Individuals struggling with unresolved complex trauma can sometimes feel like there’s no hope for recovery. Also known as complex post-traumatic stress disorder (C-PTSD), complex trauma does respond to evidence-based treatments such as psychotherapy and medications.

However, the nature of this condition is multi-layered. As such, it can be challenging to find the right combination of therapies to make a change.

C-PTSD is widely recognized among mental health professionals, but it is not yet recognized in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). The DSM-5 is a diagnostic tool that helps psychiatrists make a proper diagnosis so that appropriate treatments can begin.

The term “complex PTSD” was first suggested by Dr. Judith Herman in 1988. Dr. Herman recognized that complex trauma caused a unique set of symptoms and required a different approach to treatment than typical trauma.

What Does Complex Trauma Mean?

Complex trauma is generally defined as the exposure to multiple forms of trauma after an initiating long-term period of trauma. The experiences that lead to trauma typically begin in childhood and can continue for many years.

For example, a child who grew up in an abusive household is at high risk for developing complex trauma. Not only did the child suffer the direct trauma of being abused, but they also struggled with the emotional and physical aftermath of that abuse.

The abuse itself is traumatizing, and then the secret-keeping, neglect, lack of social outlets, and isolation that relate to the abuse are separate but related traumas. The timing and duration of abuse can affect many areas of a child’s development, including the following:

  • Brain development
  • Physiological stress response (the body’s automatic responses to stress)
  • Neurochemistry
  • Emotion regulation
  • Motor, sensory, and cognitive development
  • Missing developmental milestones
  • Feelings of fear for no reason
  • Inability to process positive feedback
  • Low self-esteem
  • Feelings of hopelessness
  • Negative thinking patterns

Feelings of loneliness and poor self-worth may lead the child into abusive relationships in adulthood. They might turn to substance use as a way to dull the pain of the past. In turn, substance use can lead to homelessness, which risks exposing the individual to other forms of trauma.

There are many more possible examples of complex trauma, and not every person who develops C-PTSD has been abused as a child. However, with this example, it’s easy to see how one symptom can be connected to many others. This often results in the need for dual diagnosis and treatment for more than one condition at the same time.

Within the framework of complex trauma, all a person’s “dysfunctional behaviors” are seen as survival strategies they have developed to cope with the difficulties they’ve encountered. Instead of asking, “What is wrong with you?” a therapist experienced with C-PTSD might ask, “What happened to you?”

Causes of C-PTSD

Complex trauma is believed to begin with some type of severe childhood abuse that is repeated over a long period of time. The constant and prolonged stress of abuse can cause lasting changes in the brain, specifically in the hippocampus, amygdala, and prefrontal cortex.

In addition to physical, sexual, and psychological abuse, other types of traumatic events related to C-PTSD can include:

  • Witnessing domestic violence
  • Genocide
  • Torture
  • Slavery
  • Childhood soldiering
  • Extreme poverty
  • Community violence
  • Racism and other extreme forms of oppression

Any situation in which a child is controlled or victimized by another person and has little or no chance to escape could lead to the development of complex trauma.

C-PTSD vs. PTSD

It can be difficult to understand the difference between complex trauma and PTSD. Doing so is especially complicated because many of the symptoms are similar.

Post-traumatic stress disorder is most often caused by a single event, such as a car accident, a natural disaster, or time served in a military war zone. In contrast, C-PTSD typically stems from repetitive long-term trauma that begins in childhood.

The Symptoms of Complex Trauma

People living with complex trauma traditionally experience all the core symptoms of PTSD, in addition to some that are unique to complex trauma. Its core symptoms are divided into three categories: avoidance, hyperarousal, and re-experiencing. They may include:

  • Flashbacks and hallucinations
  • Avoidance of people, places, or events that remind you of the trauma
  • Intrusive negative thoughts
  • Guilt
  • Increased alertness (hyperarousal)
  • Insomnia
  • Difficulty concentrating
  • Poor self-esteem
  • Irritability
  • Violent impulses
  • Suicidal thoughts or behaviors

Other symptoms that are typical for C-PTSD include:

  • Difficulty trusting other people
  • Inability to develop healthy relationships
  • Disconnection from the trauma and the world around them
  • Feelings of helplessness, shame, and guilt
  • Feeling that you are different from other people
  • Persistent sadness, depression, or suicidal thoughts
  • Loss of faith in your values, including religions, personal beliefs, or other people

Both PTSD and C-PTSD are serious mental health matters that require and can be managed by professional care. Without treatment, people living with these conditions have a higher risk of harming themselves or someone else.

Diagnosing Complex Trauma

Because it is not officially recognized by the American Psychiatric Association or included in the DSM-5, complex PTSD is often diagnosed as PTSD. Many mental health professionals do recognize complex trauma as a condition that is separate from PTSD.

The World Health Organization includes C-PTSD as a separate diagnosis in the International Statistical Classifications of Diseases and Related Health Problems, 11th Edition (2018). Despite the recognition by some, there is still no official diagnosis of C-PTSD.

The good news, though, is that PTSD and C-PTSD share similar treatments. Thus, even if you have not been diagnosed with complex trauma, help can still be available. Make sure to discuss any additional symptoms with your doctor or therapist.

C-PTSD shares several symptoms with other mental health conditions, such as borderline personality disorder. Withholding information about how you feel or any worrisome behaviors you are exhibiting may prevent you from receiving the best possible treatment for your condition.

How Is C-PTSD Treated?

Like PTSD, C-PTSD is typically addressed using multiple treatments at once. For instance, your treatment plan might include a combination of medications, psychotherapy, and lifestyle changes.

