January 11, 2021

Complex PTSD: Causes, Symptoms, and Treatments

Written by Sara Lane

Posted in Trauma, Grief & Loss and with tags: PTSD/Trauma, mental health

Complex PTSD asian woman looking sad out window

But did you also know there is something called Complex PTSD?

In any given year, the National Center for PTSD reports that around 5.2 million Americans have Post Traumatic Stress Disorder (PTSD), which equates to nearly 2 percent of the country’s population. That’s a huge number.

But did you also know there is something called Complex PTSD? They are often confused as they are very similar.

Within the last 10 years, the World Health Organization recently amended the 11th International Classification of Diseases (ICD-11) to include Complex PTSD as a sub-type of Post-Traumatic Stress Disorder that you may be familiar with.

C-PTSD is not as well known, but it is just as impactful as the very well-known PTSD. Post Traumatic Stress Disorder is paired with a sudden onset.

The average person’s experience with trauma was likely not very long-lasting. Any incident can have many effects on a person’s psyche, even if the accident was short-lived.

What you experience after outliving the initial traumatic event when you have PTSD.

As the name suggests, Complex Post Traumatic Stress Disorder is just that: complex. There is a longer period of trauma that the individual endured, which creates a more comprehensive diagnosis, treatment, and recovery process.

what is PTSD trauma and trauma treatment white woman laying on couch

PTSD and C-PTSD: The difference

Typically, PTSD is related to a single experience, like an assault or car accident.

But what about people who experienced prolonged childhood trauma, repeated abuse by family members or a spouse, were victims of human trafficking, or had other long-term traumatic experiences?

This is the kind of trauma associated with Complex PTSD, which considers the complicated and serious psychological issues that come with extended exposure to trauma that is not generally treated effectively by standard PTSD therapy.

Because Complex PTSD does meet so many of the diagnostic criteria for PTSD, it is frequently misdiagnosed as PTSD. You may see the acronym DESNOS come up if you do further research on Complex PTSD on your own.

To create awareness of the severity of chronic exposure to trauma, some medical professionals have proposed other names for the disorder, such as Disorders of Extreme Stress Not Otherwise Specified (DESNOS) or Developmental Trauma Disorder (DTD) which specifically refers to chronic trauma experienced by children and adolescents.

person in yellow rain jacket sitting on dock looking at lake and mountains C-PTSD trauma

What is Complex PTSD?

The most fundamental distinction between PTSD and C-PTSD relates to the duration and frequency of the trauma endured. PTSD is a response to a singular traumatic event. These events can range widely — from a natural disaster to physical assault and beyond.

C-PTSD is a response to an ongoing trauma, something that relentlessly takes place over an extended period of time. A common example relates to serial physical, sexual, or emotional abuse — or any combination of the three forms.

Symptoms of C-PTSD are quite broad but often include:

  • Flashbacks and nightmares
  • Physical symptoms when recalling the trauma
  • Sleep issues
  • Hyper-vigilance
  • Easily startled
  • Negative self-image
  • Avoidance
  • Problems with emotional regulation
  • Dissociation
  • Preoccupation with the abuse and/or the abuser

What causes PTSD without the C?

One of the primary specialties of multiple therapists in our practice is trauma. Post-traumatic stress is one response to trauma.

If you’re experiencing flashbacks, nightmares, or intrusive memories of the trauma, you may be suffering from post-traumatic stress disorder (PTSD).

The experience or witnessing of an intense event or situation, is typically short-lived or time-limited.  

When we experience a particularly threatening situation or loss, especially when feeling helpless or unsafe, the experience can become “frozen” in our brain.

Along with the memory are the negative feelings, thoughts, and sensations associated with that experience.

Over time, if you think of the experience again, all the negative thoughts, feelings, and sensations can flood back. The experience is not yet fully processed.

For example, when reminded of the experience, you might notice that you feel anxious, your heart starts racing, your breathing increases and becomes shallow, you feel like withdrawing or avoiding the situation. You may have intrusive thoughts about the experience.

These symptoms can be quite disturbing and could indicate Post-Traumatic Stress Disorder or PTSD.

black woman thinking about C-PTSD trauma and trauma therapy

Causes of Complex PTSD 

When the threatening event or experience is severe and prolonged over time, it can lead to what is referred to as Complex PTSD. This type of PTSD often stems from repetitive trauma such as childhood abuse or neglect, domestic violence, or living in a war zone.

Complex PTSD symptoms are very similar to those of PTSD, but they also include a strong impact on one’s view of the world as unsafe and self-concept.

Children who experience prolonged abuse are particularly vulnerable to the effects of trauma as their brain and nervous system is still developing, including their beliefs about themselves and the world.

