What is Complex PTSD and do You Have It?

Last reviewed by

Dr. Sheri Jacobson March 14, 2023

by Andrea M. Darcy

Complex PTSD (CPTSD or c-PTSD) is a relatively new diagnosis.

It describes the experience of those who suffered ongoing and inescapable trauma that has left them with long—term emotional, mental, and physical side effects.

What is complex PTSD?

Psychological trauma and its treatment is a field of psychology that is really only starting to come into its own. There is still a lot to understand, and there is ongoing controversy.

Complex trauma is currently one of these controversies. It is not yet fully accepted by all medical communities that those who suffered ongoing trauma or traumas, usually in childhood, would have symptoms different than those who experienced a single trauma.

In the USA ‘complex PTSD’ is not an official diagnosis, although the latest version of their diagnostic manual, the DSM-V, does hint at a possible set of other symptoms. The closest diagnosis here is “disorders of extreme stress not otherwise specified (DESNOS)”.

Here in the UK there is also work to be done. The National Guideline for Health and Care Excellence (NICE) still refuses to recognise complex PTSD, even as the NHS itself has recently added a page about it to their website. You might instead be given a diagnosis from the World Health Organisation’s manual the ICD-10 called “enduring personality change after catastrophic experience (EPCACE)”.

Complex Trauma vs PTSD

So how exactly is complex trauma different than post-traumatic stress disorder (PTSD)?

it is a product of ongoing, chronic trauma or traumas instead of one big trauma
the victim could not escape the trauma (a child can’t go live on his or her own)
often the trauma was in childhood
the perpetrator is in many cases known to the victim or someone they were close to.

By: Mitchell Haindfield

Symptoms of Complex Trauma

Complex trauma does share the same symptoms as PTSD (read about them in our Guide to PTSD).

The difference is that it also involves a set of other emotional symptoms that can include:

emotional ‘dysregulation’ (you struggle to control your emotions)
trust issues – you don’t trust the world, others, or even yourself
relating difficulties – you find relationships so hard you might even avoid them entirely
hopelessness – you don’t think you’ll ever change or that life will ever get better
disconnection – nobody can understand you and you feel totally different than everyone else
low self-esteem – you feel so worthless you might even often consider suicide.
identity issues – uncertain who you really are
“emotional’ flashbacks – instead of remembering images, you might be hit by states of emotion that don’t match what is going around you in the present but arise from the past.

Why You? The Causes of CPTSD

Again, c-PTSD develops after a trauma that is repetitive, lasts over time, and from which there is really no escape.

So the types of trauma that lead to complex PTSD are things like:

child sexual abuse
physical abuse and neglect
ongoing psychological abuse
having to witness ongoing abuse or violence of another
relationships that involve chronic abuse and violence
kidnappings, hostage taking, prisoner of war
human trafficking and slavery
being forced to be a sex worker
cult membership.

By: Carlos Ebert

Misdiagnosis of complex PTSD

The biggest issues here is a misdiagnosis of borderline personality disorder (BPD). The two share many symptoms such as low self-worth, suicidal thinking, and out of control emotional responses. And both can be linked to child sexual abuse.

It is possible to have both borderline personality disorder and c-PTSD. But if you feel the treatment for BPD, focussing on the ways you relate and regulate your emotions, is not working, and you know you experienced trauma? It’s worth looking into treatments for trauma as well.

What sorts of therapy can help with complex PTSD?

You are an individual, so the therapy that works for you might not be quite right for another person. But one thing to consider is whether a type of therapy will ‘re-traumatise’ you or not. Many people with complex PTSD find talk therapies that ask them about their past make their symptoms worse, not better.

The best advice here is to first use therapies that help you stabilise your emotions and triggers. Cognitive behavioural therapy (CBT) is evidence-based as a treatment for PTSD and can help with this. You might also have some success with another treatment for PTSD, eye movement desensitisation and reprogramming (EMDR), although its usually just suggested for singular, distinct traumas. Other things to look into are body psychotherapies and hypnotherapy.

Once you are more in control of your emotions and thoughts, you might want to try a talk therapy that goes deeper into your traumatic experiences, and helps you with the ways you relate to others. Schema therapy is recommended here if you experienced abuse from a family member. It focuses on creating a strong relationship of trust between you and your therapist.

