Complex PTSD Symptoms, Treatment, And Therapy Options For You

By Darby Faubion|Updated August 4, 2022
CheckedMedically Reviewed By Melinda Santa, LCSW

If you or someone you love is currently affected by complex PTSD (post-traumatic stress disorder), it can feel like you don’t know what else to do. You might feel stuck or alone in your struggle. No matter what you're experiencing right now or in the past, there are tools to help you move forward to a life that feels lighter, happier, and healthier. The fact that you’re here right now looking for answer is a great indicator that hope is not lost. Taking the courageous step to investigate and pursue treatment options for managing your symptoms is a victory. Seeking PTSD counseling has proven to be an effective option for treatment, and taking a PTSD test can help you learn more about a treatment plan. PTSD symptoms in women are different to symptoms in men, so it's crucial you connect with a therapist to learn about a treatment plan that's right for you. 

Post-traumatic stress disorder (PTSD) is a trauma-based mental illness, and whether PTSD goes away completely varies by person. It manifests in many ways and can look very different. Often it causes severe anxiety around certain triggers, a sense of jumpiness, distressing nightmares, and persistent feelings and symptoms of distress. Many people often experience PTSD and anger together. Anyone who has experienced, witnessed, or repeatedly been exposed to details of a traumatic event may develop PTSD in response. In particular, individuals who have gone througha repeated or ongoing catastrophic experience or long term trauma may have more risk factors for developing complex post-traumatic stress disorder (C-PTSD).               

If you or a loved one ever finds themself in a crisis, a PTSD hotline is a great resource that is available. More and more people are learning about this mental health challenge, especially during PTSD awareness month each June.

While PTSD may develop after a single incident, such as getting into a car accident, experiencing a robbery, living through a natural disaster, and other such relatively short-term events,complex PTSD is a relatively new diagnosis that involves a group of intricate, complex trauma symptoms that result from long-term traumatic events or multiple traumas. Examples of ongoing trauma, per the U.S. Department of Veterans Affairs, include types of interpersonal trauma like long-term physical or sexual abuse, ongoing domestic violence, being a prisoner of war, or being a victim of commercial sexual abuse, including human trafficking or prostitution. All of these are risk factors for developing complex PTSD. C-PTSD is thought to be more severe in those who experienced traumatic events for a long time, at a young age, were alone in the experience, or the experience was enacted by a caregiver, especially one they are still in contact with. 

The World Health Organization (WHO) describes C-PTSD as: “Complex PTSD is characterised by severe and persistent 1) problems in affect regulation; 2) beliefs about oneself as diminished, defeated or worthless, accompanied by feelings of shame, guilt or failure related to the traumatic event; and 3) difficulties in sustaining relationships and in feeling close to others. These symptoms cause significant impairment in personal, family, social, educational, occupational or other important areas of functioning.”

In this article, we'll look closer at symptoms of complex PTSD, which bear similarity to the symptoms of PTSD, and treatment for Complex PTSD.

Complex PTSD is A Condition Where A Person Has Experienced Repeated Trauma.

Symptoms of C-PTSD

Complex post-traumatic stress disorder usually encompasses the following PTSD (posttraumatic stress disorder) symptoms:

  • Avoidance
    • Avoiding places, people, or situations that remind someone of the traumatizing event(s)
    • Avoiding thoughts, memories, and feelings of the traumatizing event(s)
  • Re-experiencing
    • Nightmares of the traumatizing event(s)
    • Distressing flashbacks of the traumatizing events(s)
    • Frightening thoughts about the traumatizing event
  • Mood and Cognition
    • 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
    • Problems 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 startling easily
    • Experiencing outbursts of anger or explosive anger

It's worth noting that the DSM-5 (Diagnostic and Statistic Manual) does not consider C-PTSD to be a separate diagnosis or condition from PTSD. Complex PTSD has some overlap with borderline personality disorder (BPD) as well, the latter of which involves enduring personality change unless consistent treatment is utilized.

In addition to the list above, people experiencing C-PTSD may also see the following symptoms:

  • Difficulty relating to others
    • An ongoing search for a rescuer
    • Distrust of others
    • Isolating oneself from relationships, even close ones
    • Avoiding close relationships altogether
    • Engaging in predominantly unhealthy relationships
  • Difficulty regulating emotions
    • Outbursts of anger
    • Persistent sadness and depression
    • Suicidal thoughts. If you are experiencing thoughts of suicide, reach out for help immediately. The National Suicide Prevention Lifeline can be reached at 1-800-273-8255.
  • Cognitive difficulties
    • Problems 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
  • Difficulty with self-perception
    • Perceiving oneself as guilty and unworthy of help
    • Overall negative self-perception
    • An overwhelming sense of shame
    • Perceiving themselves as helpless
    • Feeling different from others
  • Preoccupation with the perpetrator/perpetrators
    • Preoccupation with revenge
    • Preoccupation with one's relationship to the perpetrator
    • Attributing power to the perpetrator
  • Damage to one's belief system
    • Lack of faith
    • Inability to feel hopeful
    • Overwhelming feelings of despair

Because children and teenagers do not have the same coping mechanisms as adults, the additional symptoms they exhibit after prolonged traumatic events, such as childhood abuse, may be a little bit different. For example, children who are six years old or younger may also experience the following symptoms:

  • Bedwetting after they have learned to use the toilet
  • Acting out the traumatic event while playing
  • Loss of speech
  • Clinging to a parent or other adult; fear of being separated from them

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

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

Complex PTSD is A Condition Where A Person Has Experienced Repeated Trauma.

