Complex post-traumatic stress disorder (CPTSD) is closely related to post-traumatic stress disorder (PTSD). However, it usually involves more severe symptoms because it develops from experiencing repeated trauma over months or years.

PTSD is a mental health condition that results from a sudden and short-term traumatic event, such as a natural disaster, assault, or car accident.

When a traumatic event is prolonged or persistent, like repeated abuse or torture, or the initial PTSD symptoms go unresolved for a long time and there are more traumatic instances, more severe symptoms may develop.

This is clinically known as complex post-traumatic stress disorder (CPTSD), and it has its own diagnostic criteria.

The symptoms of CPTSD typically involve severe PTSD symptoms and a few more that may not be common in PTSD.

Symptoms of PTSD

If you have complex PTSD, you may experience a combination of PTSD symptoms, including:

  • Reliving the traumatic experience: Nightmares, flashbacks, and other intrusive memories are common. These are usually persistent and vivid images and memories from the traumatic event that make you feel as if you’re reliving the past in the present.
  • Avoiding people and situations: Avoidance is common in PTSD. You may avoid specific situations, people, or activities that remind you of the traumatic event. Avoidance may also involve keeping yourself preoccupied to avoid thinking about the event.
  • Changing old beliefs and feelings about yourself and others: You may see the world in a different light, not be able to trust others, or believe you’re no longer safe, for example.
  • Being on alert: Hyperarousal refers to constantly being on alert or jittery. For example, you may have a hard time sleeping or concentrating. You could also be unusually startled by loud or unexpected noises.
  • Experiencing somatic symptoms: These refer to physical symptoms that don’t have a clear physical cause. For example, when something reminds you of the traumatic event, you may feel dizzy or nauseated. You could also have persistent headaches, feel fatigued, or have aches and pains.

Other possible symptoms include:

Symptoms of CPTSD

As PTSD goes untreated or you are exposed to new or persistent traumatic circumstances, complex PTSD may develop over time.

These are the main symptoms of CPTSD that differentiate it from PTSD:

  • Challenges in emotional regulation: Difficulty managing emotions and feelings, such as explosive anger or ongoing sadness, may become increasingly persistent with CPTSD. You may have intense emotional reactions and have difficulty calming yourself, or you may not have or express emotional responses to situations that merit them.
  • Changes in consciousness and self-awareness: Forgetting details of the traumatic event or feeling detached from your emotions or body (dissociation) is common in CPTSD. Even if you remember the event itself, it may feel as if it happened to someone else or was just a dream.
  • Negative self-perception and changes in identity: Feelings of guilt, shame, or worthlessness may become recurrent. Your self-esteem may gradually decrease, or you may fall into distressing and self-blaming patterns of thought, such as “What if I hadn’t gone that day?”
  • New challenges in relationships: CPTSD may lead to feelings of mistrust or awkwardness in relationships. You may start withdrawing from others, or depending on the traumatic event, you may engage in relationships that may hurt you or cause distress.
  • Loss of systems of meanings: “Systems of meaning” refer to your spiritual or philosophical beliefs about the world. For example, you may feel conflicted about your faith, humanity, or the meaning of life. You may also develop a strong sense of despair or hopelessness about the world.

Symptoms of PTSD and CPTSD may vary in frequency and intensity between people and even vary from time to time in the same person.

The main cause of CPTSD is prolonged and repetitive trauma. However, experts are still trying to establish the connection between these adverse experiences and the psychological and physiological manifestations of CPTSD.

Examples of long-term trauma that could lead to CPTSD include:

  • ongoing physical, emotional, or sexual abuse
  • being a prisoner of war
  • kidnapping
  • living in an area of war for long periods of time
  • ongoing childhood neglect

While anyone can have CPTSD, some people may be more likely to develop it than others. Aside from exposure to persistent and intense traumatic experiences, risk factors may include:

  • one or more mental health conditions, such as anxiety or depression, or a family history of it
  • hormone and neurochemical dysregulation, especially those produced during a response to stress
  • lifestyle factors, such as not having a strong support system

CPTSD is still a relatively new diagnosis. In some instances, doctors may misdiagnose it as PTSD. There’s no specific test for determining whether you have CPTSD, but keeping a detailed log of your symptoms may help a doctor make a more accurate diagnosis.

A healthcare professional may start the diagnostic process by asking about your concerns and challenges. They may also ask about your past experiences and invite you to share any particular painful situations you’re comfortable talking about. They may also ask about your family history of mental health conditions or other risk factors.

If they determine you’ve experienced symptoms of post-traumatic stress for at least 1 month, the healthcare professional will likely start with a diagnosis of PTSD.

Depending on the type of traumatic event you’ve faced and whether you have additional symptoms, such as ongoing relationship problems or changes in identity, the healthcare professional may diagnose CPTSD.

Several treatment options are available for CPTSD. A healthcare professional may recommend a combination of approaches depending on your needs.

Psychotherapy

Psychotherapy involves talking with a therapist, either alone or in a group. There are many types of psychotherapy, but cognitive behavioral therapy (CBT) is a common option for PTSD. It can help you identify and reassess negative thought patterns.

Dialectical behavioral therapy (DBT), a type of CBT, may also help you develop coping skills and healthy ways to respond to stress and build stronger relationships with others.

Eye movement desensitization and reprocessing (EMDR)

EMDR is commonly used to treat PTSD, and it can be helpful for CPTSD as well.

In an EMDR session, a healthcare professional will ask you to briefly think about a traumatic moment while moving your eyes from side to side. Other techniques include having someone tap on your hands instead of moving your eyes. Over time, this process may help desensitize you to traumatic memories and thoughts.

While there’s some debate within the medical community over its use, the American Psychological Association (APA) conditionally recommends EMDR for PTSD. More research is needed to determine how effective and safe this therapy is for CPTSD.

Medication

Medications for depression can help with some symptoms of CPTSD. A doctor may want to use them with other treatments, such as CBT.

Common antidepressants used for CPTSD may include:

If you feel like you need additional support, the National Center for PTSD, part of the Department of Veteran Affairs, offers several resources, including a PTSD coaching app for your phone.

While many of these resources are geared toward people with PTSD, you may still find them helpful for many of your symptoms.

The nonprofit organization Out of the Storm also has many online resources, including a forum, information sheets, and book recommendations, specifically for CPTSD.

Suggested reads

  • “The Body Keeps the Score” is considered a must-read for anyone recovering from trauma.
  • “The Complex PTSD Workbook” contains exercises and examples designed to empower you to take control of your physical and mental health.
  • “Complex PTSD: From Surviving to Thriving” is a great resource for breaking down complex psychological concepts related to trauma. Plus, the author is a licensed psychotherapist who happens to have CPTSD.

CPTSD is a formal mental health condition that results from prolonged exposure to one or more traumatic events. It responds well to treatment but may take some time to manage.

Support is available and relief is possible. If you have experienced traumatic experiences, a mental health professional can help with managing strategies to improve how you feel and interact with the world.