Complex PTSD: Symptoms, Diagnosis, And Treatment Options

Cognitive restructuring therapy, eye movement desensitization and reprocessing (EMDR), and exposure therapy may be used to treat complex post-traumatic stress disorder. Understanding the methods of diagnosis and treatment available for you may be helpful if you suspect you are living with complex post-traumatic stress disorder.

What is the difference between PTSD and C-PTSD? 

Below are several similarities and differences between PTSD and complex PTSD. Note that complex PTSD is not an official diagnosis from the DSM-5, so it cannot be diagnosed by a therapist to be used for insurance billing. However, it is a widely accepted theory (including by the World Health Organization) and proposed diagnosis for future renditions of the DSM. 

Post-traumatic stress disorder (PTSD) 

Post-traumatic stress disorder (PTSD) is a trauma and stressor-related disorder in the DSM-5 that can manifest differently for individuals. It often involves avoidant anxiety surrounding certain triggers, a sense of hypervigilance, distressing nightmares, and persistent distress. Symptoms of PTSD can only develop in those who have experienced traumatic event(s) or witnessed one over one month ago (before this period, an individual may be diagnosed with acute stress disorder).

Anyone can develop post-traumatic stress disorder, regardless of age. PTSD in teens and children is not uncommon, and it may develop in childhood. However, individuals who have gone through ongoing catastrophic experiences or repeated trauma may develop complex post-traumatic stress disorder (C-PTSD).

Complex post-traumatic stress disorder (C-PTSD)  

While post-traumatic stress disorder is often associated with a single incident, like a car accident, robbery, natural disaster, or traumatic wartime event, complex PTSD often develops after a group of intricate, complex trauma symptoms resulting from long-term traumatic situations or multiple traumas. 

Examples of ongoing trauma may include interpersonal trauma like long-term physical or sexual abuse, ongoing domestic violence, being a prisoner of war, or being a survivor of commercial sexual abuse, including human trafficking or prostitution. All of these can be risk factors for developing complex PTSD. C-PTSD is considered more severe in those who experienced traumatic events for years, at a young age, alone, or due to a caregiver like a parent.  

Complex PTSD is often characterized by severe, persistent challenges in behavior control. Those with C-PTSD may view themselves as worthless or defeated and may often experience feelings of guilt, shame, and failure concerning the traumatic events they’ve lived through. They may have poor mental health and difficulty sustaining relationships, and their symptoms may lead to impairment in various areas of functioning, such as work, school, and social settings. 

If you are experiencing sexual abuse or have experienced assault, note that the Rape, Abuse, and Incest National Network (RAINN) has a hotline dedicated to supporting individuals experiencing sexual assault, harassment, or intimate partner violence. You can contact them anytime by calling 800-656-HOPE (4673) or using the online chat. 

Complex PTSD symptoms of C-PTSD

Complex post-traumatic stress disorder may include the following core symptoms:

• Avoidance of people, objects, topics, ideas, animals, or situations that remind someone of the traumatizing event(s)
• Avoiding thoughts, memories, and feelings related to the traumatizing event(s)
• Nightmares of the traumatizing event(s)
• Distressing flashbacks of the traumatizing event
• Frightening thoughts about the traumatizing event
• Distorted or misplaced thoughts of guilt or blame
• Negative thoughts about the world or oneself, including a sense of hopelessness or worthlessness.
• Loss of interest in hobbies and activities
• Difficulty remembering specific events relating to or surrounding the period of trauma
• Arousal and reactivity
• Sleeping problems, including waking early, insomnia, and oversleeping
• Feeling stressed, on edge, or irritable
• Feeling jumpy or startled easily
• Experiencing outbursts of anger or explosive anger

The American Psychiatric Association did not list complex PTSD as a separate diagnosis from PTSD in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). However, C-PTSD has its own diagnosis in the most recent version of the World Health Organization’s International Classification ofDiseases (ICD-11).

Complex post-traumatic stress disorder can also overlap with borderline personality disorder, which often involves enduring personality change unless consistent treatment is utilized. Like complex PTSD, borderline personality disorder can be caused by long-term trauma. If you think you might be experiencing C-PTSD, consider seeking the medical advice of a healthcare professional. 

Other symptoms of complex post-traumatic stress disorder may include:

• Difficulty relating to others
• Searching for reassurance or a rescuer 
• Distrusting others
• Isolating oneself from relationships, including family or a partner 
• Avoiding close relationships altogether
• Engaging in predominantly unhealthy relationships
• Experiencing difficulty controlling emotions
• Feeling angry often 
• Persistently experiencing sadness and depression
• Experiencing suicidal thoughts and urges*
• Experiencing cognitive difficulties
• Struggling with memory (forgetting traumatic events, traumatic memories, or details surrounding them)
• Feeling disassociated or detached from emotions and their sense of self
• Reliving traumatic events persistently
• Struggling to perceive oneself correctly 
• Perceiving oneself as guilty and unworthy of help
• Experiencing negative self-perception
• Having an overwhelming sense of shame
• Perceiving oneself as helpless
• Feeling different from others
• Experiencing preoccupation with the perpetrator or perpetrators
• Experiencing preoccupation with revenge
• Attributing power to the perpetrator
• Feeling one’s belief system has been damaged 
• Lacking faith 
• Struggling to feel hopeful
• Experiencing overwhelming feelings of despair

If you are experiencing suicidal thoughts or urges, call the 988 Suicide & Crisis Lifeline at 988 or text 988 to talk to a crisis provider over SMS. They are available 24/7 to offer support. 988 also offers an online chat for those with an internet connection.

