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Complex PTSD: Symptoms, Causes, and What Treatment Looks Like

Not all trauma responses are the same. Complex PTSD (C-PTSD) is distinct from standard PTSD. Prolonged, repeated trauma changes how symptoms present. It makes sense – with CPTSD, there wasn’t one moment or situation. Instead, your trauma could have endured for months, years, or decades.

This gives it more time to shape reactions, feelings, thoughts, and relationship patterns. You had a need to survive something that didn’t end for a long time. The “before and after trauma” is much more murky with CPTSD. Especially if it occurred in childhood, there may not have been much of a “before” at all.

For this reason, it is sometimes hard to identify complex PTSD in adults. While daily life is often challenging with untreated CPTSD symptoms, many mistakenly believe that it’s “just who they are.” This is not true.

It’s absolutely possible to heal from complex PTSD. Identifying it is often the first step. Today, we’ll go over the symptoms and causes of CPTSD and what treatment looks like. That way, if anything we cover today feels familiar, you’ll know what to do next.

What Is Complex PTSD?

Complex PTSD is a mental health condition formally recognized in the International Classification of Diseases (ICD) 11. It stems from complex (prolonged or repeated) trauma. For example, childhood abuse, domestic violence, captivity, or human trafficking.

CPTSD shares some symptoms with PTSD, but there are marked differences. While one isn’t “worse” than the other, it’s important to acknowledge the distinctions between complex PTSD and PTSD. These differences can shape treatment goals and help professionals understand the best ways to support a person in their care.

Complex PTSD vs. PTSD

PTSD and CPTSD share some symptoms. To have PTSD or CPTSD, you must have symptoms in four core areas: changes in mood and cognition, avoidance, intrusion or re-experiencing, and arousal and reactivity. Shared symptoms often include flashbacks, hypervigilance, and avoiding external (e.g., people, objects, places) or internal (e.g., emotions) trauma reminders.

C-PTSD adds symptoms in several areas, which is part of what sets it apart from standard PTSD. These areas include emotional dysregulation, negative self-concept, and relational difficulties. In many cases, people with CPTSD experience dissociation, though a person with PTSD may dissociate, too.

Complex PTSD Symptoms

People with complex PTSD often have emotional, physical, and relational symptoms. If you have or suspect that you may have CPTSD, the following symptoms likely feel very familiar to you.

Emotional dysregulation. People with CPTSD often experience intense, sometimes unpredictable emotions. These can include anger (directed inward or outward), emotional numbness, or an inability to self-soothe when they are upset or fearful. This is part of what treatment helps with. In fact, it is a foundational area of focus. We teach emotion regulation skills before getting into deep trauma healing so that you know how to self-regulate first.
Negative self-concept. If you have CPTSD, you may carry the belief that you are “bad,” permanently damaged, or worthless. Many people experience deep-seated feelings of shame, guilt, or disproportionate self-blame. Alternatively, someone with PTSD may feel disconnected or unsure of their identity.
Relational difficulties. From the outside, relationship difficulties in CPTSD can look very different from person to person. Often, this shows up in the form of deep issues with trust or intimacy, the fear of abandonment, and unhealthy relationship patterns. Some people alternate between self-isolation and intense dynamics. Usually, this comes from an intense need to protect your independence paired with not wanting to be alone.
Dissociation. Now, to define dissociation. Broadly, it means feeling detached from your body, thoughts, identity, feelings, or surroundings. Dissociation can take different forms and vary in severity. People can experience depersonalization or derealization. You might feel like the world is unreal, dream-like, foggy, or distorted. Alternatively, you might feel detached; some people describe feeling “floaty” and unable to connect with their body or mind.
Physical manifestations. If you have CPTSD, you are significantly more likely to experience various health problems, including chronic pain and digestive issues. Most people (up to 90%) with PTSD or CPTSD have sleep disturbances, which can have a profound impact on quality of life, mood, and functioning. Hyperarousal (your body feels high-alert, tense, or on-edge), driven by the body’s fight-or-flight response, is often chronic before treatment. Your nervous system is in overdrive and does not relax, which is what causes many of the health issues we see in CPTSD.
Co-occurring concerns. Many people with CPTSD have co-occurring concerns, such as substance abuse. When this is the case, integrated care is important. It is very common that people with a history of complex trauma develop unhealthy coping mechanisms like drug and alcohol use, self-destructive behavior, and eating disorder behaviors. This isn’t something to feel ashamed of. These things meet a need. Our job is to help you find healthier ways to meet those needs.

Reading through these can help you understand why individualized, C-PTSD-specific, trauma-informed care matters as much as it does. For example, if a person with complex PTSD struggles with negative self-concept, we might focus on challenging negative beliefs or identity exploration more than we would with someone who has PTSD and doesn’t struggle in this area.

Causes of CPTSD

What causes CPTSD? CPTSD is caused by prolonged trauma where escape felt impossible. Some common causes of CPTSD include childhood neglect or abuse, domestic violence, and war. These are long-lasting and take continuous strikes at your mind and body’s sense of safety. The type of traumatic event or events you go through can most certainly shape what your symptoms look like.

