Complex Post-Traumatic Stress Disorder (CPTSD)

Complex Post-Traumatic Stress Disorder

What is complex post-traumatic stress disorder?

The majority of people have heard of post-traumatic stress disorder (PTSD), which is an anxiety disorder that can result from exposure to an extremely traumatic event, such as a storm or car accident. Recently, doctors have begun to recognize a closely related condition known as complex post-traumatic stress disorder (CPTSD). CPTSD is caused by repeated trauma over a longer period of time rather than triggered by a single event.

Is complex PTSD a separate condition?

Although DSM-5 does not assign a separate diagnosis to complex PTSD, the ICD-11 does. DSM-5 does not provide any guidance on how to differentiate between the two conditions, but some mental health professionals are beginning to make the distinction.

There is also evidence to support the validity of a separate diagnosis of complex post-traumatic stress disorder. PTSD symptoms vary between traditional and complex PTSD, according to at least 29 studies from more than 15 countries.

Clinical experts could distinguish between these two diagnoses according to a 2016 study with more than 1,700 participants from 76 countries.

What are the CPTSD symptoms?

Symptoms of CPTSD typically include those of PTSD plus a few more.

Symptoms of PTSD

Reliving the traumatic experience

This can involve nightmares or flashbacks.

Avoiding certain situations

The traumatic event might cause you to avoid certain situations or activities, such as crowds and driving. It might also cause you to become distracted so that you don’t think about it.

Changing your belief and feeling about yourself

You may avoid relationships with others, be incapable of trusting others, or believe that the world is dangerous.


Hyperarousal is the state of being constantly alert or jittery. Hyperarousal can affect your sleep and concentration, among other things. Loud noises can also startle you unexpectedly.

Somatic symptoms

Symptoms that do not appear to have an underlying medical reason. You might become dizzy or nauseated when you are reminded of the traumatic event.

Related: Somatic Symptom Disorder

Symptoms of CPTSD

CPTSD usually includes the above PTSD symptoms as well as these additional symptoms:

Lack of emotional regulation

Feelings like rage or extreme sadness are uncontrollable.

Changes in consciousness

You may forget the traumatizing event or lose touch with your emotions or body, which is called dissociating.

Negative self-perception

Perhaps you feel guilty or ashamed, to the extent of feeling completely different from the rest of the world.

Difficulty with relationships

If you lack trust or do not know how to interact with other people, you might find yourself avoiding relationships. Similarly, some may feel more comfortable in relationships with those who harm them.

Related: What is a Toxic Relationship

Distorted perception of abuser

The mind often becomes occupied with the relationship between an abuser and the victim. It can also involve a desire to revenge your abuser or to give your abuser complete control over your life.

Loss of systems of meanings

A system of meaning describes your religious or philosophical beliefs. You might lose faith or become despondent if you have long-held beliefs.

Both PTSD and CPTSD symptoms can vary greatly between people, and even within one individual over time. Some people avoid social situations for months or years, only to find themselves engaging in potentially dangerous situations months or years later.

It’s important to remember if you’re close to someone who has CPTSD, that their feelings might not always match their thoughts. In a logical sense, they may know they should stay away from their abuser. Nevertheless, they might still feel affection toward them.

What causes CPTSD?

There is still no clear understanding of how traumatic stress affects the brain and causes conditions like CPTSD. However, animal studies indicate that trauma can permanently affect the amygdala, the hippocampus, and the prefrontal cortex. Our memory function and our ability to cope with stressful situations depend heavily on these areas.

Long-term trauma can lead to CPTSD, regardless of how long it takes. However, it appears more often in people who were abused by someone they were supposed to protect or care for. People who have survived human trafficking or who have been sexually abused by a relative can be examples.

Traumas of a long-term nature include:

  • Abuse that is ongoing, whether physically, emotionally or sexually
  • Being held as a prisoner of war.
  • Experiencing long-term war
  • Being neglected as a child

Read: Emotional disorders

Are there any risk factors?

People of all ages can suffer from PTSD, but some are more prone to it than others. PTSD is also linked to:

  • Anxiety or depression-related mental illness may be present in a family member
  • Personality traits, such as temperament, can often be inherited
  • When you are stressed, your brain controls hormones and neurochemicals
  • Having a dangerous job or no support system are lifestyle factors

What is complex PTSD diagnostic criteria?

Some doctors are not aware of CPTSD because it is a relatively new condition. The difficulty of getting an official diagnosis can make it difficult to distinguish between PTSD and CPTSD. The only way to determine whether you have CPTSD is to keep a detailed log of your symptoms, which can help your doctor diagnose you more accurately. Keeping a track of your symptoms and how they change over time is very important.