What if my country won’t diagnose complex PTSD?

While any one who actually suffers complex PTSD will find it strange that someone would feel it was not a real experience, psychological terms are sadly often not accepted until they are ‘proven’ by research.

If you live in a country that does not recognise complex PTSD as a diagnosis, look for a therapist who is willing to treat you as an individual with your own unique set of issues, who has experience with trauma victims, and who is interested in the issue, ‘official’ diagnosis aside.

Need to talk to a therapist experienced with complex PTSD? We connect you with some of London’s top therapists in central locations. Outside London or even the UK? Find a therapist that suits your needs on our sister booking site.

Andrea M. Darcy is a mental health and wellbeing expert with training in person-centred counselling and coaching. She writes from experience about trauma, relationships, and ADHD, and works as a consultant helping people plan their perfect therapy journey. Find her on Instagram @am_darcy

Blog Topics: Anxiety & Stress

10 Responses to “What is Complex PTSD and do You Have It?”

Deanna

Finally an answer, I knew I was not a Borderline as I never have had the 5 out of 9. I suffered sexual, physical, and emotional abuse throughout childhood I began self injuring at the age of 5. I inserted object’s into my privates causing mutilation injuries numerous times over 50years. I just celebrated 2years injury free with the help of a trusted therapist. I hope this is accepted by USA in my life time!
Harley Therapy

Wonderful to hear, Deanna, that you have a trusted therapist and are seeing real results! That is just the power of therapy when we find a therapist we click with. We do feel there is an overdiagnosis going on around BPD in America. And it’s so important to realise that any mental health diagnosis is not an illness you’ll see under a microscope. It’s a term created by mental health professionals to describe groups of people with similiar symptoms, and, sadly, particularly in the USA, to make it easier for them to quickly prescribe meds. We often wonder what diagnosis would be left standing if our societies actually took a stand against the endemic trauma going on within them, if they actually put in place real protocol to protect children, and educate all of us on recognising trauma.
Mrs Margot Miller

My partner aged 78 has recently had an unthreatening ‘standard’ operation, and his normal quiet sensible, rather withdrawn behaviour changed – anxiety, full of fear and trepidation – shaking with fear and sleeplessness before going to the doctor or the hospital.
This meant I had to warn all the doctors, nurses, hospital workers etc we
were involved with – that ‘the patient’ was panicky and terrified, and telling him that everything
was going to be fine was not the way ….. Now the operation is over and he is recovered, he is having talks with the GP’s mental health adviser – who almost immediately proposed a diagnosis of complex-PTSD or EPCACE – which I had never heard of. So here I am trying to find out more, and where we can go from here. Would it be best to find an EMDR therapist before hoping to get cognitive behaviour therapy? We have been to a course on Mindfulness, but it was not good and the counsellors not well-trained.
Harley Therapy

We are sorry to hear that sounds like either old trauma was triggered or something in the hospital triggered a trauma response. Was he under anaesthetic? There are cases, albeit rare, where patients under anaesthetic have tiny bits of recall meaning the anaesthetic didn’t entirely work on them, and the end result is PTSD. There is no exact math to therapy, it depends on the individual, but yes, given that one experience has triggered it as opposed to a build up over time, EMDR or clinical hypnotherapy be better to try first. There is also a new modality in the UK called BWRT which might be useful. We hope this time you see some results!
Ally

