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Written by:Cynthia V. Catchings, LCSW-S

Published On: February 24, 2022

Medically reviewed by: Meaghan Rice, PsyD., LPC

Reviewed On: February 24, 2022

Updated On: July 14, 2023


Post traumatic stress disorder (PTSD) is a psychiatric condition caused by a traumatic event or experience. Usually, people with this condition are either diagnosed with PTSD acute or chronic. But there are some that are more specific, such as relationship PTSD. Complex post-traumatic stress disorder (C-PTSD) is a type of PTSD caused by repeated trauma.

While PTSD and C-PTSD share many symptoms, these conditions differ in several ways. As you continue reading, you’ll find the answers to questions like what is complex PTSD and learn more about its causes.

What Is C-PTSD?

Complex PTSD is a response to prolonged trauma or traumatic events. The term was first introduced by Julia Lewis Herman, a researcher and psychiatrist, in her 1992 book Trauma and Recovery. Although this type of traumatization often occurs during childhood, it can also happen in adulthood.

How does it differ from PTSD?

What causes complex PTSD, and what makes it different from PTSD?

“Although both PTSD and C-PTSD result from traumatic events, the main difference is that C-PTSD is caused by long-lasting trauma that’s been experienced for months or years. C-PTSD is more severe and can cause more suffering and harm, making it more challenging for the individual to heal.”

Licensed Clinical Social Worker-Supervisor (LCSW-S), CIMHP, EMDR Cynthia Catchings

People with C-PTSD experience PTSD symptoms but also struggle with other symptoms that aren’t associated with PTSD. It’s common for people with C-PTSD to also have attachment trauma, making it difficult for them to form deep, meaningful relationships with others. Since complex PTSD results from ongoing, long-term trauma, it’s typically more severe than PTSD. 

Symptoms of C-PTSD

It’s easier to answer questions like what is C-PTSD when you look at its symptoms. People with complex PTSD show core symptoms of PTSD, but they can display additional signs as well, such as:

  • Negative self-image: Low-self esteem is common. Someone with this condition may struggle with guilt and shame or feel like they’re completely worthless.
  • Emotional regulation issues: C-PTSD can make it difficult for people to manage their emotions. Sudden, intense outbursts of sadness or anger are common.
  • Dissociative symptoms: People with C-PTSD often feel disconnected from their feelings or the traumatic event they’ve experienced. They may struggle to remember traumatic events.
  • Relationship difficulties: It’s common for people with C-PTSD to isolate themselves. When forming relationships, they may struggle to trust or feel safe around others.
  • Feelings of emptiness: C-PTSD can cause people to feel numb or disconnected from others. They may feel hopeless or unmotivated to pursue goals.
  • Physical symptoms: Many people with C-PTSD experience somatization, when someone has physical symptoms in response to mental distress. Symptoms may include dizziness, headaches, and chest pains.

Causes of C-PTSD

Any form of trauma can be damaging, but do we fully understand what actually causes complex PTSD?

We know that C-PTSD is caused by prolonged trauma and typically develops in situations where the victim can’t escape or has very little control over what’s happening to them. Events that could lead to C-PTSD include:

Childhood abuse and neglect

Children depend on their caregivers, but children who grow up abused, neglected, or mistreated don’t have a sense of safety or stability. It can be difficult for them to understand what’s happening to them or do anything to stop it. Studies show that childhood trauma can also significantly affect brain development.

Domestic violence

Physical or sexual violence from an intimate partner can contribute to someone developing C PTSD symptoms. Many adults in abusive relationships don’t have the resources to leave or fear that leaving their partner will cause the domestic violence to escalate. One study found that C-PTSD was twice as common as PTSD in survivors of intimate partner violence.

Human trafficking

Human trafficking involves fraud, coercion, or force to transport and trap people. Victims of human trafficking can be forced into involuntary servitude or commercial sex work. Reports indicate that approximately 41% of human trafficking survivors develop complex PTSD.

Severe bullying

Bullying occurs when someone intentionally and repeatedly causes discomfort, physical or emotional harm to another person. While bullying can happen anywhere, it often occurs in schools or the workplace, making victims feel like there’s no way to escape their bullying. Long-term, severe bullying can cause C-PTSD.

“C-PTSD can be caused by long-term repeated trauma and is typically a result of negative childhood experiences. These may include abuse, neglect, abandonment, family violence, or human trafficking.”

Licensed Clinical Social Worker-Supervisor (LCSW-S), CIMHP, EMDR Cynthia Catchings

How to Diagnose C-PTSD

The term “complex post-traumatic stress disorder” has been used for decades. Yet, it’s still not currently recognized as a diagnosis by the American Psychiatric Association (APA) or in the DSM-5. However, it does appear in the current version of the International Classification of Diseases (ICD-11).

According to the ICD-11, people can be diagnosed with C-PTSD when they meet the diagnostic criteria for PTSD and show disturbances in self-organization (DSO). Emotional regulation issues, negative self-image, and difficulties in interpersonal relationships are all examples of DSO.

C-PTSD Treatment

When exploring complex PTSD, it’s important to look at how it’s typically treated. Since C-PTSD symptoms can be so severe, experts often recommend multiple interventions.

Treatment for C-PTSD may include:


Antidepressants can affect emotional processing and potentially reduce the severity of symptoms associated with C-PTSD. In cases where C-PTSD co-occurs with another mental health condition, some types of medication can be used to manage the symptoms of both conditions.

Trauma Therapy

Therapy for PTSD can help people with C-PTSD work through their long term trauma and build a strong sense of self. Cognitive behavioral therapy, or CBT for PTSD can make people find and change negative thought patterns related to their trauma. Forming a bond with a therapist can also help people with C-PTSD learn to trust others.

“Talking to a mental health professional can help you understand your emotions and learn to work with your thoughts and feelings. C-PTSD is complex, but with the right help and tools, you can overcome the negative feelings and reduce the symptoms to live a happier life.”

Licensed Clinical Social Worker-Supervisor (LCSW-S), CIMHP, EMDR Cynthia Catchings

Coping tips

C-PTSD often requires long-term treatment, which is why finding ways to manage your symptoms can be so necessary. For example, grounding techniques for PTSD can help you regain calm and feel connected with the world. Mindfulness can also make you more aware of your feelings so you can focus on the present.

In addition to these coping strategies, you should work to build a support system. It can be hard to connect with others when you have C-PTSD, but a social network can provide invaluable support.

Get Professional Support for C-PTSD with Talkspace

While most people are familiar with PTSD, many are unaware of complex PTSD and its symptoms. At Talkspace, a therapist can help you explore the roots of your condition and how to cope. Recovering from prolonged trauma isn’t easy, but with the help of a therapist, you will be able to start healing. 

See References

Cynthia V. Catchings, LCSW-S

Cynthia Catchings is a trilingual licensed clinical social worker-supervisor, mental health consultant, professor, and trainer for federal law enforcement agencies. Cynthia has over 15 years of experience in the mental health profession. She is passionate about women’s mental health, life transitions, and stress management. Her clinical work, advocacy, and volunteer service have focused on working with domestic violence survivors and conducting mental health research in over 30 countries.

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