The first thing your doctor will do is ask about your symptoms and any traumatic events you’ve experienced. If it makes you uncomfortable, you probably won’t need to go into too much detail for an initial diagnosis.

Afterward, they may inquire about any history of mental illness in the family or other factors that might put you at risk. If you use any recreational drugs or medications, make sure to disclose this information to your doctor. If you can be honest with them, they will be able to make the best recommendation for you.

If you have been experiencing symptoms of post-traumatic stress for at least a month and they are interfering with your daily life, your doctor will probably diagnose you with PTSD. 

They may diagnose you with complex post-traumatic stress disorder (CPTSD) if you have ongoing relationship problems and trouble controlling your emotions in addition to the traumatic event.

Before you find someone who feels comfortable with you, you may need to see several doctors. Post-traumatic stress sufferers may experience this many times.

Related: Stress Management Techniques

Complex PTSD treatment

CPTSD can be treated with a variety of methods that can reduce your symptoms and help you deal with them more effectively.


A therapist can work with you either alone or in a group. A therapist may also use cognitive behavioral therapy (CBT). You will learn to identify your negative thinking patterns and replace them with more positive, healthy thoughts with this type of therapy.

You might also be recommended dialectical behavioral therapy, a form of CBT that helps you more effectively deal with stress and form stronger relationships with others.

Eye movement desensitization and reprocessing (EMDR)

It can also be helpful for treating complex PTSD. EMDR is commonly used to treat PTSD, but it can also be used to treat complex PTSD. While your eyes are moving from side to side, you will be asked to briefly reflect on a traumatic moment. If you don’t want to move your eyes, you may have your hands tapped instead. Through this process, you may eventually become desensitized to traumatic memories.

The American Psychological Association conditionally recommends using it for PTSD, even if there is some debate within the medical community. The recommendation is still subject to further investigation due to insufficient evidence.

Related: 12 Simple Ways to Reduce Stress

Complex PTSD medication

CPTSD symptoms can also be treated with medications used for depression. When used in conjunction with another treatment method, like cognitive behavioral therapy, they often prove most effective. Common antidepressant treatments include:

  • Sertraline (Zoloft)
  • Paroxetine (Paxil)
  • Fluoxetine (Prozac)

Medications can be effective long-term for some people, but for others, you will only need them for a short time while learning new coping techniques.

Where can I find support?

A condition like complex post-traumatic stress disorder, which is under-recognized, can lead to isolation. A PTSD coaching app for your phone is one of several resources available from the National Center for PTSD. Some of these resources may be helpful for more than just PTSD symptoms, but some may be helpful for many other symptoms as well.

There is also an online forum, literature reviews, and information sheets from the nonprofit organization Out of the Storm.

Contact: Mental Help Resources

Coping with C-PTSD

PTSD treatment takes time, so managing its symptoms and coping with it is critical. You may find the following strategies helpful in managing your recovery:

  • Seek support: It is often the case that people with complex PTSD withdraw from friends and family, just as they do with PTSD. However, social support networks are essential for mental health. You can turn to a trusted friend or family member when feeling overwhelmed, angry, anxious, or afraid. 
  • Practice mindfulness: There are times when complex PTSD leaves a person feeling stressed, anxious, and depressed. You can combat distress by becoming aware of what you are feeling in the moment through mindfulness. Focusing on the present moment is part of this practice.
  • Make a note of your thoughts: PTSD symptoms such as flashbacks, intrusive thoughts, and nightmares can be managed with the help of writing in a journal, according to research. You can also use a journal to track symptoms that you can discuss with your therapist after treatment.

Living with CPTSD

CPTSD is a serious mental illness that can be difficult to treat, and for many people, it is a lifelong disorder. However, you can significantly improve your quality of life by combining therapy and medications.

Joining a support group first might relieve some of the anxiety of starting treatment. Being able to share your experience with someone in a similar situation can often be the first step toward recovery.

Recovery and outlook

It takes time to recover from complex PTSD. It is possible for some people to deal with the condition for the rest of their lives. The benefits of prolonged trauma-focused treatment, however, have been shown to result in a significant reduction of symptoms.

Trust in others and the world is one of the goals of treatment. Engaging in healthy relationships takes time, but it is a positive step to take.

People can improve their health and well-being by managing or reducing their symptoms with the right therapy, medications, and lifestyle changes.

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