Post-traumatic stress disorder (PTSD) is a psychiatric condition caused by a traumatic event or experience. Usually, people with this condition are either diagnosed with acute or chronic PTSD. But some are more specific, such as relationship PTSD. Complex post-traumatic stress disorder (C-PTSD) is a type of PTSD caused by repeated trauma.
Complex PTSD symptoms can affect your emotions, relationships, and sense of self long after a traumatic experience has ended. While PTSD and C-PTSD share many symptoms, these conditions differ in several ways. As you continue reading, you'll find the answers to questions like what complex PTSD is and learn more about its causes.
What is Complex PTSD?
Complex PTSD is a response to prolonged trauma or traumatic events. The term was first introduced by Julia Lewis Herman, a researcher and psychiatrist, in her 1992 book Trauma and Recovery. Although this type of traumatization often occurs during childhood, it can also happen in adulthood.
How complex PTSD differs from PTSD
What causes complex PTSD, and what makes it different from PTSD?
"Although both PTSD and C-PTSD result from traumatic events, the main difference is that C-PTSD is caused by long-lasting trauma that's been experienced for months or years. C-PTSD is more severe and can cause more suffering and harm, making it more challenging for the individual to heal."
- Talkspace Therapist, Cynthia V. Catchings, LCSW-S
People with complex PTSD experience PTSD symptoms butt also struggle with other symptoms that aren't associated with PTSD. It's common for people with complex PTSD also to have attachment trauma, making it difficult for them to form deep, meaningful relationships with others. Since complex post-traumatic stress disorder results from ongoing, long-term trauma, it's typically more severe than PTSD.
Core Symptoms of Complex PTSD
It's easier to answer questions like, what is complex PTSD when you look at its symptoms. People with complex PTSD show core symptoms of PTSD, but they can display additional signs as well.
Cognitive symptoms
According to research in the Journal of Traumatic Stress, complex PTSD symptoms can affect the way you think about yourself and your experiences. Common cognitive symptoms include:
- Negative self-image
- Low self-esteem
- Feelings of guilt and shame
- Feeling worthless or flawed
- Negative beliefs about yourself
Emotional symptoms
Many people with complex PTSD experience intense emotions that can feel difficult to manage. Emotional symptoms may include:
- Emotional regulation issues
- Sudden, intense outbursts of sadness
- Sudden, intense outbursts of anger
- Feelings of emptiness
- Feeling numb or disconnected from others
- Hopelessness or lack of motivation
Behavioral symptoms
Complex PTSD can affect how you interact with others and respond to everyday situations. Behavioral symptoms may include:
- Relationship difficulties
- Difficulty trusting others
- Feeling unsafe around other people
- Isolating yourself from others
- Avoiding reminders of traumatic experiences
Physical symptoms
According to research in the Journal of Psychosomatic Research, many people with complex PTSD experience somatization, when someone has physical symptoms in response to mental distress. Physical symptoms may include:
- Dizziness
- Headaches
- Chest pains
- Fatigue
- Other stress-related physical symptoms
Causes of complex PTSD
Any form of trauma can be damaging, but do we fully understand what actually causes complex PTSD? We know that complex PTSD is caused by prolonged trauma and typically develops in situations where the victim can't escape or has very little control over what's happening to them. Events that could lead to complex PTSD include:
Childhood abuse and neglect
Children depend on their caregivers, but children who grow up abused, neglected, or mistreated don't have a sense of safety or stability. It can be difficult for them to understand what's happening to them or do anything to stop it. A study in the Medico-Legal Journal shows that childhood trauma can also significantly affect brain development.
Domestic violence
Physical or sexual violence from an intimate partner can contribute to someone developing C PTSD symptoms. Many adults in abusive relationships don't have the resources to leave or fear that leaving their partner will cause the domestic violence to escalate. One study in the European Journal of Psychotraumatology found that C-PTSD was twice as common as PTSD in survivors of intimate partner violence.
Human trafficking
Human trafficking involves fraud, coercion, or force to transport and trap people. Victims of human trafficking can be forced into involuntary servitude or commercial sex work. A report in The European Journal of Psychiatry indicates that approximately 41% of human trafficking survivors develop complex PTSD.
Severe bullying
Bullying occurs when someone intentionally and repeatedly causes discomfort, physical or emotional harm to another person. While bullying can happen anywhere, it often occurs in schools or the workplace, making victims feel like there's no way to escape their bullying. Long-term, severe bullying can cause C-PTSD.
