What Is Complex PTSD? Causes, Symptoms, And Treatments

Updated November 22, 2022 by BetterHelp Editorial Team

Complex PTSD doesn’t have to take over your life.

Most people have heard the term post-traumatic stress disorder, or PTSD. In fact, many people know someone who lives with the disorder. When most people hear the term, they associate it with military veterans who have experienced combat or with someone who has experienced a violent physical or sexual attack. These aren’t the only factors that contribute to PTSD, though. Plus, PTSD can take on different forms. One of these is complex PTSD, or C-PTSD. 

What Is PTSD?

Post-traumatic stress disorder (PTSD) is an emotional response that occurs in people who are experiencing long-term effects of a traumatic event. PTSD is characterized by intense disturbance in thoughts and feelings related to the trauma.

PTSD can lead to re-living traumatic memories, difficulties with emotional regulation like explosive anger, somatic symptoms like stomach aches, negative thought patterns, and chronic stress, as well as a myriad of additional symptoms. Despite these potentially debilitating symptoms, it is entirely possible to treat PTSD through professional help.

PTSD Vs Complex PTSD

PTSD is typically associated with exposure to a single traumatic event. If the trauma is repeated or happens for a prolonged period, the individual may develop a more severe form of post-traumatic stress disorder known as complex post-traumatic stress disorder (C-PTSD).

Like PTSD, the repeated and long-term trauma of complex PTSD may be caused by experiencing childhood abuse, ongoing physical and sexual abuse, domestic violence or human trafficking, long-term homelessness or extreme poverty, the enduring personality change of war life, or other catastrophic experiences.  

If you are experiencing domestic violence, a national center for domestic violence is available, such as the National Domestic Violence Hotline, which can be reached at 1-800-799-SAFE (7233).

Symptoms Of Complex PTSD

The symptoms associated with complex PTSD vary in length and intensity.  While they are like those associated with post-traumatic stress disorder, the repeated or prolonged exposure to trauma can cause them to be more extreme in nature.

If you are experiencing any of the following symptoms of PTSD or C-PTSD, seeking professional help may be beneficial.  In addition to all the symptoms of PTSD, Complex PTSD symptoms generally include:

  • Difficulty regulating emotions and behavior: This can cause bouts of rage or anger, uncontrollable crying, or numbness. It can also manifest as risk-taking, self-injury, suicidal behavior, or sexual impulsivity.

“If you are thinking about suicide, considering harming yourself or others, feeling that any other person may be in any danger, or if you have any medical emergency, you must immediately call the emergency service number (1-800-273-8255 in the US and 0800-689-5652 in the UK) and notify the relevant authorities. Seek immediate in-person assistance.” 

  • Dissociation or amnesia regarding traumatic events: Dissociation is the experience of being disconnected from yourself. You might zone out when faced with stress or when attempting to remember a traumatic experience, for example.

  • Disturbance in self-perception: This can include an inability to feel truly at home with yourself, which relates back to feelings of dissociation. This negative self-perception can also manifest as feelings of shame, guilt, and self-loathing, which can lead to problems with employment and relationship difficulties.

  • 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. Trust in others is usually eroded by traumatic experiences, which stifles intimacy. 

  • Loss of meaning: Life may feel hopeless or 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 may manifest as physical pain, including chest pains, stomach aches, migraines, or otherwise unexplained physical symptoms.

Complex PTSD is generally considered to be more disabling than PTSD and requires careful treatment considerations. It often occurs as a comorbidity to other disorders, which means it may exist at the same time as other psychological conditions.  Addiction, anxiety, depression and eating disorders are a few examples of possible comorbid diagnoses a person with complex post-traumatic stress disorder may experience.

Recognizing Complex PTSD

Complex PTSD doesn’t have to take over your life.

Living with complex PTSD can be overwhelming. Some people describe feeling paralyzed by the fear of the trauma, even though many will never experience a similar event again. Common symptoms of complex post-traumatic stress disorder include:

  • Depression

  • Social isolation

  • Destructive or self-harming behaviors: It is not uncommon for people with complex PTSD to experiment with drugs or alcohol or to engage in risky behavior such as gambling or promiscuous sex.

  • Anger management issues

  • Anxiety

  • Dissociation

  • Flashbacks or nightmares about the event

  • A fixation on the abuser: Some may continually live in fear of the abuser or may plot revenge against them.

  • Suicidal ideation: When C-PTSD symptoms are severe, some may attempt suicide or engage in self-harming behaviors to escape the pain.

    If you or someone you know is experiencing thoughts of suicide, please call the Lifeline at 1-800-273-8255.  

The symptoms of complex post-traumatic stress disorder can cause people to feel as though they are trapped or living in a constant state of distress or danger.  For some, symptoms may remain even after several years.  It is not uncommon for people with complex PTSD to experience troubled relationships or loss of their jobs because of an inability to cope with stress. Some things that people with C-PTSD may experience include the following:

  • Trust issues: The trauma associated with complex PTSD is typically an ongoing issue.  Often, the perpetrator of the trauma is someone that the person knew and trusted. Therefore, it’s not surprising that many of those who experience C-PTSD have extreme trust issues.

  • Poor or altered self-image: Even if there is no valid reason for feeling negative about oneself, a person with C-PTSD may only identify with the trauma they experienced. A woman who was sexually assaulted may feel that she is undesirable to others now or that she deserves to be punished for what happened to her, for example. Moreover, those who experience domestic violence may feel like there is no hope of having a healthy relationship in the future.

