Complex Post-Traumatic Stress Disorder (CPTSD): How It Can Effect Your Life

By Darby Faubion|Updated May 6, 2022
CheckedMedically Reviewed By Amy Brown, MSW, LCSW, RPT-S

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.

Is Living With PTSD Becoming Overwhelming?
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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 confidential 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. A person who experiences trauma may lose their sense of security, feel helpless, and experience mental health concerns and relationship challenges.

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?

According to the Diagnostic and Statistical Manual of Mental Disorders DSM-5, several examples of trauma may result in a complex post-traumatic stress disorder diagnosis.

Some 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 or self-harming 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

Psychiatric and mental health experts from around the world use a manual called the 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.

Criteria For PTSD and C-PTSD May Include:

  1. 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.)
  1. 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.
  1. 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.
  1. 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 world view.
  • 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.
  1. Symptoms That Last For A Month Or Longer
  • Symptoms may last for more than one month to be diagnosed as C-PTSD.
  1. Decrease In Functionality
  • To be diagnosed as part of PTSD, symptoms typically impact functionality and quality of life.
  1. 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 themself.
  1. 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.

PTSD can lead to:

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 Or Self-Harming 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 emotional dysregulation, which can include emotional responses that are poorly regulated 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:

  1. 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.
  2. 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.
  3. 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.

Is Living With PTSD Becoming Overwhelming?

Why Online Therapy?

Online therapy can be an effective and safe option for therapy. It can also offer an affordable, accessible, convenient way to connect with an experienced licensed mental health professional who is a good fit for you, your needs, and your goals.

You can connect with a therapist online through ReGain from the comfort and privacy of your own home or wherever you have an internet connection.

Through ReGain, you can find effective, healthy paths to healing.

Counselor 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."

Conclusion

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. Learning effective ways to cope with the past trauma is one of the first steps to building a happier, more secure future. No matter what you're experiencing, with the right tools -- you can move forward.

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