What is Complex PTSD? Learn about the symptoms, causes and best therapies

9th August 2021
 minute read

Table of contents

Complex Post-Traumatic Stress Disorder is a painful condition that affects many. Here, we talk you through the childhood experiences that can shape it — and how you can begin to heal...

lonely disconnected woman with complex ptsd feeling on the outside

‘Sometimes I just feel as if the whole world is unsafe. And I’m not just talking about dangers like road accidents or diseases. I’m talking about jobs feeling unsafe, friendships feeling unsafe and, worst of all, even love feeling unsafe. And that’s because for me, there can be triggers everywhere, in every interaction. Whether it’s my boss being short with me or a friend not responding to a text, it doesn’t take much for me to spiral into all the feelings of shame, abandonment and fear that are core to C-PTSD’.

Tara is 35, has a job that she enjoys in publishing and loves to travel. She also has Complex Post-Traumatic Stress Disorder, otherwise known as C-PTSD. She believes that this was caused by growing up in a home where both parents had mental health issues and serious life pressures. Sometimes, her home environment could be stressful and many of her emotional needs were not met. As a result, by the time she entered adulthood she already felt exhausted, burned out and lost, plus had a deep sense of somehow being different from others. However, these past few years have been a much more hopeful time for her.

‘There’s the time before you find out you have C-PTSD and the time after it. Before I knew what was wrong with me — about three years ago now — I just couldn’t understand why I was struggling so much. Why was I having mood swings? Why would I suddenly spiral into deep despair for no real reason? Why did life seem to be more challenging for me than it did for my friends, for instance, staying in a job or romantic relationship long term? At first, my GP diagnosed me with depression, but that didn’t fully explain my symptoms to me. But now that I know what the issue is, I know how to manage it and move forward. And that makes all the difference.’

Tara’s story is not uncommon — in fact, it is only in recent years that there has been a growing awareness and understanding of Complex Post-Traumatic Stress Disorder. Previously, people with the condition were often mislabelled with a range of other issues, including personality disorders. And even today, many people with Complex PTSD don’t even know that they have the condition, meaning that they aren’t getting the support they need.

Yet what exactly is C-PTSD? How can you tell if you might have it? And most importantly, what kind of help and therapy is available?

What is C-PTSD?

'Trauma is not what happens to you, but what happens inside you as a result of what happens to you' - Gabor Maté

We often think of trauma as something that develops after one upsetting, shocking or dangerous event, such as an attack or accident. Yet can also be caused by an ongoing stressful situation, such as a childhood spent in an unstable or unhappy home. In essence, the main difference between PTSD and C-PTSD is that the former can be caused by a single or short term traumatic experience (such as a tour of duty), while with the latter, the experience is longer term.

People with C-PTSD will usually have lived through a time of feeling trapped in a difficult situation, often when they were too small to escape. This could include abuse, neglect, abandonment, bereavement, divorce or even long periods spent away from home in hospital. It’s worth noting that complex trauma isn’t necessarily caused by something huge or dramatic happening in your younger years — the unhappiness or emotional unavailability of a parent could be enough. The things that didn’t happen but that should have — and needs that weren’t met — can have a bigger impact than particular upsetting incidents that did take place. Essentially, people with C-PTSD had their feelings of safety and stability shattered when young — or may never even have had the opportunity to feel these in the first place.

And in adulthood, this lack of a sense of safety can cause a person’s mind to be filled with ongoing imaginary scenarios of catastrophe, rejection or abandonment, often playing on a loop. They can also be plagued by self-critical thoughts telling them that they are ‘worthless’ or ‘unloveable’, or chronic feelings of emptiness, loneliness and abandonment. According to trauma researcher, Bessel Van Der Kolk, this is because ‘our earliest caregivers...shape the way our rapidly growing brain perceives reality.’

However, some people might not even be fully aware that their childhood was stressful, instead describing it as ‘happy’ and ‘normal’. This is because they may have buried the more difficult memories of their younger years, or have been repeatedly told by their family that they are ‘exaggerating’ or ‘imagining’ their recollections. They may even have gone into denial about their experience while still a child. As Van Der Kolk explains, ‘Erasing awareness and cultivating denial are often essential to survival, but the price is that you lose track of who you are.’

Another core aspect of C-PTSD is that people might find it difficult to both comfort themselves (self-soothe) and accept comfort from others. In fact, they might struggle with relationships altogether, as needing things from people can feel risky. This is because their initial trauma was relational and linked to parents or caregivers, meaning that they could have difficulty trusting others or could place their trust in the wrong people. They might also find that they are constantly alert to signs of threat and that these threats can be emotional as much as physical. This could include the fear of someone snubbing them, criticising them or being angry at them. In the words of therapist and C-PTSD survivor, Pete Walker, ‘Extensive childhood abuse installs a powerful “people are dangerous” programme.’

