Complex PTSD: Symptoms, Triggers, Diagnosis & Treatment

By Danielle Boland

Post-traumatic stress disorder (PTSD) is a widely known mental health diagnosis that people are generally familiar with and its symptoms. What people do not know is another PTSD diagnosis, known as complex PTSD, results from long-term trauma and is generally experienced during childhood. To receive the best care for PTSD or CPTSD, it is important to know the differences in the two diagnoses. 


Post-traumatic stress disorder (PTSD) and complex post-traumatic stress disorder (CPTSD) are both mental health disorders resulting from a traumatic event. Both can cause flashbacks, nightmares and insomnia. Events that can lead to PTSD and CPTSD are a perceived or real threat of violence, death or injury. While PTSD and CPTSD share many similar criteria for diagnosis, specific symptoms separate the two. 

The main difference between PTSD and CPTSD is the frequency of the trauma. PTSD occurs after experiencing a single traumatic event and CPTSD is caused by recurring trauma. PTSD can develop after trauma at any age, while CPTSD usually occurs due to childhood trauma.

What Is CPTSD?

CPTSD, also referred to as complex PTSD, is not a new concept. CPTSD was first introduced by Judith Hermann in the late 1980s but was just added to the latest version of the ICD-11 in 2018 to distinguish it from PTSD. 

Unlike PTSD, which is believed to occur after a single instance of trauma, CPTSD is the result of ongoing and usually early-onset trauma such as child abuse, sexual assault or domestic violence. These situations tend to be ones where the person feels trapped or unable to escape the traumatic situation. 

CPTSD has not yet been given its own diagnosis in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) but is still important to distinguish from PTSD.

Complex PTSD Diagnostic Criteria

CPTSD and PTSD share many of the same symptoms and diagnostic criteria as the two are currently not separate. To diagnose someone with complex PTSD, the following criteria have to be met:

  • The person was exposed to death, threatened death, actual or threatened serious injury, or actual or threatened sexual violence. This can be by direct exposure, witnessing the trauma, learning of trauma happening to a close friend or family member, or indirect exposure such as first responders, police officers, etc. 
  • The traumatic event is re-experienced by consistent, unwanted, upsetting memories, nightmares, flashbacks, emotional distress after exposure to traumatic reminders and physical reactivity after exposure to traumatic reminders.
  • Avoidance of trauma-related situations after the trauma. This can include trauma-related thoughts or feelings or trauma-related reminders.
  • Two or more of the following: negative thoughts or feelings that began or worsened after the trauma, such as inability to recall key features of the trauma, overly negative thoughts and assumptions about oneself or the world, exaggerated blame of self or others for causing the trauma, decreased interest in activities, isolation or inability to feel happiness.
  • Two or more of the following trauma-related reactions that began or worsened after the trauma such as:
      • Irritability or aggression
      • Risky or destructive behavior
      • Hypervigilance
      • Heightened startle reaction
      • Difficulty concentrating
      • Difficulty sleeping
  • Symptoms last for more than one month.
  • Symptoms cause distress or day-to-day impairment, such as at work or school.
  • Symptoms are not due to medication, substance use or other illness.

CPTSD also includes behaviors such as difficulty controlling emotions, poor self-esteem, difficulty maintaining relationships, disconnecting from trauma and loss of faith or meaning in the world. 

Complex PTSD Symptoms

CPTSD shares the same base symptoms of PTSD, which include:

  • Re-experiencing: experiencing flashbacks or bad dreams of their trauma
  • Avoidance: avoiding thoughts, feelings and places that remind someone of their trauma 
  • Arousal and reactivity: being easily startled, tense or having outbursts
  • Cognition and mood changes: distorted feelings, guilt and shame, preoccupation with the traumatic event and inability to enjoy normal activities

The symptoms that are unique to and distinguish CPTSD are: 

  • Difficulties expressing emotions: it is common for someone to lose control of their emotions and experience things such as explosive anger or constant sadness.
  • Negative self-perception: a person can view themselves in a negative light, and they may feel helpless, guilty or ashamed.
  • Difficulty maintaining relationships: some people avoid relationships completely while others have unhealthy relationships, largely due to lack of trust and emotional capacity. 
  • Feeling lonely and empty: An increase in stress can worsen these symptoms and make management of CPTSD more difficult if untreated. 

Complex PTSD Test

Currently, there are no formal testing methods to diagnose complex PTSD. The recommended tactic for identifying CPTSD is to use talk therapy and symptom review with the person who may be suffering from CPTSD. Professionals have found that identifying the symptoms of PTSD, such as re-experiencing, avoidance and reactivity, and looking for accompanying symptoms such as feelings of guilt and shame, struggling in relationships and inability to control emotions, can help identify possible CPTSD. 

What Causes Complex PTSD?

