What Is Complex PTSD? Causes, Symptoms, And Treatments
You've probably heard of post-traumatic stress disorder (PTSD) before. It's the term for the mental illness that can occur in some people after they experience a traumatic event. While complex post traumatic stress disorder (C-PTSD) is related to this condition, it has some key differences.
What is PTSD?
Post-traumatic stress disorder (PTSD) affects war veterans or those who have experienced a different deeply traumatic event. The cause could be any event that caused prolonged trauma including a car accident, a violent crime, a natural disaster, or active combat in war. In the immediate aftermath of a traumatic event (up to one month after the event), someone may develop acute stress disorder (ASD). If posttraumatic symptoms persist after this period, symptoms may be diagnosed as PTSD. According to the American Psychological Association (APA), PTSD affects around 3.5% of adults annually. One of the most common symptoms is having "intense, disturbing thoughts and feelings related to their experience that last long after the traumatic event has ended," which can take the form of nightmares or flashbacks. However, there are many other symptoms common in PTSD.
People with PTSD may also experience depression, negative thought patterns, distorted thoughts and beliefs, feelings of detachment from others, destructive behaviors, being startled easily, poor sleep, and others. PTSD diagnostic criteria specify that these symptoms must last for more than a month and interfere with daily functioning. Despite these potentially debilitating symptoms, it is possible to treat PTSD through PTSD group therapy or one-on-one therapy with licensed mental health professionals.
The difference between PTSD and complex PTSD
PTSD is typically associated with exposure to a single catastrophic experience. Although it manifests similarly, people who develop complex PTSD often experience chronic trauma or trauma that happens over a prolonged period. It's a more severe form of PTSD that can result from someone experiencing recurrent abuse, early childhood trauma, human trafficking, long-term homelessness, high rates of community violence, extreme poverty, or living through war or civil unrest, for example.
It's worth noting that there's one other mental illness that has common symptoms with C-PTSD, though research has concluded that it qualifies as a separate disorder. It's called borderline personality disorder (BPD), which affects how a person thinks and feels about themselves and others. It may cause intense fears of abandonment, mood swings, unstable or troubled relationships, and drastic changes in self-image. Environmental factors such as neglect or abuse may contribute to the development of BPD and cause some symptoms similar to C-PTSD symptoms. However, borderline personality disorder is not always caused by a traumatic event.
Another related condition is enduring personality change after a catastrophic event (EPCACE). Although it could be a symptom of C-PTSD, the World Health Organization has not officially labeled EPCACE a form of PTSD.
Because of the overlap between these mental disorders, their seriousness, and the fact that BPD or EPCACE may or may not be comorbidity with either form of PTSD, it's essential to meet with a mental health professional who can arrive at the correct diagnosis. Each requires a different treatment plan, so the proper diagnosis is critical.
Symptoms of C-PTSD
The associated PTSD symptoms in women and men can vary in duration and intensity. While they are generally similar to those associated with post-traumatic stress disorder, repeated or long term traumatic events can cause them to be more extreme. If you or someone you know is experiencing some or all of the following symptoms, PTSD or C-PTSD may be the cause. Both are typically treatable, although they each require a separate diagnosis, so seeking professional help can be beneficial. In addition to the symptoms of PTSD, symptoms of complex PTSD may also include:
- Difficulty managing emotions and behavior. This can manifest as explosive anger, uncontrollable crying, or emotional numbness. It can also include risk-taking behaviors such as sexual impulsivity.
- Dissociation or amnesia regarding traumatic events. Dissociation is the experience of feeling disconnected from yourself. It could look like zoning out when faced with extreme stress or attempting to recall a traumatic experience, for example.
- Disturbance in self-perception. This can include an inability to feel truly at home with yourself, which relates to feelings of dissociation. This negative self-perception can also manifest as shame, guilt, and self-loathing, leading to employment and relationship difficulties.
