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Complex Post-Traumatic Stress Disorder: Symptoms, Causes, Risk Factors, Treatment, Diagnosis

What is Complex Post-Traumatic Stress Disorder?

Post-traumatic stress disorder (PTSD) is a psychiatric disorder that may develop in a person after experiencing a traumatic event in life. Complex post-traumatic stress disorder or CPTSD, happens if a person goes through repeated or prolonged trauma over a period of years or months. A person with complex post-traumatic stress disorder may experience more symptoms than those that define PTSD. However, the Diagnostic and Statistics Manual of Mental Disorders, 5th Edition (DSM-5), which is a common handbook used by psychiatrists and psychologists regularly, does not acknowledge complex PTSD as a separate mental condition. At the same time, the World Health organization’s International Classification of Diseases, 11th Revision (ICD-11) does acknowledge CPTSD as a separate condition, and many doctors are diagnosing it also.(1, 2, 3, 4, 5)

Conventional post-traumatic stress disorder is estimated to affect almost seven percent of people in the US at some point in their lives.(6) Symptoms of PTSD are believed to be caused by changes in parts of the brain that are associated with memory, reasoning, and emotion. The affected parts of the brain may include the hippocampus, the amygdala, and the prefrontal cortex.

Typical PTSD tends to develop after a traumatic episode, such as a natural disaster, sexual assault, or a car collision. It is typically related to one traumatic event.(7)

On the other hand, complex PTSD develops from a series of traumatic events over a period of time, or even one prolonged event. The symptoms of complex PTSD can be similar to PTSD, but they are usually more extreme and enduring than those of PTSD.

Despite the lack of guidance from the DSM-5, many mental health professionals are now starting to distinguish the two conditions.(8) Research has also shown the validity of a separate diagnosis for PTSD and complex PTSD. At least 29 studies have been carried out over 15 countries, and all have consistently shown that there are differences in symptoms between traditional PTSD and complex PTSD. A study done in 2016 having more than 1700 participating mental health professionals from 76 countries found that doctors could very well differentiate between the two diagnoses.(9, 10)

Symptoms of Complex Post-Traumatic Stress Disorder

The symptoms of complex PTSD tend to usually also include the symptoms of PTSD, but it also includes other symptoms.

Some of the common symptoms of both PTSD and Complex post-traumatic stress disorder are as follows:

  • Dizziness or trauma when recalling the traumatic event.
  • Avoiding situations that remind them of the trauma.
  • Being in a continuous state of high alert, a condition known as hyperarousal.
  • A loss of trust in the self or others.
  • Difficulty concentrating.
  • Difficulty sleeping.
  • Having a belief that the world is a dangerous place.

Some other symptoms of complex PTSD and PTSD include:(11)

  • Changes in behavior and beliefs: People with Complex post-traumatic stress disorder or PTSD tend to hold a negative view of the world, along with the people in it. They may also lose faith in their previously held beliefs.
  • A negative self-view: Complex PTSD often causes a person to develop a negative view of themselves and start feeling guilty, ashamed, and helpless. They begin to feel like they are different from others.
  • Difficulty in regulating their emotions: Such conditions can cause people to lose control over their emotions. Regulating their emotions become challenging, and they may experience intense sadness or anger or even have thoughts of suicide.
  • Develop relationship issues: Their present relationships also start to suffer due to difficulties in trusting and interacting and also because of their negative self-view. A person with either complex PTSD or PTSD may also tend to have unhealthy relationships.
  • Detachment from the trauma: Many survivors have reported having complete amnesia of their trauma.(12)
  • Developing a preoccupation with the abuser: It is often common for the victim to fixate on the abuser, on the relationship with the abuser, or even on getting revenge for the abuse meted out to them.

The symptoms of Complex post-traumatic stress disorder vary from person to person and may even change over a period of time. People who have complex PTSD may also experience many other symptoms apart from the ones mentioned above.

What Are The Causes of Complex Post-Traumatic Stress Disorder?

Researchers are still trying to understand how exactly traumatic stress impacts the brain and causes conditions like Complex post-traumatic stress disorder. However, animal studies have shown that any type of trauma can have a lasting effect on the hippocampus, amygdala, and prefrontal cortex.(13) These parts of the brain are known to play an important role in not only memory function but also on how a person responds to stressful situations.

Any type of trauma caused over a period of several months or years can cause Complex post-traumatic stress disorder. However, it seems to often affect people who have been abused by someone who was supposed to be their protector or caregiver. Some examples include survivors of childhood sexual abuse by a relative or survivors of human trafficking.

Some other examples of long-term trauma may include:

  • Being a prisoner of war
  • Ongoing childhood neglect
  • Living in an area of war for a long time
  • Ongoing sexual, emotional, or physical abuse

People who have Complex post-traumatic stress disorder or PTSD can react to various situations in life in a manner that they are reliving their trauma. A particular situation that triggers a person with complex PTSD can be random and also vary depending on the specific trauma history. A person can be triggered by conversations, situations, images, smells, and many other such factors.

