What Is Complex PTSD? Causes, Symptoms, And Treatments

Medically reviewed by Majesty Purvis, LCMHC
Updated March 22, 2024by BetterHelp Editorial Team
Content warning: Please be advised, the below article might mention trauma-related topics that include abuse which could be triggering to the reader. If you or someone you love is experiencing abuse, contact the Domestic Violence Hotline at 1-800-799-SAFE (7233). Support is available 24/7. Please also see our Get Help Now page for more immediate resources.

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.

Complex PTSD doesn’t have to take over your life

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.

Complex PTSD doesn’t have to take over your life

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

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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.

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