Complex PTSD: Symptoms, Causes And Treatments

Complex PTSD: Symptoms, and Treatments

What Is Complex PTSD? 

Complex Post Traumatic Stress Disorder  (C-PTSD) is a condition that results from prolonged or repeated exposure to traumatic events, often involving harm or abandonment by a caregiver or interpersonal relationships. It encompasses the symptoms of PTSD along with additional problems such as difficulties controlling emotions, feeling very hostile or distrustful towards others and the world, and feeling alienated. 

From a neurobiological perspective, C-PTSD is associated with changes in the brain structure and function. Research has shown alterations in the amygdala (involved in processing emotions), the hippocampus (critical for memory and learning), and the prefrontal cortex (responsible for decision-making and regulating emotions). These changes can contribute to the symptoms of C-PTSD, such as difficulty in regulating emotions, impaired memory function, and heightened fear responses.

Psychologically, the theory of learned helplessness also provides insight into C-PTSD. This theory suggests that individuals exposed to uncontrollable and persistent stressors may learn to perceive themselves as powerless, leading to feelings of helplessness and a decreased likelihood of attempting to escape or avoid traumatic situations in the future. This sense of helplessness can exacerbate the impact of trauma and contribute to the development of C-PTSD.

Complex PTSD Vs PTSD: What Are The Differences?

Complex PTSD Vs PTSD
Complex PTSD vs PTSD

Complex PTSD and Post-Traumatic Stress Disorder (PTSD) are conditions that arise in response to traumatic events, yet they differ in their origins, symptoms, and the complexity of their impacts. These distinctions are crucial for understanding their treatment and management. Let’s explore the differences between PTSD and   C-PTSD.

PTSD typically results from a single traumatic event or a series of discrete incidents. Examples include military combat, natural disasters, serious accidents, or a violent attack. The trauma is often a clear, identifiable event or series of events that pose an extreme threat to the individual’s physical or emotional wellbeing.

C-PTSD, on the other hand, stems from prolonged exposure to traumatic circumstances from which there is little or no chance of escape. Such conditions often involve sustained abuse, neglect, or violence, and are frequently interpersonal in nature. Examples include long-term domestic abuse, childhood neglect or abuse, being a prisoner of war, or living in conflict zones over extended periods.

What Causes Complex PTSD?

The Various Causes of Complex PTSD

Scientifically, the development of C-PTSD can be attributed to the prolonged activation of the body’s stress response systems. When an individual is exposed to stress, the body responds by preparing to either fight, flee, or freeze. This response is regulated by the hypothalamic-pituitary-adrenal (HPA) axis, which controls the release of cortisol, a stress hormone. In a healthy situation, once the stressor is removed, the body’s systems return to baseline levels. However, in the case of prolonged trauma, there is a constant activation of this stress response, which can lead to dysregulation of the HPA axis.

Here are the most common experiences that may have contributed to complex PTSD: 

  • Childhood Abuse or Neglect: Long-term abuse, neglect, or abandonment by caregivers during the formative years of childhood significantly increases the risk of developing C-PTSD. The continuous nature of these traumas, combined with the developmental stage of the victim, ingrains the traumatic experiences deeply into the individual’s psyche.
  • Domestic Violence: Repeated exposure to domestic violence creates a pervasive environment of fear and helplessness, often leading to C-PTSD. Victims may feel trapped by emotional, financial, or physical barriers that prevent them from escaping the abusive situation.
  • Human Trafficking or Slavery: The extreme exploitation and abuse faced by victims of trafficking or slavery, where autonomy is completely stripped away, can lead to the development of C-PTSD.
  • Prisoners of War or Concentration Camp Survivors: Prolonged captivity under conditions of extreme threat, humiliation, and abuse can cause C-PTSD. The relentless stress and trauma experienced in these conditions deeply affect the individual’s mental health.
  • Living in Conflict Zones: Continuous exposure to the violence, threat, and instability of war-torn areas or conflict zones can result in C-PTSD, especially when the individual faces direct threats to their life and well-being over an extended period.

The chronic nature of these traumatic experiences affects individuals on multiple levels, including their emotional regulation, sense of self, and ability to form healthy relationships. The trauma disrupts the victim’s belief systems, leading to pervasive feelings of helplessness, worthlessness, and profound alienation from others. The sustained stress and fear condition the brain to remain in a heightened state of alertness, affecting the individual’s ability to regulate emotions and leading to complex symptoms that characterise C-PTSD.