Since children are dependent on adults in the world, it can be easier for them to make themselves “bad” and at fault for what is happening to them. This can lead to the long-term belief that the self is shameful, unworthy, or not belonging.

Causes of C-PTSD include:

  • Prisoner of War camps
  • Domestic Violence
  • Prolonged physical/sexual abuse as a child
  • Long-term emotional abuse (as an adult or as a child)
  • Organized sex trafficking rings
  • Brothels
  • Being “pimped out” by a partner
  • Abuse of domestic laborers
  • Long-term care for a mentally ill family member

As this list makes painfully evident, one of the most important aspects of Complex PTSD is being trapped in a situation. Sometimes, as in an abusive relationship, captivity may be more emotional than physical, but that does not make it less real or less traumatic.

Symptoms of Complex PTSD

Trauma, to say the least, is complicated. It can affect so many different parts of your life and mind that it can be difficult to disguise the source of the problem.

These are generally reported symptoms, so if you feel that you may be suffering from C-PTSD, but can not identify exact symptoms, please reach out.

The symptoms of C-PTSD include:

  • Difficulty regulating emotions. The sufferer does not experience consistent or logical emotions and has difficulty regulating them and their expression. This may result in persistent “low” feelings, suicidal tendencies, or explosive anger.


  • Issues with trusting others. You may tend to distrust others and be prone to isolation. You may be feeling detached. There may be dissociative symptoms, including a blurred sense of reality with an altered sense of time and place, among other symptoms.


  • Engaging in unhealthy behaviors. Survivors may engage in forms of self-harm as a means of attempting to take back control of their bodies. They may abuse substances for the numbing effect on their pain or temporarily forget about the past and relieve anxiety. They are also more likely to struggle with co-morbid symptoms, such as substance abuse, eating disorders, obsessive-compulsive disorder, borderline personality disorder, or depressive disorders. Additionally, they are more likely to struggle with medical/physical issues.


  • Difficulty having relationships. This may manifest itself in different ways. For example, someone who experiences may Complex PTSD may be very distrustful and isolate herself. Another sufferer may be fixated on searching for a “rescuer” or worse, a relationship with someone who is controlling -a maladaptive coping mechanism that prevents the individual from being in control of his or her own life.


  • Feelings of guilt or shame. This distorted self-perception causes individuals to think of themselves as totally different from “normal” people. They may blame themselves for their abuse or their Complex PTSD symptoms. Chronic migraines are another physical symptom.

Need help? Read about how to Recover From Trauma.

hands holding brain symbol for mental health in hands how to treat Complex or C-PTSD

How to treat C-PTSD? The 3 Phases

Complex PTSD can take longer to treat than PTSD. Effective treatments that we use for PTSD and C-PTSD include:

  • Eye Movement Desensitization and Reprocessing (EMDR). EMDR has been shown to lead to positive outcomes quicker than traditional talk therapy.
  • Somatic Experiencing (SE). SE is a body-oriented approach to trauma treatment that addresses the biological and physical response to trauma as well as the psychological.
  • Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) and Dialectical Behavioral Therapy (DBT).
  • Medications can also help decrease symptoms of C-PTSD.

The three phases are necessary to tackle every element of a person’s trauma. During each phase, the goal is different and facilitates healing on many different levels.

The phases work comprehensively to reestablish safety, allow for mourning, and then reconnect with loved ones, work, and community life.

three phases of treatment for C-PTSD phase 1 is education on the effects of trauma at therapist appointment

Phase 1 

The counselor will introduce psycho-education about the effects of trauma and, particularly, a sustained, early life or cumulative nature related to the individual’s development, life course, worldview, relationships, and symptoms.

Interventions in this phase should be evidence-based and matched to individual patient needs, emphasizing emotion regulation skills, stress management, social and relational skills building, and cognitive restructuring.

Meditation and mindfulness interventions are strong secondary interventions, meaning that they are important and useful interventions but not by themselves sufficient.

In Phase 1, the therapeutic relationship is important in developing emotional and social skills through the expression of support, validation, encouragement, and in the role modeling of a healthy relationship(ISTSS Expert Consensus Guidelines for Complex PTSD November 2012 9).

The preferred format for phase 1 treatment is individual therapy but (therapist-led) group therapy is an appropriate alternative.

C-PTSD treatment phase 2 asian woman pensive thinking about past traumas how to overcome trauma

Phase 2 

Focuses directly on the review and reappraisal of trauma memories. The process involves some form of a review or re-experiencing of the events of the trauma (e.g., through narration) in the context of an actual and subjectively experienced safe environment.

The therapeutic benefit of the process arises from the patient’s capacity to maintain emotional engagement with the distressing memories while simultaneously remaining physically, emotionally, and psychologically intact.

The therapist’s presence, encouragement, guidance, and feedback support the patient in maintaining a sense of safety and continued exploration of the memory.