  • Self-harm: In an attempt to escape reality, some people with complex PTSD resort to destructive or self-harming behaviors. They may experiment with alcohol or illicit drugs. They may act impulsively, or gamble, or engage in risky sexual behavior.  Mental health professionals often say that this may be a way by which people try to take control of a situation that once caused them harm. 

  • Attachment disorders: The ability to bond and develop emotional attachments is generally formed in infancy and early childhood. A child who is neglected or abused may develop an altered sense of what attachment is. They may also be incapable of responding in an appropriate manner to a crisis or traumatic situation. While it can be difficult, it is possible for people with attachment issues to learn healthy ways of communicating and developing bonds with others. The earlier treatment begins, the better the outlook for recovery.

PTSD, Complex PTSD, And Borderline Personality Disorder: What’s the Difference?

PTSD and C-PTSD are both caused by experiencing traumatic events. Post-traumatic stress disorder is the result of one traumatic event such as a natural disaster, a car accident, or a physical attack on a person. C-PTSD, on the other hand, occurs because of repeated exposure to acts of abuse or violence.

Individuals with both PTSD and C-PTSD may experience flashbacks.  Those with “simple” PTSD may experience visual flashbacks or nightmares. However, a person with complex PTSD may also experience emotional responses to things that trigger the memory of trauma. These are sometimes referred to as emotional flashbacks. Sometimes, these responses may be triggered by something that happened to someone else. For example, a person who has been sexually assaulted may experience emotional flashbacks to their trauma after hearing of someone else who was assaulted.

Nightmares and difficulty sleeping may occur with both conditions.  C-PTSD may also cause night terrors and chronic insomnia. Both can also be associated with different health conditions like chest pains or a disruption in the prefrontal cortex.

Borderline personality disorder is a separate mental health disorder that affects the way a person thinks and feels about themselves and others. It may cause an intense fear of abandonment, mood swings, unstable or troubled relationships, and changes in self-image such as shifting from a positive to a negative self-image. Environmental factors such as neglect or abuse may contribute to the development of borderline personality disorder and cause symptoms like those that derive from PTSD and C-PTSD. However, borderline personality disorder is not always caused by a traumatic event.

Because of the strong overlap among all three disorders, it's important to meet with a professional who can arrive at the correct diagnosis. Each of these conditions requires a different treatment plan. 

Complex PTSD Treatment And Recovery

Treating Complex PTSD can be difficult because of the severity of symptoms an affected person may experience. However, with proper intervention, treating Complex PTSD is possible. Some treatment options for complex post-traumatic stress disorder include:


Psychotherapy is often referred to as talk therapy. The primary focus of psychotherapy is to stabilize the person experiencing complex PTSD so that they can express feelings, improve connections with other people, learn to effectively manage anxiety, and cope with memories of traumatic events. Research and personal stories both show that online therapy can be a powerful tool in treating symptoms of PTSD, trauma, and C-PTSD.

Exposure Therapy

Exposure therapy is a type of cognitive behavioral therapy (CBT) that focuses on reducing the emotional and physical discomfort a person feels when confronted with a distressing situation, thought, or memory.  There are several types of exposure therapy, and a psychologist can help determine which is best for you. 

Eye Movement Desensitization and Reprocessing (EMDR)

Eye movement desensitization and reprocessing (EMDR) is a type of therapy that involves a therapist working directly with a client. A therapist will ask the client to recall a memory related to the trauma they experienced.  While the client is recalling the memory, the therapist will move his finger from side to side and ask the client to follow the movement with his eyes. This process is believed to desensitize the person to the trauma by having them focus on what the therapist is doing, rather than on the memory. If EMDR is effective, the person should be able to eventually recall the memory of the traumatic event without experiencing a significant negative reaction.

Stress Inoculation Training

Other examples of therapy include stress inoculation training. This is another form of CBT that focuses on changing how individuals deal with the stress related to a traumatic event.  It is one of the most common methods of CBT used to treat post-traumatic stress disorder. Stress inoculation training involves learning to reduce stress through muscle relaxation and deep breathing exercises. Training sessions are aimed at helping clients learn necessary skills to help defend themselves against troubling or negative thoughts and reactions that may occur related to past trauma.

Cognitive Processing Therapy (CPT)

Cognitive Processing Therapy (CPT) is a type of psychotherapy used to treat PTSD and complex-PTSD that is trauma-focused.  Cognitive processing therapy is designed to help individuals learn to challenge and modify unhealthy thoughts or beliefs about the trauma they experienced.  By doing this, clients can create a new understanding of their past, thereby reducing the long-term negative effects on their life.

How Therapy Can Support You With C-PTSD

There are many options for mental health assistance.  Whether you choose to talk to a mental health practitioner or join a support group, the important thing is to know that you are not alone.

A common symptom of C-PTSD is withdrawing from people and day-to-day activities like appointments. This is understandable considering the intensity of some of the emotional responses associated with this condition. If you would like to talk to someone but are leery of in-person interactions at this time, online counseling options represent one alternative. 

Many online resources are available, and online counseling is increasingly becoming a viable choice for CPTSD treatment. Cognitive behavioral therapy (CBT) delivered online has been shown to both alleviate the severity of baseline PTSD symptoms and reduce the instances of comorbid conditions such as depression and anxiety.


Any treatment option you choose to treat PTSD or C-PTSD will take some time to be effective.  Remember, the disorder didn’t develop overnight.  Likewise, learning to cope with trauma and move forward with life does not often happen quickly.  However, by reaching out for help and using resources that are designed for people with complex post-traumatic stress disorder—like online therapy—you can begin to heal.

Counselor Reviews

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