Complex trauma or Complex Post-Traumatic Stress Disorder (CPTSD) is a separate mental health condition from PTSD, typically related to childhood abuse, among other causes. Read on to learn more about what it is, differences from PTSD, and treatment options.
What Is Complex Trauma?
Complex trauma refers to the response to a child’s exposure to multiple traumatic events as well as the long-term effects of this exposure. Often this chronic traumatization lasts months or years and is severe and pervasive, such as with abuse and neglect [1].
Complex trauma involves emotional, psychological, physical, and/or sexual abuse, or domestic violence, living in a war zone, or being held captive. It may involve human trafficking or child exploitation, among other horrific circumstances. Survivors are often at the complete control of another person and may not be able to believe it will ever end, nor be able to see a time when they can be freed [2].
According to Dr. Bessel van der Kolk, an internationally known trauma expert and author of the bestselling book, “The Body Keeps The Score: Brain, Mind, and Body in the Healing of Trauma,” trauma can be defined as any experience which overwhelms the Central Nervous System’s ability to process and recall memories [3].
Complex PTSD from Childhood Trauma
Usually this trauma occurs early in life. It can severely disrupt many essential elements of the child’s development, the formation of a sense of self, and the construction of secure attachment.
Frequently, the events occur with parents or caregivers who were unpredictable, unavailable, or a source of terror. Survivors are changed in numerous ways, including losing the ability to move into the future for living in the past and feeling “broken”.
CPTSD From Experiences in Adulthood
CPTSD can also develop due to traumatic events in adulthood, especially when the trauma is interpersonal, inescapable, or recurring. Common adult experiences leading to CPTSD include:
- Domestic violence or abuse
- Workplace trauma
- Human trafficking
- Chronic illness or medical trauma
- War, torture, or political persecution
- Religious or cult abuse
- Long-term stalking or harassment
Why Complex Trauma Is Often Misunderstood
Complex trauma (and CPTSD) is often misunderstood because of:
- Invisible Wounds: Unlike physical injuries, emotional and psychological scars aren’t visible, leading to dismissal (“Just get over it”).
- Misdiagnosis: Symptoms overlap with depression, anxiety, or BPD, so clinicians may miss the root of the trauma.
- Myth of “Single-Event” Trauma: Society recognizes PTSD from acute trauma (e.g., war, accidents) but struggles to validate prolonged trauma (e.g., emotional abuse, systemic oppression).
- Survival Responses Look Like “Flaws”: Hypervigilance, people-pleasing, or emotional outbursts are adaptive survival strategies, but others may label them as “dramatic” or “needy.”
- Self-Blame: Survivors often internalize shame (“Why didn’t I leave?”), masking the trauma’s true cause.
- Cultural Stigma: Discussing abuse, exploitation, or betrayal (especially by family/trusted institutions) is often silenced or minimized.
- Lack of Awareness: CPTSD isn’t in the DSM (only ICD-11), so many professionals aren’t trained to identify it.
What Is the Difference Between PTSD and CPTSD?
Simply put, PTSD is the result of a single event, while CPTSD is the result of a prolonged series of traumatic events. CPTSD involves broader emotional and relational difficulties than PTSD, such as:
- Emotional Dysregulation: Intense mood swings, rage, or numbness.
- Negative Self-Concept: Deep shame, guilt, or feelings of worthlessness.
- Relational Challenges: Fear of trust, difficulty setting boundaries, or revictimization.
- Dissociation: Detaching from reality or “checking out” during stress.
- Somatization: Physical pain (e.g., migraines, digestive issues) linked to stress.
- Hopelessness: A sense of being permanently damaged or having a foreshortened future.
CPTSD Assessment and Diagnosis
CPTSD is currently a diagnosis listed in the International Classification of Diseases 11th Revision (ICD-11) used outside of the US, but not in the Diagnostic and Statistical Manual 5th Revision (DSM-5) used in the US. The definition of CPTSD has shifted over time. There is also continued debate about whether CPTSD is its own disorder or part of PTSD [4].
The main diagnostic difference between the PTSD diagnosis and that of CPTSD is that an individual must have all of the criteria of PTSD at clinical levels; and in addition, they must have difficulty in these three areas as well:
- Emotional regulation
- Self Identity
- Relationship Issues
CPTSD is underrecognized in clinical settings and often conflated with other disorders. It is often misdiagnosed with Borderline Personality Disorder or depression due to overlapping symptoms (e.g., emotional instability, self-harm).
Complex Trauma Treatment Options
There is a wide range of therapy approaches for treating trauma. Best known are what can be considered top-down, focused on cognitions or thoughts. These include Cognitive Behavioral Therapy (CBT), Dialectical Behavioral Therapy (DBT), Prolonged Exposure Therapy (PE), and Trauma-Focused Cognitive Behavioral Therapy (TF-CBT), among others.
