Table of ContentsView AllTable of ContentsDefinitionSymptomsDiagnosisCausesTreatmentCopingPrognosisNext in PTSD GuideWhat Is Post-Traumatic Stress Disorder (PTSD)?
Table of ContentsView All
View All
Table of Contents
Definition
Symptoms
Diagnosis
Causes
Treatment
Coping
Prognosis
Next in PTSD Guide
Complex post-traumatic stress disorder (C-PTSD)is a condition similar topost-traumatic stress disorder (PTSD)but with additional features that make it more complicated to treat. This includes having problems with self-image, managing your emotions, and trusting others.
The treatment of C-PTSD is more or less the same as PTSD, although the journey tends to take longer. The diagnosis can also be challenging given that C-PTSD shares many of the same symptoms asborderline personality disorder (BPD), requiring an experienced mental health professional to differentiate the two.
This article takes a look at the symptoms, causes, diagnosis, and treatment of complex post-traumatic stress syndrome and the long-term outlook for this complicatedanxiety disorder.
Verywell / Tara Anand
What Is Complex PTSD?
Because of the extreme nature of the trauma, C-PTSD has three distinct features not included in the definition of PTSD.
Complex PTSD vs. PTSDPTSDRe-experiencing the traumaAvoidance of people, places, or thoughts that remind you of the traumaNegative thoughts and a feeling of detachment from the world around youHypervigilance and reactivityC-PTSDRe-experiencing the traumaAvoidance of people, places, or thoughts that remind you of the traumaNegative thoughts and a feeling of detachment from the world around youHypervigilance and reactivityDifficulty regulating your emotionsRelationship problems, including an inability to trust othersProblems with self-image and a generally negative image of yourself
Complex PTSD vs. PTSD
PTSDRe-experiencing the traumaAvoidance of people, places, or thoughts that remind you of the traumaNegative thoughts and a feeling of detachment from the world around youHypervigilance and reactivity
Re-experiencing the trauma
Avoidance of people, places, or thoughts that remind you of the trauma
Negative thoughts and a feeling of detachment from the world around you
Hypervigilance and reactivity
C-PTSDRe-experiencing the traumaAvoidance of people, places, or thoughts that remind you of the traumaNegative thoughts and a feeling of detachment from the world around youHypervigilance and reactivityDifficulty regulating your emotionsRelationship problems, including an inability to trust othersProblems with self-image and a generally negative image of yourself
Difficulty regulating your emotions
Relationship problems, including an inability to trust others
Problems with self-image and a generally negative image of yourself
Signs of Repressed Childhood Trauma in Adulthood
Symptoms of Complex PTSD
C-PTSD is currently not included in the DSM-5, though recommendations have been made for the inclusion. Part of the reluctance stems from its similarity to a mental condition known as borderline personality disorder (BPD).
What Are the Signs of PTSD? 4 Ways to Tell
C-PTSD Symptoms
Key symptoms of PTSD include:
With C-PTSD, additional symptoms are involved, including:
What Is Post-Traumatic Stress Disorder (PTSD)?
Behaviors Associated with C-PTSD
The emotionally disruptive nature of C-PTSD increases a person’s risk of certain unhelpful or harmful behaviors, including:
Complex PTSD vs. BPD
Common symptoms of BPD include:
Oftentimes, only an experienced mental health professional can differentiate the two conditions.
Diagnosing Complex PTSD
While there is no formal test to distinguish between PTSD and C-PTSD, there are three domains that the clinician will focus on during the mental evaluation:
Questions that may be asked during the evaluation include:
Causes of Complex PTSD
People with C-PTSD suffer long-term and repetitive trauma. Most survivors were unable to leave their situation and felt trapped or controlled. The risks are greater during childhood and adolescence when brain development is most vulnerable.
Examples of such trauma include:
C-PTSD and the BrainResearchers from the University of Rochester have found that PTSD can reduce nerve signaling in theprefrontal cortexof the brain which regulatesexecutive functioning. By doing so, a person is less able to maintain self-control, think flexibly, or prioritize tasks and thoughts in a rational order.By understanding these biological and physiological changes, scientists may one day be able to develop treatments and therapies that more directly target the brain of people with C-PTSD.
C-PTSD and the Brain
Researchers from the University of Rochester have found that PTSD can reduce nerve signaling in theprefrontal cortexof the brain which regulatesexecutive functioning. By doing so, a person is less able to maintain self-control, think flexibly, or prioritize tasks and thoughts in a rational order.By understanding these biological and physiological changes, scientists may one day be able to develop treatments and therapies that more directly target the brain of people with C-PTSD.
Researchers from the University of Rochester have found that PTSD can reduce nerve signaling in theprefrontal cortexof the brain which regulatesexecutive functioning. By doing so, a person is less able to maintain self-control, think flexibly, or prioritize tasks and thoughts in a rational order.
