Treating complex trauma: what to expect

Complex post-traumatic stress disorder (C-PTSD) is a response to prolonged and repeated trauma. Although this type of trauma can occur in adulthood, it is most commonly seen during childhood and adolescence. Symptoms are similar to post-traumatic stress disorder (PTSD) with an additional cluster of symptoms.

Treatment for C-PTSD is long-term and may include psychotherapy (talk therapy), eye movement desensitization and reprocessing (EMDR), and medication. A strong support system, journaling, and mindfulness are helpful coping mechanisms when someone recovers from C-PTSD.

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PTSD vs Complex PTSD

Feeling stressed after a traumatic situation is common. You may feel anxious, have a racing heartbeat, have bad dreams, or shake. This is called post-traumatic stress or PTS. PTS can be very intense, however, symptoms usually resolve within a month.

Post-traumatic stress disorder (PTSD) is a clinically diagnosed condition caused by traumatic events such as fights, natural disasters, violence, abuse, etc. Symptoms persist longer than PTS.

The Many Names of PTSD

Over the years, PTSD has been recognized for its effects on veterans. It was also called “shell shock” or “combat fatigue”.

Complex PTSD (C-PTSD) is a response to prolonged and repeated trauma that lasts for months or years. C-PTSD is most commonly seen in those who have experienced trauma earlier in life and is particularly complex when someone has been injured by a caregiver or is still in contact with the abuser.


PTSD symptoms

The symptoms of PTSD are intense and persistent. They last long after the trauma is over, usually more than a month, and include:

  • Relive a trauma: This includes unwanted memories, nightmares or vivid flashbacks.
  • Avoid triggering situations: PTSD can cause a person to avoid places, people, or activities that remind them of the trauma.
  • Changes in beliefs and feelings: A person may develop a negative view of the world, find it difficult to feel positive emotions or do something pleasant.
  • Hyperarousal: Hyperarousal is when someone is constantly “on edge”, doesn’t feel safe and is easily frightened. This can lead to reckless or self-destructive behavior.
  • Somatic symptoms: People with PTSD may develop unexplained physical symptoms such as pain, fatigue, high heart rate, dizziness, tinnitus (ringing in the ear), blurred vision, etc.

PTSD Statistics

More than 8 million Americans, ages 18 and older, have been diagnosed with PTSD.

Symptoms of C-PTSD

C-PTSD involves the symptoms of PTSD along with the following:

  • emotional dysregulation: Having trouble controlling emotions such as anger, depression and suicidal thoughts. This can lead to self-harm or risky behaviors such as substance abuse and unprotected sex (also called “sex without a condom”).
  • Changes in consciousness: A person may have periods of amnesia (forgetting) or dissociation, making them feel detached from themselves or their surroundings.
  • Negative self-perception: C-PTSD can cause a person to experience a negative self-image, shame, guilt, or self-loathing. They often express a feeling of inadequacy or difference from others.
  • Difficulty with relationships: Some people can struggle with isolation and mistrust. They may also develop an unhealthy relationship or stay too long in an abusive relationship.
  • Distorted perception of an aggressor: This can lead to an unhealthy preoccupation with the abuser. It may also include a concern for revenge.
  • Loss of sense systems: Loss of core values, religion, beliefs or faith can cause feelings of hopelessness and hopelessness.

Behavior associated with C-PTSD

  • substance abuse: Research suggests a strong correlation between substance use disorders and trauma. One of the most common theories is that drugs and alcohol are used to numb emotional pain.
  • self-harm: Self-harm can also be called self-harm or self-injury and means hurting oneself on purpose due to emotional distress.
  • Avoidance: Emotional avoidance means creating distance from unpleasant emotions. Behavioral avoidance involves staying away from people, situations, and senses that recall the traumatic event. While natural in the short term, extreme avoidance can make it difficult to manage other areas of life.
  • Inability to accept criticism: For people with C-PTSD, criticism can cause significant stress because they are already self-critical or feel shame. They may also have had an abuser who manipulated them with criticism to get an emotional reaction.

Diagnosing complex trauma

C-PTSD is not yet a diagnosis Diagnostic and Statistical Manual of Mental Disorders (DSM-5) or recognized by the American Psychiatric Association (APA). However, the World Health Organization (WHO) describes C-PTSD in ICD-11.

