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Understanding Complex PTSD: Symptoms & Recovery

What C-PTSD is, how it differs from PTSD, and strategies for recovery, including psychotherapy, self-help, social support, and medication.

Written and medically reviewed by Dr. Justin Garber, PsyD and Dr. John Ogrodniczuk, PhD

Posted January 9, 2025. Updated January 13, 2025.

"Unlike PTSD, which can result from a single traumatic event, C-PTSD stems from cumulative experiences of abuse, neglect, or coercion over extended periods of time."

Complex Post-Traumatic Stress Disorder (C-PTSD) is a psychological condition resulting from prolonged and repetitive exposure to trauma, which is often interpersonal in nature. While it shares features with PTSD, C-PTSD is considered to be distinct due to the types of events a person experiences and how symptoms manifest. This article explores what C-PTSD is, how it differs from PTSD, and strategies for recovery.

Defining PTSD

To understand what C-PTSD is, we must first define PTSD. Post-traumatic stress disorder (PTSD) is a psychological disorder that can occur when a person experiences or witnesses a traumatic event or series of events.[1] This includes experiences that are emotionally or physically harmful or life-threatening. Examples include natural disasters, serious accidents, terrorist acts, war/combat, sexual assault, childhood trauma, intimate partner violence, and bullying.

People who suffer from PTSD have intense, disturbing thoughts and feelings related to their experience that last long after the traumatic event has ended. They may relive the event through flashbacks or nightmares; feel sadness, fear, or anger; and feel detached or estranged from other people. People with PTSD might also avoid situations or people that remind them of the traumatic event, and or have strong negative reactions to something as ordinary as a loud noise (think of a war Veteran jumping to the ground when hearing a car backfire).

For a person to be diagnosed with PTSD, symptoms (see below) must last for more than a month following the traumatic event and must cause significant distress or problems in the person’s daily functioning.

Core Symptoms of PTSD include:

  1. Re-experiencing trauma through intrusive memories, flashbacks, or nightmares
  2. Avoidance of reminders associated with the trauma
  3. Hyperarousal and hypervigilance leading to exaggerated startle responses or difficulty concentrating
  4. Alterations in cognition and mood, characterized by an inability to remember important aspects of the traumatic event, negative thoughts and feelings leading to ongoing and distorted beliefs about oneself or others, or about the cause or consequences of the event

What is Complex PTSD?

There is debate about whether C-PTSD is a distinct condition from PTSD. The World Health Organization lists C-PTSD in its 11th revision of the International Classification of Diseases (ICD-11).[2] However, the American Psychiatric Association, which publishes the Diagnostic and Statistical Manual of Mental Disorders (DMS-5), doesn’t recognize C-PTSD as a distinct condition.[1]

Generally speaking, the main differences between PTSD and C-PTSD involve the duration of the trauma experienced and the symptoms. C-PTSD arises from chronic trauma that occurs in situations where escape is difficult or impossible. This type of trauma is often associated with abusive relationships, captivity, or systemic oppression. Unlike PTSD, which can result from a single traumatic event, C-PTSD stems from cumulative experiences of abuse, neglect, or coercion over extended periods of time. [1]

According to the ICD-11, to be diagnosed with C-PTSD, you must first meet criteria for PTSD. Additionally, you must have experienced repeated traumas, and the result of these traumas must cause  “disturbances in self-organization”,[1] which are characterized by:

  • Emotional Dysregulation: heightened emotional reactivity, anger outbursts, feeling emotionally numb or dissociated
  • Negative Self-Concept: feeling diminished, defeated or worthless; pervasive feelings of shame, guilt
  • Relationship Problems: feeling distant from others, having difficulty maintaining intimate relationships

Complex PTSD vs PTSD: What’s the difference in layman’s terms?

Exposure to a single traumatic event can have lasting effects and change your life. But what if you experienced repeated abuse from someone, especially at a young age? Both are traumatic, but there is evidence that suggests these vastly different traumas impact people differently.[3]

It is no surprise that a child suffering chronic abuse would have their beliefs and feelings about himself, other people, and the world as a whole significantly altered as a result.[5] He may consider that he deserved the abuse as a means to explain why something so terrible would happen to him. 

