17 Symptoms of Complex PTSD & How To Cope With Them

CPTSD is chronic trauma that occurs over time and usually in the context of personal relationships. “Complex” is a perfect way to describe this situation. The layers of this type of adversity are similar to those of an onion; even after you begin to address the problem, additional layers emerge. 

What are the 17 symptoms of complex PTSD? And have you experienced any of them? Learning about trauma and its symptoms can help you take a big step toward treating complex PTSD symptoms.

What is Complex Trauma (C-PTSD)?

Complex trauma or C-PTSD is defined as exposure to prolonged or repeated trauma and frequently interpersonal traumatic experiences, such as child abuse or neglect. C-PTSD is long-term trauma and can occur between people, and when you experience repeated trauma as a child or adult, you often have the “being or feeling trapped” feeling of constant helplessness.

Some complex trauma examples include: 

• Being a victim of or witnessing ongoing domestic violence
• Experiencing childhood abuse, such as physical abuse or emotional neglect
• Experiencing sexual abuse
• Witnessing or experiencing torture, sex trafficking, or enslavement

Dr. Judith Herman is credited with the idea of a distinct diagnosis of complex post-traumatic stress disorder. In 1988, when her ideas were made known, there were no criteria for C-PTSD.

Previously, only posttraumatic stress disorder (PTSD) was considered a diagnosis, but complex posttraumatic stress disorder (CPTSD) is now included in the International Classification of Diseases 11th Revision (ICD-11), but not in the Diagnostic and Statistical Manual 5th Revision (DSM-5). 

Several factors may increase the odds that you will develop complex PTSD:

• You experienced trauma at a young age
• Someone who harmed you or whom you believed you could trust, such as a family member
• Based on circumstances, you were unable to escape the traumatic situation

What is Complex Trauma in Adults?

Childhood trauma in adults is complicated. You think you’ve “moved past” your rough childhood, only to notice some issues that have followed you years later. While complex PTSD usually affects people with a traumatic childhood, it can develop in adulthood. 

According to Herman’s research, the formula for complex trauma includes the following:

• Behavioral issues, such as impulsivity, aggressiveness, substance abuse, and self-harm tendencies
• Emotional challenges, such as rage, depression, and panic
• Cognitive challenges, such as dissociation 
• Challenges and chaos in interpersonal relationships
• Physical signs of chronic stress, such as headaches and weakness
• After adverse childhood events, it’s normal for a person to repress their experience. Repression of trauma memories is a way for the brain to protect us from re-experiencing something harmful. While helpful for everyday function, the impact of the events eventually works its way to the surface.
• Abusive adult relationships can also involve trauma bonding, a strong connection that develops between abusers and their victims. Ongoing cycles of emotional abuse are known to create a ripple effect, causing harm even after the relationship ends.

Furthermore, cPTSD is frequently associated with a number of mental health issues in adulthood, including emotional dysregulation, depression, and chronic anxiety.

How common is CPTSD?

About 6 out of 100 adults in the global population had complex PTSD, according to recent statistics. It may impact 1% to 8% of people worldwide. [1]

Did you experience prolonged trauma at a young age? See what your trauma score is with a Breeze test today. 

Difference between C-PTSD and PTSD

Post-traumatic stress disorder and C-PTSD share some common symptoms related to trauma; however, C-PTSD encompasses a broader and more complex set of symptoms. People with C-PTSD typically have chronic and extensive issues with emotional regulation. While both involve a negative, life-altering experience, one is ongoing, and the other is usually a one-time, impactful event.

	CPTSD	PTSD
Nature of Trauma Exposure	Results from prolonged exposure to trauma, often occurring over months or years.	Typically arises from a single traumatic event, such as a car accident, assault, or natural disaster.
Symptoms	In addition to PTSD symptoms, CPTSD makes emotional regulation hard. Interpersonal relationships are also tricky. The person feels shame, guilt, or persistent hopelessness.	Symptoms include flashbacks, nightmares, severe anxiety, and avoidance of triggers related to the traumatic event.
Duration and Severity	Symptoms tend to be more pervasive and chronic. Recovery may be more complex and prolonged.	Symptoms may fluctuate in intensity over time but can resolve with treatment.
Impact on Functioning	C-PTSD causes impairment across various domains of life. Work, social life, and well-being suffer.	Impairs daily functioning and quality of life. Often allows for continued engagement in work and relationships.

