C-PTSD Explained: Recognizing the Signs and Symptoms of Complex Trauma

Complex Post-Traumatic Stress Disorder (often referred to interchangeably as Complex PTSD, complex trauma, or C-PTSD) is a psychological condition that arises from prolonged, repeated exposure to traumatic events or conditions. The term was first coined by Dr. Judith Herman, a psychiatrist based out of Harvard University, in 1992 in a paper she wrote and subsequently in various well-known books. These traumatic experiences occur during a person’s formative years, such as in early childhood. While CPTSD shares similarities with Post-Traumatic Stress Disorder (PTSD), it is a distinct diagnosis that encompasses a broader range of emotional, psychological, and behavioral difficulties. These differences are often tied to the complex, early, and sustained nature of the trauma.

Origins of C-PTSD

What sets CPTSD apart from PTSD is the chronic, often interpersonal nature of the trauma and the sense of entrapment experienced by the individual. It typically results from exposure to sustained traumatic experiences, such as:

Childhood abuse or neglect: Physical, emotional, or sexual abuse, as well as chronic neglect, are common sources. Children inherently are an incredibly vulnerable population with little personal agency and an inability to fight back or leave a situation.

Domestic violence: Prolonged exposure to a controlling or abusive partner can lead to CPTSD.

Human trafficking, enslavement, or long-term imprisonment: Environments where individuals are held captive or powerless can foster complex trauma.

War or combat exposure: While this is often linked to PTSD, those in situations of sustained violence or conflict may develop CPTSD due to the ongoing nature of the threat.

Symptoms of C-PTSD

While both PTSD and CPTSD include symptoms like flashbacks, nightmares, and heightened anxiety, those with CPTSD often experience additional symptoms tied to long-term trauma. Because a person experiences these chronic traumatic experiences beginning in childhood, symptoms can often be more pervasive due to the disruption of healthy developmental processes (such as learning how to regulate one’s emotions or developing a stable and secure sense of self). These symptoms can include but are not limited to:

Emotional Dysregulation: People with CPTSD may struggle to manage their emotions, often feeling flooded by sadness, anger, fear, or shame. They may find it hard to calm down once they are upset or, conversely, may feel emotionally “numb” and dissociated much of the time.

Interpersonal Difficulties: Because complex trauma often involves abuse from close relationships (such as a family member), individuals with CPTSD may struggle with forming and maintaining healthy relationships. They may have deep-seated suspicion and difficulties in trusting people, while on the other hand may become overly dependent on others. Intimacy can be scary and is often avoided.

Negative Self-Perception: CPTSD often leads to feelings of worthlessness, guilt, and shame. These may show up in negative beliefs of being fundamentally flawed or damaged, broken, out of control, or even powerless due to the trauma they experienced. 

Dissociation: Many people with CPTSD experience dissociation, where they feel disconnected from their body or environment. This can range from feeling detached from reality to more severe forms of identity confusion or amnesia.

Chronic Physical Symptoms: There is a strong mind-body connection in trauma, and individuals with CPTSD often report chronic pain, headaches, or gastrointestinal issues without a clear medical cause.

Diagnosis of C-PTSD

Complex PTSD is not yet an official diagnosis in the American Psychiatric Association’s Diagnostic Statistical Manual for Mental Disorders (otherwise known as the “DSM-5”), but it was added to the ICD-11 back in 2018. To meet criteria for CPTSD according to the ICD-11, a person needs to have:

All criteria for PTSD:

• Exposure to a traumatic event or events
• Subsequent elements of all three common PTSD symptom clusters
  • Re-experiencing of the event (intrusive images of the event, flashbacks, nightmares, images or emotions related to the event coming out of nowhere)
  • Persistent perception of heightened threat (hypervigilance, startle response, feeling keyed up all the time and on edge)
  • Avoidance (avoiding reminders, trying not to think about the event)

Plus three other symptoms:

• Problems with affect regulation (emotional dysregulation, heightened reactivity to minor stressors, outbursts, dissociative symptoms and emotional numbing)
• Negative self-concept (beliefs of worthlessness, feelings of shame and guilt)
• Difficulties sustaining relationships 

Treatment for CPTSD

Treatment for CPTSD is often multifaceted and can take longer than treatment for PTSD due to the deep-rooted nature of the trauma and the related emotional dysregulation that occurs. Generally-accepted treatment guidelines call for a phased approach (typically three phases).

The first phase is focused on developing safety and stability and includes tasks such as learning emotional regulation skills, building ego strength, getting support, and essentially preparing for the processing of the underlying traumatic memories. The second phase is focused on the reprocessing and reconsolidation of unprocessed, raw memories at the core of the disorder. The third phase involves reintegration into society, helping clients do what they were previously unable to do as a result of their trauma. Of course, these phases aren’t always linear. For example, a person may be in the second phase and working through old traumatic memories however may realize they need to go back to creating more safety and stability first before continuing.

Mangrove Therapy Group uses EMDR as a powerful Psychotherapy approach to treat both PTSD and CPTSD.

Living with C-PTSD

CPTSD can be a deeply challenging condition, but with the right treatment and support, individuals can heal and learn to manage their symptoms. Recovery often involves rebuilding a sense of safety and trust, learning to regulate emotions, and establishing healthier relationships. And, of course, addressing and resolving past traumatic experiences.

People with CPTSD often benefit from understanding that their symptoms are a natural response to unnatural situations. This process of normalization reduces shame and helps build a greater sense of self-compassion which is crucial for recovery. The path to recovery may be long, but with resilience, support, and the right therapeutic interventions, healing is possible.

Start Working With a Complex PTSD Therapist in Palm Beach County, FL

Complex Post-Traumatic Stress Disorder is a serious condition that results from early and prolonged exposure to trauma, often involving abuse or neglect. While CPTSD shares many similarities with PTSD, it goes beyond typical trauma responses, affecting emotions, relationships, self-perception, and physical well-being. With a combination of therapeutic approaches and self-compassion, individuals with Complex PTSD can navigate the path toward healing and reclaim their sense of self. Get in contact with our team of caring therapists for more support with addressing CPTSD. Start your therapy journey with Mangrove Therapy Group by following these steps:

• Contact Mangrove Therapy Group
• Meet with a caring therapist
• Start overcoming past trauma

Other Services Offered With Mangrove Therapy Group

PTSD and Complex PTSD are not the only services our team offers. Mangrove Therapy Group is happy to offer support with a variety of mental health services including trauma and EMDR, substance use disorders, eating disorders, body image issues, anger management, anxiety, low self-esteem, personality disorders, and much more. Please feel free to learn more about how we can support you. We also offer support with addictions such as process addictions, grief and loss, “Failure to Launch” syndrome, CBT, and DBT. Feel free to learn more by visiting our blog or FAQ page to learn more today!