Complex PTSD can change your whole world, from how you see yourself to how you relate to others. Thankfully, there are treatment options available to help you manage symptoms.
Do others experience the world the way that you do? Lately, you’re not so sure. Maybe you’re having a hard time in your relationships, or you feel a pervasive sense of sadness without knowing why.
You may find it hard to control your emotions, or perhaps you struggle with low self-esteem. You wonder whether it could be post-traumatic stress disorder (PTSD), bipolar disorder, borderline personality disorder, or something else entirely.
You’re probably familiar with PTSD, a condition that can arise after you experience a distinct trauma, like a violent crime or natural disaster. PTSD impacts 1 in 11 people in their lifetime, according to the American Psychiatric Association.
But there’s another type of trauma that’s a bit newer to the world of psychology. It’s often confused with other mental health conditions. It’s called complex post-traumatic stress disorder — a subtype or variant of the classic form of PTSD.
What is complex PTSD?
The term “complex PTSD” first emerged in 1992 in Dr. Judith Herman’s book “Trauma and Recovery.” It’s commonly abbreviated as CPTSD or C-PTSD.
CPTSD stems from trauma that occurs as a result of repeated or ongoing traumatic experiences, usually over the course of several months or years.
It often develops as a result of childhood trauma, but it can develop from repeated trauma in adulthood as well.
Currently, CPTSD is not an official diagnosis in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5).
However, it will be included in the International Classification of Diseases, 11th Revision (ICD-11), which is considered the gold standard in diagnostics by the World Health Organization (WHO).
Some research estimates that 3.3% of people in the United States meet the criteria for CPTSD, with women being more than twice as likely as men.
Causes and risk factors
Any kind of trauma sustained over the long term can lead to CPTSD. However, CPTSD is particularly common among those who experienced ongoing trauma during their developmental years — i.e., during childhood.
CPTSD may develop from trauma inflicted by those who were meant to care for or protect you. This could include family members, close family friends, teachers, coaches, or religious leaders.
Here are some examples of what can cause CPTSD:
- repeated physical or emotional abuse
- living in a politically unstable or war-torn area
- ongoing childhood neglect or abandonment
- long-term sexual abuse, such as human trafficking
- regular exposure to danger, as encountered by military personnel, police, or first responders
- family enmeshment or parentification (being a parent to your parent)
Researchers are still trying to figure out why some people develop CPTSD while others do not. So far, your likelihood depends on a few risk factors:
- family history of depression or anxiety
- genetic factors, like lower stress tolerance
- absence of a support network or “safe” connections
In order to be diagnosed with CPTSD (unofficially), you’ll need to have some classic symptoms of PTSD, such as:
- flashbacks or nightmares
- dissociation or memory lapses
- reliving the traumatic experience
- hyperarousal, or being on “high alert”
- avoidance of certain people, places, or scenarios
- dissociation or feeling detached from yourself
- somatic symptoms, like headache or upset stomach
The other CPTSD symptoms can be grouped into three main categories: negative self-cognition, emotional dysregulation, and interpersonal hardship.
When we’re young, we engage in black and white thinking — this or that, good or bad.
If you experienced prolonged trauma during childhood, you may have had trouble understanding your experience and seeing the person who hurt you as the one at fault. Instead, in order to make sense of things, you may have blamed yourself: “I must be bad, so I deserve this.”
This type of self-perception can continue well into adulthood, even if you’re not aware of it on a conscious level. It manifests as:
- having low self-esteem
- feeling a lack of self-worth
- feeling damaged
- feeling unworthy
- feeling guilty or ashamed
- feeling undeserving of good things
As the mind and body adapt to long-term trauma, it’s natural for the brain to shape your worldview around a traumatic new “normal.” By blaming yourself, it makes it easier to handle the pain.
Difficulty with controlling emotions is a common symptom of CPTSD, which can lead to a misdiagnosis as a mood disorder. These symptoms include:
- angry outbursts
- impulsive behaviors
- abrupt mood changes
- high levels of anxiety or worry
- feeling a chronic lack of safety
- ongoing sadness or upset mood
Children who experience trauma may have difficulty trusting others as adults.
You may experience frequent arguments over miscommunications or have emotional outbursts toward those you love. On the other hand, you may self-isolate or avoid interacting with others as a measure of self-protection.
You may also oscillate between wanting to be close to people and wanting to pull away. This dynamic is similar to a fearful-avoidant attachment style in attachment theory, or the push-pull dynamic that emerges in borderline personality disorder, commonly described as, “I hate you, don’t leave me.”
Symptoms of interpersonal hardship include:
- frequent conflict
- communication issues
- difficulty trusting people
- breakup/makeup pattern
- distorted perception of others or trauma bonding
- relationships that replicate childhood experiences (trauma reenactment)
Dishonesty can also come up in relationships. You may have been forced to lie or conceal your feelings in childhood to stay safe, and now it’s a survival skill that can be difficult to let go of.