We asked Rychel Johnson, a mental health professional to give insight from counseling practice In my therapy practice, I frequently encounter stories from clients. These stories paint a picture of resilience despite struggle. In many cases, these stories involve layers of traumatic moments that add up to create C-PTSD.

What are the 17 Symptoms of Complex PTSD?

Knowing what C-PTSD symptoms look like can help decode your experiences and how you feel. Part of addressing this mental health condition is understanding it better. Symptoms of C-PTSD can include the following:

Emotional & Negative Thinking Symptoms

1. Severe Emotional Distress

Additionally, you might experience overwhelming emotions, such as intense sadness, fear, anger, or shame. These emotions can be challenging to manage and may seem “too much” compared to what set them off. 

People with C-PTSD often struggle to regulate their emotions. Rapid mood swings and emotional outbursts are part of this experience. Identifying and expressing feelings is hard, causing emotional dysregulation.

You might also feel an excessive sense of guilt or shame related to your trauma. Reminders of the trauma or seemingly unrelated events can cause emotions to arise.

2. Negative Thoughts

Part of C-PTSD involves a negative outlook. Prolonged traumatic experiences lead to deeply ingrained negative beliefs. Someone with C-PTSD may feel worthless or guilty and not trust others. They often think of “black-and-white,” seeing themselves as a failure. They frequently expect the worst possible outcome in situations.

Someone with complex trauma may develop a strong guilt complex. This type of guilt extends beyond everyday guilt and shapes the person’s self-worth. They may automatically assume they are to blame in situations that do not involve them.

3. Hopelessness

If you persistently feel hopeless about the future, you aren’t alone. Persistent negative thoughts can lead to intense feelings of sadness, anxiety, and despair. Negative beliefs about others can hinder the ability to form and maintain healthy relationships. 

Hopelessness is common with C-PTSD and is a difficult feeling to shake. How are you feeling about your well-being? Take a Breeze test today to determine your current mental well-being score.

4. Loss of Interest

Have you lost interest in activities you once enjoyed? You might be feeling a loss of interest, also called anhedonia. Apathy and disinterest pair with social withdrawal when you have C-PTSD. It can feel too difficult to engage in relationships and hobbies. Or maybe you can start an activity, but struggle to maintain it.

5. Emotional Numbness

Being emotionally numb is confusing. Positive emotions like happiness or excitement are muted or absent. You may even encounter feelings of emptiness that are hard to understand. Numbing yourself disengages you from emotional experiences. 

It can also be hard to recognize or label one’s emotions with C-PTSD. There can be a lack of outward emotional expression, such as a flat or neutral facial expression and tone of voice.

6. Hypervigilance

Imagine being easily startled or always on guard; this may be part of your experience. Even when no immediate danger is present, you could have a heightened state of alertness.

Over time, people with C-PTSD may develop hypervigilance as a learned response to unpredictability. Hypervigilance is a survival mechanism for someone with trauma in their life. A chronic state of fight-or-flight can contribute to sustained hypervigilance, too.

7. Detachment

If you have C-PTSD, you might feel detached from others. You could also feel emotionally detached or disconnected from yourself. Depersonalization can occur with C-PTSD, where you feel disconnected from your body. This disconnect is uncomfortable and can be scary.

Experiencing dissociation can happen as a protective mechanism. Feeling detached from your body or your surroundings is part of dissociation. A person could also feel unable to form close relationships due to concerns about trust.

8. Flashbacks

Similar to PTSD flashbacks, complex PTSD can also involve this symptom. During a flashback, a person may feel like they are reliving the traumatic experience in real time. These flashbacks can involve realistic sensory and emotional experiences.

Behavioral & Avoidance Symptoms

9. Irritation or Anger

Feelings of anger or irritability could be linked to C-PTSD. Lacking control over your life can amplify these feelings. Chronic stress from prolonged trauma impacts the body’s stress response system. Persistent activation of the fight-or-flight response occurs as well, causing more irritability.