I grew up in an emotionally abusive household with a mother with some narcissistic tendencies and an older sister who was perceived as the perfect child. I was called stupid, fat and much worse, despite having excellent grades and being good at sports. I was regularly given a silent treatment by my mother as a punishment for saying something wrong. She would also lock herself in a room leaving me outside crying for ignoring me. I couldn’t understand what was wrong with me to deserve her treatment. She would say I was responsible for my sister’s failed exam or when someone got sick, that I had such intense look it made her sick. My sister started calling me fat and ugly when I was 12 (I have always had a healthy BMI and I have never been overweight). I was told I was too sensitive and wasn’t allowed to cry in front of them when they abused me this way. The saddest thing is I really saw myself through their eyes, as if I was materialising their version of me. I used to cry in my room as a teenager asking myself why am I feeling so much pain and wishing it would stop. Later on I chose partners who also commented on my body negatively as if I was reliving my family trauma with them. I chose those partners not out of love but because I believed they would be nice to me and they seemed like a safe choice, and I was happy someone was interested in me at all. I never approached the person I was really interested in, because I got too scared or my family would tell me that person is too good looking/smart/successful and he would never be interested in someone like me. I never trusted myself enough to make a choice on my own. I would ask the people who emotionally abused me what was good for me. I know it was irrational. Now that I am in my 30s I am much better at understanding why I behave the way I behave but understanding doesn’t lessen the pain. I suffer from elements of an eating disorder, BDM, anxiety, PTSD, depression, death anxiety and social disorder. I have tried talking therapy, medication, exercise, relationships, well paid job, etc. but nothing makes me feel safe and loved. I think it is because I have not been able to express my true self and be my own version of me and had to become precoccupied with the way I looked and behaved because of the family trauma. I keep replaying the past over and over again and wishing for someone to save me/love me unconditionally. I feel the pain is stored in my body – while I am able to rationally face the trauma and even my own wrongdoings, I feel physical tension and discomfort no matter how objectively well I look after my body, even when I exercise or eat healthy, or look ‘attractive’ according to other people. How can I accept myself and stop being my worst enemy? How can I start living and not merely surviving? What therapy would you suggest for someone like me?
Harley Therapy

Hi there Ally.There is no ‘rational’ processing of trauma. We can’t think away the effects of trauma which changes the way the brain performs and is a very physical experience if we have c-PTSD. Notice how you recount in great detail your childhood. How did you feel after writing it? Heavy, unhappy? We are wondering what kind of talk therapy you tried. You see recounting the past again and again if we have PTSD can lead to feeling WORSE, not better. Which is why going straight into certain kinds of talk therapy can just leave you feeling hopeless. Before deep diving you need therapies that stablise you first, and calm down your trauma response, like EMDR, BWRT, and hypnotherapy. And then we’d suggest you look into body psychotherapy. It’s a form of therapy that focuses on how trauma is stored in the body and how the body also ‘talks’. And also somatic therapy, which is body-based trauma therapy. Finally, you can’t snap your fingers and go from survivor to thriver. It’s a process. And note that it is also possible to overidentify with being a survivor, to take too much of our personal power from our trauma story. Yes, you survived hard things, like, unfortunately, far too many of us. But you are also much more. Your life is not just this story. What are your success stories? What goes right each day? Do you actually WANT to thrive, or is merely surviving deep down your comfort zone? Thriving can be scary. It means we have to become like everyone else instead of someone whose only identity is suffering. In summary, you are on your journey, you are trying things, you are moving forward. Also try to cut yourself some slack. You might find our article about self compassion useful http://bit.ly/selfcompassionHT. Best, HT.
Anthony Mignone

Iam 73 year old male who was beaten daily by his mother with a belt. It has caused me horribly difficult psychological problems. I suffer from intense panic attacks since 14, a binge eating disorder, sexual addictions, ocd bpd,ied, which I believe led to a fib. I was told by a psychiatrist that I had critical ptsd. I also had 2 stella ganglion block shots that did nothing. I’m in therapy but my anxiety is he’ll and I’m running out of time to ever be truly healed. I live in the USA
Chris Carlyon

Hi. Very interesting article. I have been suffering with major panic attacks and flashbacks for the last year. The attacks are triggered by noises mostly and stressful situations. I have had audible hallucinations, my eyes rolled back. Very bad flashbacks. I am very emotional. The attacks are very regular. Its effecting my ability to go out on my own. My doctor says I have anxiety disorder. But I have been told by others it could be ptsd.
Over the last 12 years I have been a carer for members of my family. 2012 my nan had cancer and died. Me and my mum cared for her, 2013 I had a heart attack. 2015-16 my dad and uncle both had bypass surgery. They nearly died. 2018 after a bad year my other uncle died because of a bad stroke and cancer. 2022 after a bad year with stage 4 lung cancer my mum died. Me and my mum looked after everyone and then I looked after my mum. I saw alot of bad things in that time as well as being ill my self. The attacks started last year after my sisters old dog was put down due to bad illness. It has been alot of trauma over these years. This is why I think I might have c-ptsd. I have had bereavement therapy and 4 sessions of normally therapy. But I am getting worse. I am due to have cbt in may but I don’t know how long I can last. I have been trying to get someone to tell me if it is ptsd or am I looking for something that isn’t there. All I know is I need help. Any suggestions would be great thanks.
Katie

