Condition Center: Complex PTSD (C-PTSD)

Photo Illustration by Ava Cruz
Photo Illustration by Ava Cruz

This informational guide, part of POPSUGAR's Condition Center, lays out the realities of this health concern: what it is, what it can look like, and strategies that medical experts say are proven to help. You should always consult your doctor regarding matters pertaining to your health and before starting any course of medical treatment.

While most people have heard of post-traumatic stress disorder (PTSD), few are able to elaborate on the related but less commonly talked about condition, complex post-traumatic stress disorder, or C-PTSD. Up to eight percent of the general population are impacted by C-PTSD, according to a recent study published in The Lancet. And with celebs like Kathy Griffin opening up about their experience with C-PTSD, the condition is starting to get more recognition. The comedian recently revealed in a TikTok video that she has "an extreme case".

While the two conditions are only a letter apart, PTSD and C-PTSD differ in several distinct ways. "PTSD can develop after experiencing a single traumatic event, such as a car accident or a natural disaster," says Emily Green, PsyD. "C-PTSD is, in contrast, the deep, long-standing developmental adaptations to chronic, repeated trauma, which disturbs not just an individual's sense of safety but their core understandings of the world, their self-worth, and their ability to trust in others and know their own voice."

Understanding C-PTSD

According to Green, C-PTSD is a somewhat new term and is not yet formally included in the Diagnostic and Statistical Manual of Mental Disorders. But it has been recently recognized as a sibling diagnosis for PTSD by the World Health Organization. The diagnosis originated in 1988 when Dr. Judith Herman of Harvard University suggested that symptoms of long-term trauma needed to be categorized by their own diagnosis, complex PTSD, according to the US Department of Veteran Affairs (VA).

"C-PTSD refers to a presentation of symptoms that may be seen in individuals who have experienced long-term exposure to trauma and represents difficulty functioning across a range of mental health domains," Green says. These effects can themselves be chronic, pervasive, and resistant to traditional treatment. According to Green, symptoms of C-PTSD include ones you'd expect to see in standard PTSD, including in three critical clusters: 1) re-experiencing (flashbacks or nightmares, intrusive memories of the trauma); 2) avoidance of people, places, or emotional experiences that are reminiscent of the trauma, including dissociative and numbing responses; and 3) hypervigilance (easily startled, constantly on guard for physical or emotional danger, irritability). Other C-PTSD symptoms may present as feelings of worthlessness, shame, and guilt; trouble controlling emotions; and difficulty connecting with others and maintaining relationships, according to the United Kingdom National Health Service (NHS). These symptoms, when untreated, are likely to get in the way of an individual's ability to move toward what matters to them in life, Green says. "Unfortunately, they also make individuals more susceptible to revictimization, which may only exacerbate these issues and put healing and progress more out of reach."

Causes of C-PTSD

There are ongoing factors that may contribute to the likelihood of a person developing the disorder. C-PTSD can develop when a person experiences not just a single traumatic event, but a long-term traumatic exposure to abuse, neglect, or physical or emotional harm, according to Green. "Originally, proponents of complex PTSD focused on childhood trauma, especially childhood sexual trauma," according to the VA. "However, there is abundant evidence suggesting that duration of traumatic exposure — even if such exposure occurs entirely during adulthood, as with refugees or people trapped in a long-term domestic violence situation — is most strongly linked to the concept of complex PTSD."

During these types of long-term traumas, the victim is typically "under the control of the perpetrator and unable to get away from the danger," per the VA. This type of trauma could include:

  • Prisoner-of-war camps
  • Concentration camps
  • Long-term domestic-violence situations
  • Long-term child physical abuse
  • Long-term child sexual abuse
  • Child-exploitation rings

This type of chronic exposure, particularly at crucial developmental stages in childhood or inflicted by those who are supposed to be a trusted or safe figure, can have long-term impacts on an individual's emotional development, self-concept, attachment style, mood regulation, and executive functioning, Green says. Repetitive trauma, in contrast to a single confined traumatic event, demands that our nervous system be constantly on guard for continued danger, even when the risk of danger no longer remains.

The Most Effective Treatments For C-PTSD

There is no one-size-fits-all approach to C-PTSD, and more research is still needed to understand and quantify what components of treatment are most effective at resolving the most debilitating aspects of the disorder. "What we do know is that effective treatment focuses on identifying and naming the trauma experiences, unpacking and noticing the maladaptive behaviors and defense mechanisms that have developed in response to repetitive exposure to that trauma, and taking steps towards understanding how those adaptations, while perhaps once effective and necessary at protecting the self emotionally, may now be working against the individual and getting in their way of living a valued life," Green says.

According to her, treatment must allow the reexamining of the inherently fractured narrative of one's life experience and the "reason" for one's victimization, away from self-blame, guilt, and shame. With this, cognitive processing therapy (CPT) and prolonged exposure (PE) have been recommended by the VA as strong treatment options. Psychotherapy in conjunction with medication may be even more effective than either one of those interventions by themselves, but as always, it will vary from person to person.

According to NHS, exposure therapy or EMDR (eye movement desensitization and reprocessing) may also be helpful.

If you or someone you know is struggling with C-PTSD, the National Alliance on Mental Illness has resources available including a helpline at 1-800-950-NAMI (6264). Or, in a crisis, text "HelpLine" to 62640. You can also dial 988, the nation's new mental health crisis hotline.