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Understanding Complex PTSD

Updated: Feb 4

Caitlin Weese LCSW-C, 200 RYT

woman lookinh into the distance

What is Complex PTSD?

Post-traumatic stress disorder (PTSD) is a condition that affects many people who have experienced a singular traumatic event. It is a mental health condition that can cause intense feelings of anxiety, fear, and stress. As research into the impacts of trauma has expanded another form of PTSD has been discovered called Complex PTSD (C-PTSD). This less well-known but equally important condition will be the topic of this blog post.

Complex PTSD is a condition that can develop after experiencing long-term, repeated trauma. This trauma can be physical, emotional, or sexual abuse, neglect, domestic violence, or witnessing domestic violence as a child. Unlike traditional PTSD, which is triggered by a single traumatic event, C-PTSD is caused by repeated incidents of trauma that can happen over a period of months or years. This idea was first introduced by Dr. Judith Herman of Harvard University in 1988. While complex PTSD initially referred solely to ongoing traumatic events in childhood, research has expanded this definition to include ongoing traumatic events in adulthood.

What are the Symptoms?

C-PTSD is characterized by a range of symptoms in addition to the symptoms seen with PTSD (avoidance of triggers, re-experiencing through thoughts, dreams etc, and a sense of danger (being easily jumpy, hyper-vigilance etc.). These include:

  • difficulties regulating emotions

  • problems with interpersonal relationships

  • negative self-perception

  • Dissociation

  • Somatic symptoms, such as chronic pain, gastrointestinal issues, and immune system dysfunction

Difficulty Regulating Emotions

One of the hallmarks of C-PTSD is difficulty with emotional regulation. Individuals with this condition may experience intense emotions, such as anger, sadness, or anxiety, and have difficulty regulating these emotions. As a result, you may use self-harm, substance use, compulsive exercise, eating disordered behaviors or many other things, to cope. As a result, many people who struggle with C-PTSD have co-occurring struggles with addiction, self-arm or disordered eating. You may also feel emotionally numb, disconnected from your feelings and body but we'll talk more about this specifically later in the blog.

Trouble with Relationships

C-PTSD can also affect a person's ability to form and maintain healthy relationships. You may struggle with feelings of distrust, fear, and insecurity in your relationships, which can make it difficult for you to connect with, and rely on, others. At other times you may swing between becoming overly-dependent on others and fiercely self-reliant. You may also struggle with boundary-setting and may have a history of being in relationships with people who are abusive or manipulative. This can be especially true to for survivors of childhood trauma and we may see ourselves recreating patterns we witnessed or experienced in childhood.

Distorted Sense of Self

Another common symptom of C-PTSD is the development of a distorted sense of self. As a result of ongoing trauma, our view of ourselves shifts to reflect our experiences. We may feel we are "bad" or become overly responsible. This can look like negative self-image, intense shame and guilt, low self-acceptance and a heightened sense of self-blame. In addition, we may also struggle with feelings of inadequacy, helplessness, and hopelessness.


Dissociation is another common symptom of C-PTSD. Dissociation is a healthy coping mechanism that allows us to disconnect from the our emotions and surroundings when we feel overwhelmed or threatened. This can manifest as feeling like you are disconnected from your body, experiencing a sense of unreality, loss of memory or feeling like you are watching the world from a distance. While its normal to dissociate from time to time (ex: losing track of time while reading) it's far more pronounced for individuals with C-PTSD. Because of the chronic nature of trauma that results in C-PTSD, individuals with C-PTSD are likely to experience dissociation on a higher level than the average person. For individuals whose C-PTSD is linked to childhood we may be more likely to dissociate in stressful situations than fight or flight, as this may have been our only option as children. If you want to learn more about fight, flight, freeze (dissociation) and fawn, you can read this post I wrote about it.

graphic explaining trauma responses fight, flight, freeze, and fawn

Long-Standing Physical Complaints

Lastly, long-standing somatic issues are another sign of C-PTSD. Because of the connection our nervous system has to the rest of the body, chronic stress and dissociation can manifest in physical complaints. These can range from headaches, migraines, diarrhea, constipation and chronic pain. These symptoms are usually hard to explain by a doctor and little to no evidence in the body may be found to identify their cause.

Treatment and Support

If you or someone you know is experiencing symptoms of C-PTSD, it's important to seek help from a mental health professional. Treatment for C-PTSD typically involves a combination of talk therapy and medication, if necessary.

Types of Therapy

Talk therapy can help individuals with C-PTSD identify and process their traumatic experiences, develop healthy coping mechanisms, and work on building healthier relationships. Some therapies that have been beneficial to those with complex trauma are Cognitive Processing Therapy, Prolonged Exposure Therapy, Trauma-Focused Cognitive Behavioral Therapy and Eye Movement Desensitization and Reprocessing (EMDR). However it is important to note that given the complex nature of C-PTSD, your therapist should pay strong attention to helping you learn and master skills to ground and calm yourself before proceeding with processing the trauma. If you're looking for tips on how to find the right trauma therapist check out this article I wrote.

Medication Options

In addition to therapy, medication, such as antidepressants, Prazosin or anti-anxiety medication, are sometimes prescribed to help manage symptoms of depression, anxiety, or struggles. While medication is not a silver bullet, it does help to alleviate symptoms enough to make processing and healing from the trauma bearable.

Alternative Options

There are also several self-help strategies that individuals with C-PTSD can use to manage their symptoms. These include mindfulness meditation, journaling, yoga, and creative activities such as art or music therapy. It's important to find what works best for you and to prioritize self-care in your daily routine. As you do, be gentle with yourself and go as slowly as you need to avoid overwhelming your nervous system.

Healing is Possible

It's also important to remember that recovery from C-PTSD is possible. With the right treatment and support, we can learn to manage their symptoms, heal from our trauma, and build healthier, more fulfilling lives. I know because I do have the honor of doing this work every day.

In conclusion, C-PTSD is a complex mental health condition that can develop after experiencing long-term, repeated trauma. It can cause a range of symptoms, including emotional regulation difficulties, problems with interpersonal relationships, negative self-perception, and dissociation. If you or someone you know is experiencing symptoms of C-PTSD, it's important to seek help from a mental health professional who specializes in treating this unique condition.

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