This triggering can often manifest as a flight or fight response that is triggered by the amygdala part of the brain, which is responsible for the processing of emotions in the brain.(14) When this happens, your brain can perceive that you are in a dangerous situation, even when you are not. This is called as an amygdala hijack, and it can bring on flashbacks, nightmares, or anxiety attacks.

Risk Factors of Complex Post-Traumatic Stress Disorder

It is possible for anyone with a history of trauma or abuse to develop Complex post-traumatic stress disorder but some people are at a greater risk of developing this condition than others. Apart from having experienced trauma in the past, some of the risk factors may include:(15)

  • Inherited personality traits often known as temperament.
  • Having an underlying mental condition, including anxiety or depression, or having a family history of mental illness.
  • Lifestyle factors like working in a dangerous job or lacking a strong support system.
  • The manner in which your brain regulates neurochemicals and hormones, especially when under stress.

How is Complex Post-Traumatic Stress Disorder Diagnosed?

Complex post-traumatic stress disorder is still a new condition, and many doctors are still not aware of it. This makes it challenging to diagnose this condition, and often you end up getting diagnosed with PTSD instead of complex PTSD. Since there is no specific diagnostic test to determine whether you have complex PTSD, it can help if you maintain a detailed log of your symptoms to help your doctor make a correct diagnosis. Try to keep a detailed record of when your symptoms began and also of any changes in these symptoms over time.

Once you find a doctor, the diagnostic process will begin by asking you about your symptoms and finding out about any traumatic events in your past. To arrive at the initial diagnosis, you don’t have to go into too much detail about the trauma, especially if it makes you uncomfortable.

Next, your doctor will enquire about any family history of mental illness as well as other risk factors. You must remember not to leave out any details about any kind of supplements or medications you take or any recreational drugs you may be using. Try to be as honest as you can be with your doctor so that you can get the best possible diagnosis.

If you have been experiencing the symptoms of post-traumatic stress for at least one month, and it starts to interfere with your day-to-day life, your doctor is likely to immediately begin with a diagnosis of PTSD. Depending on what traumatic event you have experienced and whether you have any other symptoms, including ongoing relationship problems or having trouble controlling your emotions, they may further diagnose you with complex PTSD.

It is important to remember, though, that you may need to visit a couple of doctors before you find someone you are comfortable with and who is able to diagnose you correctly. This is a very normal phenomenon for people dealing with post-traumatic stress.

How is Complex Post-Traumatic Stress Disorder Treated?

There are many treatment options for complex PTSD that can alleviate your symptoms and also help you learn how to manage them better. Some of the treatment options include:


Psychotherapy is a treatment process that involves talking with a therapist either in a group or alone. Psychotherapy may also include cognitive-behavioral therapy (CBT). Cognitive-behavioral therapy is a type of treatment that helps you identify negative thought patterns and provides you with tools to replace these negative patterns with more positive and healthy thoughts. Your doctor may also recommend dialectical behavioral therapy, which is a form of cognitive-behavioral therapy that helps develop a better response to stress while also building better relationships with others.

Eye Movement Desensitization and Reprocessing (EMDR)

Eye movement desensitization and reprocessing is a common treatment option for PTSD, and it has been proven to help people with complex PTSD as well. During this treatment, you will be asked to briefly think back about the traumatic moment in your life while moving your eyes from side to side. Some other techniques used in eye movement desensitization and reprocessing methods include having someone tap gently on your hands instead of moving your eyes from side to side. Over a period of time, this process is said to help desensitize a person to the traumatic thoughts and memories.(16, 17, 18)

However, there is a lot of debate within the medical community over the use of this EMDR technique to treat PTSD and complex PTSD. The American Psychological Association only conditionally recommends it for treating PTSD. This means that while they recommend it, but more information is still needed on how effective this therapy is. Currently, there is insufficient evidence on whether EMDR helps in complex PTSD and PTSD.(19)


Medications that are conventionally used for the treatment of depression are known to help alleviate the symptoms of complex PTSD as well. However, these medications tend to be most effective when they are combined with another form of treatment, such as cognitive-behavioral therapy. Some of the commonly used antidepressants used for the treatment of complex PTSD include:

  • Fluoxetine (Prozac)
  • Paroxetine (Paxil)
  • Sertraline (Zoloft)

While some people only benefit from these medications if taken for a long time, you may need to take them only for a short period of time while you are learning how to cope with your symptoms.


Having an under-recognized mental health condition like complex PTSD can make a person feel isolated. If you feel like you need extra support, you can turn to a mental health professional or even consult the National Center for PTSD for more resources.(20) There are many PTSD coaching apps also available on your smartphones nowadays. Many of these resources are specially geared towards people with PTSD, and you will find that these resources can help you cope better with your condition.