Regarding others, he may develop an overarching belief that other people are malevolent and uncaring. To avoid being hurt, he might always be on the watch for people’s ulterior motives. Unfortunately, he may also see danger where it does not exist, causing a lot of trouble in his relationships. 

It’s important to note that these issues are commonly seen in individuals with PTSD as well, but the severity and degree to which it is ingrained seems to be much greater among those with C-PTSD.

Approaches to Complex PTSD Recovery

Recovery from C-PTSD requires a multi-pronged approach that includes therapy, self-help strategies, and possibly medication, and is a long-term process. There is no “quick fix” for C-PTSD.

Psychotherapy for Complex PTSD

Therapy is central to recovery from C-PTSD. While there is limited research on the treatment of C-PTSD due to its relative “newness” as a diagnosis, studies are demonstrating that people can obtain significant benefit from a variety of different approaches.[6-10]

There is no ‘gold standard’ treatment recommendation for C-PTSD. When reaching out to connect with a therapist, it’s important to inquire about whether they have experience working with people who have suffered significant trauma.

Self-Help Strategies for Complex PTSD

Self-help strategies are an important complement to professional therapy for managing C-PTSD. Below are some useful strategies to consider:

1. Grounding Techniques

Grounding techniques help people stay present and avoid being overwhelmed by intrusive memories or emotions. These techniques are particularly useful during moments of dissociation or flashbacks. Examples include:

  • The 5-4-3-2-1 Method: Identify five things you see, four things you feel, three things you hear, two things you smell, and one thing you taste.
  • Sensory Grounding: Hold an ice cube, focus on its texture and temperature, or engage with a textured object to bring yourself back to the present moment.
  • Breathing Exercises: Practice deep, slow breathing, such as inhaling for four counts, holding for four counts, and exhaling for six counts.

2. Journaling

Writing can be a therapeutic way to process emotions and organize your thoughts. Types of journaling include:

  • Free Writing: Write whatever comes to mind without judgment or structure.
  • Gratitude Journaling: Note things you’re thankful for to shift focus from pain to positive aspects of life.
  • Trauma Processing: Gradually write about traumatic events to desensitize their emotional impact, but only when ready.

3. Mindfulness and Meditation

Mindfulness practices encourage people to observe their thoughts and emotions without judgment. This can help reduce anxiety and improve emotional regulation. Strategies include:

  • Mindful Breathing: Focus on the rhythm of your breath to anchor yourself in the moment.
  • Body Scan Meditation: Pay attention to sensations in different parts of your body to develop self-awareness.
  • Guided Meditation: Use apps or online resources such as our ‘Mindfulness for Men’ self-guided course for trauma-sensitive mindfulness exercises.

4. Establishing Routines

Creating predictable daily routines can foster a sense of agency and control. Start with small, manageable goals like:

  • Setting regular sleep and wake times.
  • Scheduling meals and breaks to ensure consistent self-care.
  • Allocating time for enjoyable activities or hobbies.

5. Connecting with Nature

Spending time in nature can be grounding and restorative. Activities such as walking in a park, gardening, or simply sitting outdoors can help reduce stress and promote emotional well-being.

6. Art and Creative Expression

Creative outlets provide nonverbal ways to process trauma. Activities like painting, drawing, playing music, or crafting can allow different types of expression of pent-up emotions and foster a sense of accomplishment.

7. Healthy Lifestyle Choices

Living a healthier lifestyle significantly impacts mental health. Consider the following:

  • Exercise: Regular physical activity (e.g., yoga, swimming, or dancing) reduces stress hormones and boosts mood through endorphin release.
  • Balanced Diet: Eating a variety of nutrient-rich foods supports overall mental health.
  • Adequate Sleep: Developing a consistent sleep routine improves energy and resilience.

8. Practicing Self-Compassion

C-PTSD often leads to feelings of guilt, shame, or self-criticism. Combat these by:

  • Speaking to yourself with kindness and understanding, as you would to a friend.
  • Accepting that healing takes time and setbacks are part of the process.
  • Engaging in affirmations that reinforce self-worth.

