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What to Know About Complex PTSD and Its Symptoms

Medically Reviewed by Dan Brennan, MD on April 12, 2021

You may have heard of post-traumatic stress syndrome or PTSD, but you may not be familiar with complex PTSD, sometimes known as c-PTSD. Complex PTSD is caused by prolonged or chronic trauma. Those with complex PTSD usually have at least some of the symptoms of PTSD, but they could also have other symptoms. 

Most people experience at least one traumatic event during their lives, and about a fourth go on to develop PTSD. No one knows how many people have complex PTSD. 

Symptoms of PTSD

‌People who experience trauma may feel its effects for days. If the symptoms last weeks or longer, and if they disrupt your life, you may have PTSD. See a trained mental health professional if you're worried that you might have PTSD.

Symptoms of PTSD usually fall into three categories.

Re-experiencing symptoms. Flashbacks and nightmares are probably the best-known PTSD symptoms. Memories of the trauma may trigger powerful emotions. The person may relive the sights, smells, and sounds of the traumatic event.

Sense-of-threat symptoms. Those with PTSD often feel that they must be on their guard. They may be hypervigilant (over aware of their surroundings), jumpy, and easily startled.  

Avoidance symptoms. Those with PTSD spend a lot of energy avoiding triggers — people, places, or situations that remind them of the trauma they experienced. They may self-medicate with drugs or alcohol.

What Is Complex PTSD?

Besides the symptoms of PTSD, those with complex PTSD may also have other symptoms.

Problems with self-esteem. Those with complex PTSD may feel worthless or blame themselves for their trauma. They may believe bad things happen because of something in them. 

Emotional dysfunction. Those with complex PTSD often experience intense emotions, which are sometimes inappropriate. Besides anger and sadness, they may feel like they're living in a dream. They may have trouble feeling happy.

Relationship problems. Complex PTSD can make it difficult to trust others. Some people stay in unhealthy relationships because the situation is familiar. If their trauma involved abuse, their feelings about their abuser may be complicated. Or they may obsess about their abuser or focus on revenge.

Risk Factors for Complex PTSD

Originally used to describe the results of childhood trauma, complex PTSD now includes other kinds of chronic trauma. 

  • Childhood abuse or neglect
  • Long-standing domestic violence
  • Trafficked or forced into sex work
  • Kidnapped, enslaved, or tortured
  • Incarcerated in a prisoner of war camp 
  • Witnesses to repeated acts of violence

There are also additional risk factors for complex PTSD. 

  • Multiple traumas
  • Trauma from an early age
  • Long-term trauma
  • Abuse by a close family member or friend
  • Not having a hope for change when trapped

Conditions Similar to Complex PTSD

A Harvard researcher coined the term "complex PTSD" in 1988. Mental health professionals today may use other terms.

Enduring Personality Changes After Catastrophic Events (EPCACE). To have a diagnosis of EPCACE, the person needs to have a personality change that lasts for 2 years after trauma. EPCACE is no longer recognized by the World Health Organization, which uses complex PTSD instead. Some mental health professionals prefer EPCACE and still use it.

Disorders of Extreme Stress Not Otherwise Specified (DESNOS). This term sometimes is used to mean the same thing as complex PTSD, especially in the United States. The risk factors and symptoms are very similar. 

Borderline Personality Disorder (BPD). The symptoms of complex PTSD and BPD are similar, but BPD does not require a history of trauma. Some researchers believe that genetics or brain function could be at the root of BPD. Some authorities consider complex PTSD a subtype of BPD, but others believe they're two separate conditions. 

Treatment for Complex PTSD

Because complex PTSD is a relatively new diagnosis, mental health professionals are still working on treatment options. There are still some options that may help.

  • Talk therapy to help process the trauma
  • Medication such as antidepressants and anti-anxiety medications
  • Exposure therapy in which subjects face their memories in a safe space
  • Cognitive Behavior Therapy (CBT), which addresses thought patterns 

Some therapists use a relatively new therapy called eye movement desensitization and reprocessing (EMDR). It may be helpful for complex PTSD too. In EMDR, the subject remembers a trauma while following a bilateral stimulus (one that switches from one side of the body to the other) that leads to a back-and-forth eye movement. The stimulus could be one they see such as a finger moving back and forth or a sound. EMDR is effective for PTSD, but experts debate if the bilateral stimulation is really important or if the process could happen without it.

WebMD Medical Reference

Sources

SOURCES:

Borderline Personality Disorder and Emotion Dysregulation: "Development of the new CPTSD diagnosis for ICD-11." 

Directions in Psychiatry: "Complex Trauma and Disorders of Extreme Stress (DESNOS) Diagnosis, Part One: Assessment."

The Lancet: "Preserve Enduring Personality Change After Catastrophic Experience (EPCACE) as a diagnostic resource." 

Mind: "Complex post-traumatic stress disorder (complex PTSD)."

Mohawk Valley Health System: "What is Complex Post-Traumatic Stress Disorder?"

National Alliance on Mental Illness: "Borderline Personality Disorder."

NHS Inform: "PTSD and CPTSD self-help guide." 

U.S. Department of Veterans Affairs: "Complex PTSD," "Eye Movement Desensitization and Reprocessing (EMDR) for PTSD."

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