Complex post-traumatic stress disorder (CPTSD or c-PTSD) is a mental health condition caused by exposure to prolonged or repeated traumatic events. It can significantly impact emotional well-being, daily functioning, and relationships. Treatment for CPTSD will include therapeutic techniques to process and overcome the impact of trauma.
- Complex post-traumatic stress disorder (CPTSD) is a condition similar to PTSD that causes flashbacks, fear, emotional difficulties, relationship issues, and feelings of low self-worth.
- CPTSD is sometimes diagnosed as other conditions, including PTSD, borderline personality disorder (BPD), and disorders of extreme stress not otherwise specified (DESNOS).
- Treatment for CPTSD often involves behavioral and cognitive therapies.
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Understanding Complex PTSD (CPTSD)
Complex post-traumatic stress disorder (CPTSD) is a condition often caused by exposure to repeated and prolonged trauma, usually in childhood, resulting in severe and long-term emotional and behavioral changes. [1] The details of the clinical presentation of CPTSD have changed and developed over the years. If and how CPTSD differs from other conditions, particularly PTSD, has long been a subject of debate and discussion. [2][3] In 2018, CPTSD was included in the 11th edition of the World Health Organization (WHO)’s International Classification of Diseases (ICD-11). However, it is not a distinct condition in the American Diagnostic and Statistical Manual of Mental Disorders (DSM-5). [4][5]
Terms such as enduring personality change after catastrophic experience (EPCACE) and disorders of extreme stress not otherwise specified (DESNOS) might be used in place of CPTSD, particularly in America, where the DSM-5 is the primary diagnostic classification system. [3]
Symptoms of CPTSD include the symptoms of PTSD: [1][5]
- Avoiding reminders of the trauma, including people, places, or thoughts
- Re-experiencing the trauma, such as flashbacks or memories of the events
- A persistent feeling of threat or danger
As well as three distinct symptoms: [5][6]
- Affect dysregulation, such as extreme emotional reactions, violence, or dissociation
- Persistent negative self-view, such as feeling worthless, ashamed, or guilty
- Impairments in interpersonal relationships, such as difficulties feeling close to others or avoiding social interactions
CPTSD vs. PTSD: What sets it apart
CPTSD is considered a more severe form of PTSD, leading to significant functional impairments. Both conditions involve exposure to trauma, resulting in a heightened sense of threat and fear, avoidance of reminders or potentially threatening situations, and re-experience of the trauma, such as flashbacks and nightmares. [2][5]
However, CPTSD also involves significant emotional and behavioral changes, including impairments in interpersonal relationships, emotion dysregulation, and a persistent negative self-view. For a diagnosis of CPTSD, the criteria of PTSD must be met, along with these additional symptoms. [5][6]
Additionally, although this is not always the case, it is more common for those with PTSD to have experienced a single traumatic event and those with CPTSD to have experienced chronic or repeated trauma. [3]
CPTSD vs. BPD
Childhood trauma, particularly sexual or physical abuse, is a common contributing factor in the development of both borderline personality disorder (BPD) and CPTSD. Additionally, both CPTSD and BPD involve criteria relating to emotional dysregulation. [2]
However, differences between the two conditions include: [2][7]
- Avoidance: CPTSD involves attempts to avoid potential threats and reminders of trauma, which is not a criterion of BPD.
- Fear: CPTSD includes a heightened sense of fear and threat, which is not a criterion of BPD.
- Relationships: Both CPTSD and BPD cause impairments in interpersonal relationships. However, people with BPD experience an extreme fear of abandonment and instability within relationships. This is not true of people with CPTSD, who experience avoidance and an impaired ability to connect with others.
- Self-view: People with BPD have an unstable sense of self, which may change dramatically and abruptly, whereas people with CPTSD have a persistent negative self-view.
- Impulsivity and suicidality: Impulsive behavior is common in BPD, which includes self-destructive and suicidal behaviors. In contrast, CPTSD may cause suicidality, but it is less impulsive, less frequent, and more likely to be fatal.
A 2014 study investigated CPTSD, BPD, and PTSD prevalence among 280 female child abuse survivors seeking PTSD treatment. This study found that: 7.8% of those with CPTSD met BPD criteria, 44.6% of those with BPD met CPTSD criteria, and 54.9% of those with BPD met PTSD criteria. [2] This demonstrates that, while many people with BPD experience symptoms of PTSD or CPTSD, a CPTSD diagnosis does not often indicate the presence of BPD symptoms, and therefore, the conditions are distinguishable.
What causes CPTSD?