Hi, my name is Katie,

I’m not even sure how I’m suppose to fit everything here as it’s complex and triggered and I don’t know how much detail I go into. I’m an open book I just want help. Someone tell me what it is exactly wrong or point me in a direction I haven’t gone yet. I’m tired and no one seems to hear me. They just medicate which does nothing to solve the problem. I would also not have wasted 6 years of my life going to countless drs specialists therapists and psych drs.

I grew up with my momma, whom now I believe also had undiagnosed PTSD of her own. She struggled financially our whole lives, not for lack of effort what so ever. What I know now is that my father never paid child support to help and then traumatized her by calling her a low life who couldn’t pay her bills, while him an his new family were living in houses and buying boats we were struggling to pay the light bill. The level of toxicity is truly baffling. This is the type of person he is still to this day, to the extent of calling me trash like my mom now at 39. He left the state when I was 3 and told me on a voice mail. Then shortly after married my mom and his best friend and business partner (abuse victim). He’s been in and out ever since and everytime worse than the last.

I’m a recovering alcoholic, I’ve been sober for 9 years now. Getting sober and staying sober are one of the toughest things in the world. Many failed attempts, many sponsors, countless mistakes, many apologies and amendments, a crap ton of humaning to process to learn quickly and many years of my life.

I found out I was pregnant 2 years into sobriety, Jan 2018. My mom passed away unexpectedly/suddenly March 2018. She wasn’t just my mom, she was my best friend, my rock, my net, my safe space, my home. She was the best friend and mom she could be. I was an angry alcoholic rebellious teenager and put her through hell a lot. We had our share of issues but the love was never questionable. We loved each other on a different level. We are, and she was an empath. We would always protect each other no matter what.
We worked together and hung out on the weekends.

She didn’t come to work one morning. After about an hr of not picking up her phone, I drove to her house thinking she’s asleep and didn’t hear her alarm, or volume was down (she did that sometimes). Car was in the parking lot, but the safety gate was torn to shreds. About 2 hours later a police officer told me she passed. I had seen her when we left work the night before. She was getting ready to go to the mountains with her friends for the weekend. Blindsided is an understatement. …. I called my father…my estranged, angry, verbally and mentally abusive father, if that says anything. I was not in my mind, I was not on this planet, I was not anywhere. This is a regret I hold. This began the opening of communication and the next 6 years. I stopped my feelings a few days later so that my baby didn’t have to feel my pain. I turned up the happy, momma would want us super happy, probably not so healthy, volume. Although, I don’t regret this because I allowed myself to have the magic experience of being a happy pregnant woman.

I wiped the tears of others at my mothers funeral, I didn’t speak, I was there. I was just there and I feel like I’ve just been there ever since.

Jan2019 I made the move to Vegas to be closer to my father, step mother and …. Evil or David if you prefer. The golden child, the one whom could kill someone and my parents would bury the body. The one who would physically assault me while I was in my room reading Hanson magazines and being a teenage girl. Then Run to my parents and claim I did the assaulting and they would believe him, I would get in trouble, grounded etc. this happened regularly. He also never went to school if he didn’t feel like it and I would have to do his homework because my step mother did not know the math problems they were teaching. My father was explosive, and vile, he would shove, intimidate physically to move to physically if that makes sense, yell, call us things like dumb, weak, your not the victim, later in life it’s become fat like your mom, trash like your mom, his karma and so on. He would become so angry at my mom asking about child support or him not being able to get another credit card or house or boat because of back child support that he’d get angry with me and yell things like you fat stupid b of a mother, you fat cow of a mother. You get it. Anywho my hormones from birth and grief, I love to Vegas to be closer to them. I wanted my child to have a family (don’t ask I see this now I don’t know 🤷‍♀️) and there was more Opprotunity as well so I moved. The first year the red flags were all there I was a sleep deprived only parent who waved them on by like I was at a fair. David’s explosive anger, throwing things, wall punching, manipulations. Them my fathers started showing. It’s like they were hiding it. This makes no sense I know but 🤷‍♀️ I’m not a therapist or psychologist. The first was when he physically intimidated step mom from standing to across the room and down into a chair until I stepped in. It’s been crazy ever since.