By understanding these biological and physiological changes, scientists may one day be able to develop treatments and therapies that more directly target the brain of people with C-PTSD.
How Does Intergenerational Trauma Work?
Complex PTSD Treatment
C-PTSD is treated similarly to PTSD, though the treatment is usually longer. It may include one or a combination of the following:
Psychotherapy
Evidence-based psychotherapies for PTSD such ascognitive processing therapy (CPT)andprolonged exposure (PE) therapyhave been shown to benefit individuals with C-PTSD. Skills-based psychotherapies such asdialectical behavioral therapy (DBT)may also be of benefit.
The goal is to facilitate the processing of the trauma and to identify and modify the trauma’s harmful emotional impact on your life.
EMDRcombines psychotherapy with the use of eye movements. Treatment begins with the therapist building trust and teaching eye movement techniques. EMDR helps the trauma survivor process the traumatic memories until they are no longer distressing.
The Department of Veterans Affairs considers EMDR a best-practice treatment for PTSD in military war veterans.
Medications
Healthcare providers often prescribe medications to treat PTSD and C-PTSD. These may include antidepressants such as:
What Is Integrative Treatment of Complex Trauma?Integrative treatment of complex trauma (ITCT) is an evidence-based approach used primarily for traumatized adolescents and youth between the ages of 12 and 21. It involves a combination of treatment approaches performed individually and in groups, including:Cognitive behavioral therapy (CBT)Prolonged exposure therapy (PET)Mindfulness skills trainingEmotional regulation therapy (ERT)PTSD trigger management
What Is Integrative Treatment of Complex Trauma?
Integrative treatment of complex trauma (ITCT) is an evidence-based approach used primarily for traumatized adolescents and youth between the ages of 12 and 21. It involves a combination of treatment approaches performed individually and in groups, including:Cognitive behavioral therapy (CBT)Prolonged exposure therapy (PET)Mindfulness skills trainingEmotional regulation therapy (ERT)PTSD trigger management
Integrative treatment of complex trauma (ITCT) is an evidence-based approach used primarily for traumatized adolescents and youth between the ages of 12 and 21. It involves a combination of treatment approaches performed individually and in groups, including:
How Trauma Therapy Works
Coping With Complex PTSD
Recovery from C-PTSD is a long process. It’s important to be easy on yourself and to take time to learn coping mechanisms to aid in your recovery.
These include:
Where to Find HelpIf you or a loved one are struggling with PTSD, contact theSubstance Abuse and Mental Health Services Administration (SAMHSA) National Helplineat 1-800-662-4357 for information on support and treatment facilities in your area.
Where to Find Help
If you or a loved one are struggling with PTSD, contact theSubstance Abuse and Mental Health Services Administration (SAMHSA) National Helplineat 1-800-662-4357 for information on support and treatment facilities in your area.
Outlook for Complex PTSD
PTSD can be difficult to treat. Given the complexities of C-PTSD, it may be reasonable to assume that the challenges are even greater.
Even so, you are more likely than not to experience improvement in your mental health and quality of life if you seek treatment from a licensed practitioner. Studies suggest that roughly 30% of people eventually recover from PTD, and another 40% get better with the appropriate treatment.
The impact of complex PTSD may not completely go away, but with treatment, the symptoms can drastically decrease, improving your quality of life and overall well-being.
Summary
Complex PTSD is due to prolonged and extreme trauma, such as human trafficking and childhood sexual abuse. While C-PTSD is similar to PTSD, it comes with an additional cluster of symptoms, including a negative self-image, an inability to control your emotions, and problems maintaining relationships.
C-PTSD is sometimes difficult to differentiate from borderline personality disorder (BPD) and may require an experienced mental health professional to make the call. The treatment includes psychotherapy, eye movement desensitization and reprocessing (EMDR), medications, and social support.
