Complex PTSD Symptoms, Diagnosis, And Treatment Options

Medically reviewed by Dr. April Brewer, DBH, LPC
Updated March 22, 2024by BetterHelp Editorial Team
Content Warning: Please be advised, the below article might mention trauma-related topics that include abuse which could be triggering to the reader. If you or someone you love is experiencing abuse, contact the Domestic Violence Hotline at 1-800-799-SAFE (7233). Support is available 24/7. Please also see our Get Help Now page for more immediate resources.
Complex PTSD (C-PTSD) is considered a type of post-traumatic stress disorder (PTSD) that can arise due to chronic traumatic events across a lifetime, often repeated and long-term. Some of the symptoms experienced with C-PTSD can include avoidance of triggering stimuli, nightmares, flashbacks, feelings of guilt, stress, sleeping problems, and difficulty in relationships.

Behavioral therapy, cognitive restructuring therapy, and exposure therapy may be used to treat C-PTSD. Understanding the methods of diagnosis and treatment available for you may be helpful if you suspect you are living with C-PTSD.

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It can be challenging to cope with C-PTSD

What is the difference between PTSD and C-PTSD? 

Below are several similarities and differences between PTSD and complex PTSD. Note that complex PTSD is not an official diagnosis from the DSM-5, so it cannot be diagnosed by a therapist to be used for insurance billing. However, it is a widely accepted theory (including by the World Health Organization) and proposed diagnosis for future renditions of the DSM. 


Post-traumatic stress disorder (PTSD) is a trauma and stressor-related disorder in the DSM-5 that can manifest differently for individuals. It often involves avoidant anxiety surrounding certain triggers, a sense of hypervigilance, distressing nightmares, and persistent distress. PTSD can only form in those who have experienced traumatic event(s) or witnessed one over one month ago (before this period, an individual may be diagnosed with acute stress disorder).

Anyone can develop PTSD, regardless of age. PTSD in teens and children is not uncommon, and it may develop in childhood. However, individuals who have gone through ongoing catastrophic experiences or repeated trauma may develop complex post-traumatic stress disorder (C-PTSD).

Complex PTSD 

While PTSD is often associated with a single incident, like a car accident, robbery, natural disaster, or traumatic wartime event, complex PTSD often develops after a group of intricate, complex trauma symptoms resulting from long-term traumatic situations or multiple traumas. 

Examples of ongoing trauma may include interpersonal trauma like long-term physical or sexual abuse, ongoing domestic violence, being a prisoner of war, or being a survivor of commercial sexual abuse, including human trafficking or prostitution. All of these can be risk factors for developing complex PTSD. C-PTSD is considered more severe in those who experienced traumatic events for years, at a young age, alone, or due to a caregiver like a parent.  

Complex PTSD is often characterized by severe, persistent challenges in behavior control. Those with C-PTSD may view themselves as worthless or defeated and may often experience feelings of guilt, shame, and failure concerning the traumatic events they’ve lived through. They may have low mental health, difficulty sustaining relationships, and their symptoms may lead to impairment in various areas of functioning, such as work, school, and social settings. 

If you are experiencing sexual abuse or have experienced assault, note that the Rape, Abuse, and Incest National Network (RAINN) has a hotline dedicated to supporting individuals experiencing sexual assault, harassment, or intimate partner violence. You can contact them anytime by calling 800-656-HOPE (4673) or using the online chat.

Symptoms of C-PTSD

Complex post-traumatic stress disorder may include the following core symptoms:

  • Avoidance of people, objects, topics, ideas, animals, or situations that remind someone of the traumatizing event(s)
  • Avoiding thoughts, memories, and feelings related to the traumatizing event(s)
  • Nightmares of the traumatizing event(s)
  • Distressing flashbacks of the traumatizing event
  • Frightening thoughts about the traumatizing event
  • Distorted or misplaced thoughts of guilt or blame
  • Negative thoughts about the world or oneself, including a sense of hopelessness or worthlessness.
  • Loss of interest in hobbies and activities
  • Difficulty remembering specific events relating to or surrounding the period of trauma
  • Arousal and reactivity
  • Sleeping problems, including waking early, insomnia, and oversleeping
  • Feeling stressed, on edge, or irritable
  • Feeling jumpy or startled easily
  • Experiencing outbursts of anger or explosive anger

The DSM-5 does not consider C-PTSD a separate diagnosis from PTSD. Complex PTSD can also overlap with borderline personality disorder, which often involves enduring personality change unless consistent treatment is utilized. Talk to a therapist if you think you might be experiencing C-PTSD. 


Other symptoms of C-PTSD may include:

  • Difficulty relating to others
  • Searching for reassurance or a rescuer 
  • Distrusting others
  • Isolating oneself from relationships, including family or a partner 
  • Avoiding close relationships altogether
  • Engaging in predominantly unhealthy relationships
  • Experiencing difficulty controlling emotions
  • Feeling angry often 
  • Persistently experiencing sadness and depression
  • Experiencing suicidal thoughts and urges*
  • Experiencing cognitive difficulties
  • Struggling with memory (forgetting traumatic events, traumatic memories, or details surrounding them)
  • Feeling disassociated or detached from emotions and their sense of self
  • Reliving traumatic events persistently
  • Struggling to perceive oneself correctly 
  • Perceiving oneself as guilty and unworthy of help
  • Experiencing negative self-perception
  • Having an overwhelming sense of shame
  • Perceiving oneself as helpless
  • Feeling different from others
  • Experiencing preoccupation with the perpetrator or perpetrators
  • Experiencing preoccupation with revenge
  • Attributing power to the perpetrator
  • Feeling one’s belief system has been damaged 
  • Lacking faith 
  • Struggling to feel hopeful
  • Experiencing overwhelming feelings of despair

If you are experiencing suicidal thoughts or urges, call the 988 Suicide & Crisis Lifeline at 988 or text 988 to talk to a crisis provider over SMS. They are available 24/7 to offer support. 988 also offers an online chat for those with an internet connection.

