What Is Complex PTSD?

By: Nadia Khan

Updated November 12, 2020

Medically Reviewed By: Lauren Guilbeault

Most people have heard the term post-traumatic stress disorder, commonly called PTSD.  In fact, many people know someone who suffers from the disorder.  When most people hear the words post-traumatic stress disorder, they often associate it with military veterans who have experienced exposure to war or to someone who may have been the victim of a violent physical or sexual attack.

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

PTSD is typically associated with exposure to one traumatic event.  If the trauma is repeated or happens for a prolonged period of time, causing the person to feel there is no escape, they may develop a more severe form of post-traumatic stress disorder known as Complex Post-Traumatic Stress Disorder (C-PTSD).

Like PTSD, complex PTSD may be caused by experiencing childhood neglect or abuse, being the victim of domestic violence or of human trafficking, experiencing long-term homelessness or extreme poverty, or living in an area that is affected by war. 

Symptoms of Complex PTSD

The symptoms associated with C-PTSD vary in length and intensity.  While the symptoms are like those of post-traumatic stress disorder, the repeated or prolonged exposure to trauma that sufferers experience often results in more extreme complex PTSD symptoms.

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If you are experiencing any of the following symptoms of PTSD or C-PTSD, it is important to seek help.  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 or suicidal behavior, and sexual impulsivity.
• Dissociation or amnesia regarding 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 often occurs as a comorbidity to other disorders, which means it may exist at the same time as other disorders.  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 a Person with Complex PTSD

Living with complex PTSD can be overwhelming. Some people describe feeling paralyzed by the fear of the trauma, even though many may 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 having promiscuous sex. 
• Anger management issues
• Anxiety
• Dissociation
• Flashbacks or nightmares about the event
• A fixation on the abuser (some victims may continually live in fear of the abuser or may plot revenge against them)
• Suicidal ideation: When C-PTSD symptoms are severe, some victims may attempt suicide or engage in self-harming behaviors to escape the pain of the memories.  If you or someone you know is experiencing thoughts of suicide, please call the National Suicide Prevention Lifeline at 1-800-273-8255.  The Lifeline offers free and confidential support to people who are experiencing emotional difficulties or suicidal crisis. It is available 24 hours a day, 7 days a week.

The symptoms of complex post-traumatic stress disorder can cause victims 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 C-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 C-PTSD is typically an ongoing issue.  Often the perpetrator of the trauma is someone that the victim knew and trusted.  Therefore, it’s not surprising that many victims of C-PTSD have extreme trust issues. 

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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.  Victims of domestic violence may feel like there is no hope of having a healthy relationship.

Self-harm:  In an attempt to escape reality, some people with C-PTSD resort to destructive or self-harming behaviors.  They may experiment with alcohol or illicit drugs.  They may act impulsively, or gamble.  Sexual promiscuity is a common occurrence in victims of past sexual trauma.  Mental health professionals often say that this may be a way that assault victims are trying to take control of a situation that once caused them harm. While frequent sex is not harmful, medically speaking, unprotected sex is.

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 or may be incapable of responding in what others consider an appropriate way 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 outcome.

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, auto accident or physical attack on a person.  C-PTSD, on the other hand, occurs as a result of repeated exposure to acts of abuse or violence.

Complex PTSD is different from PTSD because it often occurs in people who’ve experienced extreme violence and stress over an extended period of time.   Although PTSD can make a person feel insecure or hopeless, those feelings are not typically as extreme as C-PTSD.  C-PTSD, on the other hand, leaves individuals feeling hopeless and as if there is no way to escape the trauma. 

Both PTSD and C-PTSD sufferers may experience flashbacks.  Those with “simple” PTSD may experience visual flashbacks or nightmares.  A person with complex –PTSD may additionally experience emotional responses to things that trigger the memory of trauma.  At times, these responses may be in relation to something that happened to someone else.  For example, a person who has been sexually assaulted experience the same emotions that he/she felt when their attack happened 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. 

Hypervigilance is a reaction that many people who experience violent trauma often develop.  Hypervigilance is an increased awareness of surroundings and often an “over-the-top" sense of needing to protect oneself or be prepared for another traumatic event.

Borderline personality disorder is a 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.  While environmental factors such as neglect or abuse may contribute to the development of borderline personality disorder and the symptoms are like PTSD and C-PTSD, borderline personality disorder is not always caused by a traumatic event. 

