Complex PTSD: Symptoms, Diagnosis, and Treatment
Complex PTSD (post-traumatic stress disorder) can occur when someone is exposed to any type of early and repeated traumatic situation for long periods of time.
You may have heard the acronym PTSD. It stands for post-traumatic stress disorder, which is a mental health condition that affects people who have experienced or witnessed a traumatic event. That could include combat, assault, or a natural disaster. People who have PTSD experience strong, upsetting feelings and thoughts related to the event that last long after it is over.
Complex PTSD (C-PTSD), however, can occur when someone is exposed to any type of early and repeated traumatic situation for long periods of time. People are more likely to have C-PTSD if they’ve experienced:
Childhood trauma, such as abuse, unexpected loss or death of a loved one, neglect, or abandonment
Ongoing domestic violence or abuse
Forced prostitution or sexual assault
Torture, kidnapping, or any form of slavery
Military combat or traumatic experiences
Frequent environmental violence
Surviving any of these experiences can be incredibly difficult. If you are struggling with C-PTSD, there are ways to work through it.
Symptoms of complex PTSD
C-PTSD shares a lot of the symptoms of PTSD. These include:
Reliving the trauma through disturbing thoughts or flashbacks
Avoiding anything that reminds you of the trauma (triggers)
Feeling distant from others
Experiencing overwhelming negative emotions, such as anger, sadness, depression, and emptiness
Feeling irritable
Complex PTSD has three additional symptoms:
Difficulty controlling emotions. You may feel explosive anger, for example.
Decreased self-worth. It is common for people with C-PTSD to feel ashamed or damaged. Because of this, you may feel isolated from others. You may also feel like there is no hope or meaning in life.
Interpersonal problems. It can be hard to trust others when you struggle with C-PTSD. You may avoid relationships because of this.
Diagnosis
If you think that you may have C-PTSD, make an appointment with your doctor. To diagnose your condition, your doctor will likely:
Conduct a physical exam. This checks for medical problems that may be causing your symptoms.
Perform a psychological evaluation. This will evaluate your symptoms and the events that prompted them.
Refer you to a mental health provider.
Treatment Options
While there is no specific course of treatment for C-PTSD, trauma-focused psychotherapy is available to help. Some treatments to consider include:
Trauma-focused cognitive behavioral therapy (TF-CBT). In this type of therapy, you will learn how your body responds to trauma and stress. You will also identify and reframe problematic thinking patterns.
Eye movement desensitization and reprocessing (EMDR). This type of treatment helps you process traumatic memories. During a session, you will be guided through a specific traumatic event while rhythmically moving your eyes. This is intended to replicate the way your brain processes experiences while you sleep.
Medication. People who have C-PTSD often also struggle with conditions such as sleep disturbance or nightmares, borderline personality or mental disorders, and substance use disorders. Medicines can help manage these conditions.
Before starting therapy, check in with yourself. Note your own boundaries. If you’re not yet ready to discuss your experiences, that’s OK. There are other steps you can take to manage your symptoms.
Consider forms of social support. This can be your loved ones or people in your community. It can also be a support group for people dealing with the kind of trauma you’ve experienced. Even if you don’t feel ready to talk, knowing there are others who can relate to you can help. To find support in your area, call 1-800-662-HELP (4357) or visit https://www.samhsa.gov/find-help/national-helpline for free and confidential information.
If you are thinking of harming yourself or others, call or text 988. You will be connected to trained crisis counselors at the 988 Suicide & Crisis Lifeline. The 988 Lifeline services are free and available 24/7.
Coping mechanisms for complex PTSD
C-PTSD can sometimes lead to disorienting experiences such as flashbacks or triggers. It can be difficult in these moments to remember that the traumatic event is behind you. If you have a flashback or trigger, it’s helpful to know how to work through it. During these events, try to:
Control your breathing. Expand your stomach instead of your chest when you inhale. Exhale slowly. Count your breaths up to five. Then start over.
Carry a comfort object. This should be something that makes you feel safe and that you can easily carry with you. Examples include a picture you keep in your wallet or a piece of jewelry. This object should ground you in a comforting thought or memory.
Write down reminders. During a flashback, it is important to remind yourself that the traumatic event is over. You are safe. Of course, this can be hard in the moment. Take the time when you’re feeling well to write some comforting reminders to yourself. This way you can consult them in times of need.
Use your senses to ground yourself. For example, run cold water over your hands. Or walk slowly and count each step.
Comfort yourself. Perhaps this means curling up in a blanket. Consider listening to soothing music or watching a favorite movie. Eat your favorite healthy food or play with a pet.
Keep a diary. Writing down your experiences can help you process them. It can also help you identify thought patterns and what triggers them.
Also, try to take proactive steps to minimize C-PTSD symptoms:
Get exercise. A walk can go a long way toward reducing stress and boosting your mood.
Identify your places of comfort. It’s helpful to know that there are places where you can retreat. Perhaps this is a park close to your house or a certain coffee shop.
Meditate. Practice breathing exercises and mindfulness. During a panic attack or flashback, you can use these techniques to recenter yourself.
Create a routine. Start with a very simple routine so you aren’t intimidated by it. Write out a daily schedule that starts with tasks such as, “Get out of bed.” Starting the day with small victories will encourage you to continue with your recovery.
Be patient and kind to yourself. If you don’t get through every step of your routine, that’s OK. Recovery is a process, and everyone has their own pace. If you find you are struggling to meet a goal, set an easier one. You can get to the original goal in time.
Remember that, above all, you have a right to feel safe. You also have the right to:
Feel heard when you say “no”
Take care of yourself
Experience joy and love
Receive love and validation
Have your needs met
Have your privacy respected