What is CPTSD?
Complex post-traumatic stress disorder, also known as Complex PTSD or CPTSD, is a relatively new clinical category. It refers to a condition that is diagnosed in adults or children who have repeatedly experienced traumatic events such as neglect or abuse. Often, the feelings of distress are related to traumatic events that happened when the person was a child.
People who experience CPTSD will face many of the same symptoms as those with post-traumatic stress disorder (PTSD), but typically also have additional symptoms.
These additional symptoms might include (among others):
- Difficulty regulating emotions
- Risky behavior (difficulty controlling or regulating behaviors)
- Social problems (interpersonal and relational conflict, as well as avoidance, are common)
In addition, CPTSD is usually associated with a unique pattern of repeated trauma, such as continual sexual abuse.
Note: Though the Diagnostic and Statistical Manual of Mental Disorders (or DSM-V, the handbook often used by therapists to diagnose conditions) does not currently acknowledge CPTSD as a separate condition from PTSD, some therapists and doctors do diagnose it.
Prevalence of PTSD
Because CPTSD is a relatively new term and not currently a formal diagnosis, it is difficult to get a clear idea of just how many people experience this condition. However, it is suspected to be higher in minority (includes females, LGBT+, people of color) and immigrant populations, who may be more likely to be subject to abuse.
Difference between trauma, PTSD, and CPTSD
Trauma tends to be used as an umbrella term for the distress some people experience as a result of being exposed to one, or repeated, traumatic event(s).
PTSD, acute stress disorder (ASD) and CPTSD can be thought of as types of trauma.
Some of the differences in PTSD and CPTSD are:
PTSD is a recognized condition that can be receive a formal diagnosis, whereas CPTSD is currently not. (However, this may change in the future.)
It is thought that CPTSD is associated with repeated exposure to trauma during childhood.
On the other hand, PTSD tends to be more associated with a single traumatic event, which can occur during adulthood.
CPTSD is thought to involve the same symptoms as PTSD, albeit with additional symptoms (e..g, social difficulties, difficulty regulating emotions). Symptoms are discussed in more detail below.
Many of the treatments for PTSD are also beneficial for CPTSD. However, because of the relatively new nature of the term CPTSD, researchers are not yet certain of what the most effective treatment will be.
It appears that people with CPTSD might benefit from longer-term and more intensive support than PTSD.
Causes of CPTSD
The cause of CPTSD is often related to repeated or prolonged experience of trauma during childhood. Such trauma may include:
This is where the needs of the child are not attended to by a parent or caregiver in various ways.
The child may not receive adequate food or shelter. They may be unsafe physically, or abandoned. Their emotional needs may be neglected, if they are ignored by their parent or caregiver, for example.
The child may not form a secure attachment with their parent or caregiver.
Verbal attacks or insults. This can include obvious abuse like shouting, yelling, or calling someone names.
It can also include more covert verbal abuse, such as saying things that makes the child or individual believe that they are bad or worthless.
Emotional abuse refers to a child being deliberately made to feel wrong, bad, not good-enough, or blamed for things they did not do or had no control over.
The child may be made to feel scared, humiliated, or ignored.
This can include physical assault, exposure to pornographic material, sexualized language about body parts, sexual grooming, or being forced to become a sex worker, for example.
Any kind of violence directed at a child, such as hitting, punching, or pushing is damaging. Situations where a child is a witness to domestic violence in the home, such as between parents, are also traumatic.
Symptoms of CPTSD
As mentioned above, the symptoms of CPTSD often has overlap with PTSD, as well as additional symptoms unique to the condition.