EMDR, Somatic Work, and Integrative Therapies
However, more recent bottom-up approaches focusing on the connection between mind and body are employed successfully with CPTSD. These include [5]:
Eye Movement Desensitization and Reprocessing Therapy (EMDR): Helps process traumatic memories by using bilateral stimulation (eye movements, taps, or sounds) while recalling distress. This reduces emotional intensity and reprograms maladaptive beliefs, aiding healing from prolonged trauma. Effective for fragmented memories and somatic symptoms in CPTSD.
Somatic Experiencing: Helps release trapped trauma by focusing on bodily sensations, not just thoughts. It gently guides the nervous system to discharge stress and restore balance, reducing hypervigilance and shutdown in CPTSD. Targets the body’s role in trauma recovery.
Integrative Therapy: Combines trauma-focused approaches (EMDR, somatic work) with parts work (Internal Family Systems (IFS)), mindfulness, and nervous system regulation. Tailored to address emotional, physical, and relational wounds holistically, fostering resilience and self-compassion in long-term healing.
Sensorimotor Psychotherapy: Blends talk therapy with body-centered techniques, helping clients process trauma by tracking physical sensations, movements, and impulses. It resolves stuck survival responses (fight/flight/freeze) and rebuilds somatic awareness for lasting emotional regulation and integration.
Expressive Arts Therapy: Use creative processes (art, music, dance, drama) to access and process trauma nonverbally. They bypass cognitive defenses, unlock suppressed emotions, and foster self-expression, helping survivors reclaim agency and rebuild a sense of safety, identity, and empowerment.
Polyvagal Theory: Using the insights of Polyvagal theory it’s possible to heal from CPTSD by using these steps: 1) Self-Compassion: For your symptoms, as you cannot simply think your way out of your trauma reactions. 2) Develop Somatic Awareness: Learn to mindfully track subtle changes in your body sensations and heart rate. 3) Practice Attentional Control: Practice focusing your attention on specific cues in your environment that remind you that you are safe now [6].
Finding a Therapist for Complex Trauma
Look for a trauma-informed professional specializing in CPTSD, with training in modalities like EMDR, IFS, or somatic therapy. Verify their experience with prolonged trauma, and prioritize trust and safety in the therapeutic relationship. Ask questions like these:
- “Do you work with complex trauma survivors?”
- “How do you approach dissociation or emotional flashbacks?”
- “What’s your framework for long-term healing?”
Medication for CPTSD: Can it Help?
While no drug “cures” CPTSD, targeted medication such as Selective Serotonin Reuptake Inhibitors (SSRIs), Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs), or low-dose Naltrexone may ease symptoms such as hyperarousal, depression, or sleep disturbances. They are best used alongside therapy for holistic healing.
While they can reduce overwhelm, making therapy more accessible, they don’t address the root causes of trauma or relational wounds. Consult with a psychiatrist or psychiatric nurse practitioner experienced in trauma.
When Professional Support Becomes Necessary
Seek therapy when trauma symptoms:
- Disrupt daily life (work, relationships, self-care)
- Cause severe flashbacks, dissociation, or suicidal thoughts
- Lead to unsafe coping (addiction, self-harm)
- Persist despite self-help efforts
Critical Signs:
- Feeling “stuck” in survival mode (chronic fight/flight/freeze)
- Inability to trust others or form secure attachments
- Overwhelming shame or emotional numbness
Trauma-trained therapists provide:
- Safety and Stabilization (emotion regulation, grounding techniques)
- Trauma Processing (EMDR, parts work, somatic therapies)
- Post-Traumatic Growth (rebuilding identity, healthy relationships)
Urgent care is needed if:
- Active suicidality or psychosis
- Complete social withdrawal
- Inability to perform basic functions
Our Trauma-Informed Program at Corner Canyon
Treatment for mental health conditions and trauma is available in Utah. Are you or a loved one looking for a compassionate space to heal from anxiety, trauma, CPTSD, other mental health conditions, or addictions? Our licensed trauma-informed professional therapists and counselors at Corner Canyon Health Centers can provide compassionate help using a range of therapeutic and holistic techniques.
Reach out to our Admissions team now at Corner Canyon. We’re in a peaceful setting bordered by the beautiful Wasatch Mountains.
Sources
[1] Complex Trauma. The National Child Traumatic Stress Network.
[2] What is C-PTSD? BeautyAfterBruises.org
[3] van der Kolk, B. The Body Keeps The Score: Brain, Mind, and Body in the Healing of Trauma.
[4] Larsen S. Complex PTSD: History and Definitions. Department of National Defense. Veterans Affairs.
