C-PTSD: Symptoms, Causes, Treatment, and Coping

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 to Know About C-PTSD: A person looking upset sits on a couch across from a therapist in a chair

Verywell / Tara Anand

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. 

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.

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 dysregulation
  • Negative self-concept
  • Interpersonal 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)

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.

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.

  • 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.

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.
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Additional Reading

By Brandi Jones, MSN-ED RN-BC
Brandi is a nurse and the owner of Brandi Jones LLC. She specializes in health and wellness writing including blogs, articles, and education.