Complex PTSD Symptoms and Treatment

What is Complex PTSD?

Complex Post Traumatic Stress Disorder (Complex PTSD) is a rather severe and hard to treat version of the more widely recognized better known PTSD.

In many trauma situations the person with some luck and resilience moves beyond that incident after a period of adaptation and coping. In PTSD, the individual who is exposed to a traumatic event is impacted in a way that persists and interferes with their effective functioning. While the trauma may be severe, it is not typically chronic and many effective PTSD treatment methods have been identified which help with Post Traumatic Stress Disorder, in its simplest form. These same PTSD treatment methods however are not as effective, and may even be counterproductive, in a Complex Post Traumatic Stress Disorder case.

In Complex PTSD the exposure to the traumatic experience is often chronic, always persistent, and thoroughly debilitating. A hallmark Complex PTSD feature involves a traumatic predicament or setting in which there is no escape such as torture, experience as a hostage, or ritualized child abuse. Other features that impact Complex PTSD are the age at which the trauma occurs, the duration, the lack of support from others, and the relationship between the victim and the agent who is responsible for the trauma.

PTSD Treatment?

Complex PTSD Symptoms

In a study done for the DSM-IV Field Trial (van der Volk, et al. 1996) it seemed clear that several PTSD symptoms, often assigned a minor or supporting role in Post Traumatic Stress Disorder, are key factors in determining who is driven to seek treatment. These included depression, anger outbursts, self-destructive acts, feelings of shame, self blame, and distrust. These symptoms, along with an impaired sense of identity, dissociation, depersonalization, somatization, and attachment disruption (and intimacy problems) are hallmarks of Complex PTSD. The damage also includes an impaired capacity for self-regulation, and disturbed body image.

in addition, Complex PTSD also includes the the usual PTSD symptoms. Post Traumatic Stress Disorder in DSM-IV often includes recurring memories of the trauma, nightmares of the event(s), distress when exposed to triggers, physiological reactivity, avoidance of thoughts, feelings and places associated with the trauma, memory loss about the predicament, a feeling of detachment, restriction of affect, difficulty sleeping, irritability, hyper-vigilance, and an exaggerated startle response.

Complex PTSD Teatment

Standard PTSD treatment can be quite effective and can result in relatively fast relief. Results from studies of Trauma Focused Cognitive Behavioral Therapy, and EMDR both show promise, as does solution focused PTSD treatment, prolonged exposure therapies, and other short term models.

However for the Complex PTSD patient, the attachment disruption and difficulty trusting others or a more gradual approach, that focuses on building a therapeutic alliance in which the patient and the therapist develop a bond that can weather the challenges. While the normal approaches to treatment of PTSD also often build in some grounding, safety and relaxation skills, these are more crucial for Complex PTSD treatment, before the hard work begins.

Another early component of treatment should be to begin to work on regulation of affects, often learning self regulating and self soothing techniques to take the place of substance abuse or risky stimulus seeking. Since dissociation is often more problematic in Post Traumatic Stress Disorder, early treatment often needs to address this as well.

In later stages of PTSD treatment, the usual cognitive behavioral techniques can be useful, as part of the broader task of building a narrative that weaves an understanding into what has transpired. For Complex PTSD that narrative also likely involved the development, often for the first time of a more coherent sense of identity.

Credits and References

van der Kolk, P.A., Mc Farlane, A.C., and Weisaeth, L. (eds.) (1996) Traumatic stress: the effects of overwhelming experience on mind, body and society. New York, Guilford Press.

Herman, J.L. Trauma and Recovery. New York: Basic Books.

Trauma patient (after PTSD treatment) photo by Breahn.

