A man with C-PTSD looks out a window.Complex posttraumatic stress (C-PTSD) describes a specific type of PTSD. Also known as developmental trauma, C-PTSD develops in response to long-term trauma or repeated traumatic incidents. This trauma often, but not always, happens during childhood. This sets it apart from PTSD, which commonly occurs in service members but can happen after a single traumatic event at any point in life. 

Both PTSD and C-PTSD can improve with treatment from a trained mental health professional. Treatment options include traditional talk therapy, but other approaches can also help. Begin your search for compassionate support in overcoming C-PTSD by searching our directory for a mental health provider in your area

Complex PTSD Symptoms

Although the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) has recognized PTSD as a diagnosis since its third edition, it doesn’t yet list C-PTSD as a subtype. Other research does support C-PTSD as a separate presentation, however. 

The World Health Organization is one group that supports the existence of C-PTSD. It’s included as a diagnosis in their 2018 publication of the International Statistical Classification of Diseases and Related Health Problems (ICD-11). 

The diagnostic criteria for C-PTSD, according to WHO’s classification, include many of the same symptoms as general PTSD, including:

  1. Intrusion symptoms: flashbacks and nightmares
  2. Avoidance symptoms: emotional numbness; dissociation; avoidance of potential triggers
  3. Reactivity symptoms: hypervigilance, insomnia, etc.

However, a C-PTSD diagnosis also involves three additional categories. These include:

  1. Trouble regulating one’s emotions
  2. Developing a negative image of oneself
  3. Problems with interpersonal relationships 

Signs of C-PTSD

C-PTSD symptoms can manifest in many different ways. Some of the most common signs of C-PTSD are:

  • Periods of intense depression, thoughts of suicide, or both
  • Tending to see oneself in a negative light  
  • Persistent or recurring feelings of shame or guilt
  • Losing faith in one's personal belief system or moral code

Research suggests C-PTSD can also contribute to feelings of helplessness, vulnerability, and anger toward the source of the trauma, especially when the trauma was caused by an abuser. These feelings may contribute to a desire to seek revenge.

What Causes C-PTSD?

Any of the following experiences may contribute to the development of C-PTSD:

In short, both PTSD and C-PTSD are caused by trauma. But experts consider C-PTSD the specific result of long-term trauma. People who face traumatic experiences over and over, or live in violent, abusive, or traumatizing situations, may come to develop C-PTSD. 

Experts believe the severity of a person’s symptoms can depend on several factors, including:

  • Whether the trauma happened in childhood
  • If a parent or caregiver was responsible for the trauma
  • If the person had any support during the period of trauma
  • How long the trauma lasted

Experiencing one trauma, or a shorter period of abuse or neglect, can also cause traumatization, but this type of trauma more often results in symptoms that fit criteria for standard PTSD. 

Relationships and Complex PTSD

Coping with the effects of long-term trauma can affect emotional well-being and quality of life. C-PTSD can also create challenges in relationships. Experiencing long-term abuse, pain, or other distress can make it difficult to relate to others. Changes in mood and self-perception can also make someone feel like they’re no longer the person they used to be. They may lose hold of their sense of self or personal identity. 

These and other effects of trauma can lead someone to withdraw from the people they love and isolate themselves. People might do so intentionally or without meaning to, simply because they find it difficult to be around others. They may feel as if others can’t relate to or understand what they’ve been through, and they may also not want to discuss the trauma with anyone who didn’t experience it themselves. 

People working through C-PTSD may also struggle with trust issues. Experiencing long-term trauma can make it hard to feel safe enough to put trust in other people again. It’s possible to overcome these difficulties and learn to trust again, but it may require a patient partner and the help of a compassionate, trained counselor. 

Victimization and helplessness can also lead some people living with C-PTSD to unwittingly seek out unhealthy relationships. These may share elements of the original toxic relationship, such as jealousy or passive aggression. Some people may be unconsciously using the current relationship as a way to “redo” or “fix” the past. Other people could be desperate to find a “rescuer” and overlook red flags. Again, treatment for C-PTSD can help, as it can enable people to learn to recognize signs of unhealthy relationships and work to avoid them. 

While the primary person affected by C-PTSD is, of course, the person who experienced the trauma, the impact of the trauma can extend to family, romantic partners, and other loved ones. A partner who wants to offer support may feel hurt when they are avoided or shut out. Angry outbursts can make friends, loved ones, or children feel afraid or worried. Dissociative episodes and the loss of a sense of self can also make partners feel alone or as if their partner has become someone else. 

A person living with C-PTSD cannot help any of these effects, just as their partner also isn’t to blame. An individual with C-PTSD can address their symptoms in therapy and see improvement in all areas of life. Couples therapy or family therapy can also be highly beneficial for all members of a family affected by C-PTSD. 


  1. Böttche, M., Ehring, T., Krüger-Gottschalk, A., Rau, H., Schäfer, I., Schellong, J., Dyer, A., & Knaevelsrud, C. (2018, September 7). Testing the ICD-11 proposal for complex PTSD in trauma-exposed adults: Factor structure and symptom profiles. European Journal of Psychotraumatology, 9(1). Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6136389
  2. Complex PTSD. (2018, September 27). National Health Service. Retrieved from https://www.nhs.uk/conditions/post-traumatic-stress-disorder-ptsd/complex
  3. Complex PTSD symptoms, behavior, and treatment. (n.d.). Retrieved from https://www.bridgestorecovery.com/post-traumatic-stress-disorder/complex-ptsd-symptoms-behavior-and-treatment
  4. Dissociative identity disorder. (2016, April 20). Cleveland Clinic. Retrieved from https://my.clevelandclinic.org/health/diseases/9792-dissociative-identity-disorder-multiple-personality-disorder
  5. Cloitre, M., Garvert, D. W., Weiss, B., Carlson, E. B., & Bryant, R. A. (2014, September 15). Distinguishing PTSD, complex PTSD, and borderline personality disorder: A latent class analysis. European Journal of Psychotraumatology, 5(1). Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4165723
  6. Ford, J. D., & Courtois, C. A. (2014, July 9). Complex PTSD, affect dysregulation, and borderline personality disorder. Borderline Personality Disorder and Emotional Dysregulation, 1(1). Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4579513
  7. Giourou, E., Skokou, M., Andrew, S. P., Alexopoulou, K., Gourzis, P., & Jelastopulu, E. (2018, March 22). Complex posttraumatic stress disorder: The need to consolidate a distinct clinical syndrome or to reevaluate features of psychiatric disorders following interpersonal trauma? World Journal of Psychiatry, 8(1), 12-19. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5862650
  8. Rosenfield, P. J., Stratyner, A., Tufekcioglu, S., Karabell, S., McKelvey, J., & Litt, L. (2018). Complex PTSD in ICD-11: A case report on a new diagnosis. Journal of Psychiatric Practice, 24(5), 364-370. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/30427825
  9. Symptoms of PTSD. (n.d.). Anxiety and Depression Association of America. Retrieved from https://adaa.org/understanding-anxiety/posttraumatic-stress-disorder-ptsd/symptoms