Understanding the symptoms of complex PTSD is crucial to help provide support and treatments.

17 Symptoms of Complex PTSD

  • The symptoms of C-PTSD are more extensive than those of PTSD and involve a broader spectrum of emotional, cognitive, and behavioural disturbances. Here are 17 symptoms commonly associated with Complex PTSD: 

    1. Reliving Traumatic Events: This involves flashbacks, nightmares, and intrusive thoughts about the trauma, making it feel as though the traumatic events are happening again.
    2. Avoidance: Individuals may avoid places, people, and activities that remind them of the trauma, leading to social withdrawal and isolation.
    3. Negative Self-Perception: A persistent and distorted sense of shame or guilt, often accompanied by feelings of worthlessness or a profound sense of being different from others.
    4. Difficulty Regulating Emotions: Experiencing severe mood swings, explosive anger, or persistent sadness. Individuals may struggle to manage their emotions effectively.
    5. Dissociation: Feelings of detachment from oneself or the world, which might include feeling numb or experiencing a disconnection from one’s body or thoughts.
    6. Difficulty with Relationships: Problems in forming or sustaining relationships due to issues with trust, intimacy, or a tendency to avoid closeness with others.
    7. Sense of Perpetual Threat: A constant state of vigilance or being on guard against potential threat or danger, leading to heightened startle response.
    8. Distorted Perceptions of the Perpetrator: This may include preoccupation with revenge, idealisation or romanticization of the abuser, or a misplaced sense of loyalty.
    9. Loss of Systems of Meanings: Feelings of despair, hopelessness, or a loss of previously held beliefs and values.
    10. Impaired Attention and Consciousness: Difficulty focusing, concentrating, or remembering things, often due to being preoccupied with traumatic memories or experiences.
    11. Physical Symptoms: Unexplained physical complaints such as headaches, dizziness, chest pains, or stomach aches.
    12. Sleep Disturbances: Insomnia, frequent awakenings, or nightmares that disrupt sleep.
    13. Self-destructive or Risky Behaviour: Engaging in activities that pose a risk to oneself or others, such as substance abuse, reckless driving, or self-harm.
    14. Preoccupation with Revenge or Justice: An overwhelming desire for retribution against those perceived to be responsible for their suffering.
    15. Feeling Different from Others: A profound sense of alienation and isolation from the rest of society, feeling as though one does not belong or fit in.
    16. Hopelessness about the Future: Persistent pessimism about one’s prospects, future, and the possibility of leading a normal life.
    17. Somatic Complaints: Physical symptoms without a medical cause, often believed to be manifestations of psychological distress.

    These symptoms reflect the complex and pervasive impact of prolonged exposure to traumatic stress on an individual’s mental, emotional, and physical well-being. Treatment for C-PTSD typically involves a combination of psychotherapy, medication, and support, tailored to address the multifaceted nature of the disorder and to aid in the recovery process.

How Common is Complex PTSD In Australia? 

The current outlook for Complex PTSD in Australia reflects a broader understanding and recognition of the condition, especially with the introduction of the ICD-11 classification which includes C-PTSD as a distinct diagnosis. This recognition is crucial for treatment and intervention strategies to be effectively implemented.

The National Study of Mental Health and Wellbeing (2020-2022) reported by the Australian Bureau of Statistics provides insight into mental health disorders in Australia, including those potentially related to trauma. This study found that 21.5% of Australians aged 16–85 years experienced a mental disorder lasting at least 12 months,  including conditions related to, or including Complex C-PTSD. This statistic underscores the significant portion of the population affected by mental health issues, although it does not specify Complex PTSD directly​​.

Complex PTSD Treatments

In Australia, treatments for Complex PTSD typically involve: 

Psychological therapy

Trauma-focused cognitive behavioural therapy (CBT)

Trauma-Focused Cognitive Behavioural Therapy (TF-CBT) for Complex PTSD systematically addresses the memory of traumatic events and the maladaptive beliefs related to these events. Scientifically, it involves exposure to trauma memories or cues in a safe, controlled manner, helping individuals process and integrate traumatic experiences. 

