Complex PTSD Symptoms, Treatment, And Therapy Options For You

Updated April 14, 2023by BetterHelp Editorial Team

Complex PTSD or C-PTSD is usually considered a type of post-traumatic stress disorder that can arise due to multiple traumas or long-term traumatic events. Some of the types of symptoms experienced with C-PTSD can include avoidance of triggering stimuli, nightmares, flashbacks, feelings of guilt, stress, sleeping problems, and more. C-PTSD can look different in children and teens. Behavioral therapy, cognitive restructuring therapy, and exposure therapy may be used to treat C-PTSD. One way to connect with a licensed mental health professional to treat this disorder may be through an online therapy platform.


Post-traumatic stress disorder (PTSD) is generally a trauma-based mental illness, and it can manifest in many ways and can look different in different people. Often, it causes severe anxiety around certain triggers, a sense of jumpiness, distressing nightmares, and persistent feelings and symptoms of distress. Anyone who has experienced, witnessed, or repeatedly been exposed to traumatic events may develop PTSD in response. PTSD in teens is not at all uncommon due to the effects and other factors that influence their behavior. Individuals who have gone through repeated or ongoing catastrophic experiences or long-term trauma may develop complex post-traumatic stress disorder (C-PTSD).

While PTSD may develop after a single incident, such as a car accident, robbery, natural disaster, or other relatively short-term events, complex PTSD is a relatively new diagnosis that usually involves a group of intricate, complex trauma symptoms resulting from long-term traumatic events or multiple traumas. 

Examples of ongoing trauma may 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 can be risk factors for developing complex PTSD. C-PTSD is generally 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. 

If you or a loved one is experiencing abuse, please know that help is available. You can call the National Domestic Violence Hotline at 1-800-799-SAFE (7233).

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

It Can Be Challenging To Cope With C-PTSD.

Symptoms Of C-PTSD

Complex post-traumatic stress disorder may include the following 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

The DSM-5 does not consider C-PTSD a separate diagnosis from PTSD. Complex PTSD can have some overlap with borderline personality disorder as well, which often involves enduring personality change unless consistent treatment is utilized.

In addition to the list above, people experiencing C-PTSD may also experience 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 controlling 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 988.

  • 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 oneself 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 typically do not have the same coping mechanisms as adults, the additional symptoms they exhibit after prolonged traumatic events, such as childhood abuse, may be different. Childhood PTSD is more susceptible when the parents are divorced 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 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

It Can Be Challenging To Cope With C-PTSD.

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 and long-lasting. Survivors of these traumatic events may need more resources to help re-establish a feeling of power and control over their thoughts and actions. In addition, 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.

Standard behavioral therapies usually teach coping mechanisms and help individuals recognize and change their negative thoughts and behaviors. This type of therapy often 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. Never start or stop medication unless under the guidance of a licensed medical professional.

Another therapeutic method known as cognitive restructuring therapy generally focuses on coping with how the traumatic event occurred and helping the patient understand their thought processes. For many, self-blame, guilt, and shame can be major symptoms of the diagnosis, so restructuring therapy may put traumatic memories or events in perspective. It may ease these feelings by recognizing the reality of the situation.

Exposure therapy is a type of psychotherapy that usually exposes individuals to the trauma they once experienced in a safe way. During exposure therapy, individuals may learn to face their fears, recognize their own ability to cope, and exert control over their reactions and impulses. This PTSD therapy or therapy for PTSD often works for people who have severe symptoms of anxiety related to their traumatic experiences 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 and reprocessing therapy (EMDR), which typically 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 usually works by activating different parts of the brain and changing the way they interact with one another so that the brain is able to bring forward and process the trauma without becoming re-traumatized.

Address Complex PTSD With Online Therapy

The fear of rejection that often accompanies a C-PTSD diagnosis may cause some people to feel apprehensive about seeking help. However, talking with a professional who can help you navigate the healing process can be crucial. Attending therapy online from the comfort of your home may ease some of the apprehension you may be feeling about visiting a therapist’s office. There is an online licensed therapist for complex post traumatic stress disorder who can provide help and respond to your needs.

An online counseling platform can often connect you with experienced, licensed therapists who can help you address C-PTSD and any other mental health concerns you may be facing. Their goal is usually to provide professional help to anyone who needs assistance navigating life's difficulties. As this study explains, online PTSD counseling or therapy for mental and physical symptoms related to the disorder can be as effective as in-person sessions.  Internet-delivered treatment was associated with large improvements in all outcome measures for participants.


Post-traumatic stress disorder that occurs 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, sleeping problems, avoidance of triggers, nightmares, feelings of guilt, and more. Exposure therapy for PTSD, cognitive restructuring therapy, and behavioral therapy may be used to treat C-PTSD. Online therapy can be a good place to start if you believe you may be living with C-PTSD or any other mental health disorders.

You Don't Have To Face Post Traumatic Stress Disorder Alone.

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