22nd Dec 2022
Complex post-traumatic stress disorder, often shortened to complex PTSD, CPTSD or c-PTSD, is a mental health condition that can develop after exposure to prolonged or repeated trauma. People with complex PTSD experience a wide range of symptoms including flashbacks, intrusive thoughts, difficulty controlling emotions and dissociative symptoms. Different forms of therapy may be effective for CPTSD, while medication can be prescribed for associated symptoms such as depression or sleep problems.
Complex post-traumatic stress disorder (CPTSD) affects people who have been exposed to repeated or long-term trauma, often in childhood. It can develop in people who grew up around violence, for example, or later in life if someone is subjected to domestic violence or other forms of sustained physical abuse.
It shares many symptoms with post-traumatic stress disorder (PTSD), which can develop after a single traumatic event such as a natural disaster or sexual abuse, but is a different diagnosis. Complex PTSD is, as the name, suggests, more complicated with a greater range of symptoms that can take longer to treat.
Complex PTSD comprises core symptoms of PTSD plus additional symptoms.
PTSD symptoms are defined as follows:
In addition to the above, someone with complex PTSD will experience:
PTSD was introduced as a formal diagnosis in the 1980s, and professionals have only started to view complex PTSD as a separate condition more recently. Complex PTSD is not yet listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), used by mental health professionals in the US to diagnose mental health problems. The International Classification of Diseases, the other main diagnostic manual, produced by the World Health Organization, has included complex PTSD in its latest version.
As a result, getting a diagnosis of complex PTSD might not be straightforward. Some doctors and mental health professionals are unaware of complex PTSD, or may use other terms for it, such as:
Many CPTSD symptoms are also associated with borderline personality disorder, and there is some debate among professionals about whether complex PTSD could more accurately be defined as PTSD combined with borderline personality disorder.
As understanding of complex PTSD is still growing, some people are being diagnosed with borderline personality disorder when they may instead have complex PTSD.
Misdiagnosis can be challenging. Feeling wrongly diagnosed can be difficult to cope with, while misdiagnosis can also set you on the wrong treatment path. If you feel you have been misdiagnosed, it’s important to discuss this with your doctor or a mental health professional.
Complex PTSD is caused by repeated exposure to traumatic experiences. This often happens in childhood, to children growing up in violent or neglectful households, who have been abandoned or who are subjected to repeated abuse. Later in life, complex PTSD may develop in prisoners of war, or people who are tortured, kidnapped or made slaves. It can also result from ongoing domestic abuse.
As understanding of complex PTSD continues to grow, treatment options are still being explored. People with complex PTSD will typically be offered treatments known to work for PTSD, such as therapy.
Complex PTSD is likely to require longer and more intensive treatment than PTSD.
Medication is not usually prescribed for complex PTSD. Medication may however be prescribed to help with associated symptoms such as depression or sleep problems.
Therapies for PTSD, which may also be helpful for complex PTSD, include:
Living with someone with any mental illness can be challenging. If you are close to someone with complex PTSD you may struggle to understand what they are thinking and how they are feeling. You may witness symptoms such as flashbacks and nightmares and find yourself on the receiving end of very strong emotional outbursts.
There are many things you can do to support your loved one:
Flashbacks are moments where it feels as if a person is reliving a traumatic event. A flashback feels very real, as though it is happening all over again. Someone having a flashback might see images of a traumatic event in their mind. They might be triggered by particular situations or places, or particular noises, smells or flavors. They can be very distressing and recreate the fear and other emotions experienced at the time.
The ‘emotional flashbacks’ associated with complex PTSD are different. Instead of seeing an image of and reliving something that happened, an emotional flashback is a recreation of the emotional state the person was in at the time of the original trauma. For example, a disagreement with a partner or friend might trigger intense feelings of fear, shame and anger rooted in abuse. This can result in very strong reactions to everyday difficulties that are impossible to control and difficult to recover from.
Someone with complex PTSD may have both flashbacks and ‘emotional flashbacks’. While flashbacks are visually- and sensory-oriented, emotional flashbacks lack this aspect.
Complex PTSD and borderline personality disorder have a lot of similar symptoms. Including intense emotions, difficulty maintaining relationships and feelings of worthlessness. There are some key differences, however. Someone with complex PTSD will have a relatively stable – albeit negative – view of themselves, whereas someone with borderline personality disorder tends to switch between thinking quite positively of themselves to suddenly feeling very negative.
A similar difference plays out in relationships. Whereas someone with complex PTSD will avoid friendships and relationships when they are struggling with their mental health, someone with borderline personality disorder can change quickly from engaging with and idealizing the people in their lives to feeling very unsafe in those relationships.
Complex PTSD can take a long time and a lot of work to treat. With the right support and self-care, however, recovery is possible.