Complex PTSD is a disorder resulting from exposure to long-term trauma. Learn more about the symptoms and causes of C-PTSD.

Complex post-traumatic stress disorder (C-PTSD) is a condition that can develop after exposure to repeated traumatic events. C-PTSD has many similarities to post-traumatic stress disorder (PTSD). However, complex PTSD has additional symptoms suggesting a deeper level of psychological damage. Complex PTSD is a new condition that is still being clarified by researchers. While complex PTSD is associated with deep pain, treatment can help with coping skills and emotional healing.

What Is C-PTSD?

Complex PTSD is a collection of symptoms resulting from the endurance of trauma repeated over months or years. This prolonged trauma increases the chance that a person will be deeply affected. The symptoms that come from this kind of experience reflect a loss of hope and personal control. A person who develops complex PTSD is typically a survivor of domestic abuse, human trafficking or long-term sexual abuse. These individuals may feel like they will never break out of their situation, and the deep pain from these experiences can cause lasting psychological harm.


PTSD and complex PTSD are disorders that can develop after a person experiences trauma. Both disorders include symptoms of avoidance and re-experiencing of the trauma. Most people exposed to trauma can recover over time with support. However, a person with either PTSD or complex PTSD will show worsening symptoms without treatment.

The key difference between C-PTSD vs. PTSD is the length of time a person experiences trauma. Complex PTSD comes from more extreme long-term trauma, creating additional long-lasting symptoms. These symptoms reflect a loss of hope and a breakdown of emotional management skills.

Symptoms of C-PTSD

Because of the overlap between the two disorders, PTSD and C-PTSD share several symptoms, including:

  • Unwanted, intrusive memories of the event throughout the day
  • Recurrent nightmares about the event
  • Avoidance of thoughts, feelings or conversations connected to the trauma
  • Avoidance of activities, places or people connected to the trauma
  • Constant state of being hyperalert
  • Strong startle reactions

Complex PTSD symptoms show the damaging effects of long-term and recurrent trauma, such as:

  • Poor emotion regulation resulting in anger outbursts, persistent sadness or emptiness
  • Sensitivity to hurt feelings
  • Negative self-concept and feelings of worthlessness
  • Feelings of guilt
  • Feeling cut off and disconnected from people

C-PTSD Causes

PTSD can occur after experiencing multiple traumas, but it can also develop after a single traumatic incident. This cause differs from C-PTSD, which only emerges as a result of prolonged trauma exposure.

Complex PTSD can result from one of several types of prolonged traumatic situations, including:

  • Repeated sexual abuse by one or more people
  • Living in a war zone
  • Captivity in a human trafficking ring
  • Domestic abuse

After a person has a traumatic experience, they commonly show symptoms like edginess, anxiety and an inability to concentrate. When these types of reactions persist for an extended period after the danger is over, the person may have developed PTSD.

While PTSD is distressing enough, it is the exposure to repeated and long-term trauma that causes complex PTSD. After many months or years of continuous trauma, the individual’s mind and emotions shut down as a form of self-protection from pain and distress.

C-PTSD Risk Factors

Persistent exposure to trauma is a clear risk factor for the development of complex PTSD. Other risk factors can also increase the chances of developing complex PTSD under specific conditions.

A history of anxiety or depression could make it easier for a person to experience long-term distress. When a person lacks supportive relationships, loneliness and loss of hope can more easily set in. Early experiences with abuse or trauma make the brain and body more vulnerable to complex PTSD.

While adults can experience C-PTSD, children who are exposed to repeated trauma are highly vulnerable. According to the National Child Traumatic Stress Network, early repeated trauma interferes with a child’s development and sense of self. Because children are still in the process of developing their coping skills and relationships, C-PTSD can set in more easily. Children can more easily become trapped in an abusive situation and feel powerless to protect themselves.

C-PTSD Diagnosis

The diagnosis of complex PTSD is still being considered and reviewed by mental health experts. C-PTSD is emerging as a disorder that is related to but distinct from PTSD. However, this distinction does not have consensus among experts yet.

Diagnosis can be made with a physical exam to confirm any medical problems. A psychological evaluation is done to gather more details about a person’s history. If a person has been exposed to trauma, it must be long-term and persistent for a diagnosis of complex PTSD to be made.

According to a study in the European Journal of Psychotraumatology, complex PTSD shares many characteristics with borderline personality disorder (BPD) that can make the two disorders difficult to distinguish. A person with BPD has difficulty managing emotions and has unstable and difficult relationships. Exposure to long-term trauma erodes the ability to trust others and overwhelms coping strategies.

Treatment for Complex PTSD

According to the National Center for PTSD, treatments that are effective for PTSD also help people with complex PTSD. These treatment approaches help restore a person’s functioning and relieve symptoms. Most treatments involve some form of talk therapy. Some people may also find antidepressant or anti-anxiety medications helpful.

Common methods of therapy used to treat complex PTSD include:

  • Cognitive Processing Therapy (CPT)Cognitive processing therapy helps a person challenge and modify disruptive beliefs about their trauma.
  • Eye Movement Desensitization and Reprocessing (EMDR)EMDR helps a person’s brain reprocess the trauma by focusing on memories and using bilateral stimulation.
  • Dialectical Behavioral Therapy (DBT)DBT helps a person reduce harmful behavior and learn how to manage emotions. Individuals with complex PTSD struggle with trust in relationships. Because of these difficulties, therapy also aims to restore personal power and improve relationships.

If you or someone you care about is struggling with complex PTSD and co-occurring addiction, help is available. With centers across the country, our staff has the specialized training to treat complex PTSD. Reach out to a representative from The Recovery Village today to learn more.

Related Topics:
PTSD self treatment
Is there a cure for PTSD

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Editor – Megan Hull
Megan Hull is a content specialist who edits, writes and ideates content to help people find recovery. Read more
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Medically Reviewed By – Erika Krull, LMHP
Erika Krull has a master’s degree in mental health counseling and has been a freelance writer since 2006. Read more
Sources “Does Dialectical Behavioral Therapy (DBT) Actually Change the Way the Brain Works?” Accessed May 22, 2019. “Cognitive Processing Therapy.” July 31, 2017. Accessed May 22, 2019. “Eye Movement Desensitization and Reprocessing Therapy.” July 31, 2017. Accessed May 22, 2019.

Cloitre, M., Garvert, D. W., Weiss, B., Carlson, E. B., & Bryant, R. A. Distinguishing PTSD, Complex PTSD, and B[…]atent class analysis. European journal of psychotraumatology, September 15, 2014. Accessed May 19, 2019.

Cloitre, M., Garvert, D. W., Weiss, B., Carlson, E. B., & Bryant, R. A. “Distinguishing PTSD, Complex PTSD, and B[…]atent class analysis.” European journal of psychotraumatology, September 15, 2014. Accessed May 22, 2019. “Complex Trauma.” Accessed May 22, 2019.

Medical Disclaimer

The Recovery Village aims to improve the quality of life for people struggling with substance use or mental health disorder with fact-based content about the nature of behavioral health conditions, treatment options and their related outcomes. We publish material that is researched, cited, edited and reviewed by licensed medical professionals. The information we provide is not intended to be a substitute for professional medical advice, diagnosis or treatment. It should not be used in place of the advice of your physician or other qualified healthcare providers.