Below, symptoms are classified as specific to CPTSD, those that also apply to PTSD, as well as often-associated (co-morbid) mental health symptoms:
Symptoms specific to CPTSD
- Social withdrawal or isolation
- Self-defeating or injurious behaviors
- Tumultuous and repeated disappointments in interpersonal relationships
- Suicidal ideation or self-harm
- Risky behaviors, such as drug abuse
- Difficulty controlling emotions
- Feeling hostile or mistrustful of others
- Feeling permanently damaged, worthless, or empty
Symptoms that also apply to PTSD
- Re-experiencing symptoms
- Night terrors or distressing dreams relating to the traumatic event
- Flashbacks of the traumatic event
- Intrusive memories or thoughts related to the trauma
- Physical sensations, including sweating, trembling, or gastrointestinal problems
- Avoiding and emotional numbing
- Emotional numbing
- Avoiding thinking or talking about the event
- Avoiding places that remind the person of the event
- Negative thoughts and feelings
- Paranoia and lack of trust in others and their intentions
- Persistent anger
- Lack of interest in life or loss of motivation
- Lack of meaning or purpose in life/hopelessness
- Never feeling “good enough”
- Arousal symptoms
- Aroused nervous system (startled responses)
- Insomnia (trouble falling or staying asleep)
- Angry outbursts or irritability
- Difficulty concentrating
Associated mental health symptoms and conditions often experienced alongside CPTSD
What to do if you’re experiencing symptoms of CPTSD
There are several treatment options for CPTSD, and it’s best to select one that has been developed specifically with trauma in mind.
Some people find that the treatments available for PTSD are helpful, while others will benefit from longer-term therapy. You may consider a combination of the following treatment options:
Sensorimotor is a body-centered talk therapy that helps attend to the body’s sensations and responses of the stored trauma memories.
Mindfulness and self-compassion techniques
Working with a therapist or other provider who is versed in mindfulness practices can help clients ground and gently attend to the memories or sensations or feelings of the trauma.
Relaxation or body-work exercises
This type of exercise can bring the mind and body out of fight-or-flight mode and soothe the nervous system.
Note: Sensorimotor interventions, mindfulness, and body work not only address symptoms of trauma, but they work to process and soothe it as well – so the individual can begin to become attuned to their own body, senses, and needs and differentiate past memories and experiences from present.
Eye Movement Desensitization and Reprocessing
EMDR can help desensitize the trauma through a series of eye movements and physical tapping, led by the therapist.
Medication treatment may be beneficial for some, depending on the nature and severity of the trauma.
And most importantly, the relationship with the therapist is absolutely crucial in establishing trust and safety. Having that safe relationship can help the client work through the trauma and begin developing a relationship with their own selves that is trusting, calming, and soothing.
With the right therapist and treatment, you can push back against your symptoms of CPTSD.
What to look for in a therapist for CPTSD
Look for a trauma-informed therapist
You may have the best experience working with a therapist who understands you holistically, from the lens of a trauma-informed perspective.
While the exact details of this may look different in every practice, it is essentially a) the ability to view the complex, nuanced impact of trauma on your day-to-day life, and b) the effort to keep your emotional safety top of mind throughout treatment.
This means that your therapist should not push you to expose yourself to reminders of the trauma until you feel ready, and until you have developed a toolbox full of strategies for managing your emotions and distress.
Know what questions to ask potential therapists
These questions may prove helpful when interviewing potential therapists for CPTSD:
- What therapy type (possibly one of the examples above, like EMDR) do you use when working with clients who have survived traumatic experiences?
- How long do clients typically see you for? How can I know I am making progress with you?
- Do you have experience working with clients in similar situations as mine? (For example, if you are facing substance use disorder, insomnia, panic attacks, or any of the other co-occurring symptoms of CPTSD).
Prioritize personal fit
While personal fit is a nuanced factor, it is critical to your success in therapy. Multiple studies have revealed the importance of this factor, often referred to as “therapeutic alliance.”
On your initial phone call with the therapist, ask yourself:
- Could I see myself forming a connection with this therapist?
- Does their approach suit my personality?
- Do I feel like I will be understood, respected, and made to feel safe by this therapist?
Find therapists for CPTSD
You can find therapists who specialize in the treatment of trauma, including CPTSD, on Zencare. You can filter by insurance, fees, and location; watch therapist introductory videos; and book free initial calls to find the right therapist for you: