Complex PTSD: A Starting Guide

Experiencing a trauma – like a car accident, a robbery or being sexually violated – can have a devastating impact on your health and wellbeing. Those who are seriously affected by a single traumatic incident may end up with a diagnosis of simple PTSD. But what happens if you’ve experienced multiple and repeated traumas instead of just one? In this case, PTSD’s more complex cousin, CPTSD, might be diagnosed.

CPTSD: What Does It Mean?

If you have CPTSD, this means that you’re a survivor. Your symptoms are not a sign of illness or weakness: rather, these simply represent your body and mind attempting to make sense of and cope with a series of horrific encounters. Fortunately, you don’t need to suffer alone: there are various treatment methods that have been designed to support and empower people who have experienced chronic trauma. Read on to learn more about this condition and how it differs from simple PTSD.

What Causes CPTSD?

Chronic trauma has been shown to affect the physiological development of the brain, making it harder for the survivor to self-regulate their emotions and maintain stable relationship patterns. Often, CPTSD is caused when a child is abused by a parent or an important caregiver. Because the child has been intentionally harmed by someone on whom they are dependent for protection and survival, this can severely compromise their ability to trust and feel safe in the world.

Signs and Symptoms of CPTSD

People with CPTSD usually present with simple PTSD symptoms in addition to relationship problems, a negative view of themselves or the world and difficulties in managing their emotions.

What are the Common Behaviors/Characteristics?

Unwanted reliving of the trauma

You might experience memory blanks, intense nightmares and flashbacks, where it feels like you’ve gone back in time and you’re experiencing the trauma all over again.


Trauma can make you feel as if you’re disconnected from your own body and mind; or as if the world around you is not real, like you’re in a dream.


CPTSD makes you want to avoid being reminded of your trauma. This might involve pushing away memories that pop into your mind, or avoiding people and places that remind you of what has happened.


Chronic trauma is likely to leave you feeling afraid and tuned in to signs of danger. You’re also likely to be jumpy and on edge, even long after the trauma has stopped; and the fear may prevent you from sleeping or concentrating properly.

Negative sense of self and the world

CPTSD survivors often carry overwhelming and distorted feelings of shame, guilt and worthlessness. You may also blame yourself for what happened. On the other hand, it may also feel as if the whole world is against you and that you aren’t able to trust anyone.

Relationship problems

CPTSD makes it hard to maintain stable relationship patterns, given that so many survivors experienced abuse and betrayal early-on in life. For this reason, you may find yourself withdrawing and avoiding social contact, or else repeatedly getting involved in relationships that are characterized by conflict, abandonment or abuse.

Difficulty managing emotions

A hallmark of CPTSD is the experience of intense and uncontrollable emotions that can range from rage and hate to fear and sadness. You may find it difficult to experience any feelings of hope or happiness and you may engage in self-harm or suicidal behavior.

Stats: How Many Suffer from this Disorder?

Because CPTSD is a relatively new disorder that isn’t formally recognized, we don’t know exactly how common it is. However, simple PTSD affects 8% of the US population and a study in the journal of Clinical Psychological Science suggests that 25% – 50% of people that meet the criteria for PTSD actually have CPTSD.

Example Case of CPTSD

Angela, currently aged 27, had a tumultuous childhood living with her mom and stepfather, both of whom would drink excessively on most weekends. From the age of 3, Angela was physically and verbally abused by her stepfather and on several occasions, she was beaten so badly that she had to be admitted to hospital.

Angela had a challenging time in school and college. She struggled to manage her overwhelming emotions: feelings of sadness and anger would sneak up on her, seemingly out of the blue. She struggled to manage these intense feelings and would resort to self-harm by cutting herself or using drugs and alcohol.

Angela often experienced unwanted flashbacks of the times that her stepfather abused her – these mental images haunted her even long after she moved out of home and lived in a different state. She described herself as being in a “constant state of fear and tension, haunted by fear and guilt about her past”.

Angela also experienced insomnia, panic attacks, a sense of fatigue and an inability to concentrate in class. Her support network was limited: she had had several boyfriends, but all her relationships had ended prematurely because of fiery verbal arguments. Angela was unhappy with her life and she viewed herself as a failure.

She went to see several doctors, who gave her a diagnosis of depression with panic attacks. The pills didn’t work, however, and eventually, Angela tried to overdose on pain medications. Her suicide attempt was unsuccessful, and at the hospital, she met with a therapist who diagnosed her with CPTSD.

Angela was relieved to learn that there was a label that she could use to make sense of her experience. She worked hard in therapy and within 2 years found herself better equipped to manage her moods, anxiety and flashbacks. Soon, Angela found herself a job as a salesperson where she excelled; and she entered into a mutually respectful long-term relationship with her colleague.

Testing: What are the Diagnostic Criteria Per the DSM 5?

CPTSD is not recognized as an existing disorder within the current bible of psychiatry – the DSM 5 – despite much campaigning from clinicians who feel that simple PTSD does not accurately capture the experience of their clients. People struggling with CPTSD are thus likely to be given a diagnosis of PTSD along with other diagnoses such as depression, anxiety or personality disorders.

CPTSD and Other Conditions

People with CPTSD present with a wide and, well, complex variety of symptoms. It’s important, then, to make sure that people with this disorder aren’t mistakenly diagnosed with other problems that share these symptoms.

Complex PTSD vs Simple PTSD

CPTSD is diagnosed in the case of chronic trauma; whereas simple PTSD is diagnosed following a single traumatic event.

