Complex PTSD (A Comprehensive Understanding of C-PTSD)

This guide will briefly discuss complex PTSD (C-PTSD), symptoms, difference with PTSD, diagnosis, causes, treatment available, and the life with complex PTSD.

The complex PTSD (Post Traumatic Stress Disorder) is the term most people overlap with PTSD (Post Traumatic Stress Disorder).

Complex PTSD is related to stress, and trauma over the course of years.

Most people are familiar with the PTSD which was categorized as anxiety disorders and occur as a result of the traumatic event.

C-PTSD is a condition which is getting the recognition widely and doctors are recognizing it in recent years.

Complex PTSD occurs as a result of a series of traumatic events in a person’s life.

Complex PTSD doesn’t occur by a single event.  

Difference Between Complex PTSD and PTSD

PTSD occurs as a result of a single traumatic event, e.g., car accident, sexual abuse etc. while the Complex PTSD has a series of traumatic event, and experienced by the individual over the course of months or years.

Complex PTSD is not recognized by doctors and mental health professionals in their DSM (Diagnostic and Statistical Manual of Mental Disorders) as a condition but recognized by ICD.

Diagnostic Criteria of PTSD

The following criteria for the diagnosis of PTSD is given in DSM 5.

A.     The person was exposed to death, threatened death, actual or threatened serious injury, or actual or threatened sexual ferosity, in the following way(s):

a.     Direct exposure

b.     Witnessing the trauma

c.      Learning that a relative or close friend was exposed to a trauma

d.     Indirect exposure to aversive details of the trauma, usually in the course of professional duties (e.g., first responders, medics)

B.     The traumatic event is persistently re-experienced in the following way(s):

a.     Unwanted upsetting memories

b.     Nightmares

c.      Flashbacks

d.     Emotional distress after exposure to traumatic reminders

e.     Physical reactivity after exposure to traumatic reminders

C.    Avoidance of trauma-related stimuli after the trauma, in the following way(s):

a.     Trauma-related thoughts or feelings

b.     Trauma-related external reminders

D.    Negative thoughts or feelings that began or worsened after the trauma, in the following way(s):

a.     Inability to recall key features of the trauma

b.     Overly negative thoughts and assumptions about oneself or the world

c.      Exaggerated blame of self or others for causing the trauma

d.     Negative affect

e.     Decreased interest in activities

f.       Feeling isolated

g.     Difficulty experiencing positive affect

E.     Trauma-related arousal and reactivity that began or worsened after the trauma, in the following way(s):

a.     Irritability or aggression

b.     Risky or destructive behaviour

c.      Hypervigilance

d.     Heightened startle reaction

e.     Difficulty concentrating

f.       Difficulty sleeping

F.     Symptoms duration is more than 1 month

G.    Functional disturbance and impairment

Symptoms of PTSD

Symptoms of PTSD as given in DSM 5 are as follow:

Reliving the traumatic experience

This can include having nightmares or flashbacks.

Avoiding certain situations

You might avoid situations or activities, such as large crowds or driving, that remind you of the traumatic event.

This also includes keeping yourself preoccupied to avoid thinking about the event.

Changes in beliefs and feelings about yourself and others

This can include avoiding relationships with other people, not being able to trust others, or believing the world is very dangerous.


Hyperarousal refers to constantly being on-alert or jittery. For example, you might have a hard time sleeping or concentrating.

You might also be unusually startled by loud or unexpected noises.

Somatic symptoms

These refer to physical symptoms that don’t have any underlying medical cause.

For example, when something reminds you of the traumatic event, you might feel dizzy or nauseated.

Symptoms of Complex PTSD

People experiencing the symptoms of complex PTSD go through the following:

Lack of emotional regulation

Person experiencing complex PTSD mistakenly commonly diagnosed as BPD.

While in BPD the emotional regulation is not stable, but in complex PTSD the emotional regulation is lacking and they have uncontrollable feelings of anger and ongoing sadness.

Changes in Consciousness

Person going through complex PTSD experience the changes in his consciousness and sometimes feel detached from their own body or emotions which can be termed as dissociation.

Negative Self-Perception

Person experiencing complex PTSD also have a pessimistic view about self. They either get into extreme guilt or shame.

Difficulty with Relationships

Complex PTSD is associated with the difficulty in relationships.

Person will try to avoid relationships with other people and will have a feeling of mistrust.

They might get into relationships which are toxic and damaging for them, as a feeling of familiarity with discomfort.

Distorted Perception of Abuser

In Complex PTSD they will dwell into relationship with their abuser.

The explanation for this sort of behaviour is that they either want to take revenge from the abuser or wants the abuser to have full control over their life.

Causes of Complex PTSD

The causes of complex PTSD are still in the process of exploration.

While there are certain researches being done on the topic of figuring out the causes of complex PTSD.