Anger is often a sign of repressed childhood trauma. Traumatic experiences affect the developing brain differently. Repressed trauma from childhood can show up in our emotions, including anger. So you can feel difficulty controlling emotions. [2]

10. Self-Destructive Behavior

Someone with C-PTSD may engage in risky behaviors without concern for safety. These behaviors serve as a way to cope with emotional pain:

• Substance abuse to numb emotions or escape from reality
• Reckless driving
• Self-injury, such as cutting, burning, or hitting oneself
• Unsafe sexual practices
• Gambling
• Developing disordered eating patterns (e.g., binge eating, purging, or restrictive eating)

A person with C-PTSD may also significantly undermine their success or well-being. Sabotaging relationships and achievements can be a sign that someone is struggling. [3]

11. Physical Symptoms

Imagine you suddenly start sweating when reminded of a stressful event. With C-PTSD, it’s common to experience physical sensations, including: 

• Increased heart rate or heart palpitations
• Nausea or other stomach upset
• Sweating, especially in stressful situations
• Muscle tension or pain
• Shaking or trembling that you can’t control
• Loss of appetite
• Chronic pain or headaches
• High blood pressure 
• Shortness of breath
• Weakened immune system leading to frequent illnesses, taking longer to recover from colds, or increased sensitivity to allergens
• Persistent tiredness and lack of energy

12. Avoiding Reminders

If you have complex PTSD, there may be places or people you avoid. These reminders carry a lot of power and are triggering. Places where trauma occurred and people who were involved–they feel too daunting. 

You may find that you change your routines and withdraw from others to avoid triggers. This takes a lot of effort. Substance abuse could be a way a person copes or “numbs out.”

13. Avoiding Thoughts or Feelings

There may also be efforts to avoid thinking about the trauma. Thoughts, memories, and even conversations could all provoke intense emotions. If you have C-PTSD, you might withdraw from social settings—you never know if conversations related to your trauma will happen.

Cognitive & Sleeping Challenges

14. Memory Problems

Our brains short-circuit a bit with traumatic memories, according no neurobiologists. [4] Because trauma is tangled up in fear responses, our memory suffers as a result.  Seen as a protective mechanism, you may notice difficulty remembering pieces of traumatic situations. 

Or traumatic memories may not be cohesive. You may visualize disjointed images, sounds, or sensations instead of a continuous memory. This phenomenon is known as dissociative amnesia, in which you don’t recall pieces of the past.

Your brain was under extreme stress and may have eliminated some details as you exist in “survival mode.” Emotional issues arise, and you may ask, “Why can’t I remember my childhood?” Memories and emotions are deeply connected but confusing.

15. Distressing Memories

These memories are unwanted, intrusive memories of traumatic events. They can have a profound impact on an adult’s overall mental health. Strong, distressing emotions often accompany the memories. 

16. Trouble Sleeping

Complex trauma can interfere with your sleep. [5] Chronic stress has been linked to insomnia, nightmares, and restlessness. Constant alertness can impair the brain’s ability to process and store information correctly, disrupting sleep.

17 Nightmares

Nightmares are disturbing. Complex trauma nightmares often weave together various elements of multiple traumatic events. You may wake up with overwhelming fear or helplessness. Complex trauma nightmares tend to be recurrent and persistent over time.

Do You Have CPTSD Symptoms? Self-check Quiz

Answer each question with Yes / No. 

1. Does thinking about or experiencing unpleasant memories get in the way of your regular life?
2. Is it difficult for you to concentrate on daily tasks because you frequently feel emotionally overwhelmed or shut down?
3. Do you avoid certain people, places, or situations to avoid triggering memories?
4. Do you have trouble sleeping, concentrating, or feeling physically tense as a result of previous experiences?
5. Do you feel on edge or hyper-aware in situations that aren’t actually dangerous?
6. Do you have negative self-beliefs (“I’m broken,” “It’s my fault”) that regularly influence your decisions and relationships?
7. Do you struggle to trust others or feel safe in intimate relationships?

Mostly “No” answers: It looks like your day-to-day life might not be significantly impacted, or you have no C-PTSD symptoms at all.

