Attachment and C-PTSD: How Complex Trauma Gets in the Way

Close-up photo of loving couple holding hands while walking at sunsetComplex trauma is what happens when someone experiences multiple incidences of cruelty and abuse in the context of an unequal power relationship. This is most commonly found in people who grew up with abusive or neglectful parents, but also happens to kidnapping victims, prisoners of war, and people in abusive sexual or “romantic” relationships. The result of this complex trauma is C-PTSD (complex PTSD), which has similar effects to the posttraumatic stress (PTSD) experienced by people who have been in car accidents or similar traumatic events but involves deeper disturbances of the personality. Many people diagnosed with bipolar and other personality conditions are, in fact, survivors of complex trauma. This requires delving into the individual’s personal history and life story, rather than only analyzing their present symptoms.

Another way of looking at complex trauma and C-PTSD is the concept of attachment trauma. Attachment—the bonds that exist between one human being and another—sounds like a rather vague or abstract concept. Like all emotional states, however, such as happiness, fear, or anger, it is rooted in our biochemistry and is essential for human flourishing.

While our level of intelligence distinguishes humans from other animals, it is only through working together that we were able to survive and thrive. There is simply no way an individual human could take down a woolly mammoth. Human beings evolved to cooperate and work together in groups. One aspect of this is our unique capacity for language acquisition. For true social cooperation, however, bare communication of information is not enough. In the modern world, one may be able to go about many items of daily business (shopping, for example) without any emotional bond, but the cohesive groups in which humans evolved required a much deeper level of connection.

Even today, we can observe that an office where there is no camaraderie between employees will not function well no matter how highly they are paid. Family life, friendship groups, and romantic relationships are, of course, quite difficult to maintain without attachment. As a result of our evolution, all, or almost all, human beings feel a deep need to be attached to others regardless of whether it is strictly necessary for their survival or material prosperity. People who do not form relationships are often plagued by feelings of depression and sadness, no matter how successful they may be in other areas of life.

Attachment, however, is hard. Forming a relationship with another human being involves both verbal and nonverbal communication, as well as an intricate dance of appropriate behavior. Express too little empathy in a relationship and you may be considered cold or distant. Express too much or too early and you may be considered overbearing. High-functioning people on the autism spectrum (commonly known as Asperger’s, though this has largely fallen out of academic usage) typically lack many of the native instincts for successful relationship formation that other people have, making their lives difficult in ways that those in the general population find hard to appreciate or understand.

However, like all human traits, the ability to form attachment bonds is not purely innate; it is learned behavior. And as with most human learning, attachment is learned by doing. From the moment they exit the womb, babies are learning attachment. This, and not only the need to materially provide for the child, is the basis of the family, a universal component of human society. Even utopian social experiments which aimed to replace the family had to fall back on structures that essentially mirrored mother- and fatherhood, with mixed success.

In treating people with C-PTSD who seek therapy, building up their ability to experience attachment and to feel safe, secure, appreciated, and loved in relationships is a high priority.

It follows, therefore, that when the relationship between parents, or a replacement primary caregiver, and the child is seriously distorted by abuse or neglect, this has far wider implications than the parent-child relationship alone. Survivors of complex trauma typically emerge with gaps in their ability to form attachment bonds with others. This is not to say their desire for attachment is any less—far from it. The unfulfilled desire for connection and pervasive feeling of loneliness in survivors of complex trauma is a major contributing factor to the symptoms they experience, including depression, inability to regulate emotion, and engagement in risky or self-destructive behaviors.

In treating people with C-PTSD who seek therapy, building up their ability to experience attachment and to feel safe, secure, appreciated, and loved in relationships is a high priority. It is also an extremely difficult process. As I have discussed in previous articles, C-PTSD is best conceptualized less as a process of damage than as a learning process in highly unfortunate circumstances. Like all children, people who grow up in an environment of persistent abuse are born with potential, which they develop in their own way under adverse circumstances.

In short, survivors of complex trauma in childhood learn to live in a world turned upside down because that was the only world they ever knew. Therapy for people with C-PTSD is a delicate undertaking, involving revisiting this initial learning process and initiating a new one that allows them to grow and develop in healthier and more fulfilling ways.


  1. Cloitre, M., Garvert, D. W., Weiss, B., Carlson, E. B., & Bryant, R. A. (2014). Distinguishing PTSD, complex PTSD, and borderline personality disorder: A latent class analysis. European Journal of Psychotraumatology, 5, 10.3402/ejpt.v5.25097. Retrieved from
  2. Lawson, D.M. Treating adults with complex trauma: An evidence-based case study. (2017) Journal of Counseling and Development, 95(3), 288-298. Retrieved from
  3. Sar, V. (2011). Developmental trauma, complex PTSD, and the current proposal of DSM-5. European Journal of Psychotraumatology, 2, 10.3402/ejpt.v2i0.5622. Retrieved from
  4. Sullivan, R. M. (2012). The neurobiology of attachment to nurturing and abusive caregivers. The Hastings Law Journal, 63(6), 1553–1570.
  5. Tarocchi, A., Aschieri, F., Fantini, F., & Smith, J. D. (2013). Therapeutic assessment of complex trauma: A single-case time-series study. Clinical Case Studies, 12(3), 228–245. Retrieved from

© Copyright 2018 All rights reserved. Permission to publish granted by Fabiana Franco, PhD, therapist in New York City, New York

The preceding article was solely written by the author named above. Any views and opinions expressed are not necessarily shared by Questions or concerns about the preceding article can be directed to the author or posted as a comment below.

