What to know about complex PTSD

What to know about complex PTSD

Complex post-traumatic stress disorder is intimately linked to post-traumatic stress disorder.

A handbook often used by psychiatrists and psychologists, the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) currently does not recognize “complex post-traumatic stress disorder” as a separate condition. However it will be treated by several physicians.

An individual diagnosed with the condition may experience additional symptoms to those defining a post-traumatic stress disorder (PTSD).

PTSD is an anxiety disorder that can develop after a person experiences a traumatic event.

A doctor may diagnose complex PTSD if a person has had a prolonged or repeated trauma for months or years.

We explore what complex PTSD is in this article, and describe the associated symptoms and behaviors. We are also looking at treatment options and recuperation process.

What is complex PTSD?

Complex PTSD
Complex PTSD is a type of anxiety disorder.

PTSD is typically associated with a single event, while complex PTSD is associated with a series of events, or one prolonged event.

PTSD symptoms may arise following a traumatic episode, such as a car collision, an earthquake, or sexual assault.

At some point in their lives PTSD affects 7–8 percent of Americans. Symptoms may result from changes in certain brain regions which deal with emotion, memory , and reasoning. Affected areas may include the amygdala, the hippocampus, and the prefrontal cortex.

Complex PTSD symptoms can be more severe and serious than PTSD’s.

Despite the lack of guidance from the DSM-5 some mental health professionals have started to distinguish between the two conditions.

A doctor may diagnose complex PTSD when a person has had ongoing trauma.

This trauma most often involves physical, emotional , or sexual abuse over the long term.

Some examples of trauma which can cause complex PTSD are as follows:

  • experiencing childhood neglect
  • experiencing other types of abuse early in life
  • experiencing domestic abuse
  • experiencing human trafficking
  • being a prisoner of war
  • living in a region affected by war

Is complex PTSD a separate condition?

Complex PTSD is classified as a separate disorder by the International Classification of Diseases ( ICD), although the DSM-5 currently does not.

Complex PTSD is a relatively recent concept. Instead, healthcare professionals can diagnose another condition, because of its variable nature. They may particularly diagnose borderline personality disorder ( BPD).

Some researchers have identified areas of substantial overlap between complex PTSD and BPD.

However, the conditions may also have differences. Authors of a 2014 study found that people with complex PTSD, for example, had reliably negative self-conceptions, whereas those with BPD had unstable and changing self-conceptions.

People with complex PTSD may experience relationship problems. They tend to avoid others and may feel a lack of connection.

BPD can cause a person to swing between idealizing and undervaluing others, leading to difficulties in the relationship.

A person with BPD can also experience complex PTSD, and the combination can give rise to more symptoms.


Difficulty sleeping can be a symptom of complex PTSD.
Difficulty sleeping can be a symptom of complex PTSD.

In addition to those that describe PTSD a person with complex PTSD can experience symptoms.

Specific PTSD and complex PTSD symptoms may include:

  • reliving the trauma through flashbacks and nightmares
  • avoiding situations that remind them of the trauma
  • dizziness or nausea when remembering the trauma
  • hyperarousal, which means being in a continual state of high alert
  • the belief that the world is a dangerous place
  • a loss of trust in the self or others
  • difficulty sleeping or concentrating
  • being startled by loud noises

People with PTSD or complex PTSD may also experience:

  • A negative self-view. Complex PTSD can cause a person to view themselves negatively and feel helpless, guilty, or ashamed. They often consider themselves to be different from other people.
  • Changes in beliefs and worldview. People with either condition may hold a negative view of the world and the people in it or lose faith in previously held beliefs.
  • Emotional regulation difficulties. These conditions can cause people to lose control over their emotions. They may experience intense anger or sadness or have thoughts of suicide.
  • Relationship issues. Relationships may suffer due to difficulties trusting and interacting, and because of a negative self-view. A person with either condition may develop unhealthy relationships because they are what the person has known in the past.
  • Detachment from the trauma. A person may dissociate, which means feeling detached from emotions or physical sensations. Some people completely forget the trauma.
  • Preoccupation with an abuser. It is not uncommon to fixate on the abuser, the relationship with the abuser, or getting revenge for the abuse.