14 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Powers A, Petri JM, Sleep C, et al.Distinguishing PTSD, complex PTSD, and borderline personality disorder using exploratory structural equation modeling in a trauma-exposed urban sample.J Anxiety Disord. 2022 May;88:102558. doi:10.1016/j.janxdis.2022.102558Anxiety and Depression Association of America.Post-traumatic stress disorder.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.0000000000000327U.S. Department of Veterans Affairs.PTSD and DSM-5: DSM-5 criteria for PTSD.Anxiety and Depression Association of America.Criticism: depression and anxiety.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-yNational Alliance on Mental Health.Borderline personality disorder.Zhu X, Suarez-Jimenez B, Lazarov A, et al.Sequential fear generalization and network connectivity in trauma exposed humans with and without psychopathology.Commun Biol.2022;5. doi:10.1038/s42003-022-04228-5American Psychological Association Clinical Practice Guideline for the Treatment of Posttraumatic Stress Disorder.Cognitive behavioral therapy (CBT).U.S. Department of Veterans Affairs.Eye movement desensitization and reprocessing (EMDR) for PTSD.Agency for Healthcare Research and Quality.Interventions for the prevention of post-traumatic stress disorder in adults after exposure to psychological trauma.National Child Traumatic Stress Network.ITCT-A: integrative treatment of complex trauma for adolescents.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.170021U.S. Department of Veterans Affairs.Whole health library: therapeutic journaling.Additional ReadingGiourou 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
14 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Powers A, Petri JM, Sleep C, et al.Distinguishing PTSD, complex PTSD, and borderline personality disorder using exploratory structural equation modeling in a trauma-exposed urban sample.J Anxiety Disord. 2022 May;88:102558. doi:10.1016/j.janxdis.2022.102558Anxiety and Depression Association of America.Post-traumatic stress disorder.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.0000000000000327U.S. Department of Veterans Affairs.PTSD and DSM-5: DSM-5 criteria for PTSD.Anxiety and Depression Association of America.Criticism: depression and anxiety.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-yNational Alliance on Mental Health.Borderline personality disorder.Zhu X, Suarez-Jimenez B, Lazarov A, et al.Sequential fear generalization and network connectivity in trauma exposed humans with and without psychopathology.Commun Biol.2022;5. doi:10.1038/s42003-022-04228-5American Psychological Association Clinical Practice Guideline for the Treatment of Posttraumatic Stress Disorder.Cognitive behavioral therapy (CBT).U.S. Department of Veterans Affairs.Eye movement desensitization and reprocessing (EMDR) for PTSD.Agency for Healthcare Research and Quality.Interventions for the prevention of post-traumatic stress disorder in adults after exposure to psychological trauma.National Child Traumatic Stress Network.ITCT-A: integrative treatment of complex trauma for adolescents.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.170021U.S. Department of Veterans Affairs.Whole health library: therapeutic journaling.Additional ReadingGiourou 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
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Powers A, Petri JM, Sleep C, et al.Distinguishing PTSD, complex PTSD, and borderline personality disorder using exploratory structural equation modeling in a trauma-exposed urban sample.J Anxiety Disord. 2022 May;88:102558. doi:10.1016/j.janxdis.2022.102558Anxiety and Depression Association of America.Post-traumatic stress disorder.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.0000000000000327U.S. Department of Veterans Affairs.PTSD and DSM-5: DSM-5 criteria for PTSD.Anxiety and Depression Association of America.Criticism: depression and anxiety.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-yNational Alliance on Mental Health.Borderline personality disorder.Zhu X, Suarez-Jimenez B, Lazarov A, et al.Sequential fear generalization and network connectivity in trauma exposed humans with and without psychopathology.Commun Biol.2022;5. doi:10.1038/s42003-022-04228-5American Psychological Association Clinical Practice Guideline for the Treatment of Posttraumatic Stress Disorder.Cognitive behavioral therapy (CBT).U.S. Department of Veterans Affairs.Eye movement desensitization and reprocessing (EMDR) for PTSD.Agency for Healthcare Research and Quality.Interventions for the prevention of post-traumatic stress disorder in adults after exposure to psychological trauma.National Child Traumatic Stress Network.ITCT-A: integrative treatment of complex trauma for adolescents.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.170021U.S. Department of Veterans Affairs.Whole health library: therapeutic journaling.
Powers A, Petri JM, Sleep C, et al.Distinguishing PTSD, complex PTSD, and borderline personality disorder using exploratory structural equation modeling in a trauma-exposed urban sample.J Anxiety Disord. 2022 May;88:102558. doi:10.1016/j.janxdis.2022.102558
Anxiety and Depression Association of America.Post-traumatic stress disorder.
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
U.S. Department of Veterans Affairs.PTSD and DSM-5: DSM-5 criteria for PTSD.
Anxiety and Depression Association of America.Criticism: depression and anxiety.
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
National Alliance on Mental Health.Borderline personality disorder.
Zhu X, Suarez-Jimenez B, Lazarov A, et al.Sequential fear generalization and network connectivity in trauma exposed humans with and without psychopathology.Commun Biol.2022;5. doi:10.1038/s42003-022-04228-5
American Psychological Association Clinical Practice Guideline for the Treatment of Posttraumatic Stress Disorder.Cognitive behavioral therapy (CBT).
U.S. Department of Veterans Affairs.Eye movement desensitization and reprocessing (EMDR) for PTSD.
Agency for Healthcare Research and Quality.Interventions for the prevention of post-traumatic stress disorder in adults after exposure to psychological trauma.
National Child Traumatic Stress Network.ITCT-A: integrative treatment of complex trauma for adolescents.
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.
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
Meet Our Medical Expert Board
Share Feedback
Was this page helpful?Thanks for your feedback!What is your feedback?OtherHelpfulReport an ErrorSubmit
Was this page helpful?
Thanks for your feedback!
What is your feedback?OtherHelpfulReport an ErrorSubmit
What is your feedback?
