What is Complex PTSD?

Complex PTSD is a psychiatric condition that stems from ongoing and recurrent trauma. Symptoms of C-PTSD can be more extreme and persistent than those of PTSD. Some of the most common causes of C-PTSD are childhood abuse or neglect, or experiencing intimate partner violence.

How is C-PTSD different from PTSD?

Although PTSD and C-PTSD can both have profound impacts on an individual’s quality of life, Complex PTSD can be more severe, and impact more areas of functioning than PTSD. Since C-PTSD is caused by long-term repetitive trauma, individuals with C-PTSD experience significant difficulties in their social-emotional functioning that can extend beyond the typical parameters of PTSD. C-PTSD deeply impacts individuals' attachment mechanisms and relationship patterns, self-worth and self-esteem, and emotional regulation capacity.

What does a complex PTSD episode look like?

People with C-PTSD often experience a form of flashbacks called “emotional flashbacks.” This is when, rather than flashing back to a specific incident or memory, an individual flashes back to an overwhelming emotional state they experienced during the period(s) of trauma. Emotional flashbacks often include feeling helpless and vulnerable, overwhelming shame, intense fear, severe anger or sadness, and dissociation.

Does complex PTSD ever go away?

Yes – although Complex PTSD can take a while to treat, it is treatable. People with C-PTSD can heal through trauma focused therapy, and can get to the point where they no longer meet the diagnostic criteria.

What is it like living with Complex PTSD?

People with Complex PTSD can experience a long list of difficulties in daily life. In fact, there is so much diversity in how C-PTSD can impact people, that one of the common experiences shared by those with C-PTSD is having a long list of diagnoses from a variety of therapists. It is common for people with C-PTSD to be diagnosed with anxiety, depression, substance use disorders, eating disorders, borderline personality disorder, bipolar disorder, obsessive compulsive disorder, and more. 

People with C-PTSD experience frequent distress and impaired daily functioning due to hypervigilance, flashbacks, and avoidance of trauma reminders. Additionally, people with C-PTSD struggle immensely with relationships, suffer from deep internalized shame and low self-worth, and experience chronic emotional dysregulation, which can be highly destabilizing.

What is a C-PTSD trigger?

People who have experienced complex trauma have bodies and brains that are highly vigilant of danger, and primed for self-protection. The experience of enduring repeated trauma creates severe reactivity, where even very small things can signal danger to the brain and lead to automatic defense mechanisms surfacing. Sometimes we refer to the trauma brain as working like a faulty fire alarm – it is trying to protect us from danger, but it tends to go off even when nothing is on fire. 

For example, let’s say that someone grew up with a parent who would frequently act rageful and abusive. Someone who grew up in this kind of environment may learn to be highly sensitive to others’ tone of voice and facial expressions. They were conditioned by their traumatic environment to always be attuned to the moods of people around them. As an adult, their partner gets frustrated about something small and their mood shifts to a grumpy demeanor. The person with C-PTSD may automatically perceive their partner's mood shifts as a sign of impending danger, and they will experience the same automatic response to this current stimulus that they experienced back in their childhood, dealing with a raging parent. So they may immediately tense up, start to panic, dissociate, or try to be helpful and accommodating to manage the sense of threat.

How is C-PTSD diagnosed?

C-PTSD can be diagnosed using the criteria outlined in the ICD-11, listed below. 

Complex PTSD symptoms

People with C-PTSD experience 3 core symptoms that are shared by the standard PTSD diagnosis. These are: 

1. Re-experiencing of trauma in the form of flashbacks, nightmares, or intrusive memories 

2. Avoidance of trauma reminders 

3. Persistent sense of current threat, AKA hypervigilance 

C-PTSD includes three additional symptoms, which result from the long-term and repetitive nature of the experienced trauma. These are: 

1. Chronic emotional dysregulation, such as heightened emotional reactivity, dissociation, and emotional numbing 

2. Negative self-concept, such as persistent feelings of guilt, shame, and worthlessness

3. Insecure attachment adaptations and difficulty forming secure relationships with others 

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How is Complex PTSD treated?

Each person's path to healing will also look different, but a trauma-focused therapist who is knowledgeable about C-PTSD should be able to work with you to find the best course for treatment. Here are a few key components that I have found to be extremely significant in treating C-PTSD: 

1. Working through and releasing deep internalized shame. It is common for people with C-PTSD to blame themselves for the trauma they experienced, or to internalize the negative messaging they received about themselves while being abused or neglected. I like to work with people on understanding and exploring the shame-based stories they have internalized about themselves, so those stories can be revisited from a healthier perspective and shifted towards self-acceptance and self-compassion. 

2. Learning how to regulate the nervous system and get out of survival mode. When people are experiencing ongoing trauma, they have to heavily rely on automatic, self-protective physiological responses like fight, flight and freeze. After the trauma has passed, our bodies can get "stuck" in those defensive survival states.This can manifest in perpetual anxiety, always feeling "on edge," panic attacks, difficulty slowing down or relaxing, dissociation, numbness, and fatigue. I like to use somatic-based interventions to help people access feelings of safety within their bodies and decrease hypervigilance. 

3. Attachment focused work. One of the main functions that is damaged in cases of complex trauma is the attachment system -- the ability to form secure bonds with other humans. Anxious attachment, codependency, people-pleasing, lack of boundaries, avoidant attachment, and hyper-independence are all common adaptations for people with C-PTSD. In order to heal, we need disconfirming experiences that teach us relationships can be safe. I like to work with people on exploring their attachment patterns, and processing the severe attachment ruptures from the past that led to the various defense mechanisms listed above. 

C-PTSD focused therapy will look different depending on each individual client, but the goal is ultimately to restore a sense of felt safety and security that was lost during the repeated traumatization. 

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