What is Complex PTSD (CPTSD)? Understanding Symptoms, Causes, and Healing

What is complex post-traumatic stress disorder?

Complex post-traumatic stress disorder, or CPTSD, is a mental condition that can develop if you experience long-term or repeated trauma, especially during childhood. CPTSD involves a broader range of symptoms than post-traumatic stress disorder (PTSD). It’s not formally recognized by the Diagnostic and Statistical Manual of Mental Disorders, but is included in the International Classification of Diseases.

If you have CPTSD, you might often feel like past traumatic events define you, your life, and your worth. They seem to cast a persistent cloud over your relationships and your self-image. You might constantly feel on edge, emotionally out of control, and undeserving of love or support. It seems like you’re trapped within your trauma, and any hope of outrunning it is impossible.

While things may feel hopeless, it is possible to manage symptoms of CPTSD and live a fulfilling life. It starts with understanding the causes and effects of your trauma, and then seeking the support you need.

CPTSD vs. PTSD

PTSD is typically linked to a single traumatic event. For example, following a car accident, you might experience sudden flashbacks or vivid nightmares that pull you back into that terrifying moment. Intense and unpleasant physical reactions, such as trembling, tension, and nausea, arise when you’re reminded of the event. So, you go out of your way to avoid things that you associate with the trauma, such as cars or certain streets.

CPTSD results from more prolonged or repeated trauma. Whatever caused the trauma may have felt like it would never end. For instance, being in an abusive relationship that involves daily emotional or physical abuse can cause CPTSD.

CPTSD comes with the same symptoms of PTSD, such as anxiety, nightmares, and avoidance. However, it also brings additional issues, such as relationship difficulties, trouble managing emotions, and a negative sense of self. If you have CPTSD, you’re also at a higher risk for severe mental disorders than someone who has PTSD.

Symptoms of complex PTSD

Symptoms of CPTSD disrupt your daily functioning. They can include:

Emotional dysregulation. You might feel that your anger or anxiety is out of control. Or maybe you often feel numb and unable to fully experience joy and sorrow.

Negative self-concept. You might carry heavy feelings of guilt or shame related to your past trauma. Maybe you think of yourself as worthless or often feel undeserving of love or friendship.

Interpersonal difficulties. You might shy away from intimacy and feel wary of other people. You might expect the people in your life to eventually betray or abandon you. Perhaps you frequently have relationship conflicts that stem from trust issues or being overly sensitive.

Hyperarousal. You’re constantly on alert for threats and startle easily. It’s hard for you to ever really feel safe, and you can’t seem to relax. Maybe you struggle with insomnia, as you can’t seem to quiet your mind.

Intrusive memories. You might re-experience traumatic events in nightmares or sudden flashbacks. These types of memories can be very vivid and incredibly distressing.

Dissociation. You might feel detached from your surroundings or disconnected from yourself or your memories. For example, you might feel like what’s happening around you isn’t real, or you’re watching it happen to someone else.

Chronic physical symptoms. PTSD and CPSTD are both associated with pain. For instance, a certain symptom, such as flashbacks, might come with headaches. Or perhaps you feel fatigued because nightmares frequently disrupt your sleep.

Impact on daily life

CPTSD can make everyday life difficult in many ways. It affects how you relate to other people. Maybe you feel intense emotions that frequently result in arguments with friends and family members. Or perhaps your distrust of others leads you to withdraw socially from people altogether. All of this can drag down your self-esteem or contribute to loneliness and frustration.

Symptoms like dissociation and intrusive flashbacks affect your ability to focus at work or in school, or make it harder for you to show up every day. Then, your stress might build as financial hurdles and academic setbacks become commonplace.

CPTSD can also contribute to other mental health conditions. You might turn to alcohol or drugs to cope with the emotional pain, putting you at risk of substance abuse. Or maybe sleepless nights and relationship failures worsen your depression.

Causes of CPTSD

Prolonged trauma causes CPTSD. Here are some situations that can make you feel powerless and trapped for extended periods.

Long-term childhood abuse, neglect, or abandonment. Perhaps you were repeatedly subjected to physical violence by a trusted adult. Or maybe you were left alone for long periods of time or regularly denied affection or emotional support.

Domestic violence or long-term intimate partner abuse. Years of physical assault, constant insults, or manipulation by a partner can be a traumatic experience.

Captivity, trafficking, war, torture, imprisonment. This can involve being held captive or experiencing extreme situations like human trafficking. Days, months, or years of feeling trapped with no hope of escape can cause lasting mental distress.

Growing up in unsafe environments. For instance, you may have lived in a home or neighborhood where violence was a constant concern. You rarely felt like the world around you was safe or calm.

Treatment and recovery for complex PTSD

Therapy approaches for treating CPTSD are similar to those used for treating PTSD. A therapist might suggest some of the following options.

Trauma-focused cognitive behavioral therapy (CBT) is a type of therapy that can help you identify and then challenge or replace thoughts that relate to your past trauma. For instance, a therapist might help you challenge internal beliefs like, “The people I love will eventually betray me.”

Eye movement desensitization and reprocessing (EMDR) involves recalling traumatic events while performing rapid eye movements. This helps your brain reprocess the memory and reduce emotional distress.

Dialectical behavior therapy (DBT) is an approach that focuses on strengthening four areas: mindfulness, distress tolerance, interpersonal effectiveness, and emotional regulation. Each skill can help you address different CPTSD symptoms. For instance, improving emotional regulation allows you to cope with and work with intense, overwhelming feelings.

Skills training in affective and interpersonal regulation (STAIR), a therapy that helps you manage difficult emotions and improve your relationships, is another common approach to treating CPTSD. A therapist might guide you through this structured therapy before directly addressing traumatic memories.

An experienced therapist might suggest other approaches, and finding a provider you feel safe and comfortable with is important. If you have difficulty finding in-person therapy near you, consider weighing good online therapy options that allow you to start your mental health journey from home.

Psychotherapy is often just one piece of a broader treatment plan. Aside from therapy, treatment for CPTSD might include:

Medication. For instance, a psychiatrist or doctor might prescribe SSRIs or SNRIs to help you manage depression or anxiety that comes with CPTSD.

Group therapy or peer support. Living with CPTSD can be an isolating experience. Engaging with other people who struggle with trauma can give you a sense of validation and connection.

Self-care strategies. Activities like journaling, mindfulness meditation, and creative hobbies can help you manage emotions and ground yourself in the present when you’re overwhelmed.

Getting help for CPTSD

If you notice that your CPTSD symptoms are persistent or getting worse, getting help is crucial. Perhaps your low mood or feelings of emptiness progress to suicidal thoughts or ideation.

Or maybe your relationships with your loved ones are becoming increasingly strained as your trust in others plummets. You might notice dissociative symptoms increasingly pull you away from work or important daily chores.

Reaching out for help doesn’t always feel easy at first, but it can be a life-changing step. Know that recovery is possible if you have the right support. A caring and knowledgeable mental health expert can guide you through the healing process.

Last updated or reviewed on October 28, 2025