Authored by Pin Ng PhD

Edited by Hugh Soames

Reviewed by Michael Por, MD

CPTSD: Complex Post Traumatic Stress Disorder


Post-traumatic stress disorder has become a popular topic in mental health circles over the last two decades. It is a difficult disorder to overcome, but strides are being made in mental health healing. Complex post-traumatic stress disorder is a form of PTSD. CPTSD shares some of the symptoms of PTSD. The difference is CPTSD has some additional symptoms that individuals experience.


What are the symptoms of CPTSD


Symptoms include some typical PTSD issues and additional symptoms that are not associated with the disorder.


CPTSD symptoms include:


  • difficulty controlling emotions
  • feeling very angry
  • distrustful of the world
  • constant feelings of emptiness and hopelessness
  • feeling permanently damaged and worthless
  • feeling completely different to other people
  • feeling like nobody can understand what has happened to cause the issues
  • avoiding friendships and relationships
  • finding friendships and relationships difficult to manage
  • often experiencing depersonalization or derealization
  • headaches, dizziness, chest pains, and stomach aches
  • regular suicidal thoughts


Children and teenagers may experience CPTSD and display different symptoms.


The symptoms found in children and teenagers may include:


  • intense feelings of guilt and/or shame
  • insomnia or sleeping longer than usual
  • withdrawal or isolation
  • angry or aggressive outbursts
  • changes in behavior at home and/or school
  • anxiety and fear
  • withdrawn or closed down communication
  • self-harm
  • hyper-vigilance
  • Oppositional Defiant Disorder
  • intrusive thoughts
  • obsessive behaviors
  • eating less food than usual and having an increased concern over food and drink
  • increased risk-taking behaviors
  • substance use
  • gaming or Internet addiction
  • high-risk sexual behavior
  • waking up exhausted
  • irritable
  • low energy levels
  • Lack of self-care
  • signs of depression
  • change in voice
  • difficulty in forming trust


Individuals that experience CPTSD may experience emotional flashbacks. These are intense feelings that were originally felt by the individual during the traumatic experience. A person experiencing CPTSD may feel like they are still in the moment of the original trauma.



The biggest difference between CPTSD vs PTSD is the frequency of the trauma experience. PTSD is created by a singular traumatic event. CPTSD happens after you experience long-lasting trauma. The trauma will continue for months or years.


CPTSD vs PTSD are the result of experiences from deeply traumatic events. The events may cause flashbacks, nightmares, and insomnia. You may feel afraid and unsafe although the danger has ended.


Causes of CPTSD


Some traumatic events will cause you to experience PTSD. However, there are other, more intense traumatic issues that will bring on CPTSD.


Traumatic events that may create PTSD include:


  • childhood abuse
  • neglect and/or abandonment
  • domestic violence or abuse
  • repeatedly seeing violence or abuse
  • being force into the sex trade
  • being torture, kidnapped or forced into slavery
  • being a prisoner of war


CPTSD is more likely to be created in a person due to events including:


  • trauma from an early age
  • long-term trauma
  • escape or rescue from trauma were unlikely or impossible
  • experiencing multiple traumas
  • being harmed by a friend or family member
  • genocide
  • child soldiering


Individuals suffering from CPTSD may avoid certain situations. Situations including being around large crowds or driving a vehicle may be avoided. A person may also experience hyperarousal. Hyperarousal is the feeling of being constantly jittery and/or on alert.


Are there risk factors for CPTSD?


CPTSD can be experienced by anyone. However, there are some people who are more susceptible to CPTSD.


Risk factors for CPTSD include:


  • Existing mental illness
  • Existing family history of mental illness
  • Brain hormones and neurochemical regulation
  • Not having a strong support system
  • Having a dangerous job

CPTSD Treatment


There is not a specific diagnosis for CPTSD. It is thought by mental health experts that PTSD and CPTSD are too similar to have a separate diagnosis. Due to the similarities of both, the treatments strategies are similar too.


Strategies for CPTSD treatment include:


  • Medications which may reduce symptoms such as anxiety and depression. Medication is typically helpful when combined with psychotherapy. Antidepressants are also usually used for treatment.
  • Psychotherapy focuses on identifying an individual’s traumatic memories and negative thought patterns. These are then replaced with more realistic and positive thought patterns. These new though patterns help you learn to cope with your trauma.


Mental health practitioners may use eye movement desensitization and reprocessing (EMDR) to treat CPTSD. Therapists will use EMDR and guide your eye movements to reframe traumatic memories. Over time, the process will decrease the negative feelings you experience.


How to cope with CPTSD


It can take time for CPTSD treatments to work fully. There are strategies and techniques available to cope with and manage the symptoms of CPTSD.


Strategies to employ for CPTSD management include:


  • Finding support and positive networks can provide you with an improvement in your mental wellbeing. Speaking to friends or family members can improve your angry, anxiety, and other CPTSD symptoms.
  • Practice mindfulness and meditation are techniques that can reduce symptoms. Mindfulness gives you the chance to be in the moment, clear the mind, and focus on the present rather than the past or future.
  • Journaling gives you the chance to write down your thoughts and feelings. You may be able to identify triggers by writing down your symptoms and daily activities.
  • Support groups are good ways to find like-minded people who have been through the same experiences
  • Self-help books can also be helpful. However, ensure the self-help books are written by trained mental health professionals and not social media influencers seeking to sell their programs and books.



CPTSD and borderline personality disorder share similar symptoms. Individuals with CPTSD are sometimes misdiagnosed with borderline personality disorder. Some mental health professionals are not aware of CPTSD, making the diagnosis even more difficult. Borderline personality disorder is diagnosed when CPTSD fits the symptoms more closely.


If you have been diagnosed with borderline personality disorder, but you are worried you may have CPTSD, it is important to speak to your mental health care provider. There is treatment available for PTSD and CPTSD. If you are experiencing either PTSD or CPTSD, contact a mental healthcare provider for a proper diagnosis.

References: CPTSD: Complex Post Traumatic Stress Disorder

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  6. Yen S, Shea MT, Battle CL, Johnson DM, Zlotnick C, Dolan-Sewell R, Skodol AE, Grilo CM, Gunderson JG, Sanislow CA, et al. Traumatic exposure and posttraumatic stress disorder in borderline, schizotypal, avoidant, and obsessive-compulsive personality disorders: findings from the collaborative longitudinal personality disorders study. J Nerv Ment Dis. 2002;190:510–518. [PubMed] []
  7. Wingenfeld K, Driessen M, Adam B, Hill A. Overnight urinary cortisol release in women with borderline personality disorder depends on comorbid PTSD and depressive psychopathology. Eur Psychiatry. 2007;22:309–312. [PubMed] []
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