Complex Post-Traumatic Stress Disorder (CPTSD): How It Can Affect Your Life
Trigger Content Warning: Please note the following provides information about causes and effects of post-traumatic stress disorder and treatments, and could be triggering.
When individuals hear the words "post-traumatic stress disorder" or "PTSD," they often associate them with veterans who have experienced exposure to war or to people who have experienced a violent physical attack. However, there are also many other traumatic experiences that can lead to PTSD, such as personally enduring or witnessing physical or emotional danger, harm, or threats (or even being close to the harm or threats). Traumatic experiences may include (but aren’t limited to) childhood neglect, sudden separation from a loved one, poverty, violence in the community or the culture, war, terrorism, living with someone who experiences unmanaged substance use or mental health disorders, and experiences of sexual abuse, physical abuse, and emotional abuse.
If you or a loved one is experiencing or has experienced relationship abuse or domestic violence, please seek help. The National Domestic Violence Hotline is free and offers support 24 hours a day, 7 days a week, 365 days a year. The number is 1-800-799-SAFE (7233). You can also text “START” to 88788 or use the live chat option on the website at TheHotline.org. The Hotline provides essential tools and support to help survivors of domestic violence so they can live their lives free of abuse.
Another resource is the Crisis Text Line, which can connect anyone in crisis with a crisis counselor; text “HELLO” to 741741 from the U.S. anytime, day or night.
Trauma can occur from a stressful event or a stressful series of events. Trauma can result from a one-time situation or an ongoing stressor. Trauma can leave long-term effects on person’s functioning and/or emotional, physical, or social well-being.
On a hopeful note, people who have had traumatic experiences can also be resilient or learn resilience, which is a sense of perseverance in the face of challenges. They can learn coping strategies and healthy ways to manage and move beyond distress. Healing from trauma and living a fulfilling life can be realities.
What is complex post-traumatic stress disorder?
If a person is exposed to trauma, especially if it is prolonged or repeated trauma and they feel there is no escape, a more severe form of PTSD, known as complex post-traumatic stress disorder (Complex PTSD or C-PTSD), may develop. Complex PTSD is a type of mental health disorder that usually develops due to repeated, long-term trauma, and it can leave many effects.
What causes complex post-traumatic stress disorder?
Psychiatric and mental health experts from around the world use a manual called the Diagnostic and Statistical Manual of Mental Disorders DSM-5) to identify and treat psychological disorders. The DSM-5 is considered the highest authority for diagnoses of mental health issues. According to the DSM-5, several examples of trauma may result in a complex post-traumatic stress disorder diagnosis and may examples include:
- Experiencing childhood neglect or abuse
- Experiencing domestic violence
- Living in an area affected by war or being a prisoner of war
- Being exploited by human trafficking
- Experiencing long-term homelessness or extreme poverty
- Experiencing childhood trauma
The signs and symptoms of C-PTSD
While Complex PTSD symptoms are similar to the symptoms of PTSD, because the individual has experienced repeated exposure to the trauma, symptoms may manifest more extremely and may include:
- Flashbacks or nightmares
- Dissociation
- Anger management issues
- Anxiety
- Depression
- Social isolation
- Destructive behaviors
- An unhealthy fixation on the abuser (possible continued fear or thoughts of revenge)
The symptoms of C-PTSD often leave the survivor in a state of feeling constant distress or feeling trapped with little or no hope of escaping the source of trauma. Even after several years, the person can still experience symptoms. The constant high-stress levels associated with their experiences can hinder the survivor’s life and relationships significantly. Seeking help and treatment can be critical for the recovery of people who experience Complex-PTSD.
Understanding criteria for C-PTSD or PTSD
Criteria For PTSD and C-PTSD May Include:
One or more stressors
A stressor can be a traumatic event/events. Four types of stressors include:
- Direct exposure to trauma.
- Witnessing trauma.
- Finding out that a close relative or friend was exposed to a trauma.
- Exposure to difficult details about trauma. (This can be common among people who are routinely engaged in environments that have a lot of stressors, like emergency room healthcare providers and first responders.)
Intrusion symptoms
Symptoms of intrusion include consistently replaying thoughts of trauma. Intrusion symptoms include:
- Sudden and upsetting memories replaying.
- Nightmares or night terrors.
- Involuntary flashbacks.
- Severe emotional distress that results from being reminded of the event (exposure to a trigger).