Cognitive restructuring within TF-CBT challenges and modifies negative beliefs and attributions, aiming to reduce symptoms of PTSD. By focusing on the specific trauma and its impact on current functioning, TF-CBT facilitates the development of coping strategies, enhancing emotional regulation and reducing avoidance behaviours. This targeted approach is supported by evidence showing its efficacy in reducing symptoms of PTSD, including in individuals with Complex PTSD, by directly addressing the roots of trauma-related distress.

Eye movement desensitisation and reprocessing (EMDR)

Eye Movement Desensitisation and Reprocessing (EMDR) assists individuals with Complex PTSD by facilitating the brain’s information processing system. Through the use of guided eye movements, EMDR aims to help the mind reprocess traumatic memories, reducing their emotional impact. Scientifically, this process is thought to mimic the psychological state of REM sleep, aiding in the natural processing of traumatic events, thereby diminishing distressing memories’ intensity and enabling individuals to develop more adaptive coping mechanisms.

Dialectical behaviour therapy (DBT) 

Dialectical Behaviour Therapy (DBT) helps individuals with Complex PTSD by teaching them skills to manage intense emotions, reduce self-destructive behaviours, and improve relationships. DBT combines cognitive-behavioural techniques with mindfulness practices, focusing on acceptance and change. It aids in developing coping strategies for dealing with stress, regulating emotions, and enhancing interpersonal effectiveness, thereby addressing the complex needs of those with Complex PTSD.



Antidepressants can aid individuals with Complex PTSD by modulating neurotransmitter activity in the brain, which is often disrupted in PTSD. They primarily target serotonin and noradrenaline pathways, helping to stabilise mood, reduce anxiety, and improve sleep patterns. This biochemical approach can make emotional responses more manageable, supporting the effectiveness of psychotherapeutic interventions by reducing the intensity of PTSD symptoms, thereby facilitating better engagement with therapy and daily functioning.

Alternative Treatments

Medical cannabis may potentially help patients with Complex PTSD by affecting the endocannabinoid system, which plays a role in regulating mood, sleep, and stress responses. Tetrahydrocannabinol referred to as THC and Cannabidiol referred to as CBD are two of the numerous   compounds in cannabis that might be beneficial. THC may  alleviate symptoms like insomnia and flashbacks, whilst CBD is known for its anxiolytic and neuroprotective properties, potentially reducing anxiety and promoting emotional regulation. Always consult a healthcare professional before considering medical cannabis for Complex PTSD.

Research indicates  that Cannabinoids may hold promise as a treatment for PTSD, however further evidence is required to be able to form more definitive conclusions.

Final Reflections: Navigating the Complex Terrain of C-PTSD

Understanding Complex PTSD requires an examination that goes beyond the typical scope of Post-Traumatic Stress Disorder. This exploration into the symptoms, causes, and treatments of Complex PTSD highlights the significant effects of long-term trauma from abuse, neglect, and violence. The differences between Complex PTSD and PTSD are crucial for understanding their impact and the need for specialised approaches to treatment. C-PTSD results from enduring, complex traumas that can alter brain structure and function, affecting individuals’ emotional regulation, memory, and sense of safety.

The approach to treating Complex PTSD in Australia is designed to address the complex nature of the disorder comprehensively. It includes psychological therapies such as Trauma-Focused Cognitive Behavioural Therapy (TF-CBT) and Eye Movement Desensitisation and Reprocessing (EMDR), along with the use of medications like antidepressants to support the healing process. These treatments aim to help individuals process and integrate traumatic experiences, striving for improved stability and quality of life. Additionally, the exploration of alternative treatments continues to evolve, emphasising the importance of customised and compassionate care in the recovery process. Reflecting on the treatment of Complex PTSD offers a perspective of hope and highlights the resilience possible in overcoming the challenges posed by this condition.

Written by

Priyom holds a Ph.D. in Plant Biology and Biotechnology from the University of Madras, India. She is an active researcher and an experienced science writer. Priyom has also co-authored several original research articles that have been published in reputed peer-reviewed journals. She is also an avid reader and an amateur photographer.

Written by

Priyom holds a Ph.D. in Plant Biology and Biotechnology from the University of Madras, India. She is an active researcher and an experienced science writer. Priyom has also co-authored several original research articles that have been published in reputed peer-reviewed journals. She is also an avid reader and an amateur photographer.

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