- Fluctuating perception of the perpetrator. This symptom applies to those whose traumatic experiences were perpetrated by a specific person(s). It involves cycling between idealizing the person who inflicted the trauma, loathing them, and wanting revenge.
- Impaired ability to form meaningful relationships. People with complex PTSD related to a particular relationship may unconsciously reenact its unhealthy dynamics with future friends, partners, etc. Their ability to place trust in others is often damaged by their traumatic experiences, which can cause a tendency to develop unhealthy relationships.
- Loss of meaning or persistent sadness. Life may feel hopeless or meaningless for people with this condition. For example, someone who once felt deeply spiritual may feel disconnected from their belief systems because of their complex trauma. It's also common for those experiencing C-PTSD to lose interest and enjoyment in activities they once loved.
- Physical symptoms of traumatic stress. This phenomenon is referred to as somatization. Psychological trauma may manifest as physical pain, such as chest pain, stomachaches, migraines, or unexplained physical symptoms.
Complex PTSD is generally considered more debilitating than PTSD and requires careful treatment considerations. It often also occurs as a comorbidity with other disorders, which may exist simultaneously with other psychological conditions such as substance use disorder, anxiety, depression, and eating disorders.
If you are struggling with substance use, contact the SAMHSA National Helpline at (800) 662-4357 to receive support and resources. Support is available 24/7.
Treatment options for C-PTSD
Traumatic experiences can change the way that the prefrontal cortex behaves, triggering amygdala hyperactivity that can be difficult to address without professional help. Devising the most effective treatment plan for an individual with complex PTSD can be difficult because of the severity of the symptoms an affected person may experience. However, with proper intervention, finding ways to treat complex PTSD is possible. Medication, complex PTSD counseling or specific therapy, or a combination of both may be used, depending on the individual and their unique situation. The following are a few of the most common treatment options.
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 traumatic memories, situations, or thoughts. There are several types of exposure therapy, and a licensed psychologist can determine which one is appropriate for a given individual and their specific situation, if any.
Eye movement desensitization and reprocessing (EMDR)
In EMDR therapy, the provider will ask the client to recall a memory related to the trauma they experienced. While doing so, the therapist will move one finger from side to side and ask the client to follow the movement with their eyes. This process may help 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 traumatic memory without experiencing a significant adverse reaction.
Stress inoculation training
Another type of therapy that may be offered as a treatment for individuals with C-PTSD is stress inoculation training, another form of CBT that focuses on changing how individuals deal with the stress related to a traumatic event. It involves learning to reduce stress through muscle relaxation and deep breathing exercises. Training sessions are aimed at helping clients understand the necessary skills to defend themselves against troubling thoughts or negative feelings and the reactions that may occur related to past trauma.
Cognitive processing therapy
Cognitive Processing Therapy (CPT) is a type of trauma-focused therapy sometimes used to treat PTSD and C-PTSD. It's designed to help individuals learn to challenge and modify unhealthy or unhelpful thoughts or beliefs about the trauma they experienced. Through this process, clients may create a new understanding of their past experiences, thereby reducing long-term adverse effects on their lives.
Talk therapy
The primary focus of talk therapy, also referred to as psychotherapy, is to stabilize the person experiencing complex PTSD so that they can express their feelings, improve connections with others, learn to manage anxiety effectively, and cope with their memories of traumatic events. CBT is known as "the gold standard of psychotherapy" and is one of the most commonly practiced today.
A growing body of research suggests that CBT can be just as effective when offered online as it is in person, and studies have found that it can be an effective treatment for forms of PTSD in particular. That means appropriate care for those with this or other mental health conditions is even more widely available. With an online therapy platform like BetterHelp, for instance, you can get matched with a licensed, experienced mental health professional in as little as 48 hours. You can receive the support you need from a therapist for complex post traumatic stress disorder at BetterHelp. You can speak with them via phone, video call, and online chat to work through the challenges you may be experiencing. Their job is to offer a safe, encouraging, nonjudgmental space where you can say what's bothering you and work toward healing together. Read on for client reviews of BetterHelp therapists.