- A physical reaction or aversion to a reminder or trigger of the trauma.
Avoidance of trauma-related triggers
A symptom of PTSD can be taking steps to avoid triggers that are reminders of the trauma. Avoidance may include:
- Trying to avoid or suppress thoughts and feelings related to the trauma, the event, or time of life in which the trauma occurred.
- Intentionally avoiding trauma-related external reminders.
A decline or negative change in mental capacity and mood
A change in mental capacity or mood may occur after trauma and be related to C-PTSD. Symptoms can include:
- Being unable to remember certain things about the trauma.
- Developing an overly negative self-image or overly pessimistic worldview.
- Excessively blaming oneself or someone else for causing the trauma.
- Decreased interest in things once enjoyed.
- Feelings of isolation or being alone.
- Difficulty feeling happy.
- Irritability or aggressive behavior.
- Risky, self-destructive, or harmful behavior.
- Extreme alertness, hypervigilance, and paranoia.
- A heightened reaction to being startled.
- Difficulty concentrating.
Symptoms that last for a month or longer
- Symptoms may last for more than one month to be diagnosed as C-PTSD.
Decrease in functionality
- To be diagnosed as part of PTSD, symptoms typically impact functionality and quality of life.
Depersonalization
- A person who is living with PTSD or C-PTSD may experience a feeling of detachment from themself when exposed to triggering stimuli.
- The person may feel as if they were in a dream or as if things were happening to someone else, not to themselves.
Derealization
- A person who is experiencing C-PTSD may feel a sense of unreality or distance from reality. They may say that they feel as if what is happening is not real.
When diagnosing PTSD or C-PTSD, the therapist, counselor, or psychiatrist will also likely ensure that symptoms are not resulting from something else, such as medication, a substance use disorder, or a different illness.
How does C-PTSD affect a person's life and relationships?
Complex post-traumatic stress disorder can have far-reaching effects on a person's life and relationships.
- Attachment challenges: A person's understanding of how relationships work is formed in childhood. A child who is exposed to abuse or neglect may have an altered sense of what a healthy attachment with family and/or friends is. They also may not know how to respond appropriately in a crisis/traumatic situation.
- Trust issues: Many people living with C-PTSD (both adults and children) may have trust issues that can be extreme.
- Poor self-image: Experiences that challenge or demean how a person feels about themself can result in poor self-image. Even when there is no valid reason to think negatively about oneself, a person with C-PTSD may not be able to see the good in who they are. They may not feel worthy of healthy relationships.
- Destructive behaviors: Some trauma survivors use alcohol or drugs to escape the emotional turmoil of C-PTSD symptoms. However, in reality, the escape is only temporary. Unhealthy sexual behaviors may also be used as an escape or in an effort to feel a sense of control that was lost due to trauma.
- Obsession with a past abuser: Survivors of trauma may obsess over the person responsible for their traumatic experience. A survivor may feel an attachment to the person who caused them harm. They may dwell on ways to take revenge on the abuser or imagine ways in which the abuser experiences similar hurt to what they inflicted on others. With help and support, survivors can learn how to move forward and develop healthy thoughts.
How is complex PTSD different from "simple" post-traumatic stress disorder?
PTSD and C-PTSD can both result from experiencing trauma. The “C” in C-PTSD stands for “complex.” C-PTSD may involve more complicated and layered trauma and symptoms than PTSD, since the events that often result in C-PTSD occur repeatedly for longer periods of time. Those with C-PTSD may also experience emotional dysfunction or uncontrollable emotion, which can include emotional responses that are poorly controlled and don’t fall within what are widely considered typical or acceptable.
Sometimes PTSD and C-PTSD are not considered different diagnoses, but the World Health Organization (WHO) recognizes C-PTSD as a result of repeated trauma over months or years.
Those with PTSD and C-PTSD usually have symptoms that fall into three categories:
- Re-experiencing symptoms: These symptoms include flashbacks and nightmares. A survivor with PTSD might even experience the sights, sounds, smells, and other sensory effects of the traumatic experience. The memories can cause intense feelings of distress.
- Sense-of-threat symptoms: People living with PTSD may be on high alert, hypervigilant, and very sensitive to their surroundings. They may be easily startled or seem jumpy. They may behave as if they’re constantly on guard.
