blood pressure, or a rapid heart rate.
• Avoidance: People with PTSD or c-PTSD will go out of their way to avoid reminders of their trauma. These reminders may be people, places, objects, or even specific thoughts and feelings.

The DSM-5 does not view c-PTSD as a distinct diagnosis from PTSD. The ICD-11, however, has fewer criteria that need to be met for a PTSD diagnosis. Because of this, it uses the following additional symptoms to distinguish between PTSD and c-PTSD:⁷

• A negative self-view: People with c-PTSD may feel ashamed, guilty, or helpless after experiencing long-lasting trauma. These feelings can continue well after the trauma itself has stopped.
• Difficulty controlling emotions: C-PTSD can cause people to have trouble regulating their feelings. They may struggle with explosive anger, depression, anxiety, or suicidal thoughts.
• Relationship difficulties: Past experiences may make it harder for people with c-PTSD to trust others, which can strain relationships. They may also find themselves in unhealthy relationships that resemble past ones.

C-PTSD symptoms aren’t set in stone. You may experience depersonalization and depression at one time, then shift to a period of emotional outbursts, anger, or suicidal thoughts at another.

If you’re in crisis, help is available now. Call or text the 988 Lifeline at 988 anytime.

Complex PTSD and borderline personality disorder

Complex posttraumatic stress disorder is relatively new, and not all mental health professionals agree that it should be a distinct diagnosis. In addition, PTSD, c-PTSD, and borderline personality disorder (BPD) all share very similar symptoms. Methods for distinguishing between these diagnoses are still being proposed.⁸

Causes of c-PTSD

Complex PTSD is typically caused by repeated, intense, or long-term trauma. Prolonged traumas that can produce the condition include:

• Being abused, neglected, or abandoned as a child
• Experiencing domestic abuse
• Being a prisoner of war
• Living in a war-torn area
• Being abducted, enslaved, or tortured
• Being coerced into sex work

The symptoms of PTSD are often worse for people who experience discrimination or marginalization due to race, gender, sexuality, disability, class, ethnicity, or other factors.⁹

Experts believe someone is more likely to develop complex PTSD if:

• They first experienced trauma at a young age.
• The perpetrator was someone in a position of trust, such as a parent.¹⁰
• The trauma took place over a long period of time.
• Escape from the trauma was difficult or impossible.¹¹
• They’ve had multiple traumas.

Treatment for c-PTSD

Specific treatments are still being developed for c-PTSD. Clinicians tend to take the same approach as they would for PTSD: therapy, medication, or a combination of the two. Effective treatment for c-PTSD requires that providers use a trauma-informed model of care.¹²

Because c-PTSD can disrupt mind-body connections, physical activities like yoga, dance, or tai chi can also be a vital part of healing.

Psychotherapy

Psychotherapy, also called talk therapy, is often what springs to mind when people think of therapy. It’s a proven method that can treat many mental health conditions successfully.

Cognitive behavioral therapy (CBT) and dialectical behavior therapy (DBT) are two common, effective types of treatment that can help people regulate their feelings and replace negative thoughts with positive ones.

EMDR

Eye movement desensitization and reprocessing (EMDR) is a form of therapy that has proven especially helpful in the treatment of PTSD. In EMDR, therapists help clients reprocess vivid, “stuck” memories that cause flashbacks or intrusive thoughts and feelings. This can help clients desensitize themselves to triggers and make new connections in their brains. Its goal is to make distressing memories no longer cause strong reactions.

EMDR happens over a number of sessions, and it can be effective for both PTSD and c-PTSD.¹³ Cases of complex PTSD may require longer periods of treatment.

Medication

A combination of psychotherapy and medication can be an effective treatment for complex PTSD. Antidepressants can work well in easing some of the symptoms of this disorder.

Get help

If you’re struggling with the effects of trauma, long-lasting or otherwise, therapy can help. Browse our directory to find a licensed trauma-informed provider near you.

If you’re in crisis, help is available now. Call or text the free, confidential 988 Lifeline at 988, or text HOME to 741741 to connect with a crisis counselor.