Mental Health Trauma & Stressor-Related Disorders C-PTSD: Symptoms, Causes, Treatment, and Coping By Brandi Jones, MSN-ED RN-BC Brandi Jones, MSN-ED RN-BC Brandi Jones MSN-Ed, RN-BC is a board-certified registered nurse who owns Brandi Jones LLC, where she writes health and wellness blogs, articles, and education. She lives with her husband and springer spaniel and enjoys camping and tapping into her creativity in her downtime. Learn about our editorial process Published on January 18, 2022 Medically reviewed Verywell Health articles are reviewed by board-certified physicians and healthcare professionals. These medical reviewers confirm the content is thorough and accurate, reflecting the latest evidence-based research. Content is reviewed before publication and upon substantial updates. Learn more. by Steven Gans, MD Medically reviewed by Steven Gans, MD Steven Gans, MD, is board-certified in psychiatry and is an active supervisor, teacher, and mentor at Massachusetts General Hospital. Learn about our Medical Expert Board Print Table of Contents View All Table of Contents PTSD vs Complex PTSD Symptoms Diagnosis Causes Treatment Coping Frequently Asked Questions Complex post-traumatic stress disorder (C-PTSD) is a response to a long-lasting, repeated trauma. While this type of trauma may occur as an adult, it is most often seen in childhood and adolescence. Symptoms are similar to post-traumatic stress disorder (PTSD) with an additional cluster of symptoms. C-PTSD treatment is long-term and may include psychotherapy (talk therapy), eye movement desensitization and reprocessing (EMDR), and medications. A strong support system, journaling, and mindfulness are helpful coping mechanisms when a person is healing from C-PTSD. What Is PTSD? SDI Productions / Getty Images PTSD vs Complex PTSD Feeling stressed after a traumatic situation is common. You might feel anxious, have an increased heart rate, experience bad dreams, or get shaky. This is called post-traumatic stress or PTS. PTS can be very intense, however, the symptoms usually go away within a month. Post-traumatic stress disorder (PTSD) is a clinically-diagnosed condition caused by traumatic events such as combat, natural disasters, violence, abuse, and more. Symptoms linger for a longer period of time than PTS. The Many Names of PTSD Over the years, PTSD has gained recognition due to its effect on war veterans. It was also called “shell shock” or “combat fatigue.” Complex PTSD (C-PTSD) is a response to a long-lasting, repeated trauma that lasts for months or years. C-PTSD is most often seen in those who experienced trauma earlier in life and is especially complex when someone was hurt by a caregiver or is still in contact with the abuser. Signs of Repressed Childhood Trauma in Adulthood Symptoms Symptoms of PTSD Symptoms of PTSD are intense and persistent. They last long after the trauma has ended, usually more than one month, and include: Reliving trauma: This includes unwelcome memories, nightmares, or vivid flashbacks. Avoiding triggering situations: PTSD can cause a person to avoid places, people, or activities that remind them of the trauma. Changes in beliefs and feelings: A person may develop a negative view of the world, find it difficult to experience positive emotions, or do something enjoyable.Hyperarousal: Hyperarousal is when someone is constantly “on edge,” feels unsafe, and is easily startled. It can lead to reckless or self-destructive behaviors. Somatic symptoms: Those with PTSD may develop unexplained physical symptoms such as pain, fatigue, high heart rate, dizziness, tinnitus (ringing in the ear), blurred vision, and more. PTSD Statistics More than 8 million Americans, ages 18 and older, have been diagnosed with PTSD. What Is PTSD? Symptoms of C-PTSD C-PTSD involves the symptoms of PTSD along with the following: Emotional dysregulation: Finding it difficult to control emotions such as anger, depression, and suicidal thoughts. This might result in self-harm or risky behaviors such as substance abuse and unprotected sex (also referred to as "condomless sex"). Changes in consciousness: A person may have periods of amnesia (forgetting) or dissociation, making them feel detached from themselves or their surroundings. Negative self-perception: C-PTSD can cause a person to experience a negative self-image, shame, guilt, or self-loathing. They often express feeling inadequate or different from others. Difficulty with relationships: Some people may struggle with isolation and distrust. They might also develop an unhealthy relationship or stay in an abusive relationship for too long. Distorted perception of an