Trauma: Complex PTSD

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Allan Schwartz, LCSW, Ph.D. was in private practice for more than thirty years. He is a Licensed Clinical Social Worker in the states ...Read More

Complex Post-Traumatic Stress Disorder (C-PTSD) is a condition that results from experiencing prolonged or repeated trauma over months or years, rather than from a single event. Unlike PTSD, which can develop after one-time traumatic incidents, C-PTSD is often associated with enduring stressors like domestic abuse, captivity, or prolonged exposure to war zones. This form of PTSD encompasses a wider range of symptoms, including difficulties with emotional regulation, a distorted perception of the perpetrator, and persistent feelings of worthlessness.

Understanding Complex PTSD

Complex PTSD is characterized by several distinctive features that set it apart from traditional PTSD. Individuals with C-PTSD exhibit profound disturbances in their emotional regulation and have difficulty establishing trust in others. They may experience chronic feelings of sadness, suicidal thoughts, and outbursts of anger. Additionally, sufferers often have a distorted perception of those responsible for their trauma, sometimes exhibiting an unhealthy preoccupation with the perpetrator. These characteristics are compounded by persistent feelings of shame, guilt, and worthlessness, deeply affecting the individual’s sense of self and their capacity to form healthy relationships.


The causes of C-PTSD are rooted in prolonged, repetitive trauma where the victim feels a profound sense of control being exerted over them. This could stem from long-term abuse, torture, slavery, being a prisoner of war, and living in regions afflicted by prolonged conflict. The key aspect that differentiates C-PTSD from PTSD is the repetitive, prolonged nature of the exposure and the depth of the emotional and psychological impact it has on an individual.

C-PTSD is a relatively recent addition to diagnostic manuals. It has been officially included in the ICD-11, published by the World Health Organization, which acknowledges the complex and multifaceted nature of trauma that goes beyond the parameters of PTSD as previously understood. However, as of the latest edition, the DSM-5, used predominantly in the United States, has yet to distinctively classify C-PTSD as separate from PTSD, though discussions for its inclusion in future revisions highlight the evolving understanding of trauma-related disorders within the psychiatric community.

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Recognizing the Symptoms of Complex PTSD

Individuals suffering from Complex PTSD may exhibit a variety of symptoms that can significantly impact their daily lives. Understanding these symptoms is crucial for recognizing the disorder and seeking appropriate treatment. Key symptoms include:

  • Persistent Sadness or Hopelessness: Feelings that don’t seem to go away, similar to a cloud that hangs over every experience.
  • Flashbacks and Nightmares: Reliving the traumatic events through vivid flashbacks or terrifying nightmares that disrupt sleep.
  • Difficulty Managing Emotions: Experiencing extreme mood swings, sudden bursts of anger, or feeling numb.
  • Avoidance of Trauma Reminders: Steering clear of people, places, or activities that remind them of the traumatic events.
  • Feeling Detached from Others: A sense of disconnection from friends and family, feeling like an outsider.
  • Negative Self-Perception: Harboring deep feelings of shame, guilt, or a persistent belief of being worthless or damaged.
  • Trouble Trusting Others: Finding it difficult to trust, leading to challenges in forming and maintaining relationships.

These symptoms significantly impact an individual’s emotional regulation, their sense of self, and their ability to have healthy relationships. Victims may find it challenging to control their emotions, leading to problems with anger management or depression. Their view of themselves can become distorted, seeing themselves solely through the lens of their trauma. Consequently, their relationships suffer, plagued by a lack of trust or a constant need for reassurance.

Diagnosing Complex PTSD

Complex PTSD diagnosis involves a comprehensive evaluation of the patient’s history and symptoms. This diagnostic process looks for the key signs of C-PTSD, including prolonged exposure to trauma, difficulty regulating emotions, alterations in attention or consciousness, changes in self-perception, alterations in relationships with others, and significant changes in the victim’s belief systems.

Historically, the inclusion of C-PTSD in major diagnostic manuals has signaled a growing acknowledgment within the mental health field of the severe impact of prolonged traumatic stress on an individual’s mental health. Its official recognition in the ICD-11 reflects an important step in understanding and categorizing trauma-related disorders. However, it’s worth noting that the pathway to diagnosing C-PTSD is continuously evolving, with ongoing discussions around its classification and differentiation from PTSD, especially in diagnostic systems like the DSM. Understanding the criteria and the history behind C-PTSD’s recognition helps in grasping the complexities of diagnosing and treating this condition.

Effective Treatments for Complex PTSD

Treatment for Complex PTSD requires a multifaceted approach, recognizing the deep-seated nature of the trauma and the broad spectrum of symptoms that individuals may experience. Evidence-based therapies have shown effectiveness in treating C-PTSD, focusing on improving the individual’s ability to regulate emotions, build trusting relationships, and foster a positive sense of self. Among these are Cognitive Behavioral Therapy (CBT), specifically adapted for trauma (Trauma-Focused CBT), Eye Movement Desensitization and Reprocessing (EMDR), and Dialectical Behavior Therapy (DBT). Outcomes from these therapies often include significant reductions in the intensity and frequency of flashbacks and nightmares, improved emotional regulation, and a more stable sense of identity and self-worth.

Emerging therapies for C-PTSD are expanding the treatment landscape, offering new hope for individuals who may not fully respond to traditional treatment modalities. One such emerging therapy is Somatic Experiencing (SE), which focuses on bodily sensations to heal trauma rather than solely on cognitive processes. Another innovative approach is the use of MDMA-assisted psychotherapy, which is currently under research trials and shows promise in helping individuals process trauma by reducing fear and improving trust during therapeutic sessions. These therapies highlight the ongoing development in understanding and treating the complex and diverse impacts of prolonged trauma exposure, with early results indicating potential benefits in addressing the deep-rooted effects of C-PTSD.

Keep Reading By Author Allan Schwartz, LCSW, Ph.D.
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