What Is Complex PTSD And How To Find Help Online

Updated June 17, 2024by MyTherapist Editorial Team
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Many people are familiar with post-traumatic stress disorder (PTSD), a mental health condition brought on by exposure to a traumatic event such as a car accident, mugging, living through a natural disaster, or a dangerous combat experience. However, today's latest psychological research has uncovered a more severe form of PTSD known as complex post-traumatic stress disorder, or C-PTSD. This article discusses the symptoms of C-PTSD, how it differs from PTSD, effective treatments, and how to get help online.

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Complex post-traumatic stress disorder compared to PTSD

Complex post-traumatic stress disorder (C-PTSD) is a form of PTSD stemming from an experience of ongoing interpersonal trauma lasting for weeks, months, or years. People who develop C-PTSD repeatedly undergo trauma during domestic violence, sexual abuse, child abuse, human trafficking, war, and similar experiences. Witnessing these events can also lead to C-PTSD, as can experiencing the events directly. 

If you are experiencing domestic violence, reach out to the National Domestic Violence Hotline at 1 800 799-SAFE (7233)

The World Health Organization (WHO) has officially recognized C-PTSD as a distinct mental illness and included it in its 11th edition of the International Classification of Diseases (ICD-11.) However, the American Psychological Association still does not have an entry for this mental condition in the most recent edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), the edition used by healthcare practitioners in the United States. Nonetheless, many mental health practitioners and people with C-PTSD symptoms and trauma history agree with the WHO that C-PTSD is distinct from PTSD and benefits from specialized treatment approaches. 

The DSM-5 moved the classification of PTSD from the anxiety disorder designation to a new category called “Trauma and Stressor-related Disorders,” along with adjustment disorder, acute stress disorder, and several others, recognizing that these conditions are unique in having a distinct external cause and variability of symptoms between individuals. 

The primary distinctions between PTSD and C-PTSD are that C-PTSD involves ongoing traumatization that includes an interpersonal element. For example, someone robbed in the street might develop PTSD, whereas someone who has experienced ongoing domestic violence or childhood sexual abuse is more likely to develop C-PTSD. In C-PTSD, a person often experiences a collapse of their ability to trust others and feelings of intense shame, guilt, and anger. 

Researchers believe these C-PTSD symptoms result from trauma that impacts specific brain areas, including the amygdala, hippocampus, and prefrontal cortex. As a result, the most successful treatment options help a person heal through practices that make gradual changes to the structure of these brain areas, for example, meditation, mindfulness practice, yoga, breath work, and Eye Movement Desensitization and Reintegration therapy (EMDR.) 

Complex post-traumatic stress disorder symptoms

The symptoms of C-PTSD are similar to PTSD. However, they are often more severe and include feelings of shame, guilt, and self-loathing that are less likely in PTSD. Other frequent symptoms include:

  • Flashbacks
  • Nightmares
  • Emotional dysregulation resulting in anger and irritability in everyday situations
  • Feelings of helplessness
  • Distorted sense of self
  • Hypervigilance and panic attacks
  • Avoiding specific places and people
  • Disassociation 
  • Apathy
  • Somatic symptoms including fatigue, dizziness, and nausea

One difference between PTSD and C-PTSD involves how a person experiences flashbacks. Many people with PTSD have visual flashbacks of the trauma they endured, such as reliving visual memories of a car crash. In contrast, people with C-PTSD often have emotional flashbacks in which they do not have visual recall of the trauma but instead experience overwhelming emotions related to the events. These emotional flashbacks can occur in response to average daily life frustrations and disappointments, causing havoc in the person’s life.  

Disassociation is another frequent feature of C-PTSD. Repeated traumatization or betrayal by trusted people can lead to memory loss, disassociation, and feelings of detachment from one’s surroundings. This loss of recall of events can make challenging to find help or even to understand the nature of one’s problems. However, having explicit recall of trauma is not essential for successful treatment.  

It is also important to note that severe symptoms of C-PTSD and PTSD can appear at any time after the traumatic events. Some people develop immediate symptoms, and others mild symptoms that suddenly worsen months, years, or even decades after the event in Delayed-Onset PTSD.