abuser: This may result in an unhealthy preoccupation with the abuser. It may also include a preoccupation with revenge. Loss of systems of meaning: Losing core values, religion, beliefs, or faith can cause a sense of hopelessness and despair. Behavior Associated With C-PTSD Substance abuse: Research suggests a strong correlation between substance use disorder and trauma. One of the most common theories is that drugs and alcohol are used to numb emotional pain. Self-harm: Self-harm may also be called self-injury or self-mutilation and means hurting yourself on purpose due to emotional distress. Avoidance: Emotional avoidance means creating distance with unpleasant emotions. Behavioral avoidance is staying away from people, situations, and senses that are reminders of the traumatic event. While this is natural in the short term, extreme avoidance can make it difficult to cope with other areas of life. Inability to accept criticism: For those with C-PTSD, criticism can cause severe stress because they are already self-critical or feel shame. They may have also had an abuser who manipulated them with criticism to get an emotional reaction. Diagnosing Complex Trauma C-PTSD is not yet a diagnosis in Diagnostic and Statistical Manual of Mental Disorders (DSM-5) or recognized by the American Psychiatric Association (APA). However, the World Health Organization (WHO) describes C-PTSD in the ICD-11. While there is not a formal test to distinguish between the two, C-PTSD includes three additional clusters of symptoms as mentioned above, including: Emotional dysregulationNegative self-conceptInterpersonal difficulties Causes of C-PTSD Those with C-PTSD suffer long-term and repetitive trauma and are often hurt by a caregiver. Most survivors were unable to leave the situation and felt trapped or controlled. C-PTSD risk factors involve chronic exposure to trauma, especially during childhood and adolescence when brain development is most vulnerable. Some examples of trauma include: Emotional, physical, or sexual abuse Sex trafficking and exploitation Neglect Abandonment Being a child soldier Slavery Torture Genocide Prisoner of war (POW) How Does Intergenerational Trauma Work? Complex Trauma Treatment C-PTSD is treated similarly to PTSD. However, treatment is usually longer. It may include one or a combination of the following: Psychotherapy: Psychotherapy, or talk therapy, should be conducted by a trained therapist. It’s best to find one with experience in treating trauma. The goal is to identify harmful thoughts and behaviors, decrease symptoms, and develop coping techniques for better functioning in daily life. Eye movement desensitization and reprocessing (EMDR): EMDR combines psychotherapy with the use of eye movements. Treatment begins with the therapist building trust and teaching eye movement techniques. EMDR helps the trauma survivor briefly focus on a memory and process it until it is no longer distressing. Medication: Healthcare providers often prescribe medications to treat PTSD and C-PTSD. These may include antidepressants such as Zoloft (sertraline), Paxil (paroxetine), Prozac (fluoxetine), and Effexor (venlafaxine), as well as other agents. Food and Drug Administration (FDA) Off-Label Medications Zoloft and Paxil are FDA-approved for PTSD. Prozac and Effexor are considered “off-label.” This means they may be commonly prescribed for the condition, but don't carry the formal FDA indication for their use. How Trauma Therapy Works Coping With C-PTSD Recovery from C-PTSD is a long process. It’s important to be easy on yourself or your loved one with C-PTSD. The following are coping mechanisms that are helpful when used along with treatment: Find support: C-PTSD may cause you to shy away from being social. However, it is important to have a strong support system so you can reach out to those you trust. This might include friends, family, support groups, church, or other groups. Practice mindfulness: Mindfulness means being self-aware, intentionally shifting attention to the present, and restructuring thought patterns. Mindfulness techniques don’t have to be elaborate. One can incorporate them into walking, eating, breathing, meditation, music, and hobbies. Journaling: The brain can have a hard time processing difficult events. Journaling provides a place to write down private feelings and reflections. Putting thoughts on paper helps you express and begin to let go of emotions. Summary Complex PTSD, also referred to as C-PTSD, can result from chronic trauma that usually happens during childhood and adolescence. While it is similar to post-traumatic stress disorder (PTSD), it