- Avoidance symptoms: Survivors living with PTSD may spend significant time and energy avoiding anything that could trigger reminders of the trauma. In addition to avoiding situations, places, or people, they may try to avoid feelings of trauma by numbing them with the use/misuse of alcohol or drugs.
Treatment for complex-PTSD
Complex post-traumatic stress disorder can be treated, and symptoms can be managed. Both help and hope are available. It is important for survivors to know that trauma-informed therapists are trained to provide therapy in a safe environment. They are mindful about actively avoiding re-traumatization, especially if details of the trauma arise.
Effective treatment options may include:
Eye movement desensitization and reprocessing (EMDR)
EMDR is a type of therapy that involves a therapist working directly with a client. After preparation and a session or two getting comfortable with one another, the therapist usually asks the client to recall a memory related to the trauma that was experienced. The therapist will move their finger from side to side and ask the client to follow the movement with their eyes. This process may work to desensitize the person to the trauma by having them focus on what the therapist is doing rather than on the memory. A goal is to have the client eventually recall the memory without any significant adverse reaction.
Psychotherapy
Psychotherapy is a type of talk therapy. It can be done in group sessions or one-on-one with a counselor and client. The primary focus of psychotherapy is to stabilize the person experiencing C-PTSD so that they can address feelings, improve connections with other people, and learn to effectively manage emotions and memories of trauma.
Medications
While there are currently no drugs that have been designed specifically to treat the symptoms of PTSD and Complex-PTSD, there are medications that can help manage the symptoms associated with the disorders. For example, antidepressants and anti-anxiety medications can be helpful.
Please reach out for help
If trauma is affecting you, please know that there are safe, effective treatments that can help you find happiness and contentment for your future. Seeking therapy can help you begin the journey toward healing.
Why online therapy?
Online therapy can be an effective and safe option for therapy. Through Regain, you can find effective, healthy paths to healing.
Therapist reviews
"He's down to earth. He understands veterans and PTSD. He's also kind and caring."
"Austa has been wonderful thus far. She has helped my partner and me during an unimaginably difficult time. She has helped us process the effects of a traumatic experience at an appropriate pace. She has also guided us in communicating effectively and setting appropriate boundaries in our relationship. I was hesitant to pursue counseling initially, but I truly believe that it is making a difference in our relationship. Austa is easy to talk to, and she is a great listener. I would wholeheartedly recommend her as a counselor."
Takeaway
C-PTSD can feel very overwhelming at times. It's important to know that you don't have to struggle through this alone, although you may feel lonely. No matter what you're experiencing, with the right tools -- you can move forward.
Frequently Asked Questions (FAQs)
What are the symptoms of complex post-traumatic stress disorder?
C-PTSD symptoms are similar to those of people diagnosed with PTSD, but symptoms of Complex PTSD include:
- Anxiety
- Depression
- Nightmares about the event
- Destructive behaviors
- Social isolation
- Difficulty controlling emotions
If you would like to learn more about diagnosis and symptoms, look at the section in this article about the Diagnostic and Statistical Manual of Mental Disorders DSM-5 guidelines for diagnosis and treatment.
Is complex PTSD serious?
Complex PTSD is more severe than PTSD.
According to the Diagnostic and Statistical Manual of Mental Disorders DSM-5, C-PTSD affects people who have experienced long-term trauma, childhood trauma, and is thought to be more severe if the person was alone during the traumatic event, if it happened early in life, if a parent or a caregiver caused the trauma, or if the person with C-PTSD is still in contact with the person who caused the trauma, as this can trigger traumatic memories.
Is complex PTSD worse than PTSD?
In general, complex PTSD is a more severe form of PTSD. Complex PTSD is a disorder that can develop due to repeated trauma or long-term trauma.
However, the two are quite similar and are actually not even listed as different disorders in the Diagnostic and Statistical Manual of Mental Disorders DSM-5.
How is complex PTSD treated?
Treatments available for people with complex PTSD include medications, psychotherapy, trauma-focused cognitive behavioral therapy, and Eye Movement Desensitization and Reprocessing (EMDR).
A therapist, counselor, or psychiatrist will follow the most recent guidelines in the Diagnostic and Statistical Manual of Mental Disorders DSM-5.
Is complex PTSD a mental illness?
Yes. Both PTSD and Complex PTSD are trauma-based mental illnesses, as defined in the Diagnostic and Statistical Manual of Mental Disorders DSM-5.
