Complex Post Traumatic Stress Disorder (C-PTSD)

Complex Post Traumatic Stress Disorder (C-PTSD) was recognised as having its own classification by the ICD in June 2018. The ICD is the International Classification of Diseases. The definition of Complex Trauma or Complex Post Traumatic Stress is a 'psychological disorder which can develop in response to repeated or prolonged experience of interpersonal trauma where the individual involved has little or no chance of escape.'

What is the Difference between PTSD and Complex PTSD?

Post-Traumatic Stress Disorder (PTSD) describes a set of somatic and cognitive defence mechanisms which can manifest following a traumatic event or events. Complex Post Traumatic Stress Disorder Symptoms (C-PTSD) are more complex because they might involve a series of traumatic incidents which occurred over a period of time where a person is unable to escape physically or emotionally. Complex PTSD might also be characterised as trauma that has occurred in the context of a relationship - something that has happened or did not happen (e.g. neglect) to a person that has caused him or her harm (Parnell L, 2013). Relational trauma which might cause PTSD may have taken place during childhood and early life development. Childhood trauma is often defined as complex because it can interfere with a child’s normal development. A child’s psyche develops in response to ongoing trauma meaning they might have an unstable internal working model. Flashbacks and C-PTSD symptoms can be particularly intense. Examples of circumstances which can cause complex trauma might include emotional abuse, sexual or physical abuse or neglect.

Complex PTSD Causes

There are a number of different situations and circumstances which can contribute to the likelihood of developing Complex Post Traumatic Stress Disorder (C-PTSD) symptoms. Symptoms can manifest whilst trauma is occurring, a short time after trauma or many months or years later. Possible causes of C-PTSD might include:

  • Repeated and prolonged physical, sexual and psychological abuse.
  • Prolonged periods of neglect
  • Chronic violence from an intimate partner
  • People involved in kidnapping and hostage situations
  • Victims of slavery and human trafficking
  • Prisoners of war or concentration camp survivors
  • Defectors of cult type organisations
  • Narcissistic child abuse

Complex PTSD Symptoms in Children and Adolescents

We might experience difficulties in early life which might involve being mistreated, family violence, abuse or detachment from a primary caregiver. In some cases it is the child’s primary caregiver that is responsible for the trauma that the child experiences. This can lead to developmental trauma. Repeated traumatic experiences in childhood can lead to difficulties in the following areas.

  • Attachment difficulties which might manifest in relationships regarding boundaries and difficulty building trust.
  • Difficulties with sensory processing in terms of receiving and responding to sensory information as well as the increased likelihood of having medical difficulties.
  • Difficulty managing and regulating emotional affect, expressing emotions, communicating needs and understanding internal states.
  • Difficulties with controlling behaviour, impulses, aggression, limited ability to self sooth and sleeping problems.
  • Difficulties relating to cognition – including regulating attention and executive functions like planning, judgement, initiation, focusing, completing tasks and self-monitoring. Difficulty with receptive and expressive communication skills.
  • Dissociation symptoms. These might include dissociating away from surroundings as well as physical, emotional experiences and difficult memories.
  • Self-concept difficulties around body image, shame and self-esteem. Internal working model of self can be negative. Fragmented and disconnected autobiographical narrative.

We might experience complex trauma symptoms through-out life or they can manifest a long time after the trauma has passed. Although the trauma has passed, we might feel as if we are experiencing trauma symptoms in the present. Experiencing traumas early in life can make our modus operandi one of survival. We have always suppressed feelings or felt like we are fighting to survive making this a way of life rather than what we might perceive to be a trauma symptom.

Complex PTSD Symptoms in Adults

Adults with Complex Post Traumatic Stress Disorder may have experienced trauma in childhood and or in adulthood. Childhood trauma can cause difficulties in relation to development and sense of self. This is especially true if the trauma is caused by a primary caregiver or someone a child has a significant attachment to. As a result of these difficulties Complex Post Traumatic Stress Disorder symptoms might be experienced in adulthood.

Emotional dysregulation

Difficulties with emotional regulation, affect regulation and impulse control. Emotions might be experienced as strong, intense and unmanageable as if they have taken over or not really experienced at all because of emotional numbing. Preoccupation with suicide and self-injury. One might also pendulate between explosive or inhibited anger.

PTSD Symptoms

You might experience core PTSD symptoms including intrusive memories and dreams, flashbacks, alteration in cognitions and moods, and hyper-arousal. You might also develop avoidance behaviours to avoid difficult thoughts and feelings relating to the trauma or view of self. You might also experience gaps in traumatic memories (amnesia), dissociation and depersonalisation.

Alteration in self-perception

Conflicting thoughts and feelings regarding your sense of self. Having feelings of helplessness, shame, guilt and self- blame or finding it difficult to find compassion for yourself. Also feeling unsafe, alone or different from other people. Also having difficulty taking the initiative and finding direction or meaning in life.

Alterations in relation to others

You might project attributes onto a perpetrator which are not warranted or a true reflection of who they are. Examples might include: having total power or they might be idealised so that you take on their belief system. You might also experience paradoxical gratitude or sense of a special or supernatural relationship with a perpetrator. Alternatively you might also ruminate on ways of enacting revenge on a perpetrator.

Difficulties with intimacy and interpersonal relationships

You might experience difficulties in interpersonal relationships which might manifest as difficulties putting up boundaries or building trust or showing compassion for others. You may also use safety behaviours which involve cutting yourself off from friends or family by isolating yourself.

Somatisation/physical symptoms

Experiencing psychological distress as body based physical symptoms. These might manifest as unexplained feelings of anxiety or physical symptoms of headaches, chest pain, dizziness, nausea and stomach aches.


You may feel in a state of unease or generalised dissatisfaction with life or feel as if you have lost your faith in the world, one’s place in the world or experience feelings of hopelessness and despair.

Psychiatric difficulty

Increased likelihood of psychiatric difficulties namely borderline personality disorder or bipolar disorder


Dissociative disorders characterised by a disruption or discontinuity in the normal integration of consciousness, memory, identity, emotion, perception, body representation, motor control of behaviour.

High risk behaviour

Engaging in high risk behaviour involving self and others. Examples might include: self-harm, drug abuse, alcohol misuse or high-risk sexual activity

Secondary difficulties

Experiencing difficulties with addiction or cross addiction, anxiety, stress and depression symptoms

Complex PTSD Healing

Healing from Complex PTSD or complex trauma takes time and a commitment to oneself to allow space for that healing. Psychotherapy is one of the best ways to help yourself if you feel you are suffering from complex PTSD symptoms.