On the animals’ studies have been done, which showed that the long-lasting impact on amygdala, hippocampus and prefrontal cortex are involved in complex PTSD.

Complex PTSD is caused by the ongoing traumatic event of the following nature:

·        ongoing physical, emotional, or sexual abuse

·        being a prisoner of war

·        living in an area of war for long periods of time

·        ongoing childhood neglect

Risk Factors for Complex PTSD

The risk factors for complex PTSD are as below:

·        Anxiety and depression or family history of these disorders

·        Personality traits, or temperament

·        How brain functions and regulates hormones and neurochemicals in response to stress

·        Lifestyle factors of not having much support

Treatment of Complex PTSD

As other disorders have different treatment options available, Complex PTSD has the following available treatments:


Psychotherapy involves the management of the problem with the help of a therapist/ counsellor/ mental health professional who resolve the issues using talk therapy.

Cognitive behaviour therapy is one form of treatment approach used to deal with the negative thought patterns, and replace those faulty thoughts with the more positive or realistic thoughts.

Art Therapy

In art therapy, the therapist assists the person experiencing the symptoms to deal with the painful feelings and experiences.

In art therapy when the person is colouring, they are finding a safe place to express their emotions.

Colouring engages the different parts of their brain which allows them to process the trauma in different ways.

They can even talk about those difficult memories of abuse and trauma.

However, there is more than colouring in art therapy, the colouring trends suggest different learned experiences.

Art therapy, just like talk therapy, has enormous healing potential when done with a trained professional.

In fact, for those with post-traumatic stress disorder (PTSD), working with an art therapist has been a lifesaver.

Eye Movement Desensitization and Reprocessing (EMDR)

EMDR is another commonly used approach to treat PTSD, this treatment is recommended for complex PTSD as well.

In EMDR, the individual suffering from Complex PTSD will be asked to think about the traumatic event and while moving their eyes from side to side.

Other techniques included in this are having other people tap on the individual’s hand instead of the person moving their eyes.

This EMDR has an effect in desensitizing the person with the traumatic memory.

During EMDR therapy sessions, you relive traumatic or triggering experiences in brief doses while the therapist directs your eye movements.

EMDR is thought to be effective because recalling distressing events is often less emotionally upsetting when your attention is diverted.

This allows you to be exposed to the memories or thoughts without having a strong psychological response.

Over time, this technique is believed to lessen the impact that the memories or thoughts have on you.

American Psychological Association recommends the used of EMDR for PTSD under some conditions.


The medication available for Complex PTSD are basically the same for the depression. As the symptoms have some overlapping.

Medication gives efficient results if it is combined with the CBT.

The most commonly used antidepressants used for Complex PTSD are:

·        Sertraline (Zoloft)

·        Paroxetine (Paxil)

·        Fluoxetine (Prozac)

Living with Complex PTSD

If the person is suffering from Complex PTSD, it can be terrifying and causes isolation.

PTSD is a condition in which the person needs help and support from others.

Rehabilitation centres or different organizations sometimes provide support. e.g. National centre for PTSD, and other organizations.

Support groups for the person living with complex PTSD are also available one-to-one and online sessions.

When a person is living with complex PTSD, they sometimes lose trust in others and try to engage in everyday activities.

When a person wants to live a healthy balanced life, the activities they can do are:

·        exercising regularly

·        finding a job

·        making new friends

·        socializing with old friends, if these relationships were healthy

·        taking up a hobby

Recovery from the PTSD takes time, and persistence can be promising, as well as the healthy relationships with friends and family are beneficial.

If you’re dealing with PTSD, you must consider get a Service Dog.

Frequently Asked Questions for Complex PTSD

What is complex PTSD vs PTSD?

he complex PTSD is when the person goes through a serious of traumatic experiences or goes through a traumatic experience for an extended period of time.

While in PTSD there is a single traumatic experience.

Is Complex PTSD a disability?

Yes, if the PTSD is disabling the person to function in their environment, it comes under disability and some companies even offer insurance for the disability.

Is Complex PTSD real?

Yes, Complex PTSD is a dangerous condition and affect people who live through the long term trauma.

It causes symptoms similar to PTSD.

How does Complex PTSD affect the brain?

The complex PTSD affects the brain by altering the neurochemicals.

The brain regions affected by complex PTSD are hippocampus, amygdala, and prefrontal cortex.





Recommended Books

Complex PTSD: From Surviving to Thriving: A Guide and Map for Recovering from Childhood Trauma 

 The Complex PTSD Workbook: A Mind-Body Approach to Regaining Emotional Control and Becoming Whole 

 The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma 

 It’s not me: Understanding Complex Trauma, Attachment and Dissociation CPTSD Journal: Beautiful Journal for Complex Post Traumatic Stress Disorder Sufferers With Symptom & Trigger Tracking, Anxiety & Mood Trackers, … Exercises, Gratitude Prompts and more.

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