What Is Complex PTSD?

By Nadia Khan

Updated March 26, 2020

Reviewer Lauren Guilbeault

Most people have heard of PTSD, and most people even know someone who suffers from it, but fewer people know about Complex PTSD.

Complex post-traumatic stress disorder (Complex PTSD) is a mental condition resulting from ongoing or repetitive exposure to traumatizing and highly stressful situations. The signs and symptoms of the disorder are varied and generally intense, similar to PTSD. However, some critical differences exist between PTSD and Complex PTSD. In this article, we'll discuss the origin of these conditions and how they might affect individuals who suffer from them.

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Most people who are familiar with PTSD know it as trauma disorder that can occur after exposure to a traumatic event like war, assault, natural disaster, or any event that threatens someone's life or safety. It's usually the result of one specific incident.

Complex PTSD, on the other hand, develops after repeated exposure to traumatizing or abusive conditions. In most cases, Complex PTSD is related to events that occurred and persisted through childhood, but it's possible to develop the disorder as an adult.

Examples of situations that can cause Complex PTSD include:

  • Long-term childhood abuse
  • Surviving imprisonment in a concentration or labor camp
  • Being held captive
  • Exposure to repeated domestic violence

In short, living in any type of oppressive situation where one feels powerless for a long period of time can result in the development of Complex PTSD.

Symptoms of Complex PTSD in Adults and Children

If the symptoms listed below sound familiar, it's important to seek medical help, so a healthcare professional can evaluate you and determine if you meet the required criteria to be diagnosed with Complex PTSD.

In addition to all of the symptoms of PTSD, Complex PTSD symptoms generally include:

  • Difficulty regulating emotions and behaviour: This can cause bouts of rage or anger, uncontrollable crying, or numbness. It can also manifest as risk-taking, self-injury or suicidal behaviour, and sexual impulsivity.
  • Dissociation or amnesia around traumatic events: Dissociation is the experience of being disconnected from one's self. One might "zone out," or one's mind might go blank when faced with stress or when attempting to remember a traumatic experience.
  • Disturbance in self-perception: This can include an inability to feel truly at home with oneself, which relates back to feelings of dissociation. It can also manifest as feelings of shame, guilt, and self-loathing.
  • Fluctuating perception of the abuse perpetrator: This symptom involves cycling between idealizing the person who inflicted the trauma and loathing them and/or wanting to seek revenge.
  • Impaired ability to form meaningful relationships with others: Often people with Complex PTSD re-enact their traumatic relationship with others, either by re-victimizing themselves or by victimizing others. Trust in others is usually eroded by the traumatic experiences, which stifles intimacy.
  • Loss of meaning: Life often feels hopeless and meaningless for people with this condition. For example, someone who once felt deeply spiritual may find they feel disconnected from their belief systems.
  • Experiencing physical symptoms of traumatic stress: This is referred to as somatization; traumatic psychological pain ultimately manifests as physical pain, including digestive issues, migraines, or otherwise unexplained physical symptoms.

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Complex PTSD is generally considered to be more disabling than PTSD and requires careful treatment considerations. The condition is frequently comorbid with other disorders, including addiction and eating disorders. Because Complex PTSD can look like or be mistaken for other conditions like learning disabilities or ADHD (especially in children), it's critical to get evaluated by a professional. Although speaking with a professional may seem overwhelming, there are many ways that you can connect with someone, and we'll talk about some of them at the end of this article.

What Are Telltale Behaviours of People with Complex PTSD?

If someone is living with untreated, undiagnosed Complex PTSD, there are a variety of common behaviors that may be triggered by their condition. For example, substance abuse is a common struggle for those who have Complex PTSD. Some turn to drugs or alcohol for relief and as a way to cope with the symptoms of their disorder. Often this approach can develop into an addiction, which is another complex problem. (If you believe you may suffer from addiction, you can get help. Please reach out to a mental health professional or a support group.)

Another common behavior of people with Complex PTSD is self-injury or self-harm. Again, these behaviors are used as an attempt to manage the pain of living with unresolved traumatic stress. Avoidance of distress or pain, especially of anything similar to the original traumatic conditions, is another telltale sign. This can look like avoiding conflict altogether by becoming a "people pleaser," lashing out at someone for offering a minor criticism, or deflecting criticism onto other people.

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These behaviors generally develop as a response to the original traumatic conditions, and at the time they were the only possible way to survive. However, now that the trauma is in the past, these behaviors are self-destructive and can be hurtful to loved ones, especially if they're being yelled at or treated poorly.

