What is Complex PTSD?

Complex Post-Traumatic Stress Disorder (C-PTSD) is a psychological experience that typically arises after prolonged, repeated exposure to a traumatic experience or environment. Our brains tend to process events as traumatic when they trigger feelings of isolation or powerlessness. One may experience C-PTSD due to prolonged abuse or neglect, ongoing exposure to war, frequent community violence, or any other experience that leads to the individual feeling trapped and helpless.


How is C-PTSD different from PTSD?

According to the Cleveland Clinic, the primary difference between C-PTSD and PTSD is the length of time that an individual spends exposed to the source of their trauma. Short-term events, such as natural disasters or car accidents, would result in PTSD. This is not to say that those traumatic events do not have long-term consequences that impact the individual (i.e. potential injuries, economic struggles caused by the event, etc.); however, the person impacted is not forced to live within that traumatic moment on a long-term scale.


In contrast, experiences of ongoing abuse would result in C-PTSD, because that scenario forces someone to feel trapped in ongoing, potentially unpredictable, circumstances. A similar feeling of helplessness amid prolonged trauma could arise due to the trauma of seeking refuge from one’s country of origin, which may also result in C-PTSD. Any experience that leaves someone feeling alone and out of control of their own life, day in and day out, for a significant period of time can cause them to develop C-PTSD.


There is a large debate in the psychological field about whether PTSD and C-PTSD should result in different diagnoses. Currently, both experiences would result in a diagnosis of PTSD. At the same time, there is considerable value in understanding the nuances around the impacts of chronic trauma.


Struggling with Sleep

Someone who is managing C-PTSD is likely to experience challenges related to their sleeping schedule. Many people who experience trauma suffer from nightmares and flashbacks, which can leave them feeling like they are constantly reliving the pain and anguish they experienced, as though their trauma is occurring in the present moment. As pointed out in a post from the C-PTSD Foundation, sleep trouble for individuals with C-PTSD is often the result of their heightened anxiety.


Anxiety symptoms often appear after a traumatic event. These can include various physical sensations, such as trembling, frequent headaches, frequent stomach pains, heart palpitations, or nausea. Cognitively, this person may also experience challenges related to concentration, difficulty regulating their emotional responses, and an overall sense of fear daily.

Interpersonal challenges

People who struggle with C-PTSD may have a difficult time maintaining long-term friendships or romantic relationships. This may be due to a fear of building trust, which causes them to push people away. It could also be the result of one’s inability to regulate their emotions, which may cause the people in their life to feel hurt. Additionally, the National Center for PTSD says that individuals with C-PTSD may feel like they need to find someone who can save them, which may result in a significant emotional burden placed on an individual’s shoulders.

Avoidance of triggers

Many people with C-PTSD will most likely be aware of the things that trigger them, such as certain settings, people, or even behaviors. Anything that brings them back to that feeling of helplessness can be considered very triggering. This person may not feel equipped to deal with these triggers, which tends to result in an extreme avoidance of that behavior, place, or person.

For example, someone who was abused by a caretaker who struggled with substance abuse may avoid situations that involve drinking or drug use. This happens because they have an association between substance use and their abuser, even if their abuser is not involved in that specific situation. Breaking this association is possible but it involves hard work, which can make this person feel overwhelmed and hopeless.

What Would Therapy Treatment for C-PTSD Include?

Therapeutic treatment for C-PTSD would most likely follow the Cognitive-Behavioral Therapy (CBT) approach. CBT has organized a lot of valuable research to guide treatment for any condition related to anxiety, which includes C-PTSD and PTSD.

Learning About the Body’s Response to Trauma

A core component of CBT often involves the therapist educating the client about their body’s physical response to trauma. This will help the client feel less ashamed when they find themself with heart palpitations after experiencing a trigger. 


The therapist might explain that our physical responses to stress are meant to keep us safe. If you were in front of a Woolly Mammoth, as many of our ancestors were, the heart palpitations would help you escape and find safety. Understanding that our body’s response has a purpose can help us feel less alone. From there, the therapist can teach skills around management of these symptoms.

Exploring Thought Patterns

CBT therapists often help clients redirect or reframe common thoughts as a way to show that they have control over their thoughts. For example, a client and a therapist may work on reframing ideas about drinking. Perhaps the client has an automatic thought that anyone who drinks alcohol will physically harm them; the therapist would help them counter that thought.

Exposure Therapy

Exposure therapy is the most reliable way to help someone work through any form of anxiety. A mental health therapist would help the client find ways to face their fears, often starting with low-stress exposures and working up to higher levels as the client grows more comfortable.

For example, the person who avoids substances may begin treatment by holding an empty, washed wine glass for a few minutes during a therapy session. As the client grew comfortable with that experience, they may advance to watching a documentary about substance abuse during a session, and they would continue to increase exposures until the client felt that they could handle day-to-day exposures appropriately.

Seeking Support

If you’re interested in finding therapy to work through trauma, Trust Mental Health is a wonderful place to start. Our therapists are trained in CBT, and many of them specialize in helping clients process traumatic experiences through the use of empirical evidence and compassionate therapeutic relationships. Contact us today for a free 15 minute consultation..