What is complex PTSD?

Complex PTSD, otherwise referred to as C-PTSD, is closely related to post-traumatic stress disorder (PTSD) though may include some additional symptoms and the causes may be different.

Where PTSD usually results from a specific event, such as a natural disaster, major accident or assault, complex PTSD is caused by ongoing or repeated stress or trauma (known as complex trauma), particularly if this happens in your younger years. Repeated relational trauma is often part of C-PTSD sufferers' experience.

The developmental and psychological impact of repeated, complex trauma can often be more significant than the effects of a single traumatic event. The symptoms of complex PTSD may not show up for years and may only become clear to people in adulthood.

Experiences that may contribute to complex PTSD include:

neglect and/or abuse in childhood
witnessing or being the victim of domestic abuse or violence
being forced or manipulated into prostitution
living in an area affected by war
torture, kidnapping or slavery
other adverse childhood experiences

The symptoms of post-traumatic stress disorder include:

flashbacks
depression and/or difficulty managing your mood
insomnia
difficulty concentrating
being triggered by particular stimulus that remind you of the event
physical symptoms like dizziness, headaches, stomach aches
engaging in numbing behaviours like drinking or other substance abuse, overexercising, or emotional eating
avoidance behaviours (for example, avoiding places that remind you of the scene of the trauma)
hyperarousal/hypervigilance (feeling accutely aware of your environment, and 'jittery')

Additional symptoms that may be present in complex PTSD include:

feelings of guilt or shame and/or having a negative self-view
feeling like you may be permanently damaged or that you are different to other people
feeling distrustful towards the world, or angry
dissociative symptoms (feeling outside of your body)
feeling numb, empty or hopeless
trouble in relationships, whether romantic or platonic
avoiding friendships and relationships, or finding them very difficult
experiencing emotional flashbacks, where you feel similarly to during the trauma (for example, scared, ashamed, helpless)

As with PTSD, there are some factors that make it more likely that you will develop complex PTSD. These include:

the trauma you experienced happened in childhood
the trauma was ongoing or repeated
you felt unsafe for a prolonged period of time
you were subject to harm by someone that you trusted or was close to you

How can therapy help complex PTSD?

NICE recommends EMDR (eye movement desensitisation and reprocessing) for the treatment of PTSD, and it can also be used to support people who have complex PTSD.

If you have C-PTSD, you may also benefit from psychodynamic psychotherapy where you can explore your childhood experience with your therapist. If part of your experience is feeling mistrustful of other people, you will likely need to engage in relatively long-term therapy in order to build a trusting and robust relationship with your therapist.