Complex post-traumatic stress disorder (CPTSD) can develop following prolonged or repeated experiences of trauma, particularly where escaping the situation was difficult or impossible.
Although CPTSD shares many features with post-traumatic stress disorder (PTSD), it can also affect how someone manages emotions, sees themselves and relates to other people.
For some people, the effects of complex trauma can continue long after the original danger has passed. Understanding why these responses happen can be an important part of recovery.
What Is Complex PTSD?
Complex PTSD (CPTSD) is a mental health condition that can develop following prolonged or repeated experiences of trauma, particularly when the person felt unable to escape or had little control over what was happening.
It shares many of the symptoms of PTSD, such as flashbacks, nightmares, avoiding reminders of the trauma and feeling constantly on alert. However, CPTSD can also have a broader effect on how someone manages their emotions, sees themselves and relates to other people.
This is particularly common when traumatic experiences happened repeatedly, occurred during childhood or took place within relationships where the person should have been able to feel safe.
What Are the Symptoms of Complex PTSD?
Someone with CPTSD experiences the core symptoms associated with PTSD. These can include intrusive memories or flashbacks, avoidance of reminders of what happened and a persistent sense of threat.
There may also be difficulties in three additional areas.
Difficulty Managing Emotions
Emotions may sometimes feel extremely intense or difficult to control. At other times, a person might feel emotionally numb or disconnected.
Anger, fear, sadness, or shame can seem to appear quickly, especially when something in the present triggers an emotional response connected to earlier experiences.
These reactions are not necessarily deliberate. The brain and nervous system can continue responding to cues associated with previous danger even when the person is now safe.
Negative Beliefs About Yourself
Complex trauma can affect a person’s sense of identity and self-worth.
Someone may experience persistent feelings of shame, guilt, failure or worthlessness. They might blame themselves for what happened or believe there is something fundamentally wrong with them.
These beliefs can be particularly powerful when traumatic experiences occurred during childhood or involved someone the person depended upon or trusted.
Difficulties With Relationships
Relationships can also be affected.
Some people find it difficult to trust others or feel safe when becoming emotionally close. Others may fear rejection or abandonment, withdraw from relationships, or stay highly alert for signs that another person is angry or unhappy with them.
These patterns make more sense when viewed in the context of what someone has previously experienced, rather than simply as a relationship problem.
What Causes Complex PTSD?
CPTSD is most commonly associated with repeated or prolonged traumatic experiences from which escape was difficult or impossible.
These experiences can include childhood physical, emotional or sexual abuse, childhood neglect, prolonged domestic abuse, trafficking, torture, captivity and repeated exposure to violence.
Trauma occurring within important relationships can have a particularly significant impact because the person who should provide safety may also be the source of fear.
This is one reason there can be connections between childhood trauma and adult relationships, attachment, self-worth and the way someone responds to perceived danger.
CPTSD vs PTSD: What's the Difference?
PTSD and CPTSD are closely related, and both can develop following extremely threatening or distressing experiences.
Both involve core trauma symptoms such as re-experiencing, avoidance and a continuing sense of threat.
The main difference is that CPTSD also involves persistent difficulties with emotional regulation, negative beliefs about the self and relationships.
It is sometimes said that PTSD results from a single traumatic event while CPTSD results from repeated trauma. That is an oversimplification. PTSD can also follow repeated or multiple traumatic experiences.
The distinction is based on the pattern of symptoms someone experiences rather than simply counting how many traumatic events occurred.
Can Complex PTSD Be Treated?
Yes. Psychological treatment can help people experiencing CPTSD.
Treatment needs to take the individual into account rather than assuming everyone with complex trauma needs exactly the same approach or timetable.
For some people, therapy may initially involve developing trust, understanding trauma responses and finding ways of managing overwhelming emotions or dissociation before working directly with traumatic memories.
Trauma-focused psychological therapies can then be used where appropriate. EMDR therapy is one treatment used for PTSD and trauma-related difficulties and involves processing distressing memories so that they become less disturbing in the present.
People with complex PTSD may need more sessions or additional time to establish safety and trust, particularly where trauma has affected relationships or someone’s ability to regulate strong emotions.
Recovery From Complex Trauma
Recovery does not mean pretending that traumatic experiences did not happen or erasing the past.
Therapy can instead help reduce how much past experiences continue to dominate the present.
Over time, this may involve feeling safer, understanding emotional and physical trauma responses, developing a less critical relationship with yourself and experiencing greater choice in relationships and everyday life.
Complex trauma can have wide-ranging effects, but those effects do not have to remain unchanged. With appropriate support, people can process traumatic experiences and develop different ways of relating to themselves, other people and the world around them.
Further Reading on Trauma & Recovery
If you'd like to understand trauma in more depth, I've put together two reading lists covering trauma recovery and the nervous system.