Although there is no formal test to distinguish between the two, C-PTSD includes three additional groups of symptoms, as mentioned above, including:

  • emotional dysregulation
  • Negative self-image
  • Interpersonal difficulties

Causes of C-PTSD

People with C-PTSD suffer from long-term, repetitive trauma and are often injured by a caregiver. Most survivors were unable to leave the situation and felt trapped or controlled.

Risk factors for C-PTSD involve chronic exposure to trauma, particularly during childhood and adolescence, when brain development is most vulnerable.

Here are some examples of trauma:

  • Emotional, physical or sexual abuse
  • Sex trafficking and exploitation
  • Negligence
  • Abandonment
  • To be a child soldier
  • Slavery
  • Torture
  • Genocide
  • Prisoner of War (POW)

Treatment of complex trauma

C-PTSD is treated the same way as PTSD. However, the treatment is usually longer. It may include one or a combination of the following:

  • Psychotherapy: Psychotherapy, or talk therapy, should be conducted by a qualified therapist. It is best to find one who has experience dealing with trauma. The goal is to identify harmful thoughts and behaviors, decrease symptoms, and develop coping techniques for better functioning in daily life.
  • Eye Movement Desensitization and Reprocessing (EMDR): EMDR combines psychotherapy with the use of eye movements. Treatment begins with the therapist building trust and teaching eye movement techniques. EMDR helps the trauma survivor briefly focus on a memory and process it until it is no longer distressing.
  • Medication: Health care providers often prescribe medications to treat PTSD and C-PTSD. These may include antidepressants such as Zoloft (sertraline), Paxil (paroxetine), Prozac (fluoxetine), and Effexor (venlafaxine), as well as other agents.

Off-label drugs from the Food and Drug Administration (FDA)

Zoloft and Paxil are FDA approved for PTSD. Prozac and Effexor are considered “off label”. This means that they may be commonly prescribed for the condition, but do not carry formal FDA indication for their use.

Dealing with C-PTSD

Recovery from C-PTSD is a long process. It is important to be kind to yourself or your loved one with C-PTSD. The following coping mechanisms are helpful when used with treatment:

  • Find help: C-PTSD can prevent you from being social. However, it’s important to have a strong support system so you can reach out to those you trust. This may include friends, family, support groups, church, or other groups.
  • Practice mindfulness: Mindfulness means being aware of yourself, intentionally shifting attention to the present, and restructuring thought patterns. Mindfulness techniques don’t need to be elaborate. They can be incorporated into walking, diet, breathing, meditation, music and hobbies.
  • Logging: The brain may struggle to process difficult events. Journaling provides a place to write down private feelings and thoughts. Putting thoughts on paper helps you express and begin to let go of your emotions.


Complex PTSD, also called C-PTSD, can result from chronic trauma that typically occurs during childhood and adolescence. Although similar to post-traumatic stress disorder (PTSD), it comes with an additional group of symptoms. Treatment for C-PTSD includes psychotherapy (talk therapy), eye movement desensitization and reprocessing (EMDR), medications, and the development of new coping mechanisms.

A word from Verywell

Difficult emotions and thoughts resulting from complex trauma can lead to isolation and loneliness. Daily life and relationships can become difficult because you use all your energy to cope. It’s good to seek immediate treatment with a licensed therapist to help you work through your feelings, build better relationships, and enjoy a fulfilling life.

Frequently Asked Questions

  • How are complex trauma treated?

    Complex trauma is treated with a combination of psychotherapy (talk therapy), eye movement desensitization and reprocessing (EMDR), medication, and the development of powerful coping mechanisms.

  • Do complex traumas disappear?

    The impact of complex trauma may not go away completely, but with treatment the symptoms of complex trauma can significantly decrease, helping the person with daily functions and giving them a high quality of life.

  • What is Integrative Complex Trauma Treatment?

    Integrative treatment is an evidence-based, multimodal approach to treating C-PTSD in adolescents.

  • What is the best psychotherapy for complex trauma?

    Certain types of cognitive behavioral therapy (CBT) have been shown to be effective for PTSD. Eye Movement Desensitization and Reprocessing (EMDR) is also helpful in processing trauma-related emotions.

  • Is complex trauma the same as PTSD?

    They are similar, but complex trauma (C-PTSD) arises from repeated, chronic, long-term exposure to trauma, usually from childhood. PTSD can occur after short-term trauma.

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