PTSD vs. CPTSD
PTSD can develop as a result of experiencing or witnessing a distinct traumatic event, like a car accident or violent assault. In 1980, the APA added PTSD as a diagnosis in the third edition of the DSM.
Those who live with PTSD have a heightened fight, flight, or freeze response. This creates an ongoing sense of danger along with other symptoms, like flashbacks or nightmares, even when the danger has long since passed.
CPTSD, on the other hand, comes from trauma that occurs repeatedly. It presents many of the same symptoms as PTSD, but it can also change how you view yourself, how you control your emotions, and how you relate to others.
Since CPTSD isn’t in the DSM-5 yet, it may be hard to get an official diagnosis; your doctor may not be aware that it even exists.
If you’ve experienced symptoms for one month or longer, your doctor may diagnose you with PTSD, a mood disorder, or another trauma-related condition, such as:
borderline personality disorder
dissociative identity disorder
A proper diagnosis of CPTSD is important because it impacts the kind of treatment you will receive. While other mental health conditions appear to have similar symptoms, many come from genetic factors (rather than environmental factors), so they’re addressed differently.
If you feel that trauma plays a role in your symptoms, it’s a good idea to reach out to a trauma specialist. Try to find a doctor who understands CPTSD and the multitude of ways it can impact your life.
Complex trauma can be just that — complex. There’s no one-size-fits-all treatment protocol. Consider an integrative approach, with education, psychotherapy (talk therapy), self-care, and medication if suggested.
Research shows that cognitive behavioral therapy (CBT) and eye movement desensitization and reprocessing (EMDR) can be effective for treating symptoms of CPTSD and traditional PTSD.
A number of other trauma approaches are gaining traction as well, particularly for those who live with disassociation, since talking about trauma too soon can actually do more harm than good.
In her book “Healing the Fragmented Selves of Trauma Survivors,” Dr. Janina Fisher draws on a number of therapeutic approaches, including somatic therapies (body-based therapies) and internal family systems, to help trauma survivors find “resolution” in their core self. This replaces negative self-beliefs with compassionate acceptance.
World-renowned trauma expert Bessel van der Kolk is a proponent of rewiring the brain and reestablishing trust in the physical body through practices like yoga. ResearchTrusted Source shows that yoga can be an effective adjunctive treatment for PTSD.
Note, though, that it might be worth looking for trauma-informed yoga sessions. In these sessions, the yoga instructor will be sensitive to the fact that trauma can be stored in the body, and that certain body movements or motions can trigger emotional reactions. This helps to create a safe space to practice and facilitate healing.
Studies show that dialectical behavior therapy (DBT) can be effective at managing borderline personality disorder (BPD), which has many overlapping symptoms with complex trauma. It centers on mindfulness, acceptance, and distress tolerance.
Tips for living with complex PTSD
To compliment your work in talk therapy, consider body-focused self-care, like tai chi, weight lifting, or dancing. Your life experiences may have taught you to turn off your relationship with your body, and these activities can help bring you back into it.
Also, check in with yourself several times a day. Close your eyes and ask your body:
- What do you need?
- How can I support you?
- Where does this feeling live?
It can also be helpful to keep a daily journal about your feelings. Every so often, engage in “self-study” and see if you can recognize any patterns. These insights can be helpful to bring up in therapy.
If you are dealing with flashbacks, try this flashback halting protocol. Along with that, build up a meditation practice and do deep breathing techniques, like box breathing (inhale for a count of 4, hold for 4, exhale for 4, hold for 4, repeat).
No matter what your inner critic says, remember this: You are not broken. You are not a lost cause. You are not alone.
CPTSD is treatable and support is available. You can use the American Psychological Association’s Psychologist Locator to find a therapist who is familiar with trauma. You can also look up support groups near you.
If you’re in a relationship, you may want to consider couple’s therapy for extra support. It can be helpful to have an objective person in the room to help with communication.
The more you learn about CPTSD, the less alone you may feel. Here are some well-known books that can support you on your journey:
- “The Body Keeps the Score” by Bessel van der Kolk, MD
- “Healing the Fragmented Selves of Trauma Survivors: Overcoming Internal Self-Alienation” by Janina Fisher, PhD
- “Trauma & Recovery” by Judith Lewis Herman, MD
- “The Complex PTSD workbook” by Arielle Schwartz, PhD
- “Waking the Tiger” by Peter Levine, PhD
- “Trauma and the Body” by Pat Ogden, PhD
- “The Body Heals Itself” by Emily Francis
- “What Happened To You? Conversations on Trauma, Resilience, and Healing” by Bruce D. Perry, MD, PhD, and Oprah Winfrey