What Is Complex PTSD?

Complex PTSD is a trauma-related condition that can develop after prolonged or repeated trauma, often trauma that was hard or impossible to escape, such as ongoing childhood abuse or neglect, domestic violence or captivity. It includes the core symptoms of PTSD along with lasting difficulties in three areas: managing emotions, how you see yourself, and relationships with others.

PTSD has three core features: re-experiencing the trauma through intrusive memories, flashbacks or nightmares; avoiding reminders of it; and a persistent sense of threat, such as being on edge or easily startled.

Complex PTSD includes those features, plus what clinicians call disturbances in self-organization:

• Emotional regulation. Emotions that feel overwhelming or, at the other extreme, shut down and numb.
• Self-concept. Deep, lasting beliefs of being worthless, defeated or to blame, often with shame or guilt.
• Relationships. Difficulty feeling close to people or sustaining relationships, and often a sense of being cut off from others.

It depends on the manual. The World Health Organization's International Classification of Diseases, ICD-11, recognizes complex PTSD as a separate diagnosis. The American diagnostic manual widely used in North America, the DSM-5-TR, does not list it separately. In practice, clinicians in Canada recognize the pattern and treat it, whichever manual is used for paperwork.

You may see lists of 17 symptoms online. That number comes from an older edition of the American manual, the DSM-IV, which listed 17 symptoms of PTSD, not complex PTSD. Current criteria are organized differently. Rather than counting symptoms from a list, it is more useful to notice the pattern: PTSD symptoms plus longstanding difficulties with emotions, self-worth and relationships.

Complex PTSD is most often linked to trauma that was repeated, prolonged and interpersonal, especially when it happened in childhood or at the hands of people who were meant to provide care or safety. Not everyone who goes through these experiences develops it. Support, temperament and later relationships all make a difference.

Complex PTSD is treatable. Treatment is often phase-based:

• Stabilization. Building safety and skills for managing overwhelming emotions and staying grounded.
• Processing. Working through traumatic memories with trauma-focused therapies such as EMDR and trauma-focused cognitive behavioural therapy. Some people also find approaches such as Brainspotting helpful.
• Integration. Rebuilding relationships, self-worth and a life that is not organized around the trauma.

Progress usually takes longer than for PTSD after a single event, and the relationship with a trusted therapist is a central part of the work.

If you recognize these patterns in yourself, a psychologist experienced in trauma can assess what is going on and help you choose an approach. If you are in crisis, call or text 988 at any time. The Alberta Mental Health Helpline is 1-877-303-2642.

Our clinicians work with PTSD and complex trauma in Calgary, Red Deer and Cold Lake, with EMDR and Brainspotting available at some locations. We also work with veterans and first responders. No referral is needed. Call 1-888-622-8350.

We direct bill many insurers, including Alberta Blue Cross, Canada Life, Sun Life, Manulife, Greenshield and Medavie Blue Cross, so you pay only the part your plan does not cover. See direct billing and insurance.

Related reading: What is a trauma bond?, Signs of unprocessed trauma and Your first EMDR session.