Complex PTSD

Numerous traumatic events and ongoing trauma can cause complex PTSD (C-PTSD) - a severe form of PTSD. Our page explains what this condition is, its symptoms, causes, and treatment options.

What is Complex PTSD?

Like PTSD, complex PTSD is an anxiety disorder but there are some distinct differences. Instead of one traumatic event, repeated or continued trauma (or complex trauma) can be the cause. Childhood experiences can often be at the root of issues.

PTSD versus complex PTSD
The DSM-5 provides criteria for diagnosing various mental health disorders but does not classify complex PTSD as a standalone condition. However, the ICD-11 - which records and classifies all medical conditions, including mental health disorders - does.

Following the ICD-11 criteria, a 2017 study found that C-PTSD was more common than PTSD.

Symptoms of complex PTSD

Symptoms can vary in individuals experiencing PTSD and C-PTSD. Though, the symptoms are often more severe in people with C-PTSD. People with C-PTSD may experience the symptoms of PTSD along with additional symptoms:

  • Suicidal thoughts
  • Feeling different from other people
  • Being in a continued state of high alert (hyperarousal)
  • Difficulty regulating your emotions, such as explosive anger or ongoing sadness
  • Experiencing repeated dysfunction and distress in your relationships
  • A negative self-view, possibly feeling shame, guilt, or helplessness
  • Preferring to avoid some friendships or family members
  • Dissociative symptoms, such as depersonalisation or derealisation
  • A distorted perception of your abuser



Flashbacks are common in people with complex PTSD and can be frightening. You may re-experience the traumatic events or feel the same emotions as you did during the events.

Some people with C-PTSD also relive their experiences through nightmares, which can lead to insomnia. Anything that reminds you of your traumatic experiences could trigger a flashback.

Flashbacks and nightmares do not feature in the C-PTSD of some people.


Complex PTSD triggers

A trigger can cause a strong reaction and intensify your emotions. Exact triggers differ depending on each person’s experience. Though, they tend to fit into the categories below. 

  • Specific environments
  • Words, conversations or topics
  • A person that looks similar to your abuser
  • Distinct smells, noises, sensations, or tastes
  • Others discussing individuals linked to the trauma
  • A song, book, or movie that you associate with the trauma
  • A time of day, day in the week, a month of the year, specific date 

For example, if your house was an unsafe environment and always smelt like potpourri, that smell may now bring a wave of symptoms. If you can identify your trigger, it allows you to avoid becoming triggered.

A therapist may work with you to gently expose yourself to a particular trigger when you are prepared, so it becomes less troublesome. We call this exposure therapy and explain this in more detail in our treatment section. It can be useful to share your triggers with trusted loved ones, as they can help you through this.

Triggers in relationships

Complex PTSD may affect your relationships as it can impact your ability to feel safe with or trust others. You may not open up to them or put yourself in a position where you could be hurt. 

C-PTSD can also cause overwhelming emotions, such as anger or sadness, which may influence your actions in the relationship. You may feel like it’s hard to be close to one another and experience issues with intimacy.

You do not need to share everything about your experience with your partner. However, sharing the information you are comfortable with can help them to understand you better. If you explain your triggers, your partner can also work with you to deal with them. For example, they can learn the signs of a flashback, your coping techniques and boundaries.







Similarly to PTSD, there is a diagnostic assessment process where we assess your experiences and resulting symptoms. Before seeking help, many search online for a complex PTSD test. These typically include questions that highlight symptoms that you may not have noticed. But you cannot self-diagnose complex PTSD - diagnose without the assistance of a mental health professional. 

If you use a complex PTSD test, we recommend using it as a tool to decide whether to contact a professional. However, if you experience any symptoms that concern you, we recommend seeking professional advice. A professional can determine the most likely diagnosis from your experiences and symptoms, as there are conditions with overlapping symptoms.

Due to overlapping symptoms and a lack of awareness of C-PTSD, some people with C-PTSD receive a misdiagnosis of BPD. BPD stands for borderline personality disorder. Other diagnoses include EPCACE (enduring personality changes after catastrophic events) and DESNOS (disorders of extreme stress not otherwise specified).



The key defining factor of C-PTSD is the experience of repeated trauma. Examples of this are below.

Traumatic events that can cause C-PTSD:

  • An ongoing form of violent or emotional abuse
  • Experiencing human trafficking or forced prostitution
  • Childhood exposure to violence, abuse, neglect or abandonment
  • Being a prisoner of war, experiencing torture, kidnapping, or slavery

Researchers believe that C-PTSD can affect areas of the brain, including the hippocampus, amygdala, and prefrontal cortex. These parts of the brain are linked to our memory function and stress response, e.g. fight or flight. 

People with PTSD often have abnormally high levels of stress hormones, such as adrenaline, which could lead to hyperarousal. This may also lead to a numbed state, where you feel like you have no emotions.

Risk factors

People who have experienced the above events do not always develop C-PTSD. However, certain factors can mean you are more likely to.

Risk factors for Complex PTSD include:

  • Experiencing trauma at a young age
  • Experiencing trauma by a parent or caregiver
  • The trauma lasts a long time or occurs multiple times
  • Underlying mental illness or a family history of mental illness
  • Remaining in contact with the person responsible for the trauma

In general, women are twice as likely as men to experience PTSD. A gender difference in potential traumatic events could explain this. For example, men are more likely to experience accidents, man-made disasters, and military combat. While women are more likely to experience sexual abuse and assault. Men may be less likely to seek help for their difficulties.


C-PTSD treatment options vary and overlap with PTSD treatments, though complex PTSD can take longer to treat. Typical treatment options include psychotherapy, cognitive behavioural therapy (CBT), Eye Movement Desensitisation and Reprocessing Therapy (EMDR), dialectical behavioural therapy (DBT), prolonged exposure therapy (PET), and medications. These treatments can help you manage and overcome the symptoms of C-PTSD.

Talking therapy

You may have talking therapy in a one-to-one session or as part of a group. Talking therapy aims to identify traumatic memories that are still affecting you and help you process your trauma.

Cognitive behavioural therapy

We often use CBT alongside talking therapy. Specifically, we use TF-CBT, which stands for trauma-focused CBT. It is a type of talking therapy that involves discovering and addressing harmful thought patterns. Your thoughts and beliefs influence your feelings and actions. By adapting your thought patterns, we can improve how you feel and behave.

Read our blog to learn more: Why choose Kove for CBT therapy?

Prolonged exposure therapy

As previously discussed, PET involves gradually exposing you to a potential trigger. We may do this by discussing the traumatic events (imaginal exposure) or asking you to confront otherwise-safe triggers (in vivo exposure). 

EMDR (Eye movement desensitization and reprocessing)

EMDR therapy is also effective for people with C-PTSD. During EMDR therapy, we help you process traumatic memories while consciously distracted by a visual, auditory, or tactile stimulus. 

Learn more about C-PTSD and treating C-PTSD with EMDR on our Complex PTSD and EMDR therapy page.


Some people with C-PTSD benefit from using medications for depression (antidepressants) or anxiety alongside psychotherapy. Depression and anxiety are common symptoms of C-PTSD, which these medications can combat. 

At Kove, we can discuss the option of medication with you. But you will need to speak with your GP or a psychiatrist if you feel this option is necessary.




Private complex PTSD therapist

If you are experiencing complex PTSD symptoms, our therapists can assess, diagnose, and treat your condition. CBT and EMDR therapy are two of our specialisms and are highly effective at treating C-PTSD. 

Once we have completed our thorough assessment process, you will receive a tailored treatment plan. Book an initial consultation today to get started.

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