comes with an additional cluster of symptoms. C-PTSD treatment includes psychotherapy (talk therapy), eye movement desensitization and reprocessing (EMDR), medications, and the development of new coping mechanisms. A Word From Verywell Difficult emotions and thoughts stemming from complex trauma can lead to isolation and loneliness. Daily life and relationships can become strenuous because you use all of your energy coping. It’s good to seek immediate treatment with a licensed therapist to help you work through your feelings, form better relationships, and enjoy a fulfilling life. Helpline If you or a loved one are struggling with C-PTSD or PTSD, contact the Substance Abuse and Mental Health Services Administration (SAMHSA) National Helpline at 1-800-662-4357 for information on support and treatment facilities in your area. For more mental health resources, see our National Helpline Database. Frequently Asked Questions How is complex trauma treated? Complex trauma is treated through a combination of psychotherapy (talk therapy), eye movement desensitization and reprocessing (EMDR), medications, and the development of strong coping mechanisms. Does complex trauma go away? The impact of complex trauma may not completely go away, but with treatment, the symptoms of complex trauma can drastically decrease, helping the person with daily functions and giving them a high quality of life. What is the integrative treatment of complex trauma? Integrative treatment is an evidence-based, multimodal approach to treating C-PTSD in adolescents. What is the best psychotherapy for complex trauma? Certain types of cognitive behavioral therapy (CBT) have been shown to be effective for PTSD. Eye movement desensitization and reprocessing (EMDR) is also helpful in processing trauma-related emotions. Learn More: What Is Cognitive Behavioral Therapy? Is complex trauma the same as PTSD? They are similar, but complex trauma (C-PTSD) stems from repeated, chronic, long-term exposure to trauma, usually from childhood. PTSD can occur after short-term trauma. Was this page helpful? Thanks for your feedback! Sign up for our Health Tip of the Day newsletter, and receive daily tips that will help you live your healthiest life. Sign Up You're in! Thank you, {{form.email}}, for signing up. There was an error. Please try again. What are your concerns? Other Inaccurate Hard to Understand Submit 11 Sources Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy. Cloitre M, Garvert DW, Brewin CR, Bryant RA, Maercker A. Evidence for proposed ICD-11 PTSD and complex PTSD: a latent profile analysis. Eur J Psychotraumatol. 2013;4. doi:10.3402/ejpt.v4i0.20706 Anxiety and Depression Association of America. Post-traumatic stress disorder. National Center for PTSD. U.S. Department of Veterans Affairs. PTSD and DSM-5: DSM-5 criteria for PTSD. Gupta MA. Review of somatic symptoms in post-traumatic stress disorder. Int Rev Psychiatry. 2013;25(1):86-99. doi:10.3109/09540261.2012.736367. Flanagan JC, Korte KJ, Killeen TK, Back SE. Concurrent treatment of substance use and PTSD. Curr Psychiatry Rep. 2016;18(8):70. doi:10.1007/s11920-016-0709-y United States Department of Veterans Affairs. PTSD: National Center for PTSD. Anxiety and Depression Association of America. Criticism: depression and anxiety. Rosenfield PJ, Stratyner A, Tufekcioglu S, Karabell S, McKelvey J, Litt L. Complex PTSD in ICD-11: a case report on a new diagnosis. J Psychiatr Pract. 2018;24(5):364-370. doi:10.1097/PRA.0000000000000327 American Psychological Association Clinical Practice Guideline for the Treatment of Posttraumatic Stress Disorder. Cognitive behavioral therapy (CBT). Boyd JE, Lanius RA, McKinnon MC. Mindfulness-based treatments for posttraumatic stress disorder: a review of the treatment literature and neurobiological evidence. J Psychiatry Neurosci. 2018;43(1):7-25. doi:10.1503/jpn.170021 U.S. Department of Veterans Affairs. Whole health library: therapeutic journaling. Additional Reading Brainline: All About the Brain Injury and PTSD. What are the differences between PTS and PTSD? Clinical Practice Guideline for the Treatment of Posttraumatic Stress Disorder. Medications for PTSD. Ford JD. Complex PTSD: research directions for nosology/assessment, treatment, and public health. Eur J Psychotraumatol. 2015;6:27584. doi:10.3402/ejpt.v6.27584 Giourou E, Skokou M, Andrew SP, Alexopoulou K, Gourzis P, Jelastopulu E. Complex posttraumatic stress disorder: The need to consolidate a distinct clinical syndrome or to reevaluate features of psychiatric disorders following interpersonal trauma?. World J Psychiatry. 2018;8(1):12-19. doi:10.5498/wjp.v8.i1.12