  • Leave a Comment
  • Aliya R.

    Aliya R.

    March 5th, 2019 at 9:47 PM

    Thank you so much for your insightful and sensitive description of this difficult but treatable condition.

  • Robin


    June 20th, 2019 at 3:14 PM

    I think many providers miss the mark on this: “treating people with C-PTSD who seek therapy, building up their ability to experience attachment and to feel safe, secure, appreciated, and loved in relationships is a high priority.” Often the focus seems to be on personal healing but not in the context of family or relationships. Partners and family members of people with C-PTSD are not included enough in the therapeutic process, and while the survivor may do well in some treatment programs they often are unprepared to return to their families, and their families haven’t been provided with tools or support. I am in a partners of survivors group, and we talk about this frequently. We need more family-centered therapists and interventions. The original trauma didn’t happen in isolation; the healing cannot either.

  • Claudia


    June 21st, 2019 at 3:42 AM

    I worked in treatment centers for addiction and felt the same need; a way to treat the whole family for the addict to thrive.



    June 29th, 2019 at 7:41 AM

    Please provide me with more details on how best to treat complex trauma in children.

  • The GoodTherapy Team

    The GoodTherapy Team

    June 29th, 2019 at 8:54 AM

    Hi Ferdinand,

    Thanks for your comment. If you would like to consult with a mental health professional, please feel free to return to our homepage,, and enter your postal/zip code into the search field to find therapists in your area. If you’re looking for a counselor that practices a specific type of therapy, or who deals with specific concerns, you can make an advanced search by clicking here:

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  • Bryan


    November 18th, 2019 at 11:10 AM

    I’m really struggling with this and not sure how to handle it. I’ve been isolated and alone all my life. No family. No friends. No relationships. Just me, myself, I, and my therapist.
    At 48, I’m now starting to try to figure out how to make friends. But I don’t seem to have the social skills necessary to do it. As any friendships I do make only last for a short period of time and then they just “disappear”. I get that one reason is, I may be considered “too negative” or “toxic”, but then I’m in the grieving process of long-term childhood trauma that has shatter my entire life in to millions of pieces. Of course I’m negative. Of course I can be overwhelming to other people. And I am good at making acquaintances, but not friends. I have no clue how people learned to do this. I was never taught social skills. The only skill I learned growing up was to detach, for self-protection. Now as an adult, how the hell am I supposed to learn these social skills and learn how to make friends, at the same time risk coming off too “negative” and yet still authentically grieve the loss of my childhood, my young adulthood, and the last 40 years of my life that has been numbness, isolation, and trauma? I think being open is scaring people off. I’m not sure. But I cannot seem to figure out how to make friends. I don’t get how others learned this. Where the hell, at 48, am I supposed to learn how to make friends?

  • Dr. Memo

    Dr. Memo

    March 24th, 2020 at 10:21 AM

    Thank you very much for your lovely insights which give me considerable amount of better understanding of wife problems.

  • Rachel


    July 10th, 2020 at 9:52 PM

    I have seen therapists and psychologists in the past, but they have been hesitant to give me a clear diagnosis. After prolonged research, I believe that I am suffering from c-ptsd. My symptoms are consistent with this diagnosis without falter. However, I have a lingering concern about BPD. I initially sought a doctor because I thought this was my problem, but it was only determined that I have ADHD and non specified anxiety disorder. She felt that many of my symptoms resulted from developmental trauma and that I would benefit more from therapy. I had signs of borderline, but it was unclear. Years following that visit I found myself in controlling relationship with a physical abusive partner. I had to spend months planning my escape because I had no support system to fall back on. I was diagnosed with PTSD, but I avoided therapy for years following out of shame and fear of being misunderstood. I thought I could push through the symptoms and move forward. I had made a lot of progress, but I also avoided intimacy and relationships. For years I would isolate, so no one would judge me for what I was going through. The last couple years, however, I have been seeking more informed help and learning about c-ptsd. Through online research, I’ve found grounding techniques and tools to identify my symptoms and triggers. It’s been incredibly healing. I’ve been in my first serious relationship in 6 years this year. Things were rocky at first, but we had finally moved to a place of support and trust, but then COVID happened. I spent the first 6 weeks locked up in bliss with my boyfriend, but then I started to feel scared and cagey. I noticed myself dissociating and then came the nightmares and panic attacks. I’m 30 years old and I have not relived those memories in years. It put an incredible strain on my relationship despite trying to explain trauma to my partner. I was the one that ultimately broke up with him, but it was mostly out of fear of abandonment. He had suggested we take a break. I’ve been over texting and wavering between wanting him completely out of my life and sheepishly hoping we can slowly build back trust and security. He wants to get back together eventually, but I have a hard time trusting him now. I truly think my abandonment fears are based on the current climate and my fear of finding work/supporting myself when I have no family to rely on. I can see where I am being needy, but it’s not typical for me in a relationship. I also genuinely fear abandonment at this point. I’m just still unclear about the difference between c-ptsd and bpd. I have a clear idea about who I am at the core, but I’ve struggled finding my true calling or a definite career path. I would say that my personality and general interests are consistent, I just feel a little lost. I’m finally looking for a therapist, but I’m trying to keep within a limited budget. I can’t afford to see a doctor right now. The abandonment thing is just concerning me. I would like to talk to a trauma counselor, but I’m afraid that I actually may have BPD. Does that effect therapy choice significantly? I still feel like c-ptsd makes the most sense for my symptoms, but please be real with me about that. Is there anyone on here that might have a few insights?

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