Complex PTSD symptoms may vary, and can change over time.

People with the condition may also have symptoms that aren’t mentioned above.


People with PTSD or complex PTSD may attempt to manage their symptoms by exhibiting certain behaviours. Examples of these behaviors include:

  • abusing alcohol or drugs
  • avoiding unpleasant situations by becoming “people-pleasers”
  • lashing out at minor criticisms
  • self-harm

Such behaviors can develop as a way to cope with trauma and emotional pain or to forget it. Often, during the period of trauma a person develops them.

Once the trauma is no longer going on, a person may start healing and decrease their reliance on these behaviours. Or, with the passage of time the behaviors will persist and even worsen.

Friends and family of people with complicated PTSD should be aware that these types of behaviors can reflect coping strategies and attempts to recover some emotional control.

A person can seek treatment to recover from PTSD or complex PTSD, and learn to replace these behaviors with more positive and constructive ones.


Effective treatments for complex PTSD include psychotherapy, eye movement desensitisation and reprocessing (EMDR), and medicines.


Individual or group therapy may help treat complex PTSD.
Individual or group therapy may help treat complex PTSD.

Psychotherapy may take place on a one-to-one basis or in a group setting.

Initially, therapy will focus on stabilizing the person so that they can:

  • address their feelings, including distrust and negative worldviews
  • improve their connections with others
  • deal adaptively with flashbacks and anxiety

Several forms of trauma-focused treatment can be used by the therapist include cognitive behavioural therapy ( CBT) or dialectical behavioural therapy (DBT).

CBT aims to replace negative patterns of thought with more positive ones.

DBT helps people cope with stress, desires for self-harm and suicidal thoughts and behaviours.


EMDR is a technique that can support people suffering from PTSD or complex PTSD.

The therapist would then ask the person to remember the traumatic memory after preparation and practice. The therapist will move one finger from side to side, and the person with their eyes will follow the movement.

This process, when effective, helps desensitize the person to the trauma so that they can eventually remember the memory without having a strong adverse reaction to it.

EMDR is controversial because the precise mechanism through which it operates is unclear.

However under certain conditions, several guidelines, including those from the American Psychological Association, recommend EMDR as a treatment for PTSD.

They caution that further research will be required to confirm EMDR ‘s effectiveness for trauma.


Some depression medications may reduce complex PTSD symptoms. In combination with psychotherapy, these medicines can be particularly effective.

A person can take the medication for the short or long term, depending on the severity of the symptoms and the therapy ‘s effectiveness.

For complex PTSD a doctor may prescribe one of the following antidepressants:

  • fluoxetine (Prozac)
  • paroxetine (Paxil)
  • sertraline (Zoloft)

Living with complex PTSD

Having complex PTSD can be frightening. It can cause alienating and isolating feelings.

People with complex PTSD should be able to receive help from organizations that recognize the disorder.

Examples might include:

It may also aid in attending a support group, in person or online, to communicate with those who are having similar experiences.

Complex PTSD can cause people to lose confidence in others and it is essential that people try to engage in day-to-day work. This can be a crucial step for people working to lead healthy , balanced lives.

These activities may include:

  • exercising regularly
  • finding a job
  • making new friends
  • socializing with old friends, if these relationships were healthy
  • taking up a hobby

One therapeutic aim is to seek to build or recapture feelings of trust in others and the world.

This will take time but it is a good step to engage in healthy relationships with family and friends.

Recovery and outlook

It takes time to recuperate from complex PTSD.

The condition poses lifelong challenges for some people. However, people can manage their symptoms and enjoy a good quality of life with changes in therapy , medication, and lifestyle.