Understanding Complex Post Traumatic Stress Disorder

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Complex Post Traumatic Stress Disorder (C-PTSD) has become widely recognized as a more psychologically pervasive and debilitating form of PTSD. While Simple PTSD is currently the only diagnosis in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV TR), C-PTSD is widely accepted and recognized as a distinct diagnosis of its own. Practitioners around the United States and Canada are petitioning to have this diagnosis added in the next diagnostic manual release, and have already published numerous books and treatment guides on the disorder.


Unlike “simple” PTSD, C-PTSD arises from prolonged chronic trauma occurring to the individual. For example, a woman who is raped and suffers severe emotional distress surrounding the event will warrant a “simple” PTSD diagnosis while a woman who suffered years of ongoing sexual abuse from a family member will be diagnosed with C-PTSD.

The most common causes of C-PTSD revolve around childhood trauma; including prolonged sexual abuse by family members or clergy, violence in the childhood home, or childhood neglect. C-PTSD can arise from any prolonged exposure to trauma, whether the traumas occurred during childhood or adulthood. For example, a diagnosis of C-PTSD is warranted for prisoners of war who have withstood years of torture by enemy hands.


Since C-PTSD arises from prolonged exposure to trauma, the effects are often devastating. If the traumas were experienced during childhood development, pervasive emotional and social dysfunction is often present. This occurs because during childhood we are developing our emotional regulation skills, social functioning skills, and our self-identities. Exposures to trauma disrupts what we learn to be standard or normal in relationships. In other words, the traumatized child may learn that trauma is what occurs in all relationships and to both expect and accept it in the future.

When C-PTSD arises during adulthood, a dramatic change in the individual’s perception of both themselves in the world and the world itself will occur. The individual may no longer feel human or “worthy” of a healthy relationship. They may feel as though they have “lost” themselves and that they are a “husk”. This can be understood as a form of disassociation from themselves. The individual may also globally distrust other people, inadvertently seek out similar abusive relationships, or only seek out relationships with protective caregiver figures.

Due to the chronic nature of the abuse, individuals with C-PTSD often lose their sense of self, self-worth, and describe themselves as not feeling human. Individuals with C-PTSD are often re-victimized later in life due to their inability to recognize unhealthy warning signals early on in their relationships and believing that abuse is normal. Oftentimes these individuals believe they deserve maltreatment or that it is their fault.

Diagnostic Criteria

C-PTSD does not yet have a formal diagnostic criteria system like “simple” PTSD. Despite this, the foremost criterion for diagnosis that is widely accepted is that he individual have experienced prolonged abuse that has significantly impacted their ability to function in a healthy manner.

Beyond that, the symptoms that may arise in the individual have been described as sometimes similar to those described in the neurobiology of PTSD or that of a personality disorder. “Simple” PTSD symptoms involve flashbacks, nightmares, avoidance of thoughts and reminders, emotional numbness, hopelessness, avoiding pleasant activities, reexperiencing the trauma, difficulty concentrating, memory problems, and relationship problems.


The Mayo Clinic