What Is Complex PTSD? (2024)

Complex post-traumatic stress disorder (C-PTSD) is a condition similar to post-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 as borderline 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 complicated anxiety disorder.

What Is Complex PTSD?

PTSD is a type of anxiety disorder included in the "Diagnostic and Statistical Manual of Mental Disorders" (DSM-5) issued by the American Psychiatric Association and the "International Classification of Diseases"(ICD-11) issued by the World Health Organization.

PTSD is characterized by a traumatic event such asa sexual assault,warfare,or domestic violence that causes symptoms ranging from "re-living" the trauma to avoiding anything that reminds you of it.

In 2022, the ICD-11 introduced C-PTSD as a distinct entity that shares features with PTSD but has several of its own. Under the ICD-11 definition, C-PTSD is thought to be caused by traumas that were especially severe or prolonged, often where there was no means of escape. Examples include human trafficking and child sexual abuse.

Because of the extreme nature of the trauma, C-PTSD has three distinct features not included in the definition of PTSD.

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).

C-PTSD Symptoms

With C-PSTD, the symptoms of PTSD are compounded by several others that affect how you relate to yourself and others.

Key symptoms of PTSD include:

• Experiencing flashbacks, nightmares, and repetitive sensations of the trauma
• Experiencing physical sensations, such as pain, sweating, trembling, or feeling sick
• Taking unhealthy steps to avoid anything that reminds you of the trauma, leading to isolation and emotional numbness
• Always being on edge or easily startled
• Constantly assessing for threats around you
• Sleep and concentration problems

With C-PTSD, additional symptoms are involved, including:

• Negative self-image, including feelings of worthlessness, shame, and guilt
• Problems controlling your emotions
• Interpersonal relationship problems, including a general distrust of people

Behaviors Associated with C-PTSD

The emotionally disruptive nature of C-PTSD increases a person's risk of certain unhelpful or harmful behaviors, including:

• Inability to accept criticism: If you have C-PTSD, criticism can cause severe distress because you are already self-critical or feel shame.
• Substance abuse: Research suggests a strong association between substance use and trauma as a means to help numb the pain.
• Self-harm: Self-harm not only includes intentionally hurting yourself or trying to commit suicide but also being reckless and taking unnecessary risks that put you in harm's way.
  

Complex PTSD vs. BPD

C-PTSD and BPD differ in several key ways. Firstly, BPD is a personality disorder. This a mental health condition characterized by long-term patterns of disruptive thoughts, moods, and behaviors that negatively affect interpersonal relationships. Unlike someone with an anxiety disorder, a person with a personality disorder has no idea that their actions are disruptive or unreasonable.

Even so, placing the symptoms of C-PTSD side by side with BPD illustrates how alike the two conditions are at first sight.

Common symptoms of BPD include:

• Unstable and chaotic relationships
• A distorted self-image
• Impulsive and reckless behaviors
• Inability to receive or accept criticism
• Chronic feelings of emptiness
• An abnormal fear of abandonment
• Inability to control one's emotions, including explosive outbursts
• A general distrust of others with moments of paranoia
• Emotional "splitting" (viewing something as either being all bad or all good)
• Recurrent suicidal ideation or self-harm

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:

• Emotional dysregulation
• Negative self-concept
• Interpersonal difficulties

Questions that may be asked during the evaluation include:

• What happens when you feel stressed, angry, or frustrated?
  
• How do you think people who know you see you?
• How do you feel about yourself?
• Are there people in your life you trust?
• How do you get along with your spouse? Co-workers? Family?

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:

• Sexual abuse
• Domestic violence
• Sex trafficking
• Child abuse, neglect, or abandonment
• Being a child soldier
• Being a prisoner of war
• Living through wartime trauma
  

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

Psychotherapy, or talk therapy, should be conducted by a trained therapist. It’s best to find one with experience in treating trauma.

Evidence-based psychotherapies for PTSD such as cognitive processing therapy (CPT) and prolonged exposure (PE) therapy have been shown to benefit individuals with C-PTSD. Skills-based psychotherapies such as dialectical 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.

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 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:

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

Zoloft and Paxil are approved by the U.S. Food and Drug Administration (FDA) for the treatment of PTSD. Prozac and Celexa are used off-label (meaning for purposes other than those licensed by the FDA).

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:

• Finding 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.
• Practicing mindfulness: Mindfulness means being self-aware and intentionally shifting attention to the present. Mindfulness techniques don’t have to be elaborate. You 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 get a distance from painful emotions.
  

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.