Complex Post Traumatic Stress Disorder

Distraught woman

When an individual receives a diagnosis of complex post traumatic stress disorder, he or she has suffered trauma over a prolonged period of time. The person had little control over the situation and little or no chance to escape from the situation.

Differences between C-PTSD and PTSD

One of the main differences between complex post traumatic stress disorder (C-PTSD) and PTSD is the length of time that exposure to the trauma lasted. In cases of C-PTSD the traumas experienced are long term. Another difference between individuals that suffer with PTSD and C-PTSD is those diagnosed with C-PTSD often have changes in their self-concept and their feelings of self and self-worth.

Some clinicians claimed C-PTSD merited being its own diagnosis. However, C-PTSD was not included in the newest version of the American Psychiatric Association's (APA) Diagnostic and Statistical Manual of Mental Disorders. In the most recent version (DSM-5) released in 2013, the characteristics of C-PTSD are now included as a sub-type of PTSD, but are not referred to as C-PTSD.

Characteristics of C-PTSD

Complex post traumatic stress disorder often occurs when a person has experienced long-term, repeated exposure to emotional or social traumas or abuse that lasts for months, and in some cases, years. This condition is also known as:

  • C-PTSD
  • Complex PTSD
  • Disorders of extreme stress, not otherwise specified
  • Complex trauma
  • Developmental trauma disorder

A person suffering from C-PTSD may have been held captive or felt as if they were being held captive in a situation. This person:

  • Is completely under another person's control
  • Does not see a way out of the situation
  • Feels trapped with no way of escape
  • Has little hope of getting out of the situation
  • Feels as if they have no power
  • Has no control over the situation

Termed a psychiatric or psychological injury, C-PTSD involves the complex actions, reactions and interactions of the body's systems, referred to as the biopsychosocial system. The interactions that take place include aspects of systems and functions of the body that are:

  • Biological
  • Psychological
  • Social

Causes of C- PTSD

The following are examples of some of the long-term situations or conditions that lead to a diagnosis of C-PTSD:

  • Childhood sexual abuse
  • Childhood physical abuse
  • Childhood emotional abuse
  • Domestic sexual abuse
  • Domestic physical abuse
  • Domestic emotional abuse
  • Taking care of a mentally ill family member
  • Taking care of a chronically ill family member
  • Captivity as a prisoner of war
  • Hostages
  • Concentration camp survivors
  • Victims of forced labor
  • Long term torture
  • Victims of kidnapping
  • Victims of bullying
  • Exposure to long term crisis conditions

Symptoms of Complex - PTSD

When an individual has C-PTSD, they have ongoing difficulty functioning in many areas of their lives. This is especially true in the areas of emotion and social interaction. The symptoms and characteristics of C-PTSD are often categorized into seven areas, or domains; these domains are areas of functioning that are impaired. Common symptoms and characteristics of people with C-PTSD can be organized by domain.


Symptoms and characteristics in this domain include:

  • Issues with relationship boundaries
  • Social isolation
  • Difficulty perceiving and responding to the emotional states of others
  • Distrust
  • A lack of empathy


Symptoms in this area include:

  • Amnesia
  • Development of two or more distinct states of consciousness with impaired memories
  • Distinct alterations in states of consciousness


The biology domain includes:

  • Problems with sensorimotor development
  • Problems with balance and coordination
  • Hypersensitivity to physical contact
  • Increased medical problems like pelvic pain or autoimmune disorders

Affect or Emotional Regulation

Characteristics and symptoms in this domain include:

  • Difficulties with emotional self-regulation
  • Problems describing feelings
  • Difficulties knowing and describing how one feels
  • Problems communicating wants and desires

Behavioral Control

Symptoms associated with behavioral control include:

  • Poor impulse control
  • Self-destructive behavior
  • Outward aggression
  • Sleep problems
  • Eating disorders
  • Substance abuse
  • Difficulty obeying and understanding rules
  • Re-enactment of past traumas in everyday life


This domain includes:

  • Problems around disturbances of body image
  • Low self-esteem
  • Shame and guilt


People with issues in this domain may have:

  • Difficulties with attention
  • A lack of sustained curiosity
  • Difficulty with planning and anticipating
  • Difficulty understanding own role in what happens to them
  • Learning difficulties
  • Language development problems

Each Person Is Different

It is important to remember that each individual diagnosed with this condition is different. They each have their own set of circumstances and situations, and each will react to treatment in different ways.

Complex Post Traumatic Stress Disorder