Trauma is the cause of CPTSD. The type, duration, and nature of the trauma may differ, but research suggests that chronic, prolonged, or repetitive trauma, often in childhood, is a strong predictor of CPTSD. This might include torture, repeated childhood sexual or physical abuse, concentration camps, slavery, or prolonged domestic violence. [3][6]
Children and adolescents are more vulnerable than adults to CPTSD. Exposure to trauma during the developmental stages can impact the individual’s cognitive, behavioral, and emotional development, thus increasing the risk of CPTSD symptoms. [6]
Environmental factors can influence the risk of developing CPTSD symptoms. For example, people in a supportive and caring environment might be less likely to develop CPTSD following trauma. Additionally, genetics can impact susceptibility, vulnerability, and resilience, influencing CPTSD development. [1][8]
Recognizing the symptoms of CPTSD
Symptoms of CPTSD can include: [3][6]
- Nightmares about the traumatic events
- Extreme fear, possibly easily startled or stressed
- Hypervigilance, such as making attempts to guard from potential threats and changing behaviors to feel safer in various situations
- Flashbacks, memories, or images of the events
- Avoiding situations or people that might serve as a reminder of the trauma, potentially changing jobs, schools, home, or other circumstances to avoid reminders
- Feelings of guilt and shame, perhaps thinking that they should have done something to protect themselves or others from the traumatic events
- Little interest in forming friendships or relationships, or struggling to form close connections with others
- Impaired functioning at school, work, personal life, or social situations
- Severe distress and emotional impact, such as self-destructive or reckless behaviors, aggression or violence, dissociation, inability or unwillingness to experience any positive emotions, or sensitivity to stressful situations
- May experience symptoms of psychosis or depression, or suicidal ideation
- May abuse substances
How CPTSD affects daily life and relationships
CPTSD can have a significant impact on a person’s emotions, functioning, and relationships, negatively impacting daily life. It can cause mild to severe impairments in various areas of life, including: [3][9]
- Emotional instability and distress that impact well-being and inhibit fulfilling or meaningful experiences
- Distrust, fear, and anxiety may cause barriers to meeting personal and social needs
- People might struggle to make friends or form romantic relationships
- There might be places or situations that are triggering or distressing, preventing people from attending or accessing enjoyable or necessary environments
- Symptoms could impair academic and professional functioning, thus potentially impacting the individual’s financial stability
The link between CPTSD and addiction
Exposure to trauma is a risk factor for substance abuse and addiction. Therefore, people with CPTSD may be more likely to experience substance use issues. This can be linked to various factors, including: [10]
- Self-soothing or self-medicating CPTSD symptoms with drugs and alcohol
- Self-destructive and risky behaviors, which are often a feature of CPTSD, may include the misuse of substances
- Substance use might be used as a coping strategy, such as numbing, distraction, or avoidance of CPTSD symptoms
Evidence-based treatments for CPTSD
Currently, evidence for the treatment of CPTSD is limited, as the diagnosis is still new, or symptoms are considered a part of PTSD. As such, treatments for CPTSD involve evidence-based approaches to trauma-related conditions such as PTSD and comorbid mood or substance disorders. [11][12] This includes: [1][11]
- Cognitive behavioral therapy (CBT)
- Trauma-focused cognitive therapy (TF-CT)
- Narrative exposure therapy (NET)
- Eye movement desensitization and reprocessing (EMDR)
- Skills training in affective and interpersonal regulation (STAIR)
These therapeutic approaches focus on processing and recovering from traumatic events, increasing emotion regulation skills, and improving relationships. Further research is required to develop interventions that meet the specific and complex needs of those with CPTSD. [1][11]
Medications may be included in treatment approaches to help manage specific symptoms, including antidepressants. However, pharmacological approaches to CPTSD treatment have also not been extensively studied and require further investigation. [11]
Practical coping strategies and self-care tips
Coping strategies and self-care tips that might help people manage symptoms of CPTSD can include: [12]
- Self-soothing: Calming activities, such as holding comforting objects, listening to music, breathing strategies, or grounding techniques, can help to manage distressing emotions and situations.
- Learning triggers: Keeping a diary or a record of circumstances that have felt distressing can help with recognizing and managing triggers.
- Support networks: Friends and family can provide safety and support. Some people may prefer to confide in a professional or call a helpline.
- Peer support: Various support groups or online support forums are available and can provide a feeling of care and belonging among others with similar experiences and symptoms.
- General well-being: Taking care of general health can be beneficial to mental well-being. This can include healthy diets, physical exercise, and consistent sleep patterns.
Seeking help and support
People can consult with their primary care physician for advice about CPTSD. They may be able to offer support and make a referral to a specialist assessment and treatment service where interventions can be accessed.
Online forums and charities can also provide information about CPTSD and tips to help people manage their symptoms.
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