  1. Edition, F., 2013. Diagnostic and statistical manual of mental disorders. Am Psychiatric Assoc, 21, pp.591-643.
  2. Maercker, A., 2021. Development of the new CPTSD diagnosis for ICD-11. Borderline personality disorder and emotion dysregulation, 8(1), pp.1-4.
  3. Herman, J.L., 1992. Complex PTSD: A syndrome in survivors of prolonged and repeated trauma. Journal of traumatic stress, 5(3), pp.377-391.
  4. Resick, P.A., Bovin, M.J., Calloway, A.L., Dick, A.M., King, M.W., Mitchell, K.S., Suvak, M.K., Wells, S.Y., Stirman, S.W. and Wolf, E.J., 2012. A critical evaluation of the complex PTSD literature: Implications for DSM‐5. Journal of traumatic stress, 25(3), pp.241-251.
  5. De Jongh, A.D., Resick, P.A., Zoellner, L.A., Van Minnen, A., Lee, C.W., Monson, C.M., Foa, E.B., Wheeler, K., Broeke, E.T., Feeny, N. and Rauch, S.A., 2016. Critical analysis of the current treatment guidelines for complex PTSD in adults. Depression and anxiety, 33(5), pp.359-369.
  6. National Institute of Mental Health (NIMH). 2022. Post-Traumatic Stress Disorder (PTSD). [online] Available at: <https://www.nimh.nih.gov/health/statistics/post-traumatic-stress-disorder-ptsd> [Accessed 2 May 2022].
  7. 2022. [online] Available at: <https://www.psychiatry.org/patients-families/ptsd/what-is-ptsd> [Accessed 2 May 2022].
  8. Maercker, A., 2021. Development of the new CPTSD diagnosis for ICD-11. Borderline personality disorder and emotion dysregulation, 8(1), pp.1-4.
  9. Cloitre, M., Brewin, C.R., Bisson, J.I., Hyland, P., Karatzias, T., Lueger-Schuster, B., Maercker, A., Roberts, N.P. and Shevlin, M., 2020. Evidence for the coherence and integrity of the complex PTSD (CPTSD) diagnosis: Response to Achterhof et al.,(2019) and Ford (2020). European Journal of Psychotraumatology, 11(1), p.1739873.
  10. Keeley, J.W., Reed, G.M., Roberts, M.C., Evans, S.C., Robles, R., Matsumoto, C., Brewin, C.R., Cloitre, M., Perkonigg, A., Rousseau, C. and Gureje, O., 2016. Disorders specifically associated with stress: A case-controlled field study for ICD-11 mental and behavioural disorders. International Journal of Clinical and Health Psychology, 16(2), pp.109-127.
  11. Giourou, E., Skokou, M., Andrew, S.P., Alexopoulou, K., Gourzis, P. and Jelastopulu, E., 2018. Complex posttraumatic stress disorder: The need to consolidate a distinct clinical syndrome or to reevaluate features of psychiatric disorders following interpersonal trauma?. World journal of psychiatry, 8(1), p.12.
  12. Choi, K.R., Seng, J.S., Briggs, E.C., Munro-Kramer, M.L., Graham-Bermann, S.A., Lee, R.C. and Ford, J.D., 2017. The dissociative subtype of posttraumatic stress disorder (PTSD) among adolescents: Co-occurring PTSD, depersonalization/derealization, and other dissociation symptoms. Journal of the American Academy of Child & Adolescent Psychiatry, 56(12), pp.1062-1072.
  13. Bremner, J.D., 2022. Traumatic stress: effects on the brain. Dialogues in clinical neuroscience.
  14. Cptsdfoundation.org. 2022. Reclaiming Power Back from Triggers | CPTSDfoundation.org. [online] Available at: <https://cptsdfoundation.org/2019/08/26/reclaiming-power-back-from-triggers/> [Accessed 3 May 2022].
  15. Karatzias, T., Hyland, P., Bradley, A., Cloitre, M., Roberts, N.P., Bisson, J.I. and Shevlin, M., 2019. Risk factors and comorbidity of ICD‐11 PTSD and complex PTSD: Findings from a trauma‐exposed population based sample of adults in the United Kingdom. Depression and anxiety, 36(9), pp.887-894.
  16. Chemtob, C.M., Tolin, D.F., van der Kolk, B.A. and Pitman, R.K., 2000. Eye movement desensitization and reprocessing.
  17. Davidson, P.R. and Parker, K.C., 2001. Eye movement desensitization and reprocessing (EMDR): a meta-analysis. Journal of consulting and clinical psychology, 69(2), p.305.
  18. Wilson, D.L., Silver, S.M., Covi, W.G. and Foster, S., 1996. Eye movement desensitization and reprocessing: Effectiveness and autonomic correlates. Journal of behavior therapy and experimental psychiatry, 27(3), pp.219-229.
  19. https://www.apa.org. 2022. Eye Movement Desensitization and Reprocessing (EMDR) Therapy. [online] Available at: <http://www.apa.org/ptsd-guideline/treatments/eye-movement-reprocessing.aspx> [Accessed 3 May 2022].
  20. PTSD, N., 2022. VA.gov | Veterans Affairs. [online] Ptsd.va.gov. Available at: <https://www.ptsd.va.gov/index.asp> [Accessed 3 May 2022].
Team PainAssist
Team PainAssist
Written, Edited or Reviewed By: Team PainAssist, Pain Assist Inc. This article does not provide medical advice. See disclaimer
Last Modified On:May 11, 2022

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