The experience of safety and the attendant availability of attentional, cognitive, and emotional resources provide the therapeutic circumstances in which reappraisal of the meaning of the traumatic experiences can be conducted.

Its purpose is to facilitate the reorganization and integration of the traumas into autobiographical memory in a way that yields a more positive, compassionate, coherent, and continuous sense of self and relatedness to others. Individual therapy (including in conjunction with group therapy) is recommended for this treatment phase.

Does your spouse suffer from PTSD? Read more on how to cope.

black woman re-integrating into society following trauma treatment with white friend smiling talking trauma treatment

Phase 3

This marks the transition out of therapy to greater engagement in community life.

Towards the end of the treatment, the therapist and patient consolidate the gains in emotional, social, and relational competencies.

The therapist supports and guides the individual in applying skills to strengthen safe and supportive social networks.  They work to build and enhance intimate and family relationships.

Plans for education, employment, recreation, and social activities or meaningful hobbies should be considered and organized.

Phase 3 planning also includes the proposed use of “booster” sessions to refresh skills or address a life challenge. As well as an articulation of relapse prevention interventions and identifying alternative mental health resources.

Phase 3 is essentially a plan for follow-up care, a part of treatment that is routine for other psychiatric disorders associated with significant personal and social resource loss but may be overlooked in the treatment of Complex PTSD.

Getting Treatment for Your Complex PTSD

The healing steps toward complex post-traumatic stress disorder recovery can be varied and many. Complex post-traumatic stress disorder (C-PTSD) is an increasingly common psychological disorder. Often, treatment for complex PTSD may involve cognitive behavioral therapy (CBT), group therapy, and other forms of therapy, including:

These are just a few examples. However, more and more, eye movement desensitization and reprocessing therapy (or EMDR) has shown to be a productive and successful choice for anyone in this situation.

For survivors of chronic trauma, special attention is paid to issues of power and control.

Therapy also works to help normalize their ability to have relationships. Then they feel safe and connected during everyday life and in their interactions with others.

Experiencing trauma is hard enough, but the lasting effects can stay with you for a long time. Finding help is a fundamental step toward complete healing.

Your trauma does not define you. It does not need to limit your potential. Though, it will try to limit your relationships and diminish your quality of life.

What is EMDR?

If you experience a physical wound, it won’t heal if it is regularly re-injured. EMDR is a form of psychotherapy that works on a similar truth. The idea is to “block” the haunting memories so that your brain has time to heal from the initial damage. While other forms of recovery rely on talk therapy or medication, EMDR is based on the patient’s own rapid, rhythmic eye movements.

Research shows that such eye movements can reduce the impact of emotionally-charged memories.

During a session, you will follow the therapist’s moving hands with your eyes. You will be asked to recall both a traumatic event and the feelings that the event provokes. The patient continues to focus on the external stimulus (the moving finger) while discussing any new thoughts they have about their trauma. This cycle is repeated until the patient’s reported level of distress has decreased enough to include some new and positive information.

white woman and her daughter meeting with trauma therapist

How EMDR Can Aid Complex Post-Traumatic Stress Disorder Recovery

While more work has to be done to directly identify the mechanisms of EMDR, it is believed to build new connections in your memory. These connections link the trauma-related memories with the positive, new information created during the session.

Over time, the positive information takes hold. This allows it to have a stronger influence on your perceptions and behaviors than trauma-related thinking. Traumatic events create memories that often go unprocessed. The dual focus of an EMDR session facilitates processing and thus, healing.

Besides such groundbreaking and proven effects, EMDR for complex post-traumatic stress disorder recovery is also:

  • Cost-effective
  • Non-invasive
  • Short-term

Treatment can involve as few as 6 to 12 sessions that run from 60 to 90 minutes. These sessions can take place once or twice a week.

Where Can You Learn More?

If you or someone you know has been diagnosed with Complex PTSD, it can feel daunting to figure out where and how to start. It’s essential to get yourself a qualified guide.

Reach out to an experienced therapist to talk about something as unusual as EMDR. Your complex post-traumatic stress disorder recovery is not a path to tread alone. At Eddins Counseling Group, in Houston, TX, we have counselors with extensive experience in EMDR and trauma therapy. With the support of a skilled EMDR counselor, you have the support you need to work towards healing.

Holly Lark Eddins Counseling Group offers trauma therapists what is C-PTSD trauma and how to treat it

Next Steps

Here at Eddins Counseling Group, we have specialists to help you work through your trauma, all of it.  No matter how intense it may feel, we can see you through it. We can help lessen the effects of Complex Post Traumatic Stress Disorder, improve your quality of life, and let the healing begin.

If you’d like more information on getting treatment for complex PTSD, give us a call at 832-559-2622 or click here to schedule an appointment.

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