If you’d like to learn more about understanding and treating PTSD, check out the National Center for PTSD. They offer a series of services for people with complex PTSD and people with PTSD, including:
- Resources for family and friends of people with complex PTSD and people with PTSD
- Resources for treatment options near you or treatment options online
- Reliable information about mental illness with the most modern sources like the Diagnostic and Statistical Manual of Mental Disorders DSM to help you better understand your own psychology or that of a friend or family
- Read testimonials from people with complex PTSD and people with PTSD
- Understand how therapy works and how CPTSD and PTSD are treated
Is complex PTSD the same as borderline personality disorder BPD?
No. Though complex PTSD and BPD have many similar symptoms and could both be caused by traumatic events, they are not the same. People with complex PTSD can also have borderline personality disorder BPD - a personality disorder listed in the mental disorders DSM - characterized by an unstable sense of self and unstable relationships.
Do I have PTSD or C-PTSD?
It can be difficult to know if you have Post-Traumatic Stress Disorder PTSD or Complex Post-Traumatic Stress Disorder C-PTSD, especially as they are not listed as separate in the Diagnostic and Statistical Manual of Mental Disorders DSM-5.
To answer this question, consider what type of trauma you have been exposed to. PTSD usually comes about as a result of a singular traumatic event. In contrast, C-PTSD is a result of extensive, consistent trauma, sometimes over the course of years, such as sexual or physical abuse.
You may also be able to determine the difference by looking at the severity of your symptoms. For example, a PTSD flashback may be visual, like a video playing in your mind, whereas a C-PTSD flashback might mean a severe emotional response, like a panic attack or rage.
Can complex PTSD be cured?
There is no simple cure for C-PTSD. People with Post-Traumatic Stress Disorder PTSD and complex PTSD receive treatments, and the effects of C-PTSD may go away over time and with treatments.
When thinking about psychological conditions, it may be helpful to hope to ‘resolve’ your issues rather than ‘cure’ them. When you have psychological problems, like an anxiety disorder, especially trauma-based problems, there is an unresolved problem from the past that still weighs on you.
Confronting and understanding your past traumas can be a frightening, lengthy process, but it is just that: a process. Perhaps there is a day when you feel you are ‘cured,’ only to spiral back into the depths the next day. This is natural, albeit frustrating, and it takes a long time. But people with Post-Traumatic Stress Disorder PTSD and people with CPTSD can find relief from confronting, understanding, and resolving their trauma.
A therapist can help with a plethora of issues, including but not limited to:
- Any anxiety disorder
- Complex PTSD from surviving long-term trauma or various traumatic experiences (this type of trauma involves repeated exposure to one or multiple traumatic events)
- Borderline Personality Disorder BPD
- Post-Traumatic Stress Disorder PTSD from surviving a specific, traumatic event
The most important thing to remember is that there is a treatment for PTSD available. Diagnoses of PTSD are not as uncommon as you think. Many people have suffered from past trauma before, and many have received help, resolved their trauma, learned how to respond to stress healthily, and moved on to live peaceful, unburdened, happy lives. There are trained professionals who know how to treat PTSD, treat complex PTSD, and guide you along the way.
Life is not simple for anyone, but people with PTSD and CPTSD carry an especially heavy burden. That does not mean that burden is impossible. You can, and will, leave your trauma in the past if you dedicate your time and resources to getting better.
You are not your trauma. You are a whole person, and you deserve to enjoy life.
What is the difference between PTSD and C-PTSD?
CPTSD, or Complex Posttraumatic Stress Disorder, is a more severe version of PTSD, or Post-Traumatic Stress Disorder. It develops as a result of long-term trauma or multiple traumatic experiences (as opposed to PTSD, which develops after a singular traumatic event). When it comes to complex trauma, stress is commonly experienced. CPTSD can be comorbid with bipolar disorder and other mental disorders as well.
All of the symptoms of PTSD also apply to CPTSD, but some symptoms are unique to CPTSD. These include:
- Feeling helpless and hopeless
- Long-term relationship difficulties
- Trouble managing emotions
- Feeling guilty, ashamed, or worthless
- Persistent suicidal thoughts
If you or a loved one are experiencing suicidal thoughts, be sure to reach out for help immediately. The National Suicide Prevention Lifeline is available 24/7 and can be reached at 1-800-273-8255.
Is C-PTSD worse than PTSD?