Social Support

A supportive network is critical for recovery. Relationships built on trust, empathy, and understanding provide a foundation for healing. Participating in group therapy or peer support groups can help mitigate feelings of isolation and foster a sense of belonging and being understood. 

Medication

There are no medications that specifically treat C-PTSD. However, your physician may prescribe certain medications to help manage certain C-PTSD symptoms, such as:

  • Antidepressants like selective serotonin reuptake inhibitors (SSRIs) or serotonin and norepinephrine reuptake inhibitors (SNRIs).
  • Anti-anxiety medications.
  • Sleep medications.

Medications should only be considered as an adjunct to therapy, and not as a stand-alone treatment for C-PTSD.

Conclusion

Complex PTSD is a debilitating condition. While its challenges are significant, recovery is possible through tailored therapeutic interventions, self-help strategies, and robust support systems. Healing from C-PTSD is a journey that requires patience and self-compassion. Progress may be gradual, so it’s essential to embrace small victories along the way.

About the Author

Dr. Justin Garber, PsyD is a clinical psychologist in private practice specializing in men’s mental health. He is focused on helping teen boys and adult men utilize psychotherapy as a tool in addressing the loneliness epidemic men are experiencing. Prior to private practice. Dr. Garber was a PTSD specialist for the Department of Veterans Affairs in Texas and New Jersey.

References:

  1. American Psychiatric Association. (2022). Diagnostic and Statistical Manual of Mental Disorders (5th-TR). American Psychiatric Association.
  2. World Health Organization. (2019). International Statistical Classification of Diseases and Related Health Problems (11th ed.). https://icd.who.int/
  3. Harris, J., Loth, E., & Sethna, V. (2024). Tracing the paths: a systematic review of mediators of complex trauma and complex post-traumatic stress disorder. Frontiers in Psychiatry, 15, 1331256. https://doi.org/10.3389/fpsyt.2024.1331256 
  4. Bachem, R., Levin, Y., Zerach, G., Cloitre, M., & Solomon, Z. (2021). The interpersonal implications of PTSD and complex PTSD: The role of disturbances in self-organization. Journal of Affective Disorders, 290, 149–156. https://doi.org/10.1016/j.jad.2021.04.075
  5. Cloitre, M., Garvert, D. W., Brewin, C. R., Bryant, R. A., & Maercker, A. (2013). Evidence for proposed ICD-11PTSD and complex PTSD: A latent profile analysis. European Journal of Psychotraumatology, 4(1), 20706. https://doi.org/10.3402/ejpt.v4i0.20706
  6. Niemeyer, H., Lorbeer, N., Mohr, J., Baer, E., & Knaevelsrud, C. (2022). Evidence-based individual psychotherapy for complex posttraumatic stress disorder and at-risk groups for complex traumatization: A meta-review. Journal of Affective Disorders, 299, 610–619. https://doi.org/10.1016/j.jad.2021.12.056
  7. Henley, B. M. (2023). Psychodynamic techniques elicit emotional engagement in complex post-traumatic stress disorder. Psychoanalytic Psychotherapy, 37(3), 231–242. https://doi.org/10.1080/02668734.2023.2231059
  8. Melegkovits, E., Blumberg, J., Dixon, E., Ehntholt, K., Gillard, J., Kayal, H., et al. (2022). The effectiveness of trauma-focused psychotherapy for complex post-traumatic stress disorder: A retrospective study. European Psychiatry: The Journal of the Association of European Psychiatrists, 66(1), e4. https://doi.org/10.1192/j.eurpsy.2022.2346
  9. Darby, R. J., Taylor, E. P., & Segovia Cadavid, M. (2023). Phase-based psychological interventions for complex post-traumatic stress disorder: A systematic review. Journal of Affective Disorders Reports, 14, 1-11. Article 100628. https://doi.org/10.1016/j.jadr.2023.100628
  10. Swee, M. B., Corman, A. G., Margolis, J. M., & Dick, A. M. (2024). Compassion-Focused Therapy for the Treatment of ICD-11-Defined Complex Posttraumatic Stress Disorder. American Journal of Psychotherapy, 77(3), 135–140. https://doi.org/10.1176/appi.psychotherapy.20230019

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