Then 4 years ago after a relationship which ended in a man confessing he previously had a sexual relationship with his ex gf at a different times, 10 yr old daughter, for 3 years. Casually like it was nothing said this. My world, it went numb like I shut down. It was too much, then a few weeks later I started having massive panic attacks unable to move and shaking uncontrollably. I sought help from my psychiatrist at the time. He was on vacation and a fill in Dr saw me for 5 minutes diagnosed me bipolar. 3 years, 17 different medications from antidepressants antipsychotics anticonvulsants mood stabilizers, tranquilizers, 2 seizures, countless er visits and 3 not bipolar diagnosis from a neurologist and two psychologist later. I’m still here trying to figure this out. During this time my brother and I were living in the same house. He decided to come down stairs and start picking at me, and looking for a rise. I begged him to leave me alone, I had a rough week. He intimidated me into the pantry closet and then began the typical “your a waste, why are you here, no one wants you here, your fat like your mom, your ugly” and so on. I had it. I’ve said so many times in 6 years it’s vile and repulsive and not to mention my mother at all. She’s not even here to defend herself so yes I will absolutely defend her. I don’t condone this, I hate violence and anger and hostility. I do not apologize however for defending myself against a bully. Anywho he got his rise, I picked up a four inch potted plant (I still have the plant). And brought it back and moved my body forward as if I was going to throw it in order to scare him away. He ran up the stairs, I put the pot back down on the counter. I started up the stairs making loud stops so he knew I was coming. I told him I’d had enough and that we needed to have a serious talk. When I got to the top of the stairs I knocked on his door and told his to come out I didn’t have the plant I wanted to talk. I then heard a gun cock from behind the door. (I know this sound because I was healed up at gun pointing to my head in my 20s). I heard this is slow motion the mechanisms moving. My heart hit the floor, I grabbed my daughter, my phone, lock my bedroom door, into the bathroom locked that door and go into the tub and called his mom (they lived a minute away) and then cops as soon as I told her to come help.

The cops spent 20 minutes with evil and then came and asked me two questions one of which was did you see a gun. Then told me they couldn’t do anything because I didn’t see a gun and the sound could have been anything. Two cops proceeded to chat with my brother while walking upstairs to his room, and all taking guns to his vehicle and letting him go to our parents house for the night.

This has never once been actually talked about. I try. They said we both did bad things that night and that they talked to David. But I have been kicked out of the family, they want a relationship with my daughter and if I don’t comply they go silent which they are the only people I know here. The last conversation I attempted to have about the issue I started to get emotional any cry (They don’t like my feelings, I’m always been too emotional too sensitive) I hear Evil from the background saying “your so stupid”. listening to this with my parents without anyone stating he was even around. I never agreed to discuss anything with David nor do I want to. I’m pretty sure that’s a normal response to this situation. So again they don’t believe David came down antagonizing a rise for quite literally zero reason. I was making a pbj for Leigha so I could get in bed I was beat. This is crazy to me, so incredibly wrong on so many level for so many reasons. They state they won’t talk to me about David anymore that I’m jealous and obsessed. 🫠 they say I’m crazy and hang theirs hats on bipolar that “my daughter has a mental problem”. As a non therapist who’s been in therapy for pretty much my entire life, don’t get me started on unpacking this. 😵‍💫 okay sorry for the novel of issues!! Any and all help is so so so appreciated!!!!! 🙌🏻
Katie

Crap! Katie again! My whole point of this was to say thank you for another possibility. I feel a bit stupid honestly right now. Why was this not even ever considered with me I wonder. Why was it that I woke up after 35 years as a bipolar patient whom actually could not function now and not something so simple as PTSD after a VERY traumatic experience. Crazy… how something that seems so minor could have a trickle effect of what’s transpired.