C-PTSD in children and teens 

Because children and teenagers may not have the same coping mechanisms as adults, the additional symptoms they exhibit after prolonged traumatic events, such repeated physical abuse, may differ. Childhood trauma survivors may experience the following symptoms: 

  • Bedwetting after they have learned to use the toilet
  • Acting out the traumatic event while playing
  • Losing speech 
  • Clinging to a parent or other adult
  • Fearing separation 

Older children and teens often experience many of the same symptoms as adults, although they sometimes experience the following symptoms of complex PTSD as well:

  • Disrespectful or destructive behavior
  • Misplaced guilt over not being able to prevent death or injury
  • Feelings of or a preoccupation with revenge

Complex PTSD treatment

Complex PTSD treatment can be similar to PTSD treatment for many people. However, due to the nature of the traumas the person may have experienced, treatment can be longer-lasting and more intensive. Survivors of these traumatic events may need more resources to regain power and control over their thoughts and actions. 

For those with C-PTSD, treatment may focus on developing a strong, positive sense of identity. There can be several approaches for those seeking to treat PTSD or complex PTSD, including the following.

Behavioral therapy 

Standard behavioral therapies teach coping mechanisms to help individuals recognize and change maladaptive thoughts and behaviors. This type of therapy often addresses symptoms as they arise rather than ignoring them or trying to push through them. A standard behavioral therapy that may be used as a starting point for PTSD or C-PTSD is cognitive-behavioral therapy (CBT). However, this format may not work for those looking for a person-centered or emotionally-focused form of therapy. 

Cognitive-restructuring therapy (CPT)

A therapeutic method called cognitive-restructuring therapy focuses on coping with how traumatic events occurred and helping the client understand their thought processes. For many, self-blame, guilt, and shame can be significant symptoms of the diagnosis, so restructuring therapy may put traumatic memories or events in perspective. It may ease these feelings by helping individuals recognize the reality of the situation.

Exposure and response prevention therapy (ERP) 

Exposure therapy is a type of psychotherapy that can safely expose individuals to fears surrounding triggers. During exposure therapy, individuals may learn to face their fears, recognize their ability to cope, and exert control over their reactions and impulses. This type of therapy may reduce learned helplessness and a lack of confidence. This type of therapy for PTSD often works for people who have severe symptoms of anxiety about or closely related to their traumatic experiences. 

Eye movement desensitization and reprocessing therapy (EMDR) 

Eye movement desensitization and reprocessing therapy (EMDR) is a type of therapy that was developed to treat PTSD. It utilizes bilateral brain stimulation to engage both parts of the brain while the client talks about trauma. The therapist may use non-painful hand buzzers, lights, or finger movements in front of the client’s eyes to stimulate the brain. 

Peer-reviewed studies have found that EMDR is effective and can change the balance between the limbic area and prefrontal cortex, improving how they interact so that the client can bring forward and process the trauma without becoming re-traumatized by discussing the event. This form of therapy is often used for one trauma but can be used for more trauma. However, for C-PTSD, EMDR may be more long-term. 

Internal family systems therapy (IFS) 

Internal family systems therapy (IFS) is a more modern form of treatment often used for C-PTSD in particular. It involves “parts work,” looking at the different parts that can form in an individual’s personality. IFS providers believe that every person has parts, but trauma can further solidify these parts. Some people might have parts of themselves that are more protective, guarded, and scared and parts that are more social, trusting, and open. IFS works on helping clients accept every part of their personality openly and lovingly by returning to past events in mind and mentally “saving their past self” from what occurred. 

It can be challenging to cope with C-PTSD

Address complex PTSD with counseling 

Fear of rejection often accompanies a C-PTSD diagnosis and may cause some people to feel apprehensive about seeking help. However, talking with a mental health professional who can help you navigate the healing process can be crucial. Attending therapy online through a platform like BetterHelp can help you find support from home and may ease apprehension about visiting a therapist’s office. 

An online counseling platform can connect you with experienced, licensed therapists who practice various therapeutic models. When you sign up, you can request a specialist in C-PTSD to get started. If you’re unsure about the effectiveness of online therapy, you can look at studies that have found online PTSD counseling as effective as in-person sessions. Internet-delivered treatment is often associated with significant improvements in symptoms and long-term results. 


Post-traumatic stress disorder due to multiple or long-term traumatic events rather than a single event may be classified as complex PTSD or C-PTSD. It may involve symptoms like flashbacks, stress, insomnia, avoidance of triggers, nightmares, feelings of guilt, and shame. Exposure therapy for PTSD, cognitive processing therapy, and internal family systems are a few options for individuals considering support. However, you can reach out to a therapist any time online or in your area to learn more about the treatment that could work for you.
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