People with CPTSD also have additional symptoms that are not normally a part of simple PTSD, including difficulties with regulating their emotions, relationship problems, changes in the way that they see themselves and an ongoing preoccupation with their abuser, whether in the form of hate or idealization.

Related Conditions

Clinicians who are unfamiliar with CPTSD may end up mistakenly diagnosing and treating other conditions instead, such as depressive, anxiety and personality disorders. Although people with CPTSD share symptoms with these conditions, it’s important that they get the correct diagnosis – being told that you have depression or borderline personality disorder can leave you feeling as if the problem lies within you, when in reality the trauma that you have suffered is to blame.

CPTSD In Adults/Children

CPTSD affects both adults and children; and many adults with CPTSD experienced abuse or neglect when they were young. There are some tell-tale signs of trauma in children that you can look out for. These include the tendency to ‘act out’ what happened to them during play, separation anxiety, secondary enuresis (sudden bed-wetting after a period of being dry) and unusual precocious behavior with adults that they have never met.

Teens with CPTSD, on the other hand, are more likely to behave impulsively, aggressively and to get in trouble with authority figures.

Complex PTSD Treatment

If you have experienced chronic trauma, life has dealt you an unfair hand. The good news, however, is that help is available. There are many safe and effective therapy techniques that can help you to cope, including eye movement desensitization and reprocessing (EMDR), psychodynamic talk therapy, dialectical behavior therapy, and cognitive behavioral therapy.

Seeing a psychologist can help you to regain a sense of safety, empowerment, and control over your own life and destiny.

Possible Medications for CPTSD

People with CPTSD often have symptoms of depression; and for this reason, antidepressant medications (including Zoloft, Prozac or Effexor) may be prescribed. However, talk therapy is generally recommended as a first-line intervention and most clinicians will recommend that pills be taken in addition to, rather than instead of therapy.

In addition to the standard mainstream medications typically used for CPTSD, there are a number of alternative treatments in advanced stages of study under the FDA. These include MDMA, psilocybin (magic mushrooms), and ketamine. Each of these treatments works to resolve different aspects of CPTSD, with MDMA focused on general healing from trauma, psilocybin focused on anxiety and depression, and ketamine to help reduce suicidal thoughts.

Home Remedies to help CPTSD

Unfortunately, there is no quick fix for CPTSD. Through therapy, however, you will be given techniques and strategies which you can then practice in your own time to help cope with your symptoms. Therapy is vital – but it’s what you do at home, in your own time, that makes the process that much more effective.

Living with CPTSD

Living with CPTSD is about giving yourself space and time to start regaining a sense of trust and safety in the world. You’ll also need to learn to give yourself the sort of care and kindness that you deserve. Speak to a therapist or visit this page for some self-care tips.

Insurance Coverage for CPTSD

Because CPTSD is not yet recognized as an official disorder, your insurance company may not fund treatment. However, the symptoms of CPTSD overlap with several other disorders and you may be diagnosed with both simultaneously. Therefore, if your health plan includes mental health coverage, you may still qualify for funding. Speak to your doctor or insurance company to find out about your options.

How to Deal/Coping With CPTSD

CPTSD can be overwhelming and it’s not at all unusual to experience powerful sensations of guilt and/or mistrust, which can make it incredibly uncomfortable to ask for some support. However, the best way of coping with this condition is by allowing yourself to be supported by a trained mental health practitioner who can walk this path with you

Look out for These Complications/Risk Factors

The most significant factor that puts you at risk of developing CPTSD is living in an environment in which acts of interpersonal violence are likely to occur. Research also suggests that women are at an increased risk of experiencing trauma, which is not all that surprising given the frequency with which gender-based violence occurs.

People who have experienced chronic trauma are at an increased risk of committing suicide. If you find yourself thinking about hurting yourself, reach out for support immediately. You can approach your nearest emergency room or even call 911 for some guidance. You can also visit this website, which provides a list of suicide hotlines around the world.

How to Find a Therapist

Ask your insurance company or nearest general practitioner to point you in the direction of a reliable therapist. Alternatively, search online for practicing clinicians in your area.

What Should I be Looking for in an LMHP?

  • A good client-therapist fit. Make sure that you feel safe and comfortable in the presence of your therapist! If you happen to have experienced gender-based violence, you may feel more comfortable with a clinician whose gender is the same as yours.
  • Find someone with experience in treating trauma and CPTSD specifically. CPTSD is a relatively new diagnostic term, so try to find someone who understands your situation and what you need going forward.

Questions to Ask a Potential Therapist

  • Have you worked with people who have CPTSD?
  • What form of therapy would you recommend for treating this condition?
  • In what ways could treatment help me?
  • What time slots do you have open and how often would we meet?
  • What are your rates?
  • Would my treatment be covered by my health insurance?

CPTSD Resources and Support Helpline

  • Self-care tips for CPTSD:
  • National Suicide Prevention Lifeline: 1-800-273-8255
  • List of international suicide hotlines:
  • An online support group for people with CPTSD:
  • Online resources for people with CPTSD:


author avatar
Angel Rivera
I am a Bilingual (Spanish) Psychiatrist with a mixture of strong clinical skills including Emergency Psychiatry, Consultation Liaison, Forensic Psychiatry, Telepsychiatry and Geriatric Psychiatry training in treatment of the elderly. I have training in EMR records thus very comfortable in working with computers. I served the difficult to treat patients in challenging environments in outpatient and inpatient settings
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