For immediate help with C-PTSD
Please note that BetterHelp is not an emergency resource. If you need help now, the links and phone numbers below can connect you with services immediately. All of the following are available 24/7.
- Crisis Text Line: Text HOME to 741741
- Veterans Crisis Line: Call 1-800-273-8255 (and press 1) or text 838255. For support for the deaf and hard of hearing community, please use your preferred relay service or dial 711, then 1-800-273-8255.
- The PTSD Foundation of America (a faith-based organization): 1-877-717-7873
- The National Suicide Prevention Lifeline: 1-800-273-8255
- The National Domestic Violence Hotline: 1-800-799-7233
Counselor reviews
"Ted is an example of what a person is gifted to do!!! It 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 tough time. Shana is very knowledgeable and experienced. I would recommend her."
Takeaway
C-PTSD is a disorder closely related to PTSD but stems from a different form of trauma and may have additional symptoms or manifestations. Effective treatment for both conditions is available.
What are the symptoms of complex PTSD?
Complex PTSD (C-PTSD) also referred to as Disorders of Extreme Stress Not Otherwise Specified (DESNOS) has a variety of symptoms, including:
- Emotional Dysregulation: Intense and unpredictable mood swings, difficulty managing emotions, and feeling overwhelmed by emotional reactions.
- Dissociation: Feeling disconnected from oneself or the world, experiencing periods of "spacing out" or feeling detached from reality.
- Relationship Difficulties: Struggles with forming and maintaining healthy relationships, often due to difficulties with trust, intimacy, and boundaries.
- Negative Self-Perception: Persistent feelings of shame, guilt, self-blame, or a distorted self-image due to the trauma experienced.
- Distorted Self-Concept: Feeling powerless, helpless, or as if you're fundamentally flawed due to the trauma. This can lead to a sense of worthlessness.
- Difficulty with Trust: Struggling to trust others and maintaining a heightened sense of hypervigilance, leading to challenges in forming close connections.
- Emotional Flashbacks: Experiencing emotional states that were present during the traumatic events, which can trigger feelings of fear, panic, or extreme sadness.
- Chronic Shame: Persistent feelings of shame and humiliation that stem from the traumatic experiences and may lead to avoiding people or situations.
- Impaired Self-Care: Difficulty taking care of oneself, often due to feelings of unworthiness or a lack of self-compassion.
- Somatization: Experiencing physical symptoms, such as headaches, stomachaches, or other physical discomfort, as a result of the psychological distress.
- Hypervigilance: An intense and ongoing state of alertness and heightened awareness, often accompanied by difficulties with concentration and sleep disturbances.
- Avoidance Behaviors: Avoiding people, places, or situations that trigger memories of the traumatic experiences, which can limit daily activities and social interactions.
- Loss of Meaning: Struggling to find meaning in life or experiencing a sense of hopelessness due to the trauma's impact.
It's important to note that individuals with C-PTSD may experience these symptoms to varying degrees, and not everyone will exhibit all of these symptoms.
Is complex PTSD a serious condition?
Yes, Complex Post-Traumatic Stress Disorder (C-PTSD) is considered a serious psychological condition. It's a more complex and severe variant of Post-Traumatic Stress Disorder (PTSD) that develops as a result of prolonged exposure to traumatic events, often involving physical abuse, sexual abuse, neglect, or chronic interpersonal trauma. C-PTSD has also been found to occur at higher rates in children who have experienced trauma through sex trafficking. C-PTSD can have a significant impact on a person's overall well-being, mental health, and daily functioning.
The symptoms of C-PTSD are wide-ranging and can deeply affect various aspects of an individual's life, including their relationships, self-esteem, ability to regulate emotions, and overall sense of safety. People with C-PTSD might struggle with forming and maintaining healthy relationships, experience difficulties in managing emotions, and have a distorted self-concept due to chronic nature of long-term trauma.
What is complex PTSD explained simply?
