How is Complex Post Traumatic Stress Disorder Diagnosed? And Other Questions

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Complex Post Traumatic Stress Disorder

Some individuals experience terrible trauma that lasts for months or years. This prolonged, repeated and chronic trauma, known as complex post traumatic stress disorder can cause symptoms beyond those of PTSD.

Question: How Does Complex PTSD Differ from PTSD?

Answer: The term complex post traumatic stress disorder, or Complex PTSD, better explains the severe psychological damage caused by repeated trauma occurring over months or years. This trauma may include being held as a captive, physically or emotionally, where an individual is being controlled by someone else and is unable to escape. Examples of such traumatic experiences include prisoner of war camps, domestic violence, long-term physical abuse, long-term sexual abuse, and any trauma experienced by the very young. People with post traumatic stress disorder, on the other hand, suffer short-term traumas such as car accidents or natural disasters.

Complex PTSD additionally differs from PTSD with three specific features, including dysregulation of emotions, pathological dissociation, and stress-related physical health breakdowns. Emotional dysregulation involves severe emotions that can leave an individual wondering what he or she may be feeling from one moment to the next. Pathological dissociation represents a prolonged, sudden, and involuntary loss of knowing one’s identity, environment, or personal thoughts and feelings. Finally, health breakdowns can occur with pain or another real medical illness, and the individual constantly worries about it and does not to respond to treatment due to stress on the body.

Q: Are there Additional Complex PTSD Symptoms?

Answer: Yes. Other symptoms of Complex PTSD, also known as Disorders of Extreme Stress Not Otherwise Specified (DESNOS), include changes in self-perception, with feelings of shame, guilt, helplessness, and a sense of being different from people. Relationships can change with isolation, distrust, or a constant need for being rescued. Individuals with Complex PTSD may become preoccupied with the perpetrator, giving him or her total power or becoming obsessed with revenge. Loss of faith or feelings hopelessness and despair can also occur.

Q: How is Complex Post Traumatic Stress Disorder Diagnosed?

Answer: Complex post traumatic stress disorder is not really diagnosed because it is not a separate diagnosis in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-V). In the 1990s, Complex PTSD was proposed as a separate diagnosis from PTSD when the DSM-IV was being revised. The disorder, though, was not codified as a separate diagnosis because it was judged to be similar to other diagnoses. The American Psychiatric Association is reviewing the issue for the DSM-V, but the diagnosis will not be finalized before 2012.

Typically, a person is thought to have Complex PTSD if he or she has experienced severe trauma, has had symptoms for over a month, and these symptoms disrupt daily activities.

So, the question should not be, “How is complex post traumatic stress disorder diagnosed?” - rather, a better question to ask is, “When will Complex PTSD be recognized as a separate diagnosis?” A new diagnosis will represent more recognition and better treatments for this complicated disorder.

Q: What other Difficulties are Associated with Complex Post Traumatic Stress Disorder?

Answer: Individuals with Complex PTSD are at high risk of alcohol and substance abuse. They may expose themselves to other risky behaviors such as physical danger, accidents, and unprotected sex. Self-mutilation and other forms of self-harm are also common in people with Complex PTSD.


Ford, Julian. “Complex PTSD.”

Whealin, Julia M. and Slone, Laurie. Complex PTSD.