Complex PTSD

Complex PTSD- Post-traumatic stress disorder (PTSD)

Complex PTSD may be diagnosed in adults or children who have repeatedly experienced traumatic events, such as violence, neglect or abuse.

Complex PTSD is thought to be more severe if:

  • The traumatic events happened early in life
  • The trauma was caused by a parent or carer
  • The person experienced the trauma for a long time
  • The person was alone during the trauma
  • There is still contact with the person responsible for the trauma

As it may take years for the symptoms of complex PTSD to be recognised, a child’s development, including their behaviour and self-confidence, can be altered as they get older. Adults with complex PTSD may lose their trust in people and feel separated from others.

However, complex trauma is not always the result of childhood trauma. It can also occur when adults experience violence in the community e.g. domestic and family violence, civil unrest, war trauma or genocide, refugee and asylum seeker trauma, sexual exploitation and trafficking, extreme medical trauma and/or re-traumatisation.

Is complex PTSD a separate condition?

The International Classification of Diseases (ICD) identifies complex PTSD as a separate condition, though the DSM-5 currently does not.

A person with complex PTSD may experience symptoms in addition to those that characterize PTSD.

Common symptoms of PTSD and complex PTSD include:

  • Reliving the trauma through flashbacks and nightmares
  • Avoiding situations that remind them of the trauma
  • Dizziness or nausea when remembering the trauma
  • Hyperarousal, which means being in a continual state of high alert
  • The belief that the world is a dangerous place
  • A loss of trust in the self or others
  • Difficulty sleeping or concentrating
  • Being startled by loud noises

People with PTSD or complex PTSD may also experience:

  • A negative self-view. Complex PTSD can cause a person to view themselves negatively and feel helpless, guilty, or ashamed. They often consider themselves to be different from other people.
  • Changes in beliefs and worldview. People with either condition may hold a negative view of the world and the people in it or lose faith in previously held beliefs.
  • Emotional regulation difficulties. These conditions can cause people to lose control over their emotions. They may experience intense anger or sadness or have thoughts of suicide.
  • Relationship issues. Relationships may suffer due to difficulties trusting and interacting, and because of a negative self-view. A person with either condition may develop unhealthy relationships because they are what the person has known in the past.
  • Detachment from the trauma. A person may dissociate, which means feeling detached from emotions or physical sensations. Some people completely forget the trauma.
  • Preoccupation with an abuser. It is not uncommon to fixate on the abuser, the relationship with the abuser, or getting revenge for the abuse.

Symptoms of complex PTSD can vary, and they may change over time. People with the condition may also experience symptoms that are not listed above.


People with PTSD or complex PTSD may exhibit certain behaviours in an attempt to manage their symptoms. Examples of such behaviours include:

  • Abusing alcohol or drugs
  • Avoiding unpleasant situations by becoming “people-pleasers”
  • Lashing out at minor criticisms
  • Self-harm

These behaviours can develop as a way to deal with or forget about trauma and emotional pain. Often, a person develops them during the period of trauma. These behaviours are a completely understandable way of dealing with this very difficult condition, but other ways can be learnt.

Treating complex PTSD

Dr Nikki Schuck has over 20 years of experience treating complex PTSD. Dr Schuck will assess each person to come to a joint decision as to the best way to treat their symptoms. You may be offer trauma-focused or compassion focused Cognitive Behavioural Therapy (TF- CBT or CF- CBT), Eye Movement Desensitisation and Reprocessing (EMDR) or Narrative Therapy for trauma (Narrative Therapy).

People with complex PTSD often find it difficult to trust other people. You may be offered more therapy sessions than usual so you have time to build a trusting relationship with your therapist.

Please find here a good link to further information from MIND for Complex PTSD.