Yes, CPTSD (Complex Posttraumatic Stress Disorder) is a more severe version of PTSD, and it has some similarities with bipolar disorder. The two stress disorders (PTSD and CPTSD) are very similar, but they have slightly different causes and symptoms. When someone experiences a traumatic period in their life, they can develop Complex PTSD from surviving the situation. It typically results from complex trauma such as long-term childhood mistreatment or other ongoing traumatic experiences. When a person experiences this kind of trauma, stress is very likely to result.
Those who live with CPTSD can experience all of the symptoms associated with PTSD and a few others. These include a negative self-image, trouble controlling emotions, relationship issues, and preoccupation with an abuser. It is possible to treat Complex PTSD, so don’t hesitate to get professional help if you need it. Professionals who help others with complex trauma stress that therapy can do wonders in alleviating the symptoms of CPTSD.
What are C-PTSD symptoms?
The main difference between PTSD and Complex PTSD (CPTSD) is that PTSD mainly has post-traumatic symptoms, while CPTSD has those symptoms plus a change in how one views the world. Some of the symptoms, such as mood swings, have similarities with bipolar disorder. When a person goes through this type of complex trauma, stress often results. The CPTSD symptoms include but are not limited to:
- Issues with traumatic memories
- Flashbacks or reliving the complex trauma
- Depression
- Mood swings
- Feeling guilty or ashamed
- Suicidal thoughts
- Always being on high alert
- An obsession with an abuser
- Constantly feeling afraid
If you or a loved one are experiencing suicidal thoughts, be sure to reach out to The National Suicide Prevention Lifeline for immediate help. This hotline is available 24/7 and can be reached at 1-800-273-8255.
What Causes C-PTSD?
CPTSD, or Complex Posttraumatic Stress Disorder, is caused by long-term complex trauma experienced over time, such as childhood abuse, ongoing domestic violence, or human trafficking. PTSD, on the other hand, results from a singular traumatic experience. CPTSD is a more severe version of PTSD, with post-traumatic symptoms and a drastic change in how a person views themselves and the world. It also has some similar symptoms to those experienced in bipolar disorder, such as problems controlling emotions. In the case of long-term or ongoing trauma, stress is also a common symptom.
Does complex PTSD ever go away?
Complex PTSD, which results from long-term complex trauma, is treatable through therapy and other methods. Long-term therapy has been proven to be highly effective in treating Complex PTSD. Oftentimes, the best treatment for CPTSD is immersion in a residential mental health treatment program. However, it takes time and effort to work through CPTSD, improving your quality of life by seeking professional help greatly. If you feel uncomfortable speaking to a therapist in person, you can also try online counseling services like ours here at ReGain!
Is complex PTSD serious?
Complex PTSD or CPTSD is a severe psychiatric disorder that results from prolonged or repeated complex trauma. It is a similar but more serious version of PTSD, with all of the typical posttraumatic symptoms plus a drastic change in how one view themselves and the world around them. With this type of trauma, stress often comes as a symptom too. Luckily, treating Complex PTSD is possible and proven to be effective, just as it has been for other stress disorders. Don’t hesitate to reach out and get professional help if you need it--ReGain is a great place to start!
What does C-PTSD mean?
CPTSD stands for Complex Posttraumatic Stress Disorder. This is a more severe version of PTSD that develops due to ongoing or long-term complex trauma. This complex trauma could range from childhood abuse and sex trafficking to domestic violence and other repeated traumatic experiences. Of course, for those who have survived trauma, the stress in various forms is a very common result. Along with the usual PTSD symptoms, those who live with CPTSD may experience these Complex PTSD symptoms as well:
- Trouble controlling emotions
- Viewing life as meaningless
- Distorted memories or perceptions of the trauma
- Negative self-image
- Dissociation
- Problems with maintaining relationships
If you or someone you know are experiencing suicidal thoughts, be sure to reach out to The National Suicide Prevention Lifeline for immediate help at 1-800-273-8255.
Is Complex PTSD a disability?
CPTSD can be considered a disability in some cases, but it’s necessary to provide documented evidence to receive disability benefits. Generally, your medical records must prove that you experienced trauma, have symptoms that point to PTSD, and that those symptoms prevent you from functioning at a normal level. The specific requirements to receive disability benefits for CPTSD can vary from state to state. However, so be sure to do further research on the state where you live. Overall, the trauma, stress, and other symptoms of CPTSD will not result in disability benefits unless they are documented in your medical records.
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