Understanding Complex PTSD
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For years now, it has been clear to us that traumatic experiences endured during childhood profoundly shape how a person behaves, feels, and thinks in adulthood. However, until recently there was no formal diagnosis that described this experience. Complex Post-Traumatic Stress Disorder (C-PTSD) was included in the 11th edition of the ICD published by the World Health Organization, while it has not yet been included in the DSM. The introduction of this new diagnostic category emerged from the clinical need to describe the pervasive and chronic difficulties faced by individuals who have been exposed to long-term stressors, primarily of an interpersonal nature (Katatzias & Levendosky, 2019). The person becomes trapped in an adverse situation over which they have no control and from which there is no escape. As Herman (1992) notes, “This trauma occurs when the victim is in a state of captivity, under the control and domination of the perpetrator.” Indicatively, some possible causes for the development of C-PTSD may include:
Ongoing physical, sexual, and/or psychological abuse or neglect during childhood.
Living long-term within an abusive relationship.
School bullying.
The experience of war.
Being taken hostage or held in captivity (e.g., prisoner of war or concentration camp).
Slavery and human trafficking.
Differences between PTSD & C-PTSD
The main difference between simple PTSD and Complex PTSD lies in the nature and duration of the traumatic experiences. PTSD can be triggered by exposure to a single shocking traumatic event, such as a car accident, natural disaster, or violent assault. Often, the person relives the traumatic experience through vivid flashbacks—intense, sensory memories of the event—causing high levels of stress and distress.
C-PTSD, on the other hand, refers to individuals who have been exposed to multiple traumatic experiences or prolonged trauma, usually during childhood, such as abuse by a caregiver. These are layers of trauma that interact with one another, leaving the person overwhelmed and filled with fear and anger. In this case, the trauma is re-experienced through emotional flashbacks rather than clear memory recall. In simple terms, the person may not consciously remember the traumatic event, but after a present-day trigger, they feel just as devastated as they did at the time of the trauma. This leads to a disproportionate reaction that they struggle to understand (Walker, 2013).
An example would be a young woman who has an argument with her partner about household chores, and his voice rises in anger. Suddenly, she is flooded with fear and despair without understanding why. This disagreement triggered an emotional flashback, transporting her back to childhood when her father’s anger led to unpredictable and violent outbursts.
Symptoms (ICD-11)
According to ICD-11 (WHO, 2022), the symptoms of C-PTSD include some of those seen in PTSD (re-experiencing the trauma in the present, avoidance of reminders, and a persistent sense of threat), but additionally involve difficulties in self-organization. Individuals who develop C-PTSD may experience:
Difficulties regulating emotions.
A negative self-concept.
Difficulties forming and maintaining relationships.
It is clear that prolonged and repeated exposure to traumatic events that cause intense stress affects multiple aspects of a person’s life—sometimes to the extent that it “steals” their life and their ability to self-actualize.
Living with C-PTSD
Complex trauma shapes how individuals see themselves and the world, creating a deeply negative self-image and impairing social interactions. Survivors of C-PTSD struggle to manage their emotions. They may battle chronic anxiety, sadness, disgust, and shame, living under a constant sense of threat. They often view themselves as worthless or damaged. Many experience a persistent feeling of emptiness or hopelessness and feel disconnected from themselves and others. They may display anger or distrust toward the world, believing that others cannot understand what they have been through.
It is also common for them to suffer from chronic physical symptoms such as headaches, gastrointestinal problems, and muscle pain. In relationships—romantic or friendships—they may avoid closeness, struggle to maintain connections, or even become re-traumatized within them (Walker, 2013). All of the above are normal reactions to an abnormal situation.
There is also significant comorbidity (co-occurrence of disorders) with depression, anxiety disorders, and substance use (Shevlin et al., 2017). In fact, this is often the reason people seek help from a mental health professional in the first place.
The path to recovery
People with C-PTSD often suffer—sometimes for their entire lives—without understanding what is happening to them, and their symptoms are frequently attributed to their personality.
If you feel that your experience is reflected here, it is important to seek help. Through a safe therapeutic relationship, as well as your own journey toward resilience, you can begin to understand how your past has affected you and what triggers emotional flashbacks. You can learn to regulate your emotions and treat yourself with self-compassion.
Remember that recovery from trauma is a journey, not a destination. We cannot change what happened to us (and that is a painful truth), but we can learn to live with it and discover new ways to grow and flourish despite the pain.