"C-PTSD can be caused by long-term repeated trauma and is typically a result of negative childhood experiences. These may include abuse, neglect, abandonment, family violence or human trafficking."
- Talkspace Therapist, Cynthia V. Catchings, LCSW-S
How to Diagnose Complex PTSD
The term "complex post-traumatic stress disorder" has been used for decades. Yet, it's still not currently recognized as a diagnosis by the American Psychiatric Association (APA) or in the DSM-5. However, it does appear in the current version of the International Classification of Diseases (ICD-11).
According to the ICD-11, people can be diagnosed with complex PTSD when they meet the diagnostic criteria for PTSD and show disturbances in self-organization (DSO). Emotional regulation issues, negative self-image, and difficulties in interpersonal relationships are all examples of DSO. A mental health provider can evaluate your symptoms, trauma history, and overall functioning to determine whether complex PTSD may be contributing to your experiences.
Complex PTSD Treatment
When exploring complex PTSD, it's important to look at how it's typically treated. Since complex PTSD symptoms can be so severe, experts often recommend multiple interventions, as per research in the European Journal of Psychotraumatology. Treatment for complex PTSD may include:
Medications
Antidepressants can affect emotional processing and potentially reduce the severity of symptoms associated with C-PTSD. In cases where C-PTSD co-occurs with another mental health condition, some types of medication can be used to manage the symptoms of both conditions.'
Trauma Therapy
Therapy for PTSD can help people with C-PTSD work through their long-term trauma and build a strong sense of self. Cognitive behavioral therapy, or CBT for PTSD can make people find and change negative thought patterns related to their trauma. Forming a bond with a therapist can also help people with C-PTSD learn to trust others.
"Talking to a mental health professional can help you understand your emotions and learn to work with your thoughts and feelings. C-PTSD is complex, but with the right help and tools, you can overcome the negative feelings and reduce the symptoms to live a happier life."
- Talkspace Therapist, Cynthia V. Catchings, LCSW-S
Coping tips
C-PTSD often requires long-term treatment, which is why finding ways to manage your symptoms can be so necessary. For example, grounding techniques for PTSD can help you regain calm and feel connected with the world. Mindfulness can also make you more aware of your feelings so that you can focus on the present. In addition to these coping strategies, you should work to build a support system. It can be hard to connect with others when you have C-PTSD, but a social network can provide invaluable support.
How Talkspace Can Support Recovery From Complex PTSD
While most people are familiar with PTSD, many are unaware of complex PTSD. Living with complex PTSD symptoms make it difficult to feel safe, connected, or in control of your emotions, and healing involves learning new ways to cope with the lasting effects of trauma.
Talkspace connects you with licensed therapists experienced in helping people process traumatic experiences and better understand emotional responses. Through online therapy, you can access PTSD treatment options from wherever you feel most comfortable and rebuild your sense of self. Access professional support from a Talkspace therapist and begin your journey to emotional well-being.
Frequently Asked Questions (FAQs)
What are the early signs of complex PTSD?
Early complex PTSD symptoms can include emotional regulation difficulties, feelings of shame, negative self-image, and relationship challenges. Some people also experience emotional numbness or physical symptoms such as headaches and dizziness.
How do complex PTSD symptoms differ from PTSD?
Complex PTSD symptoms include all core PTSD features plus additional challenges with self-concept, emotional regulation, and relationships. While PTSD stems from a single traumatic event, complex post-traumatic stress disorder develops from ongoing trauma. People with complex PTSD often struggle more with trust and interpersonal connections.
Can bullying cause complex PTSD symptoms?
Yes, PTSD from bullying can develop when someone experiences severe, prolonged bullying that they can't escape. This is especially true for workplace or school bullying, where victims feel trapped. Long-term bullying creates the repeated trauma exposure that leads to complex PTSD symptoms rather than standard PTSD.
Are physical health problems linked to complex PTSD symptoms?
Yes, many people with complex PTSD experience somatization, where mental distress manifests as physical symptoms. Common physical complex PTSD symptoms include chronic headaches, dizziness, chest pain, gastrointestinal issues, and muscle tension. These symptoms are real responses to psychological trauma requiring professional attention.
When should you seek help for complex PTSD symptoms?
You should consider seeking help if symptoms such as emotional distress, flashbacks, difficulty trusting others, relationship challenges, or persistent feelings of shame or anxiety are interfering with your daily life. A mental health professional can help you understand your symptoms, develop coping strategies, and work toward healing and recovery.