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Comments 17 comments

iain-mars profile image

iain-mars 5 years ago from United Kingdom

Great hub thanks


Dee42 profile image

Dee42 5 years ago from Beautiful Arkansas

Very informative and interesting.


authorfriendly profile image

authorfriendly 5 years ago from Charleston, SC Author

Thanks Ian and Dee. There wasa lot more I could write about Complex PTSD, and I covered some of that on the website linked to in it.


kims3003 4 years ago

Excellent and well written hub with helpful information. nice style of writing too


MikeSyrSutton profile image

MikeSyrSutton 4 years ago from An uncharted galaxy

It looks like you have done your homework and understand this disorder well! Nice job on a tricky topic and paralyzing condition.


authorfriendly profile image

authorfriendly 4 years ago from Charleston, SC Author

Thanks Mike, Complex PTSD can certainly be paralyzing, and Post Traumatic Stress Disorder requires a special skillset for treatment, and the Complex version requires a whole different tack.


lincolnlights2012 4 years ago

My son suffers from chronic PTSD. After 18 years in military he was less than honorably discharged 9 months after returning from this war. He is 37. Lost his family, career, home, statis, money, etc. Masking ptsd with alcohol since they would not give him anything to help sleep since he was a pilot. 2 dui arrests later and he was out of the military.

Now in treatment for alcohol but needs it for ptsd.


authorfriendly profile image

authorfriendly 4 years ago from Charleston, SC Author

There are a couple veterans groups that may go to bat for him, as the services, while improved of late, have been rather unresponsive to the PTSD problem. Hope he gets some help, the VA should have something in place in your community, if he remains eligible.


Laura Schneider profile image

Laura Schneider 4 years ago from Minneapolis-St. Paul, Minnesota, USA

Way to go, authorfriendly! I love this informative hub. It doesn't get too details for us "non-M.D."s, but it gives practical descriptions and advice. Keep up the good writing! Mental illness is so widespread and even more misunderstood. Articles like this help the population (including those with a mental disorder) to understand better what mental illnesses are all about--I've researched a lot, and I still learned something new. (Voted up and etc.)


authorfriendly profile image

authorfriendly 4 years ago from Charleston, SC Author

Thanks Laura,

I did try to gear it to be helpful for the casual reader who is exploring the and trying to understand the symtoms and treatment issues with complex ptsd. You would be surprised how few psychologists and psychiatrists know much about this issue.


Laura Schneider profile image

Laura Schneider 4 years ago from Minneapolis-St. Paul, Minnesota, USA

I don't think that would surprise me at all, actually--the amount of knowledge that the health providers know seems inversely related to the amount there is to know. This is good work you're doing, though: keep it up!


Mary Alice 4 years ago

Yes, very well written and easy to read. Thank You.


kymp profile image

kymp 3 years ago from Carefree, AZ

Excellent article! I suffer from Complex PTSD and thankful there are wonderful people like you sharing information to help raise awareness!


repoprimo profile image

repoprimo 2 years ago from California

Fantastic Article.. I am a MST survivor with Complex PTSD. You did a great job working with the subject and outlining it. If you are interested, you can go through my blog archives, and get a direct look at the days and moments of a Complex PTSD sufferer. http://attentiontoptsdandmst.blogspot.com/ The majority of the symptomology can be found, in the earlier posts of this blog back in the archives. However, I was impressed with the information you shared.

The treatment you might have forgotten, for Complex PTSD, that I am undergoing is EMDR.. IT seems to be getting to the root of many issues, but I have been told that dynamic Psychotherapy, and EMDR, is pretty extensive in treatment benefits, I was also told that I will always have trace elements of the PTSD, due to the wide range of Trauma's and the number of traumas suffered, during my life. I hope everyone who does and is fighting with this, as I am; finds relief.. IT is pure heck.


authorfriendly profile image

authorfriendly 23 months ago from Charleston, SC Author

I also use EMDR at times, but more for acute stress like a rape. I use some portion of the ideas in my ongoing work with Complex PTSD


katrice sullivan 18 months ago

I think I qualify for cptsd. As parental abuse as a child, and a man tried to beat me to death, as an adult. I realize that I have "hair-triggers" in situations whereI I feel verbally abused. I also suffer with BiPolar II.


authorfriendly profile image

authorfriendly 18 months ago from Charleston, SC Author

Sometimes Biploar 11 is a diagnosis that unsuspecting clinicians give to describe the rapid changes that come with dissociative processes in the CPTSD, not saying that about yours but worth considering

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