Complex post-traumatic stress disorder tests

The first step for mental health seekers is a complete physical exam to rule out the presence of any underlying medical conditions that could be related to symptoms. You can get a physical exam from your primary care provider or local public health department. After a physical exam, the next step is a psychological evaluation with your physician, a psychologist, or a psychiatrist. These are the only professionals who can official diagnosis a mental illness. Psychological evaluations generally consist of questions that screen for commonly diagnosed mental health disorders and a detailed personal history interview with the clinician. In some cases, others close to the patient provide information as well. 

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It is crucial to tell your healthcare provider about any history of trauma, such as childhood sexual abuse, domestic violence, human trafficking, military experience, or similar events, no matter how long ago it happened. 

Once you have a diagnosis from a licensed medical doctor, psychologist, or psychiatrist, you can seek treatment with them or look for a therapist with experience in C-PTSD symptoms and treatment. Your provider may recommend talk therapy, group therapy, interventions like EMDR, and lifestyle changes such as improvements in diet and exercise. In addition, your healthcare provider may ask you to take more than one type of assessment based on your symptoms.

Complex post-traumatic stress disorder recovery

Common treatments for C-PTSD are psychotherapy, medication, and lifestyle changes. C-PTSD symptoms can improve and go away over time. However, the recovery process can take longer than for someone with a PTSD diagnosis. 

These are the most frequently used treatments for C-PTSD:

Cognitive-behavioral therapy (CBT)

Cognitive-based therapies focus on assisting a person in challenging unhelpful attitudes and beliefs that hold them back. In addition, the therapist helps the client examine maladaptive learned behaviors and develop healthier and more productive ways to act and think.

Exposure therapy (ERP)

ERP focuses on the gradual reintroduction of the traumatic stimulus that triggers a stress response in the patient. Exposure therapy aims to reduce the effect of specific traumatic reactions. Psychology researchers have found that gradually introducing someone to a negative stimulus over time can reduce the stimulus's impact.

Eye movement desensitization and reintegration therapy (EMDR)

EMDR is an exposure therapy that often includes specific eye movements, sounds, and tactile sensations occurring as the patient incrementally relives painful memories. The number of treatments varies from one or two sessions to twenty or more, depending on the type of trauma. People with C-PTSD are likely to need multiple sessions. The US Department of Veterans Affairs endorses EMDR as an effective PTSD treatment. 

Medication therapy

Doctors and psychiatrists can prescribe various medications for C-PTSD symptoms, including antidepressants and anti-anxiety drugs. 

Non-traditional and emerging therapies

The following are examples of non-traditional and emerging therapies for C-PTSD:

Acupuncture - This ancient Chinese holistic treatment can help mitigate C-PTSD symptoms for some. Research studies have shown acupuncture for C-PTSD has the same effects as equivalent cognitive-behavior therapy sessions. You can find acupuncture providers through a Google search for "acupuncture provider near me."

Meditation and Mindfulness - Practicing meditation or mindfulness are other ways to mitigate anxiety and depression symptoms of C-PTSD. People who practice mindful breathing often report a reduction in symptoms over time. A quick Google search can find results for practitioners in your area.

Service Animals – Some organizations train dogs and other service animals as companions for people with mental health conditions like PTSD and C-PTSD. These animals can provide emotional support and a feeling of personal protection that is beneficial for people overcoming trauma. Mental health service animals have the same rights and privileges as medical service animals and are allowed wherever medical service animals are allowed.

Online therapy options for C-PTSD

Research evidence concludes that online CBT therapy for stress disorders like C-PTSD is as effective as in-person therapy sessions. It is also less expensive and makes treatment more accessible. Online therapy platforms like BetterHelp.com offer convenient access to mental health providers with experience in using CBT to treat C-PTSD symptoms, and you can choose the provider you want and change if you like. In addition, you can meet with your therapist at a time that’s most convenient for you using video, phone, or text. 

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Takeaway

The compounding factor in C-PTSD is repeated exposure to trauma that involves another person or group of people, making it distinct from PTSD. The traumatic experience involves events like sexual abuse, domestic violence, human trafficking, and being a prisoner of war. Healing from C-PTSD can be challenging, but several forms of therapy are successful for many people, including online CBT, EMDR, and practicing relaxation techniques like mindfulness, meditation, deep breathing, and getting regular exercise and eating healthy food. 

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