Understanding complex post-traumatic stress disorder (CPTSD)

Complex post-traumatic stress disorder (CPTSD) is a mental health condition that can affect people who experience traumatic events that threaten their life or safety (e.g. prolonged abuse or a natural disaster).

But while trauma may disrupt your memory, impact your sense of identity, or affect your emotions and healthy relationships, it doesn't mean you can’t still live a happy and healthy life. There's a range of supports available to help people living with CPTSD over the short or long term.

This can help if:

• you’ve experienced prolonged trauma

• you think you might have CPTSD or you’re experiencing symptoms of CPTSD

• you want to understand the difference between PTSD and CPTSD

• you know someone living with CPTSD.

What is complex post-traumatic stress disorder (CPTSD)?

Not everyone who experiences traumatic events will develop CPTSD or PTSD. However, trauma can leave lasting impacts on some people, who can develop symptoms of these disorders.

Complex post-traumatic stress disorder can develop at any age, usually after someone has experienced repeated or prolonged traumatic events that threaten their sense of safety and wellbeing. People with CPTSD will often have experienced past traumatic situations that they couldn’t avoid or stop, or over which they had little or no control.

Living with CPTSD can sometimes feel challenging, lonely or scary, but it's important to understand that you aren’t alone and that support is available.

What causes someone to experience CPTSD?

CPTSD is caused by experiencing chronic trauma, such as childhood abuse or neglect, sexual abuse, domestic violence, war and conflict, kidnapping, or a natural disaster. 

When a person constantly feels unsafe, their brain employs defence mechanisms such as hypervigilance and flashbacks to protect them from future threats. 

While these defence mechanisms can help to protect someone during a traumatic moment, they can become unhelpful when they keep happening long after the danger has passed.

CPTSD vs PTSD: what’s the difference?

While post-traumatic stress disorder can also be caused by one or more traumatic events, its symptoms differ from those that someone with CPTSD may experience.

Symptoms of PTSD

PTSD is characterised by intrusive mental or physical responses to trauma. Someone with PTSD might: 

• have vivid memories, flashbacks or nightmares about the traumatic event

• avoid reminders of the traumatic event by ignoring thoughts, feelings, activities or people that remind them of the event

• have negative moods and thoughts

• experience increased anxiety and feel easily wound up or on edge.

Learn more about what it’s like to live with PTSD by listening to high school student Sam’s story.

Symptoms of CPTSD 

Different people may experience CPTSD in different ways. It includes the symptoms of PTSD,  some or all of the following symptoms:

• Intense emotional reactions. This includes heightened emotional reactions to small stressors, reckless or destructive behaviour, or being unable to experience positive emotions.

• Dissociation. People with CPTSD may experience episodes of dissociation, where they feel detached from their own bodies or from a sense of reality.

• Negative self-belief. CPTSD can make someone feel unsure of themself from moment to moment, and can prompt feelings of guilt, shame or failure.

• Physical symptoms. These can include headaches or stomach aches, without an apparent cause.

• Difficulty in relationships. People with CPTSD may find it difficult to form and maintain healthy relationships, due to trust issues and a fear of abandonment.

• Chronic feelings of emptiness. It’s common to feel numb or empty when experiencing CPTSD.

• Hypervigilance: This is experienced as feeling constantly on edge, as if danger is ever-present.

• Nightmares: Someone with CPTSD may have repeated, disturbing dreams related to the trauma.

Remember that while these symptoms can be tough to experience, they are very common for someone living with CPTSD. With the right help and support, many people with CPTSD are able to regain a sense of control and live happy and healthy lives.

How do I get a CPTSD diagnosis?

Being diagnosed with CPTSD isn't always straightforward, as the symptoms overlap with a lot with other disorders. Because of this, CPTSD is only diagnosed by a mental health professional. If you think you’re experiencing CPTSD, the first step is to chat with your general practitioner (GP) about your symptoms and experiences. They can then support you in seeking a diagnosis and refer you to other health professionals for more specific treatment and support. 

What kind of treatment do I need for CPTSD?

Your GP will likely refer you to a psychologist, who will help you to develop strategies and skills for processing the trauma, or to a psychiatrist, who can prescribe medication to help you manage your CPTSD symptoms.

Your psychologist may use one of the following therapy options to help with your CPTSD treatment:

• Cognitive Behavioural Therapy (CBT). CBT is a type of psychotherapy used to address different kinds of mental health issues, including helping to change negative thought patterns and behaviours as part of CPTSD treatment. Trauma-focused CBT may be particularly helpful.

• Cognitive Processing Therapy (CPT). CPT is a type of CBT that also helps you to change upsetting thoughts but has a specific structure for creating the space for this to happen.

• Eye Movement Desensitisation and Reprocessing (EMDR). EMDR is a form of therapy that can help to reduce the distress of CPTSD symptoms by using eye movement while recalling certain life experiences.

• Dialectical Behaviour Therapy (DBT). DBT is a mix of two different strategies: 'acceptance' and 'change'. The therapy helps you to accept yourself as you are, but with the understanding that making some changes is important for your recovery.

There are also other types of treatment available that your psychologist may recommend, depending on your experience of CPTSD.

Will CPTSD go away over time?

The process of recovery and healing from CPTSD is unique to each person and takes time. People living with this disorder may also find that they need different types of support at different times in their life.

Remember: you are not alone. Your community, professional support and resources are available to guide you on your recovery journey. By accessing professional support and practising self-help methods, people living with CPTSD are able to respond to their trauma in a healthy way and to live fulfilling and happy lives.