Complex Post-Traumatic Stress Disorder (C-PTSD) is a condition that some people develop after going through very tough and painful experiences for a long time. These experiences might include things like being in an abusive relationship or growing up in a difficult environment.
C-PTSD can make people feel really upset and worried. It can also affect how they see themselves and how they relate to others. People with C-PTSD might have trouble controlling their emotions or feeling safe. Without treatment, they could find it hard to trust others or feel good about themselves throughout their adult life.
What triggers complex PTSD trauma?
Complex Post-Traumatic Stress Disorder (C-PTSD) can be triggered by prolonged exposure to traumatic events, particularly those involving chronic trauma and abuse. Here are some common triggers that can contribute to the development of C-PTSD:
- Childhood Abuse and Neglect: Experiencing physical, emotional, or sexual abuse, as well as neglect, during childhood can significantly contribute to the development of C-PTSD.
- Domestic Violence: Being in an abusive relationship where there's ongoing emotional, physical, or sexual abuse can lead to C-PTSD.
- Childhood Bullying: Suffering from prolonged bullying or social exclusion during childhood or adolescence can be a trigger for C-PTSD.
- War and Conflict: Exposure to prolonged periods of war, conflict, or violence, especially in a combat setting, can lead to the development of C-PTSD.
- Human Trafficking: Survivors of human trafficking, who experience repeated traumatic events and exploitation, are at risk of developing C-PTSD.
- Long-Term Discrimination: Facing systemic discrimination, racism, or prejudice over an extended period can contribute to the development of C-PTSD.
- Chronic Illness or Medical Trauma: Living with chronic illness or experiencing repeated medical procedures or treatments can lead to ongoing trauma and the development of C-PTSD.
- Repetitive Victimization: Individuals who have experienced multiple traumatic events over time, such as multiple abusive relationships or multiple incidents of violence, are at risk for C-PTSD.
- Childhood Attachment Issues: Insecure or disrupted attachments in childhood, such as inconsistent caregiving or early separations from caregivers, can contribute to C-PTSD.
- Natural Disasters: Surviving multiple natural disasters or enduring prolonged periods of instability due to natural events can trigger C-PTSD.
Everyone's experience is unique, and the triggers for C-PTSD can vary widely. The severity of trauma and individual coping mechanisms also play a role in how C-PTSD develops. Seeking treatment and professional support can help individuals understand and manage their triggers, develop coping strategies, and work toward healing and recovery.
How does a person with complex PTSD act?
A person with Complex Post-Traumatic Stress Disorder (C-PTSD) may exhibit a range of behaviors and symptoms due to the impact of prolonged trauma. It's important to remember that everyone's experience is unique, and individuals with C-PTSD may display different combinations of these behaviors:
- Emotional deregulation
- Avoidance
- Hyperarousal
- Flashbacks and dissociation
- Negative self-perception
- Trust issues
- Emotional numbing
- Attachment issues
- Shame
- Intense reaction to triggers
Does complex PTSD ever go away?
Complex Post-Traumatic Stress Disorder (C-PTSD) is a serious condition that can have a lasting impact on an individual's life. While C-PTSD may not completely "go away" in the sense of never having any impact, with appropriate treatment and support, many individuals can experience significant improvements in their symptoms and overall well-being.
Therapeutic interventions, such as trauma-focused therapy (including approaches like Cognitive Behavioral Therapy and Eye Movement Desensitization and Reprocessing), can help individuals learn coping strategies, process traumatic memories, and develop healthier ways of managing their emotions and behaviors.
How do you fix complex PTSD?
Complex Post-Traumatic Stress Disorder (C-PTSD) is a complex condition that doesn't have a quick "fix," but it can be managed and treated effectively with a combination of approaches. Here are some steps that can contribute to managing C-PTSD:
- Therapy: Engaging in trauma-focused therapy, such as Cognitive Behavioral Therapy (CBT), Eye Movement Desensitization and Reprocessing (EMDR), or Dialectical Behavior Therapy (DBT), can help individuals process traumatic memories, develop coping strategies, and improve emotional regulation.
