What complex PTSD is
Complex PTSD develops after trauma that is prolonged, repeated or interpersonal, where escape was difficult or impossible. Compared with PTSD, it adds long-lasting problems in how a person feels about themselves, manages emotions and relates to others. It is included in ICD-11; DSM-5 does not list it separately.
Core PTSD symptoms
- Re-experiencing: flashbacks, intrusive memories and nightmares that feel as if the trauma is happening now.
- Avoidance: avoiding thoughts, feelings, people or places linked to the trauma.
- Sense of current threat: hypervigilance, being on edge, easily startled.
Additional symptoms in complex PTSD
- Emotional dysregulation: intense anger or sadness, difficulty calming down, or feeling numb or disconnected.
- Dissociation: feeling detached from yourself or your surroundings.
- Negative self-concept: feeling worthless, defeated, ashamed or guilty.
- Relationship difficulties: feeling distant from others, difficulty trusting, or avoiding closeness.
What about the “17 symptoms”?
Lists of 17 symptoms come from the older DSM-IV criteria for PTSD, which described 17 symptoms across re-experiencing, avoidance and numbing, and hyperarousal. They include intrusive memories, nightmares, flashbacks, distress at reminders, physical reactions, avoiding thoughts and places, memory gaps, loss of interest, detachment, emotional numbing, a sense of a shortened future, sleep problems, irritability, poor concentration, hypervigilance and an exaggerated startle response. They describe PTSD rather than the specific features of complex PTSD.
Physical symptoms
- Sleep problems and nightmares.
- Headaches, stomach problems and chronic pain.
- Fatigue.
- Racing heart and muscle tension.
See insomnia.
Causes
- Childhood physical, sexual or emotional abuse or neglect.
- Domestic violence.
- Being held captive, trafficked or tortured.
- War and genocide.
- Long-term bullying or coercive control.
See trauma bonding.
Conditions that overlap
Complex PTSD can be confused with or occur alongside borderline personality disorder, depression, anxiety, dissociative disorders and substance use. Careful assessment helps guide treatment.
See bipolar vs BPD and anxiety and depression.
Diagnosis
A psychologist or psychiatrist makes the diagnosis after a detailed assessment of symptoms and history. Questionnaires such as the International Trauma Questionnaire, developed for ICD-11, help distinguish PTSD from complex PTSD.
Treatment
- Stabilisation: building safety, coping skills and emotional regulation.
- Trauma-focused therapies: trauma-focused CBT and EMDR (eye movement desensitisation and reprocessing).
- Integration: rebuilding relationships, self-worth and daily life.
- Medication: may help with depression, anxiety or sleep.
NICE guidance recommends trauma-focused therapies, with additional sessions and support for people with complex needs.
Self-help strategies
- Grounding techniques when feeling overwhelmed; see grounding techniques for anxiety.
- Regular routines for sleep, meals and activity.
- Breathing and relaxation exercises.
- Identifying triggers and planning coping steps.
- Connecting with supportive people or groups.
- Limiting alcohol and drugs.
Relationships and trust
Difficulties with trust and closeness are common. Therapy can help people recognise patterns, set boundaries and build safe relationships. Partners and families can support recovery by learning about trauma and being patient.
Recovery is possible
Complex PTSD can take longer to treat than PTSD, but many people improve significantly. Progress is often gradual, and setbacks are part of the process.
Complex trauma in children and teenagers
Children who experience ongoing abuse or neglect may show difficulties with emotional control, attention, behaviour, attachment and learning. Safe, predictable care, trauma-informed schools and specialist therapy help. Early support can reduce the risk of long-term difficulties.
Understanding triggers and emotional flashbacks
Many people with complex PTSD describe emotional flashbacks: sudden waves of fear, shame or helplessness without a clear memory of the trauma. Noticing these states, naming them and using grounding and self-compassion can reduce their intensity over time.
See fear of abandonment.
When to seek urgent help
- Thoughts of harming yourself or ending your life.
- Feeling unable to keep yourself safe.
- Severe dissociation or losing touch with reality.
- Being in an unsafe or abusive situation.
Key points to remember
- Complex PTSD follows prolonged or repeated trauma.
- It combines PTSD symptoms with emotional, self-image and relationship difficulties.
- The “17 symptoms” lists describe older PTSD criteria.
- Trauma-focused therapy with stabilisation helps many people recover.
Questions about complex PTSD
These answers are general information and do not replace an examination or individual medical advice.
What is the difference between PTSD and complex PTSD?
Complex PTSD adds difficulties with emotions, self-image and relationships.
What are the 17 symptoms of PTSD?
They come from older DSM-IV criteria, covering re-experiencing, avoidance and hyperarousal.
What causes complex PTSD?
Prolonged or repeated trauma, often in childhood.
Can complex PTSD be cured?
Many people improve significantly with treatment.
Is complex PTSD the same as BPD?
No, though they share some features and can co-occur.
What therapy is best for complex PTSD?
Trauma-focused CBT and EMDR, often after stabilisation.
Can complex PTSD cause physical symptoms?
Yes, including sleep problems, pain and fatigue.
How is complex PTSD diagnosed?
Through assessment by a mental health professional.
Can adults develop complex PTSD?
Yes, after prolonged trauma such as domestic violence.
Can complex PTSD develop years after trauma?
Symptoms can emerge or become clearer later, often during stress.
Sources
- NHS · PTSD (post-traumatic stress disorder)
- NICE NG116 · Post-traumatic stress disorder
- Cloitre M et al. The International Trauma Questionnaire: development of a self-report measure of ICD-11 PTSD and complex PTSD. Acta Psychiatr Scand. 2018
This guide is for general information and does not replace medical advice. How a problem is diagnosed and treated depends on your examination and medical history. If you think you have an emergency, contact your local emergency services.