Complex post-traumatic stress disorder (C-PTSD)

If you have symptoms of post traumatic stress disorder (PTSD), and also have problems with managing your emotions and having relationships, you might have complex PTSD.

Symptoms of PTSD:

• re-experiencing or re-living traumatic events in the form of; flashbacks, nightmares, repetitive images or sensations, sweating, feeling sick or trembling.
• avoidance and emotional numbing, such as avoiding people or places that will remind them of the trauma, or distracting oneself with work or hobbies.
• feeling 'on edge' and finding it difficult to relax, which may lead to irritability, angry outbursts, sleeping problems and difficulty concentrating.

Symptoms of complex PTSD

The symptoms of complex PTSD are similar to those of PTSD but may also include:

• feelings of worthlessness, shame and guilt
• problems controlling your emotions
• finding it hard to feel connected with other people
• relationship problems, such as keeping friends and partners

Causes of complex PTSD

The causes of complex PTSD are often associated with experiencing recurring or long-term traumatic events, for example:

• childhood abuse or neglect
• domestic violence
• sexual abuse
• torture, sex trafficking, or slavery
• war

You are also more likely to develop complex PTSD if you experienced trauma at a young age, were harmed by someone close to you who you trusted or were unable to escape trauma. 

People who have these difficulties and often the people around them, including professionals may think that this is just they way they are and they cannot be changed. This is not true. An important first step is for you to recognise what this problem is because it is often misunderstood and therefore the wrong treatment is given. Recognising the problem is often difficult because people with this are much more vulnerable to other difficulties such as depression and because these symptoms are like the symptoms of anxiety and depression. This means that people have often had lots of different diagnoses and sometimes have found that their treatments have not helped, or have only helped a bit.

In order to recognise these patterns and to change them, it is useful to give them a name but many different names have been used, which is confusing.

We know more about complex PTSD now, are recognising it more and more, but terminology and understanding varies. It can look like emotional unstable personality disorder (EUPD) because of the difficulties in regulating emotions, and it is possible to have both. 

Most recently, researchers have come to understand how these patterns come from repeated abuse, stress or trauma in childhood, often from a caregiver, and how similar the patterns are to people who suffer trauma in adulthood, for example, soldiers in war situations. The pattern of problems they get, which is very similar, is called Post Traumatic Stress Disorder (PTSD). So we now call these problems "Complex PTSD".

The major difficulties in life and the distress that C-PTSD causes can be reduced by addressing the rapid and extreme changes in thinking and behaviour and replacing these with more regular steady routines, thinking ahead and predicting difficulties and more helpful ways of dealing with thoughts and situations.

A good psychological assessment will determine the most suitable approach that is right for you. 

There are effective psychological therapies available which include eye movement desensitization and reprocessing (EMDR) and dialectical behaviour therapy (DBT) informed approaches. These can be extremely effective in helping people achieve major change and improvement in the quality of their lives. This sort of therapy is usually only available from specialist mental health services.