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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

The treatment of complex post-traumatic stress disorder can be difficult because of the severity of symptoms an affected person may experience.  However, with proper intervention, overcoming C-PTSD is possible. In fact, with the right help and by learning ways to effectively cope with stress, people with C-PTSD can learn to live a happy and fulfilled life with few to no long-term effects.

Some treatment options for complex post-traumatic stress disorder include:

Psychotherapy-Psychotherapy is often referred to as talk therapy.  The primary focus of psychotherapy is to stabilize the person experiencing C-PTSD so that they can express feelings, improve connections with other people, learn to effectively manage anxiety and deal 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 is a type of cognitive behavior therapy that focuses on reducing the emotional and physical distress 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), 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 their 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 reaction.

Stress Inoculation Training 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.  It involves learning to relax and reduce stress by using muscle relaxation and deep breathing exercises.  These sessions are aimed at helping clients learn necessary skills to help defend themselves against troubling or negative thoughts and reactions related to the trauma that may occur. 

Medications- People with post-traumatic stress disorder often process things related to possible threats differently.  Their “fight or flight” response is easily triggered because of the past traumatic event(s).  Being in a constant state of hyper-vigilance can lead to emotional shut down and physical illnesses.  For some, prescription medication may be necessary.  While there are currently no drugs that have been designed specifically for the treatment of PTSD or C-PTSD, there are medications that help manage the symptoms associated with the disorders, such as anxiety, depression or sleep disturbances.  A primary care provider or mental health professional can evaluate your symptoms and determine what medications, if any, are needed to help manage symptoms. 

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

Healing Takes Time

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

How BetterHelp Can Support You

If you have been diagnosed with complex post-traumatic stress disorder or think that you are experiencing symptoms related to C-PTSD, talk to your doctor or a mental health professional.  Getting treatment as soon as possible can help prevent symptoms of PTSD from getting worse. 

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

Local health units and mental health centers can provide access to mental health care providers.  If you would like to talk to someone but are unsure of face-to-face encounters at this time, online counseling options are a great way to get professional help without the pressure of in-person appointments.  Most online services, like that offered by BetterHelp, give users the option of talking by phone, video calls, text or email. Whatever option you choose, remember you are not alone and you are worth the time and effort it takes to overcome post-traumatic stress disorder. Please note that depending on the severity of symptoms, online therapy may not be an appropriate substitute for in-person therapy for treating C-PTSD.

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Conclusion

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.

For immediate help with C-PTSD, please see:

Please note that BetterHelp is not an emergency resource. If you need help now, the resources below can help you:

• 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

All of these emergency resources can be reached 24/7. 

Frequently Asked Questions (FAQs)

Is complex PTSD serious?

Yes, complex PTSD is a serious condition.  Left untreated, C-PTSD can lead to long-term mental health issues such as anxiety disorder, depression or self-harm. 

Is Complex PTSD worse than PTSD?

Complex PTSD, in simple terms, is like heightened PTSD.  While they have similar symptoms, the symptoms of C-PTSD are often more extreme or exaggerated.  Nevertheless, both disorders are serious and should be addressed by a mental health professional.

Is Complex-PTSD a diagnosis?

Although the Diagnostic and Statistical Manual of Mental Disorders does not identify C-PTSD as a separate diagnosis from PTSD, many physicians and mental health professionals do.  The International Classification of Diseases does identify complex PTSD as a separate condition.

Can complex PTSD be cured?

There is no magic “cure” for complex PTSD. However, with intervention and committed ongoing treatment, people with C-PTSD can learn to recognize triggers and mange symptoms, so that severe symptoms are reduced, and eventually eliminated.

Is C-PTSD a permanent disability?

In some cases, C-PTSD may be considered a disability.  For individuals who want to claim disability due to C-PTSD, a thorough medical history of emotional disturbances that interfere with life activities and an inability to cope are necessary.  A complete psychological evaluation and mental health history are also required to help support a claim for disability related to C-PTSD.

Is Complex PTSD the same as borderline personality disorder?

Although the two disorders share similar symptoms, complex PTSD and borderline personality disorder are two separate diagnoses.

What are the symptoms of C-PTSD?

Flashbacks of the traumatic event, hypervigilance, difficulty concentrating, exaggerated startle reflex (easily scared), nightmares and night terrors, and altered self-image are common symptoms associated with C-PTSD.

What does C-PTSD feel like?

Some people with C-PTSD describe it as feeling like they are in a constant state of stress or fear.  It can cause a person to feel as though they are trapped in a nightmare with no way of escape.  The increased anxiety and stress associated with C-PTSD can also lead to the development of chronic anxiety disorders and depression if left untreated.