Understanding Complex Post-Traumatic Stress Disorder (C-PTSD)

Understanding Complex Post-Traumatic Stress Disorder (C-PTSD)


Understanding Complex Post-Traumatic Stress Disorder (C-PTSD): How is it diagnosed and treated?

Some individuals with borderline personality disorder (BPD) or post-traumatic stress disorder (PTSD) have never quite felt that their diagnosis described what they were experiencing with their mental health. Maybe some people have wondered about the symptoms they are experiencing, and after reading about BPD and PTSD felt some symptoms portrayed their experience but did not completely explain what was going on. Similar to both these diagnoses but also possessing key differences from them, complex post-traumatic stress disorder (C-PTSD) is a new concept that is being investigated by mental health professionals. This diagnosis consists of symptoms of post-traumatic stress disorder and borderline personality disorder with additional symptoms that characterize it as a separate disorder. If you are wondering if there might be another explanation for your symptoms or want to understand what C-PTSD is and how to treat it, whether for yourself, a loved one, or just to understand it, keep reading to find out!


What is Post Traumatic Stress Disorder (PTSD)?

PTSD is a disorder that manifests in specific individuals when they experience a single traumatic event that inhibits a person’s ability to perform daily functioning. Unlike C-PTSD, PTSD is a reaction to a single event, not prolonged trauma over time. Source. Trauma can, unfortunately, happen to any of us, and it is essential to understand that PTSD is not an uncommon response to these incidents and recognize that any of these symptoms can appear that you may need help treating. When this disorder was first recognized, PTSD was mostly linked to war veterans that had experienced terrifying and traumatic situations during their time serving. Even today, whenever anyone mentions PTSD, it is often linked back to war. Over time, it began to be understood that anything traumatic could trigger this disorder.

In many cases, domestic violence is a significant cause of manifestation in women. PTSD, for some people, is the brain’s way of coping with intense amounts of stress and fear and reacting to protect the person from having to endure that pain again. PTSD can manifest as a response to any event a person deems traumatic such as car accidents, near-death experiences, assault, emotional and physical abuse, and natural disasters. It is essential to understand that not everyone will develop PTSD as a response to trauma and that some reactions such as sadness, anger, nightmares, or anxiety are common for anybody who suffers a traumatic experience. To be diagnosed with PTSD, an individual must meet the following criteria:

  • Experiencing a stressor: A person experiences a stressor, which includes the threat of death, serious injury, or sexual violence that happens to themselves, or the individual can develop it by witnessing it happen to another person. Alternatively, the symptoms can develop within an individual who has a close friend or relative that experienced one of these stressors or is indirectly and repeatedly exposed to details of the event. Source

  • Intrusive symptoms: This includes intrusive memories, nightmares, dissociative reactions including flashbacks to the event, prolonged distress in response to reminders of the event, and physiological reactions to reminders of the trauma. Source

  • Avoidance: This means that the individual avoids trauma-related thoughts or feelings and external reminders such as people, places, or situations. Source

  • Mood Disturbances: Negative alterations to a person’s mood. A person must meet two of the following: Inability to recall key features of the event, distorted negative beliefs and expectations about oneself or the world around them, endless blame of self or others, persisting negative emotions, diminished enjoyment in activities once enjoyed, feeling detached from others and inability to experience positive emotions. Source

  • Altered Behaviors: Altered reactivity or arousal, including aggressive behavior, self-destructive behavior, hypervigilance, exaggerated startle response, concentration issues, and disturbances in sleep. Source

Furthermore, an individual must experience the symptoms for one month or more, the symptoms must have a negative effect on different areas of life, and the symptoms cannot be explained by other factors such as the medication one is taking, substance abuse or another medical illness one may be diagnosed with. According to the Diagnostic and Statistical Manual of Mental Disorders an individual must experience a stressor, one or more symptoms matching the intrusive symptoms and one or more relating to avoidance, two or more symptoms in mood disturbances and altered behaviors, and meet the duration, functional significance, and exclusion categories outlined above. Source


What is Borderline Personality Disorder? (BPD)

A borderline personality disorder is a personality disorder with symptoms that may easily get confused with those of C-PTSD. To understand whether what a person may be experiencing is related to BPD or C-PTSD, we must understand BPD and what differentiates it from the diagnosis of C-PTSD. This diagnosis appears to commonly manifest in late adolescence to early adulthood. Having BPD can immensely impair relationships, work, school, and other aspects of life, but with intense psychiatric treatment through therapy and learning healthier coping skills, it can be treated and eventually no longer meet the criteria for the diagnosis. Like C-PTSD, BPD is commonly linked to prolonged trauma in the form of childhood abuse. To meet the criteria for diagnosis, a person must display five out of the nine symptoms used in clinical assessment. The nine symptoms are:

  • Frantic efforts to avoid real or imagined abandonment

  • Unstable and intense interpersonal relationships

  • An unstable self-image or sense of self

  • Impulsivity in at least two areas that cause damage to the person (sex, binge-eating, reckless driving, substance abuse or self-harm)

  • Instability in mood that lasts a couple of hours rather than days at a time (quickly fluctuates) and can be expressed as irritability, anxiety or dysphoria

  • Chronic feelings of being “empty inside.”