CPTSD is specific in that the trigger for this mental health disorder is long-term or sustained traumatic events. The types of sustained traumatic events that can cause CPTSD are:

  • Long-term childhood psychological, physical, sexual abuse or neglect
  • Sustained domestic violence
  • Long-term imprisonment such as a concentration camp or prisoner of war camp
  • Involuntary prostitution or sex trafficking
  • Intergenerational racial or religious bias

Long-term trauma does not just affect mental health but physical health as well. According to an article in U.S News, the chronic repercussions of trauma can include:

  • Cardiovascular disease
  • Concentration and memory problems
  • Depression
  • Hypertension
  • Sleep problems
  • Stroke
  • Weight gain

Complex PTSD Triggers

A trigger is anything that reminds someone of a traumatic event in any way. This can include sights, smells, sounds, thoughts, people or even places. When someone with CPTSD encounters a trigger, they feel as if they are back in the traumatic event and can have physical and psychological symptoms as if they were experiencing the trauma all over again. 

Triggers can be difficult to avoid, depending on the trauma someone has experienced.

In therapy, it is important to identify what someone’s specific triggers may be to better prepare for any CPTSD symptoms and coping mechanisms. Some important steps to handle CPTSD triggers include:

  1. Identify your triggers
  2. Have a plan to handle an episode
  3. Have a support system
  4. Participate in talk therapy or join a support group

These tools can help someone suffering from CPTSD manage their symptoms and work towards recovery. 

Complex PTSD Treatment

Although complex PTSD can feel very overwhelming to overcome, there are treatment options available to those suffering from CPTSD. There are various degrees of intervention that someone with CPTSD can explore, including multiple therapeutic options, medication and more. 

Complex PTSD Therapy

Participating in psychotherapy with a licensed mental health professional has been shown to be the most effective intervention in treating complex PTSD. A therapist can help someone suffering from CPTSD explore their triggers and fear and learn to trust people and situations again. They can also help their patients develop healthy coping mechanisms to use when CPTSD symptoms occur. If you or someone you love is suffering from CPTSD, find a CPTSD therapist near you.

Complex PTSD Medication

Medications can help reduce symptoms of CPTSD, such as anxiety or depression. They are most beneficial when combined with psychotherapy. Antidepressants are the most common type of medication used to help treat complex PTSD.

EMDR For Complex PTSD

A type of psychotherapy that has been used to treat complex PTSD is eye movement desensitization and reprocessing (EMDR). EMDR uses eye movements guided by the therapist to process and reframe traumatic memories. This process helps to reduce PTSD symptoms and reactions to the traumatic memory over time.

Complex PTSD Workbook

Workbooks are helpful parts of the treatment toolkit for CPTSD symptoms. For example, a workbook for mind-body therapy helps those suffering from CPTSD maintain an awareness of their thoughts, feelings, bodily sensations and the surrounding environment through a gentle, nurturing approach with a focus on proper breathing.

Complex PTSD and Addiction

According to the U.S Department of Veterans Affairs, addiction and substance abuse can often co-occur with complex PTSD, especially in veterans. It has been reported that 46.4% of individuals with lifetime PTSD also met criteria for substance use disorder. Although there aren’t many current studies that show the relationship between CPTSD and addiction, many of the symptoms and hardships that affect those who have PTSD also occur in CPTSD. Anxiety and depression are common with CPTSD when substances are abused in an attempt to lessen the unpleasant symptoms associated with CPTSD. 

Living With Complex PTSD

CPTSD is a serious and debilitating mental health disorder that is rightfully gaining more attention over the years. Complex PTSD is considered an enhanced PTSD, with symptoms such as shame, feeling permanently damaged, social withdrawal, despair, hostility, and loss of previous self. Those suffering from complex PTSD often also have poor self-esteem, which leads to hardships in relationships and feeling alone and isolated.

If you or someone you love is suffering from the symptoms of complex PTSD, there is treatment available. Reach out to a mental health provider near you today to get the help you deserve. The Nobu app can also connect you to a licensed therapist for an additional fee. 

Edited by – Abby Doty

Abby Doty graduated from Hamline University in 2021 with a Bachelor’s in English and Psychology. She has written and edited creative and literary work as well as academic pieces focused primarily on psychology and mental health. She is passionate about removing the stigma around mental health and recovery. In her free time, Abby loves reading, painting, and petting dogs… Read more.

Written by – Danielle Boland

Danielle is a licensed clinical social worker, currently living and practicing in central Connecticut. Danielle graduated from Columbia University in 2012 with a Masters of Social Work, and always had the goal of opening her own private practice. She specializes in women’s issues, maternal health and postpartum mental health. Danielle is passionate about empowering people of all ages and hopes to use her writing skills to provide more resources for those looking to improve their mental health… Read more.

dr angela phillips

Medically Reviewed by – Dr. Angela Phillips

Angela is a licensed therapist and clinical researcher, and has worked in public, private, government, and not-for-profit organizations, across clinical and research-oriented roles. Angela’s clinical and research experience has included suicide prevention, cognitive behavioral… Read more.