Mostly “Yes” answers: Symptoms are most likely interfering with your daily life. Seek assistance from a support group or a therapist who is trained in trauma healing.

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How to Heal From Complex Trauma (C-PTSD)

Effective treatment involves a combination of approaches, from talk therapy to medications. Therapy with a mental health professional offers a safe environment for dealing with CPTSD symptoms and managing related emotions. And it’s the prior method to treat complex trauma symptoms. It allows you to develop the coping skills required to deal with traumatic stress from the past and move closer to a happy present.

Judith Herman, trauma expert, outlined three stages of recovery from severe trauma:

1. Safety and Stabilization. Restoring the survivor’s sense of security, mastery, and stability in their body and surroundings is our priority in this stage. Developing routines, lowering core symptoms, and fostering trust are all part of this.
2. Remembrance and Mourning. During this stage, survivors begin to process and tell the story of their trauma in a safe, supportive environment, mourning losses and making sense of what happened.
3. Reconnection and Integration. The emphasis on this stage is on rebuilding life, forming healthy relationships, reclaiming purpose, and reconnecting with community, all while integrating trauma into one’s life story rather than being defined by it.

Emotional intelligence can play a role in how you process trauma. Discover your EQ score with a Breeze test today.

5 Therapy Approaches for C-PTSD

There are several effective therapy approaches, and each one is made to fit the needs of the person. Some important types are:

1. Eye Movement Desensitization and Reprocessing (EMDR): A structured method for treating PTSD that is frequently quicker and more effective than traditional therapy. EMDR uses bilateral stimulation to alter memories.

2. Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) is an evidence-based paradigm that provides a safe space for children and their caregivers to process traumatic events. Its duration can vary according to the needs of each individual.

3. DBT, or dialectical behavior therapy, was initially used to treat borderline personality disorder. It helps people with PTSD from childhood abuse by teaching them to be mindful and to control their emotions.

4. Prolonged Exposure Therapy (PE): This cognitive behavioral treatment gradually exposes patients to memories of traumatic experiences in order to help them manage their anxiety and fear.

5. Somatic experiencing and body-based therapies: This method helps adults process trauma by releasing the body’s stored stress response. Breathwork, movement exercises, yoga, dance therapy, and guided meditation can all help with unprocessed memories of the past.

Medication

As of right now, the FDA in the United States has not approved any drugs to treat PTSD or CPTSD.  Antidepressant medications, which are only prescribed by licensed medical professionals or therapists, may be beneficial for certain individuals as they begin therapy.

Coping strategies that help with the healing of complex trauma symptoms

• Art therapy. Drawing, painting, sculpting, dancing, and singing can all help you reconnect with your inner child through creativity and imagination.
• Reconnect with your inner child. The purpose of this practice is to compensate for the love and support you needed but may not have received during the traumatic event. Imagine returning to the experience from which you are recovering, and your younger self meeting your current adult self. Talk to your inner child, hug him or her, and offer comfort.
• Reading: Additionally, reading about childhood trauma is helpful to begin understanding your story better. Knowing that you are not alone with your struggles is powerful.
• Try to give yourself compassion you never received: Replace negative self-talk with positive affirmations to develop a kinder, more compassionate relationship with yourself. 
• Ask support from trusted people: You may also need to seek help from your natural support system. 

Sources:

1. National Institutes of Health, NIH Publication No. 23-MH-8124, Revised 2023
2. Conti L, Fantasia S, Violi M, Dell’Oste V, Pedrinelli V, Carmassi C. Emotional Dysregulation and Post-Traumatic Stress Symptoms: Which Interaction in Adolescents and Young Adults? A Systematic Review. Brain Sci. 2023
3. Li D, Luo J, Yan X, Liang Y. Complex Posttraumatic Stress Disorder (CPTSD) as an Independent Diagnosis: Differences in Hedonic and Eudaimonic Well-Being between CPTSD and PTSD. Healthcare (Basel). 2023 
4. Bremner JD. Traumatic stress: effects on the brain. Dialogues Clin Neurosci. 2006
5. So CJ, Miller KE, Gehrman PR. Sleep Disturbances Associated With Posttraumatic Stress Disorder. Psychiatr Ann. 2023