That said, it's important to remember that, if you or a loved one are exhibiting telltale signs of Complex PTSD, you're not an inherently bad person. Your behavior is a reaction to the severe psychological trauma you endured, and it's possible to get better.

What Distinguishes Complex PTSD from PTSD and Borderline Personality Disorder?

Symptoms of Complex PTSD overlap a great deal with symptoms of PTSD, as well as symptoms of Borderline Personality Disorder (BPD). However, the three are distinct and separate conditions. A 2014 study identified some distinguishing features of Complex PTSD. While people with BPD have an unstable self-concept, people who have Complex PTSD report a consistent self-concept; it just happens to be "consistently negative."

In addition, people with BPD have difficulty with relationships. This is generally attributed to their tendency to fluctuate between idealizing and devaluing others and avoiding abandonment at all costs. Those with Complex PTSD also struggle with relationships, but this is a result of avoidant behavior and feeling disconnected or alienated from others.

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Because of the strong overlap between all three disorders, it's especially important to meet with a professional who can arrive at the correct diagnosis. Each requires different treatment, and it's critical to find the one that will be most effective for you. Start a conversation with a professional today.

Complex PTSD Treatment and Recovery

Because Complex PTSD and BPD share many of the same symptoms, the treatment developed for BPD (Dialectical Behavioral Therapy - DBT) is also used to treat Complex PTSD. DBT can support you in learning to regulate your emotions and to tolerate distress and pain instead of avoiding it or dissociating from it. BDT also helps individual's develop mindfulness skills (referred to as "wise mind").

In order to heal from the effects of trauma and Complex PTSD, it's also important to do the work of trauma processing as part of your treatment plan. Therefore, any therapy your participate in should be trauma-informed. DBT will help build coping skills, but trauma processing is a critical step to getting your body and mind back to a stable baseline. Generally, trauma-informed DBT is referred to as DBT-PTSD.

Before the work of trauma processing is started, however, it's important to develop the healthy coping skills and emotional tools that DBT teaches. Without those tools, trying to engage in processing can be re-traumatizing, causing continued and possibly heightened suffering, which could perpetuate the condition. This approach is usually referred to as phase-oriented treatment.

Are You Sliently Suffering From Symptoms Of Complex PTSD?
We Can Help. Click Here To Get Matched With A Licensed Professional Counselor.

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There are three stages to phase-oriented treatment:

1) Stabilization by building emotional regulation and distress tolerance skills.

2) Processing trauma under the care of a trauma-informed, trained mental health professional.

3) Reconnecting with yourself and rebuilding a sense of self-esteem and security.

By undergoing phase-oriented trauma therapy, it's possible to recover from Complex PTSD. Another emerging treatment for Complex PTSD is phase-oriented EMDR,(Eye Motion Desensitization, and Reprocessing). This treatment is a mind-body intervention that mimics the effects of REM sleep to process traumatic material. Research is in complete on using this treatment method for Complex PTSD, but it's currently used successfully for PTSD. It 's even used by the Department of Defense and Veteran's Affairs, and the World Health Organization.

How BetterHelp Can Support You

Complex PTSD is a very serious condition. If you're suffering from it, it can be extremely difficult to continue with your normal life. However, you should know that you're not alone. Millions of people around the world have suffered from PTSD or Complex PTSD, and with the right help and support, many of them have rebuilt their lives and found happiness. You can, too.

Although research on treating Complex PTSD is still ongoing, this condition responds to many of the methods described in this article, in addition to other methods used to treat PTSD. One of the most significant and effective treatment methods is psychotherapy. If you're presenting with any of the symptoms mentioned above or want to discuss your situation with someone, consider seeking help through BetterHelp.

BetterHelp has a network of licensed, professional counselors who can offer years of experience helping people learn to cope with Complex PTSD. The platform is completely anonymous, and you can access it from the comfort and privacy of your own home (or wherever you have an internet connection). Below, you'll find some reviews of BetterHelp counselors from people experiencing similar issues.

Counsellor 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."

"It is with pleasure that I write this review for Shana Latham. I have PTSD and Anxiety Disorder. Shana has been instrumental in helping me through a very difficult time. Shana is very knowledgeable and experienced. I would recommend her."


Whatever difficulties you're going through, you don't have to go through them alone. You can find support in family, friends, and even a counselor. With the right tools, you can get back to life and activities you used to enjoy. Take the first step today.

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