Conditions

Understanding Complex PTSD: Symptoms and Treatment

June is PTSD Awareness Month, an ideal time to explore complex post-traumatic stress disorder (CPTSD). Unlike PTSD, CPTSD stems from prolonged trauma and has unique symptoms and impacts. Learn about CPTSD’s causes, effects, and strategies for healing and managing this challenging condition.

Grow Therapy therapist Gregorio (Greg) Lozano III LPC By Greg Lozano
Woman stares off in the distance.

Updated on Jun 05, 2024

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No matter how strong and resilient humans are, the mind and body have limits. Just as a body can eventually weaken and suffer consequences after repeated trauma, so can the mind. June is PTSD Awareness Month, which means it’s the perfect time to take a closer look at complex post-traumatic stress disorder (CPTSD) and the impact it can have on everyday life.

If someone continues to endure trauma, they may risk developing CPTSD, a mental health condition similar to post-traumatic stress disorder (PTSD) but with differences in underlying causes, symptoms, and comorbidities.

Discover everything you need to know about CPTSD here, including ways to heal from trauma.

What is Complex PTSD?

Complex post-traumatic stress disorder (C-PTSD or CPTSD) occurs when a person endures continuous trauma over a long period of time. It’s the continuous nature of CPTSD that causes so much harm, especially if the trauma is caused during childhood, a time when children’s brains are still developing and they don’t yet have the coping skills to deal with distressing events.

They might think the traumatic childhood experiences (for example, physical or sexual abuse) they’re dealing with are normal, or even their fault, but it’s not until later in life that they realize they’re experiencing trauma.

Signs of CPTSD

As Bessel van der Kolk writes in his book, The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma, “Trauma affects the entire human organism — body, mind, and brain. In PTSD the body continues to defend against a threat that belongs to the past.”

Not only do the symptoms of CPTSD overlap with the classic symptoms of PTSD, but they can also overlap with other mental health conditions, like depression, anxiety, sleep disorders, attention-deficit/hyperactivity disorder (ADHD), and borderline personality disorder (BPD).

CPTSD tends to manifest in the form of avoidance, panic, and emotional dysregulation. People with CPTSD will often avoid situations that may present situations that feel unsafe or cue memories of past trauma.

- Alan Deibel, LCPC

Childhood trauma is a risk factor for all of these conditions, so it might be challenging to treat them without addressing a person’s underlying trauma.

According to Mental Health America, CPTSD can affect people in the following areas:

Alan Deibel, a Grow Therapy licensed clinical professional counselor (LCPC), says that some additional symptoms of CPTSD include hypervigilance, re-experiencing or reliving vivid and distressing memories as flashbacks or nightmares, and intense physiological reactions that don’t match the situation.

“CPTSD tends to manifest in the form of avoidance, panic, and emotional dysregulation. People with CPTSD will often avoid situations that may present situations that feel unsafe or cue memories of past trauma. They experience strong physiological signs of panic which often are interpreted as ‘This is dangerous and I need to move away from it.’ Those who’ve endured trauma tend to have a smaller ‘window of tolerance,’ meaning it doesn’t take the same intensity of distress to trigger difficult emotions as it would for someone without CPTSD,” says Diebel.

Diagnosing CPTSD

Because CPTSD is quite new and a separate diagnosis from PTSD, it’s not yet listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). However, the World Health Organization (WHO) included CPTSD in the 11th edition of the International Statistical Classification of Diseases and Related Health Problems (ICD-11), which was published in 2018.

According to the ICD-11, for CPTSD to be diagnosed, all the symptoms of PTSD must be present along with the following diagnostic criteria.

CPTSD is characterized by severe and persistent:

  1. Problems in affect regulation.
  2. Beliefs about oneself as diminished, defeated, or worthless, accompanied by feelings of shame, guilt, or failure related to the traumatic event.
  3. Difficulties in sustaining relationships and in feeling close to others.

These symptoms cause significant impairment in personal, family, social, educational, occupational, or other important areas of functioning.

What Causes CPTSD?

Whereas PTSD can occur in a person after a single event — such as a car accident, a natural disaster, or a violent attack, to name a few — CPTSD arises when someone has undergone long-term trauma.

The types of chronic trauma that can incur CPTSD include:

Essentially, CPTSD typically involves someone being hurt by another person — like with childhood abuse — and the hurts are ongoing, repeated, and often involve a betrayal and loss of safety. The ICD-11 describes situations from which CPTSD can arise as “extremely threatening” and “from which escape is difficult or impossible.”

What’s the Difference Between PTSD and CPTSD?

With just one word differentiating their names, PTSD and CPTSD have many similarities in terms of symptoms and treatment. But there are some big differences, too.

“CPTSD is a specific type of PTSD in which the trauma experienced is/was ongoing versus it being a singular traumatic event,” shares Diebel.

To go further in-depth, PTSD is different from CPTSD in the following ways:

Deibel adds, “It’s important to note that C-PTSD is not currently listed as a separate diagnosis in the DSM-5. However, both the ICD-11 and WHO recognize it as a distinct diagnosis. Most mental health practitioners in the USA use the DSM-5 for diagnosis so many people who seek treatment for these concerns will be diagnosed with PTSD.”