Complex PTSD symptoms in children and teens

Because children and teenagers may not have the same coping mechanisms as adults, the additional symptoms they exhibit after prolonged traumatic events, such repeated physical abuse, may differ. Childhood trauma survivors may experience the following symptoms: 

• Bedwetting after they have learned to use the toilet
• Acting out the traumatic event while playing
• Losing speech 
• Clinging to a parent or other adult
• Fearing separation 

Older children and teens often experience many of the same symptoms as adults, although they sometimes experience the following symptoms of complex post-traumatic stress disorder as well:

• Disrespectful or destructive behavior
• Misplaced guilt over not being able to prevent death or injury
• Feelings of or a preoccupation with revenge

Complex PTSD treatment

Complex PTSD treatment can be similar to PTSD treatment for many people. However, due to the nature of the traumas the person may have experienced, treatment can be longer-lasting and more intensive. Survivors of these traumatic events may need more resources to regain power and control over their thoughts and actions. 

For those with C-PTSD, treatment may focus on developing a strong, positive sense of identity. There can be several approaches for those seeking to treat PTSD or complex PTSD, including the following.

Behavioral therapy 

Standard behavioral therapies teach coping mechanisms to help individuals recognize and change maladaptive thoughts and behaviors. This type of therapy often addresses symptoms as they arise rather than ignoring them or trying to push through them. A standard behavioral therapy that may be used as a starting point for PTSD or C-PTSD is cognitive-behavioral therapy (CBT). Cognitive-behavioral therapy can help participants identify negative thoughts that may contribute to or exacerbate their symptoms. It can also help individuals with C-PTSD address symptoms of a potential comorbid condition, such as a mood disorder (e.g., major depressive disorder) or personality disorder (e.g., borderline personality disorder). However, this format may not work for those looking for a person-centered or emotionally-focused form of therapy. 

Exposure and response prevention therapy (ERP) 

Exposure therapy is a type of psychotherapy that can safely expose individuals to fears surrounding triggers. During exposure therapy, individuals may learn to face their fears, recognize their ability to cope, and exert control over their reactions and impulses. This type of therapy may reduce learned helplessness and a lack of confidence. This type of therapy for PTSD often works for people who have severe symptoms of anxiety about or closely related to their traumatic experiences. 

Eye movement desensitization and reprocessing therapy (EMDR) 

Eye movement desensitization and reprocessing therapy (EMDR) is a type of therapy that was developed to treat PTSD. It utilizes bilateral brain stimulation to engage both parts of the brain while the client talks about trauma. The therapist may use non-painful hand buzzers, lights, or finger movements in front of the client’s eyes to stimulate the brain. 

Peer-reviewed studies have found that EMDR is effective and can change the balance between the limbic area and prefrontal cortex, improving how they interact so that the client can bring forward and process the trauma without becoming re-traumatized by discussing the event. This form of therapy is often used for one traumatic event. For complex post-traumatic stress disorder, however, EMDR may be able to address long-term trauma. 

Internal family systems therapy (IFS) 

Internal family systems therapy (IFS) is a more modern form of treatment often used for C-PTSD in particular. It involves “parts work,” looking at the different parts that can form in an individual’s personality. IFS providers believe that every person has parts, but long-term trauma can further solidify these parts. Some people might have parts of themselves that are more protective, guarded, and scared and parts that are more social, trusting, and open. IFS works on helping clients accept every part of their personality openly and lovingly by returning to past events in mind and mentally “saving their past self” from what occurred. 

Mental health care for complex PTSD

Fear of rejection often accompanies a C-PTSD diagnosis and may cause some people to feel apprehensive about seeking help. However, talking with a mental health professional who can help you navigate the healing process can be crucial. 

Processing a traumatic event with an online mental health provider

Attending therapy online through a platform like BetterHelp can help you find support from home and may ease apprehension about visiting a therapist’s office. An online counseling platform can connect you with experienced, licensed therapists who practice various therapeutic models. When you sign up, you can request a specialist in C-PTSD to get started.

The efficacy of online therapy as a treatment for trauma

If you’re unsure about the effectiveness of online therapy, you can look at studies that have found online PTSD counseling as effective as in-person sessions. Internet-delivered treatment is often associated with significant improvements in symptoms and long-term results.