Antidepressants such as Zoloft or Prozac may be prescribed to help decrease symptoms of depression or anxiety. Getting these symptoms under control first can offer great improvement in quality of life and improve a patient’s ability to benefit from other changes.

During psychotherapy, treatments are likely to focus on identifying the traumatic memories that have impacted the person’s life. Several types of therapy may be applied to help the patient minimize the impact of negative memories and change their own thinking and behavioral patterns.

Trauma therapy is an individualized approach to therapy that specifically focuses on healing traumatic events from the past. Some of the interventions that may be included in your customized trauma therapy program include:

Cognitive Behavioral Therapy (CBT)

CBT is a short-term type of therapy that focuses on problem-solving. It helps patients better understand how their actions and feelings are affected by their thoughts. CBT is designed to address problems by adopting more positive thinking patterns.

Dialectical Behavioral Therapy (DBT)

DBT is a type of cognitive-behavioral therapy that teaches people how to live in the present. DBT stresses the importance of accepting who you are right now in this moment while still learning how to change unwanted behaviors. This therapy is often recommended for people with a history of self-harm or suicidal ideation.

Mindfulness

Mindfulness is the habit of paying attention to the small moments in life without thinking about past mistakes or anticipating the future. Yoga, journaling, and meditation are some of the most common ways people learn how to be more mindful.

Eye Movement Desensitization and Reprocessing (EMDR)

EMDR is a method that seeks to retrain the way the brain reacts to a traumatic memory. The therapist leads the client through different types of stimuli while the client recalls a memory. Specific types of eye movement, tapping, or blinking are used to reprocess the memory.

With EMDR, the goal is not to erase traumatic memories. Instead, you seek to decrease the negative emotions that are attached to those memories.

Deep Transcranial Magnetic Stimulation (dTMS)

Deep transcranial magnetic stimulation uses magnetic fields to stimulate the nerve cells inside your brain. This stimulation may help improve the symptoms of depression and other symptoms related to complex trauma.

By using magnets, dTMS remains a non-invasive procedure. It may be recommended when other treatments have been unsuccessful.

Hyperbaric Oxygen Therapy (HBOT)

HBOT treatments are used to relieve the symptoms of PTSD. The increased oxygen levels that occur during HBOT are thought to heal damaged brain tissue and promote new tissue growth. Repairing parts of the brain that were affected by ongoing childhood trauma makes HBOT a promising therapy for complex trauma.

Lifestyle Changes

Lifestyle changes that may help reduce C-PTSD symptoms include:

  • Having good sleep hygiene and getting adequate amounts of restorative sleep
  • Avoiding caffeine, nicotine, and other stimulants
  • Exercising regularly
  • Eating a healthy diet
  • Getting support through therapy or peer-support meetings
  • Making time to participate in hobbies and activities you enjoy
  • Avoiding alcohol and drugs (self-medicating)
  • Volunteering to help others
  • Practicing gratitude

Complex trauma is a multi-layered issue that deserves care from a mental health professional. Lifestyle changes alone are not enough to address serious symptoms like emotional regulation or suicidal thoughts.

However, making the changes needed to live a healthy and positive lifestyle is a great start. Doing so will help support your other efforts to recover from traumatic experiences.

Who Can Develop Complex Trauma?

Almost everyone is at risk for developing C-PTSD and other conditions related to complex trauma. Though childhood abuse and neglect are among the most widely recognized precursors to complex trauma, they are not the only cause. Even children who have grown up in stable homes can experience ongoing or interrelated trauma outside of the house.

While they typically begin in childhood, the experiences that lead to complex trauma can start at any time. If you or any child or young person you know has signs of complex trauma, reach out to help them. Symptoms will typically worsen over time without treatment and can result in suicide.

Getting Help for Your C-PTSD

Help is available, and treatment can be effective. Speak to a therapist who is familiar with complex trauma and C-PTSD. Remember that you may not be diagnosed with C-PTSD, but it is not necessary to obtain that specific diagnosis to receive treatment.

The types of traumas that can lead to mental health concerns are difficult to talk about. The thought of bringing up painful memories or exposing family members you still care about is frightening. However, you deserve to live a full, happy life without the weight of trauma holding you back.

Many survivors manage to reach adulthood without ever talking about their trauma to another person. But if you’re experiencing symptoms of PTSD or C-PTSD, it may be time to seek treatment.

All Points North offers a personalized trauma therapy program to address your needs and help you recover from complex trauma. Contact us at 424.644.6486 or fill out our online contact form for more information.

References

  • Cardenas, Valerie A., et al. “Changes in Brain Anatomy during the Course of Posttraumatic Stress Disorder.” Psychiatry Research: Neuroimaging, vol. 193, no. 2, 2011, pp. 93-100, https://doi.org/10.1016/j.pscychresns.2011.01.013. Accessed 6 May 2024.
  • Child Welfare Information Gateway. (2023). Child maltreatment and brain development: A primer for child welfare professionals. U.S. Department of Health and Human Services, Administration for Children and Families, Children’s Bureau. https://www.childwelfare.gov/pubs/issue-briefs/brain-development/
  • “Complex PTSD.” Veterans Affairs, 1 Jan. 2007, www.ptsd.va.gov/professional/treat/essentials/complex_ptsd.asp#two.
  • Holmes, Leonard. “Childhood Abuse and Neglect Actually Change Brain Structure.” Verywell Mind, 10 Mar. 2024, www.verywellmind.com/childhood-abuse-changes-the-brain-2330401#citation-2.
  • Teicher, Martin H, et al. “Childhood Maltreatment: Altered Network Centrality of Cingulate, Precuneus, Temporal Pole and Insula.” Biological Psychiatry, www.biologicalpsychiatryjournal.com/article/S0006-3223(13)00857-3/abstract. Accessed 6 May 2024.