Single-incident trauma can lead to PTSD, but not CPTSD. A single incident has a clear beginning and end. Unlike developmental or childhood trauma, which is very common in people with CPTSD, single-event trauma often happens when someone already has a developed sense of self and safety.

Treatment

CPTSD treatment helps you reclaim your life, well-being, and identity. There are various evidence-based treatments that help people overcome CPTSD symptoms. Here’s a little bit about what to expect in treatment for complex PTSD symptoms. If you have any questions, our admissions team is here to help.

Treatment approaches

Therapy is the foundation of effective treatment for complex trauma. CPTSD and PTSD treatment at Sanford involves the most evidence-based treatments for trauma, which include but are not limited to the following. At our center, they are always tailored to the needs of the individual.

EMDR. Eye movement desensitization and reprocessing (EMDR) helps people reprocess traumatic or triggering memories so that they have less power or emotional charge. It should always be conducted by a therapist with specialized EMDR training.
Trauma-focused CBT. Also called TF-CBT, trauma-focused CBT is a specific type of cognitive behavioral therapy that helps people overcome the emotional and behavioral effects of trauma. It helps you challenge unhelpful thoughts and beliefs, build coping skills, and work toward personal goals.
DBT. Dialectical behavior therapy (DBT) focuses on emotion regulation, distress tolerance, interpersonal effectiveness, and mindfulness. It is a skill-based treatment that is often helpful for people with CPTSD, especially in addition to other approaches.
Somatic approaches. The mind-body connection is often lost or fractured with CPTSD. Somatic approaches help “reset” the body’s threat response and get out of fight-or-flight mode. They can help you reconnect with your body and feel safe.

In some cases, medication can support treatment outcomes alongside therapy. For example, some people need medication for PTSD-related sleep issues, like nightmares and insomnia. Others may benefit from medication for co-occurring anxiety or depression. While it’s beneficial for many when paired with therapy, medication isn’t a standalone treatment for CPTSD.

Residential vs. outpatient

Residential inpatient and outpatient treatment programs can both address CPTSD. Sanford Behavioral Health offers a full continuum of care. If you’re not sure what program is the best starting point for you, our team can provide a recommendation. The right level of care for you at this time depends on your current symptoms and treatment needs.

Residential CPTSD treatment involves living on-site at our center in Michigan for the duration of the program. It is highly structured. People spend most of the day in therapy. Staff members are present 24/7. It’s often ideal for people who have moderate to severe symptoms that affect daily life functioning, need around-the-clock supervision, or who have co-occurring conditions (e.g., co-occurring substance use disorders).

Outpatient treatment options include partial hospitalization, intensive outpatient, and outpatient programming. Our partial hospitalization program (PHP) for trauma is the next step down from residential care: clients live off-site but come to therapy at our center for full-day therapy. Intensive outpatient and outpatient programs are even more flexible, allowing people to work or continue school while in treatment.

When to Seek Help

How do you know if it’s time to seek help for CPTSD? Whether you are already diagnosed with a mental health condition or suspect that you have CPTSD but are not yet diagnosed, professional help matters. Talk to a treatment provider if:

Symptoms affect your daily functioning for months.
Your relationships, mental health, or physical health are deteriorating.
You are self-medicating with alcohol and/or other substances or behaviors.

Seek urgent medical attention if you have thoughts of self-harm.

Contact Sanford Behavioral Health for CPTSD Treatment

C-PTSD is treatable. Sanford Behavioral Health provides trauma-informed care in Michigan. Our multidisciplinary team specializes in a comprehensive range of evidence-based and supportive therapies. Whether you are in inpatient or outpatient treatment, we will help you build a personalized treatment plan to address your unique CPTSD symptoms.

Our inpatient and outpatient mental health programs are covered by most forms of insurance. When you contact Sanford, we can verify your insurance coverage, tell you more about your treatment options, or answer any questions you have, 100% cost- and commitment-free.

Frequently Asked Questions

Is complex PTSD a real diagnosis?

Yes. Complex PTSD is a real diagnosis included in the ICD 10.

Can complex PTSD be cured?

People with PTSD can reach full remission. While it is not generally described as “cured” from a medical perspective, people do recover and heal from it with treatment. This typically means they no longer meet criteria for the disorder.

What is the best therapy for complex PTSD?

There’s no “best” therapy for complex PTSD across the board, but there are evidence-based treatments often considered the most effective. These generally include EMDR and behavioral therapies like CBT and DBT for emotion regulation. The therapy one person finds most impactful may differ completely from another’s. Many benefit from a combination of approaches.

How long does treatment take?

CPTSD treatment often takes 1-3 years of consistent therapy. This doesn’t mean it’ll take this long to see improvement. Progress is gradual. Initial stabilization comes first. Deep processing, shifting core beliefs about yourself, others, and the world, and working on interpersonal effectiveness or relationships usually come next. Everyone’s timeline is different.