  • Intense and inappropriate bouts of anger or difficulty controlling anger (outbursts, consistent fighting)

  • Stress-related paranoia or dissociative symptoms


It is important to note that often those with BPD are highly stigmatized. It is hard for many people to understand their quickly changing moods and fears that often lead them to push others away. Those with BPD were usually exposed to intense suffering and negative situations that warped their ability to form healthy coping and interpersonal skills. Most of their symptoms manifest as a way to protect themselves from fear and hurt that they may have experienced before, similar to C-PTSD Source. It has been said that those with this disorder usually experience heightened emotional responses compared to the average person, so their negative emotions are often severely painful for them Source. If they opt to be consistent with therapy, new coping and interpersonal skills can be taught for them to recover and live more fulfilling lives. 


What is Complex Post Traumatic Stress Disorder (CPTSD)?

Complex post-traumatic stress disorder was first suggested by Judith Herman of Harvard University, who believed a new diagnosis was warranted to explain the effects of long-term trauma and abuse. Although one horrific event can cause intense damage to one’s mental health, prolonged suffering can be theorized to have an impact that differs from one single event. Although mentioned, the recognition of C-PTSD as a diagnosis has been rejected for entry into the Diagnostic and Statistical Manual of Mental Disorders by the American Psychological Association, stating that more conclusive research needed to be done. But,  in 2018, it was recognized by The World Health Organization as a diagnosis. WHO considers C-PTSD a “more intense PTSD” but shows that the movement for C-PTSD is becoming a more accepted concept Source

C-PTSD is called “complex” because the field of trauma and stress in psychology has labeled multiple, chronic, and developmentally damaging traumatic events as “complex trauma” Source. Those who experience it have often endured extreme psychological abuse or torture or been exposed to horrific and terrifying events for extended durations. Some examples of these traumatic events include domestic violence, physical or sexual abuse, torture, sex trafficking, or imprisonment and are commonly interpersonal in nature. Physical symptoms from C-PTSD are not uncommon, and often victims will experience neck and back pain, headaches, gastrointestinal symptoms, chronic fatigue, and other symptoms that manifest due to the body coping with emotional pain  Source.

Those with C-PTSD will experience the fundamental symptoms of PTSD. The difference is that unlike PTSD, those with C-PTSD may additionally struggle with:

  • Emotional regulation that includes flashbacks that make one experience the emotions they felt at the time of the trauma, severe depression, suicidal thoughts, and difficulty controlling anger. 

  • Changes in self-perception that make a person view themselves in a more negative light. 

  • Fixation and preoccupation with their perpetrator 

  • Inability to maintain stable personal relationships due to mistrust that leads a person to alienate themselves 

  • Changes in beliefs and losing faith in humanity 

  • Behaviors including lashing out at minor criticism, drug or alcohol abuse, becoming “people-pleasers,” and self-harm may or may not be present in an individual. 


How is C-PTSD Treated?

Although it may be an uncomfortable, challenging and lengthy process, those with C-PTSD have the potential to recover through intense psychiatric intervention. It is hard to define the disorder as entirely curable. However, it can be managed and improved with treatment so that individuals can live more positive and enjoyable lives. So far, strategies utilized to treat PTSD have shown to be useful for C-PTSD as well. Some examples of the treatment approaches professionals have been taking to help alleviate the symptoms of the disorder are:

  • Trauma-focused Cognitive Behavioral Therapy: A form of Cognitive Behavioral therapy explicitly developed for PTSD patients. 

  • Eye movement desensitization and reprocessing (EMDR): This treatment consists of having the patient make rhythmic eye-movements while recalling the trauma they experienced. 

  • Medication to treat depressive symptoms and sleep problems caused by the disorder or used if the individual is unwilling to try talk therapies, although medication is not often prescribed for PTSD or C-PTSD treatment. If a doctor recommends medication, antidepressants are the most commonly used medication to help manage the symptoms, although it should be noted that PTSD and depression are two separate illnesses. 

  • Group therapies, art therapy, and Dialectical Behavioral Therapy (DBT) have also had some success in treating those diagnosed with C-PTSD but should not be used on their own. 

  • Exercise, finding a job, forming new friendships, or taking on a new hobby are all ways one can take steps to begin managing their disorder.



Final Thoughts

If you or someone you know has experienced continuous trauma and is exhibiting the symptoms in this article, it is highly encouraged you to reach out to a mental health professional to diagnose and treat the symptoms correctly. Suffering from this disorder can be highly debilitating and discouraging that things will ever get better. However, there are various people, even people you have not met yet who want to support you and see you thrive. It is entirely achievable to recover and live a fulfilling life with the right resources; all you have to do is ask for help! Support is all around you, and that is a vital part of recovery. It may take some patience and be challenging at times, but I know you can do this! If you enjoyed this post or have any questions, please feel free to leave a comment below and keep checking back for new posts!

About Mattias Sommers

Mattias Sommers

Mattias Sommers is a Mental Health Advocate who’s a strong supporter of the use of cannabis and CBD to treat mental health. Leading with empathy and understanding, Mattias hopes to educate others to help those struggling to overcome hardships live a more fulfilling life. Mattias’ self-care routine includes art, poetry, photography, and caring for her dog Josie.

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