Complex PTSD Treatment

Complex PTSD treatment may be similar to PTSD treatment for many people. However, many experts believe that the treatment for C-PTSD should be more in-depth or long-lasting. Survivors of these kinds of traumatic events may need more resources to help re-establish a feeling of power and control over their own thoughts and actions. In addition, treatment may focus on developing a strong, positive sense of identity. There are several approaches for those seeking to treat PTSD or complex PTSD.

Standard behavioral therapies teach coping mechanisms and help individuals to recognize and change their negative thoughts and behaviors. This type of therapy also focuses on addressing symptoms as they arise, rather than ignoring them or trying to push through them to something more positive.

At times, it may be necessary or helpful to use medications to manage C-PTSD symptoms. Some medication regimens may include antidepressants, anti-anxiety medications, and sleep aids.

Antidepressants help to relieve some negative mood symptoms, such as excessive guilt, shame, and blame. Alternatively, anti-anxiety medications are used to help relieve the symptoms of fear, worry, and extreme stress that often accompany a diagnosis of complex posttraumatic stress disorder.

Another therapeutic method known as cognitive restructuring therapy focuses on dealing with how the traumatic event occurred and helping the patient understand their thought processes around the event. For many, self-blame, guilt, and shame are major symptoms of the diagnosis, so restructuring therapy helps put traumatic memories or events in perspective. It works to ease these feelings by looking at the reality of the situation.

Exposure therapy is a type of psychotherapy that exposes individuals to the trauma they once experienced in a safe way. During exposure therapy, individuals learn to face their fears, recognize their own ability to cope with it, and exert control over their reactions and impulses. This therapy often works for people who have severe symptoms of anxiety related to their traumatic experience or experiences. It may be a step taken later on in a patient’s treatment plan.

One type of exposure therapy is eye movement desensitization therapy (EMDR), which involves the client talking about or answering questions about their trauma while focusing on a moving dot or something similar. Peer reviewed studies have found that EMDR works by activating different parts of the brain and changing the way they interact with one another, like the prefrontal cortex and limbic area, so that the brain is able to bring forward and process the trauma without becoming re-traumatized.

Help For Complex PTSD With Therapy

The fear of rejection that often accompanies a C-PTSD diagnosis may cause some people to be apprehensive about seeking help. The benefits of talking with someone who can help you navigate the healing process is crucial.

There are many options for talking with mental health professionals, such as a counselor or therapist. Some people prefer to meet in-person in a controlled setting, like a therapist’s office. It provides a safe place to explore feelings and learn new tools. Others may prefer to have more control over when and where they communicate with a counselor. In these instances, online counseling is a great option.

BetterHelp, an online counseling platform, can connect you with experienced counselors, doctors, and social workers who can help you address Complex Post-Traumatic Stress Disorder and any other mental disorders or mental health issues you may be facing. Their goal is to provide professional help to anyone who needs assistance navigating life's difficulties. Online counseling for battling mental symptoms and physical symptoms related to C-PTSD, (including a mental health condition like depression and anxiety) has been shown to be just as effective as in-person sessions. A study looking at 318 BetterHelp users found that those users experienced a significant reduction in depressive symptoms in just 3 months of sessions, and fewer ongoing physical symptoms.

Online counseling can be a great, straightforward way to begin receiving help today to cope with both the mental and physical symptoms of trauma. With no waiting around for an open spot in your local counselor’s office, online counseling can begin as soon as you’re ready, whether via messaging or phone calls or video chats. Plus, BetterHelp’s service is completely confidential, making sure your information stays safe and private.

Below you'll find some reviews of BetterHelp counselors from people experiencing similar issues.

Counselor Reviews

"Ted is an example of what a person is gifted to do!!! Has given me direction to go forward with complex PTSD. It's been a productive year and looking to more growth."

"Dr. Cooley was able to identify my needs and address appropriate therapy. I no longer have PTSD events that are not manageable. He has given me tools and resources to deal with my issues. I became brave enough to make positive change in my life and found I could experience joy and genuine love."


Dealing with any kind of trauma can feel overwhelming, but help is available from mental health professionals and licensed wellness professionals. If you're affected by complex post-traumatic stress disorder, you can learn tools to work through your chronic trauma, mitigate negative thought patterns, and regain your sense of power and identity. Though C-PTSD can be very difficult to experience, don’t lose faith! BetterHelp offers many online resources, including licensed, experienced, effective online therapy. You can fully manage settings, such as the type of therapy and therapist you would like, how often your sessions occur, and much more.

With help from a qualified therapist, it's possible to gain coping mechanisms to lead a healthier life and treat PTSD. Take the first step today.

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