Your response to trauma won’t always look the same as someone else’s. Your experiences — and how long or how often you went through them — can all impact trauma symptoms later in life.
Living with complex post-traumatic stress disorder (C-PTSD) might mean behaving recklessly or having feelings of hostility or dissociation that make daily life difficult. You may feel like you’ve lost your sense of spirituality or feel overwhelmed by shame.
If C-PTSD doesn’t sound familiar to you, that’s because there’s still some debate in the mental health community about its formal classification. If a mental health professional is following the DSM-5 criteria, you may just be diagnosed as having PTSD.
But PTSD is more often associated with one traumatic event, whereas complex trauma could be connected to repeated events. For this reason, some experts have pushed for C-PTSD to be a recognized diagnosis in all manuals, separate from PTSD.
PTSD versus C-PTSD: What’s the difference?
One difference between C-PTSD and PTSD has to do with how these conditions are defined. C-PTSD isn’t a recognized diagnosis in the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5). While the manual does acknowledge that some people may experience severe symptoms with PTSD, it doesn’t give a separate diagnosis based on C-PTSD specifically.
In the World Health Organization’s International Classification of Diseases (ICD-11), C-PTSD is listed as its own condition. In this manual, C-PTSD includes symptoms of PTSD but focuses on the group of traits often seen with chronic trauma. In a 2017 study, C-PTSD was actually found to be more common than PTSD based on ICD-11 criteria.
PTSD in both the DSM-5 and the ICD-11 includes symptoms that are:
- strong and frequent
- related to reactivity
In the DSM-5, negative feelings toward yourself and the world around you are included in the criteria for PTSD.
In the ICD-11, these symptoms are called “disturbances of self-organization (DSO),” and could mean a possible C-PTSD diagnosis.
Symptoms of DSO include:
- difficulty managing emotions, or emotional dysregulation
- relationship difficulties
- a negative view of yourself
If you’ve experienced repeated trauma or long-term trauma, you may have a higher chance of developing C-PTSD symptoms. In some cases, a single traumatic event may be enough to cause C-PTSD.
Symptoms and signs of C-PTSD
Symptoms of C-PTSD often include the same types of symptoms seen with PTSD, such as:
- recurrent and intrusive thoughts or dreams
- mental and physical reactions to reminders of the traumatic event
- avoidance of people, places, things, or events that remind you of the trauma
- memory loss
- negative thoughts toward yourself or the world
- bad moods that stick around
- detachment and disinterest
- difficulty showing positive emotion
- hypervigilance, or being on “high alert”
- trouble concentrating
- startling easily
- trouble sleeping
But if you live with C-PTSD, you could have more severe DSO-type symptoms, like:
- a negative view of yourself
- dissociation, or disconnecting from yourself and your emotions
- emotions that feel “out of control”
- relationship difficulties
- loss of your belief system
- difficulty recognizing reality
Negative view of yourself
You may have feelings of shame or guilt related to the traumatic experience. You may also feel like you’re to blame or even permanently changed in some negative way.
Dissociation is a detachment from yourself and your emotions. You may also have trouble remembering parts of the traumatic experience or forget it happened at all.
Intense emotions might include anger or sadness, and they often seem to come without warning.
You may not feel as though you can trust anyone or come to expect that others will harm you. You may also find yourself in other traumatic situations if abuse was a regular part of your past.
Loss of belief systems
Your spiritual beliefs and worldview can change after trauma. You might wonder if there’s any purpose or meaning to what you once believed.
If you’ve survived abuse, your thoughts might focus on your relationship with the person who abused you. You may also become focused on thoughts of revenge or feel responsible for your abuser’s actions. Just remember: You are not at fault.
Complex PTSD triggers
If you live with C-PTSD, you might find that certain emotions or situations can bring on intense symptoms related to your trauma.
What triggers this response for you will probably look different than what triggers it for someone else. This is largely because a trauma trigger is related in some way to the original trauma.
For example, it could be something you picked up with one of your five senses when the trauma was taking place. Some common triggers include:
- specific physical sensations or pain
- intense emotions like fear, sadness, or anger
- a breakup or divorce
- specific smells, sounds, or tastes
- a month, date, or time of year
- reading a book or watching a movie that makes you think of the trauma
- specific places, like the dentist’s office or church
Do I have C-PTSD? How to find out
A mental health professional can diagnose C-PTSD (or PTSD). If you’ve had trauma and feel its impact on your daily life, help is available.
You might not know where to start, but this is natural. Your doctor can help you find trustworthy resources in your area.
If you decide to see a mental health professional, you might receive a C-PTSD diagnosis if you complete the International Trauma Questionnaire.
The questionnaire — a self-reporting tool used to identify PTSD and C-PTSD — can also help determine if your symptoms are happening along with another mental health condition.
Treatments for C-PTSD may include:
- therapy, with a focus on cognitive behavioral therapy (CBT) and dialectical behavior therapy (DBT)
- integrative adaptation and development after persecution and trauma (ADAPT) therapy
- eye movement desensitization and reprocessing (EDMR) therapy
- somatic therapies like somatic experiencing
Symptoms of C-PTSD can look like PTSD co-occurring with other mental health conditions. A mental health professional will be able to rule out other possible diagnoses.
Borderline personality disorder (BPD) with PTSD, for example, shares many traits with C-PTSD. Still, a 2018 study suggests some differences. It argues that C-PTSD symptoms include a more negative self-focus, whereas someone with BPD might tend to change between a positive and negative view.
Living with C-PTSD can change how you feel about yourself, those around you, and life in general.
Your symptoms may feel intense, and you might wonder if anyone else understands what you’re experiencing. Whether you live with PTSD or C-PTSD, you aren’t alone.
Support networks and professional help are available. You may also be able to soothe some of your symptoms through:
- relaxation techniques
- nutrition and movement
- online support groups
- reconnecting with safe friends and family
Learning more about C-PTSD care plans may also help you on your road to recovery.