Also, if you are diagnosed with PTSD but feel you could be experiencing CPTSD, bring it up with your therapist. This can help the therapist get a very clear picture of what you are experiencing, and you can work together to determine the most fitting treatment plan for you moving forward.

How to Manage CPTSD

While CPTSD is a chronic condition, with treatment and lifestyle changes, it can be managed. Here are some interventions that can help someone living with CPTSD:

Therapy

Our Grow Therapy providers recommend several types of therapy for CPTSD, including trauma-focused counseling, like cognitive processing therapy (CPT), eye movement desensitization and reprocessing (EMDR), somatic therapy, cognitive behavioral therapy (CBT) and dialectical behavior therapy (DBT). “Group therapy can also be helpful by reducing isolation,” says Galica.

Additionally, the National Center for PTSD states that prolonged exposure therapy can benefit individuals with CPTSD. Sometimes, people with CPTSD or PTSD don’t seek out therapy because they’re afraid that they’re going to have to talk about their trauma in detail. However, many treatment models, including EMDR, somatic therapy, and DBT, don’t require people to talk at length about their trauma. Although people are welcome to share about what they went through in therapy, they don’t have to in order for the treatment to work

If a person with CPTSD chooses to partake in psychotherapy, they may embark on these important treatment goals with a mental health professional:

Trauma has been the focus of many mental health professionals in the past, and as a result, there are some models that can be used as education or therapy tools for people who are dealing with complex PTSD.

One such model is Trauma Affect Regulation: Guide for Education and Therapy (TARGET), which is a strengths-based approach created by Julian Ford, a clinical psychologist and Professor of Psychiatry and Law at the University of Connecticut, and Rocio Chang, Assistant Professor of Psychiatry at the University of Connecticut.

TARGET teaches survivors of trauma a set of seven skills: Focus, Recognize triggers, Emotion self-check, Evaluate thoughts, Define goals, Options, and Make a contribution (FREEDOM). Trauma survivors can use these skills to regulate their severe emotional states, manage intrusive trauma memories, promote self-confidence, and accomplish lasting recovery from trauma.

Another trauma model is STAIR, which stands for Skills Training in Affective and Interpersonal Regulation and was created by Dr. Marylene Cloitre, the Clinical Professor (Affiliate) of Psychiatry and Behavioral Sciences at Stanford University School of Medicine. STAIR is an evidence-based cognitive-behavioral therapy model for people dealing with PTSD and complex PTSD and for those with PTSD and comorbid disorders.

STAIR helps adolescents and adults deal with trauma by helping them learn about their symptoms, how to regulate their emotions, and enhance their relational and social capabilities. STAIR has proved to be an effective approach, especially when followed by exposure therapy, and therapists like this model because it provides practical skills in dealing with day-to-day life problems.

Lifestyle Changes

Deibel says that people dealing with CPTSD can make lifestyle changes regarding their self-care. “This includes ensuring adequate sleep, proper nutrition, consistent exercise, connection with a healthy support system, attending therapy, and staying away from mood-altering substances, to name a few.”

Medication

Only sertraline and paroxetine, both antidepressants, are currently approved by the Food and Drug Administration (FDA) to be used for PTSD. However, certain medications can be prescribed for certain symptoms of CPTSD, such as if an individual has problems sleeping or is experiencing anxiety.

Confront and Deal with Trauma Through Therapy

If you or a loved one appears to be experiencing any of the symptoms detailed above or has endured any of the aforementioned types of trauma, it might be time to find a therapist. Even if you think you don’t have CPTSD, you may be dealing with one of its common comorbidities, such as depression, anxiety, or ADHD.

Putting your trust in one of our Grow Therapy providers will give you the best possible chance of managing whatever you’re going through while also learning strategies to help you deal with your daily life and develop a healthier sense of self.

FAQs

  • According to Melissa Galica, a Grow Therapy licensed professional counselor (LPC), childhood abuse and neglect can cause CPTSD.

  • “CPTSD can significantly impact daily functioning by causing emotional dysregulation, dissociation, negative self-perception, difficulty with relationships, and problems with concentration, motivation, and maintaining employment,” shares Melissa Galica, a Grow Therapy licensed professional counselor (LPC). “Those with CPTSD may feel constantly on edge.”

  • “CPTSD is a chronic issue and can cause symptoms at any stage of one’s life. That doesn’t mean the symptoms cannot be managed, though,” explains Alan Deibel, a Grow Therapy licensed clinical professional counselor (LCPC). “Many individuals successfully gain coping strategies and insights through therapy and can live a life not impacted by their traumatic past.”

About the author
Grow Therapy therapist Gregorio (Greg) Lozano III LPC Greg Lozano

Greg Lozano is a licensed professional counselor who specializes in working with individuals with severe mental illnesses such as depressive, bipolar, schizophrenia, and substance abuse conditions.

This article is not meant to be a replacement for medical advice. We recommend speaking with a therapist for personalized information about your mental health. If you don’t currently have a therapist, we can connect you with one who can offer support and address any questions or concerns. If you or your child is experiencing a medical emergency, is considering harming themselves or others, or is otherwise in imminent danger, you should dial 9-1-1 and/or go to the nearest emergency room.

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