- Medication: In some cases, medication might be prescribed to manage symptoms of a separate condition like anxiety, depression, or sleep disturbances that often accompany C-PTSD.
- Self-Care: Prioritizing self-care activities, such as exercise, mindfulness, and maintaining a healthy routine, can contribute to managing symptoms and improving overall well-being.
- Support System: Building a strong support network of friends, family, and support groups can provide a sense of belonging and understanding, which is crucial for healing.
- Education: Learning about C-PTSD, its symptoms, triggers, and coping strategies can empower individuals to better manage their condition.
- Healthy Coping Mechanisms: Developing healthy ways of coping with stress, such as journaling, art therapy, deep breathing, or engaging in hobbies, can be beneficial.
How painful is complex PTSD?
Complex Post-Traumatic Stress Disorder (C-PTSD) can be very painful for individuals who experience it. The emotional and psychological impact of prolonged exposure to traumatic experiences can lead to significant distress and challenges in various aspects of life. Individuals may feel emotional pain through anxiety, depression, dissociation, emotional distress, and isolation or lonliness.
The pain of C-PTSD is valid and real. Seeking professional help from therapists who specialize in trauma can provide individuals with the necessary tools and strategies to manage their symptoms, heal from their traumatic experiences, and work towards reclaiming their well-being.
Can someone with CPTSD have a relationship?
Yes, someone with Complex Post-Traumatic Stress Disorder (C-PTSD) can have relationships, but it might present certain challenges. C-PTSD symptoms can impact how individuals form and maintain connections due to its effects on emotional regulation, trust, and interpersonal dynamics. However, with self-awareness, support, and effective treatment, individuals with C-PTSD can develop healthy and fulfilling relationships.
What is it like living with complex PTSD?
Living with Complex Post-Traumatic Stress Disorder (C-PTSD) can be a complex and challenging experience. It impacts various aspects of daily life and can influence thoughts, emotions, behaviors, and relationships. Here's what it might be like for someone living with C-PTSD:
- Emotional Rollercoaster: Individuals with C-PTSD often experience intense and fluctuating emotions. Mood swings, sudden shifts between fear and anger, and feeling overwhelmed by emotions are common.
- Flashbacks and Triggers: Flashbacks, where past traumatic events feel like they're happening again, can be distressing. Triggers—situations, people, or things that remind them of the trauma—can lead to emotional reactions or panic.
- Hyperarousal and Hypervigilance: Living in a constant state of alertness and heightened sensitivity to potential threats can lead to fatigue, difficulty concentrating, and challenges in relaxation.
- Relationship Struggles: Trust issues, difficulty forming and maintaining healthy relationships, and fears of being betrayed are common due to the impact of past trauma.
- Avoidance and Isolation: To prevent triggers, individuals might avoid situations or people that could be associated with their trauma. This can lead to social withdrawal and isolation.
- Negative Self-Perception: Feelings of shame, guilt, and a distorted self-image can erode self-esteem and self-worth.
- Dissociation: Feeling disconnected from oneself or reality—experiencing periods of "spacing out" or feeling detached—can be disorienting.
- Physical Symptoms: The emotional distress of C-PTSD can lead to physical symptoms such as headaches, stomachaches, and tension.
- Impaired Daily Functioning: C-PTSD can make it challenging to work, study, or carry out daily activities, often due to the impact of emotional and cognitive difficulties.
- Chronic Anxiety: Persistent anxiety, fear, and worry about potential danger can be exhausting and overwhelming.
- Nightmares and Sleep Disturbances: Frequent nightmares and disrupted sleep are common, impacting both sleep quality and overall well-being.
- Struggles with Self-Care: Difficulty maintaining self-care routines due to low self-esteem, emotional challenges, or feelings of unworthiness.
Despite these challenges, recovery is possible with proper treatment and support. Many individuals with C-PTSD learn to manage their symptoms, develop coping strategies, and experience improvements in their overall well-being.
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