What Is Complex PTSD?

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.

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.