In short, complex trauma can affect your ability to learn how to manage your emotions and thoughts, set boundaries, develop a strong sense of self and build healthy relationships in adulthood. Feelings of shame, fear, grief, sadness, confusion, isolation, anger and numbness are also common. Sadly, you might also find that you keep reliving traumatic childhood experiences into adulthood, for instance, being stuck in a cycle of abusive relationships. This means that some people with C-PTSD end up being repeatedly re-traumatised as adults.

Emotional flashbacks — when the past hijacks the present

A big challenge of C-PTSD is that it can make you feel as if stressful and painful experiences are not in the past but instead, something that you keep having to relive, often daily.

Re-experiencing an old trauma in the present moment is known as a ‘flashback’. And while these can be visual or auditory, people experiencing complex trauma responses tend to get what is known as ‘emotional flashbacks’. This is the experience of being intensely flooded with a difficult emotion — such as fear, shame or grief — seemingly out of the blue. As a result, emotional flashbacks can be incredibly overwhelming and make the person with C-PTSD appear moody, erratic or even volatile to others.

But in fact, even although it might seem as if flashbacks come out of nowhere, they are actually caused by ‘triggers’, which just means anything that reminds you of a past trauma. A trigger could be a social interaction, sight, sound, smell or even a thought, dream or memory. However, sometimes the trigger isn’t obvious. For instance, you could have a difficult interaction with someone that unconsciously reminds you of a controlling parent and afterwards, be flooded by feelings of overwhelming anger. But you might not necessarily link the two things — instead, it could feel as if you’ve become angry for no reason.

This is why having C-PTSD can often feel like being on a rollercoaster of ever-changing emotions with a sense that there is no rhyme or reason to it all. As a result, life can often seem disorienting and you might sometimes feel like a stranger to yourself.

As described by Tara, ‘I was convinced for the longest time that other people knew some “secret to life” that I didn’t understand. But in actual fact, it’s just that they weren’t being constantly triggered like I was. They got to have normal, peaceful, productive days without regular flare ups of painful emotions and memories.’

What are the signs of C-PTSD?

If you think that you might be experiencing complex trauma, then there are a wide variety of signs that you can look out for. These include:

  • Emotional flashbacks.— Hypervigilance to various forms of danger (physical, mental, emotional, social).
  • Difficulty controlling emotions.Difficult concentrating.
  • Constant feelings of hopelessness or emptiness.
  • Feelings of shame.
  • Feelings of anger or distrust towards the world.
  • Feelings as if you are permanently damaged or worthless.
  • Feeling as if you are different from other people.
  • Feeling as if nobody can understand you.
  • Being highly critical of yourself.
  • Being socially anxious or avoiding social situations.
  • Avoiding friendships and relationships (or finding them very difficult).
  • Experiencing dissociative symptoms like depersonalisation, derealisation or dissociation.
  • Suppressing your feelings and needs (self-abandonment).
  • Going through periods of increased sleeping, eating, substance use or losing yourself in work (or any activity that is a distraction from emotional pain or loneliness).
  • Having any kind of addiction.
  • Chronic physical symptoms such as headaches, chest pains, stomach aches or tension in the body.
  • An overactive startle response e.g. jumping at noises that don’t seem to affect others.
  • Regular suicidal feelings.

Bear in mind that it can be fairly common for people with complex trauma to be mislabelled with conditions such as borderline personality disorder or bipolar disorder. At other times, the whole picture of complex trauma responses is missed and only certain symptoms, such as depression, anxiety or addiction, are seen, meaning the person only gets partial answers and sometimes, even the wrong treatment.

Fight, flight, freeze and fawn — the four states of C-PTSD

One core aspect of C-PTSD is that you can become stuck in a particular ‘trauma response’ to such an extent that your life, perceptions and relationships end up being defined by it. By what does this mean, exactly?

Most of us know about the ‘fight or flight’ trauma responses to stressful situations. But when the stress is ongoing and inescapable — as is often the case in childhood — other survival responses are required: freeze and the least well-known, fawn.

But what exactly is fawning and how can it protect us in difficult situations? In a stressful or situation, it can be adaptive to try to pacify the person who is the source of threat or who has the power to provide what is needed — particularly when this other person is an unpredictable, unavailable or dangerous caregiver. By surrendering and giving in to what the other person wants, punishment might be avoided (or lessened) and sometimes some needs — for example, for attention or praise — might be met. If a parent is unwell themselves, taking care of them may help the child feel safer and more stable in the world, even if other needs are not being met.

People with C-PTSD can often find themselves stuck on one of these four responses long term, or even flipping back and forth between a couple of them. But what does it mean to be stuck in fight, flight, freeze or fawn? Surely someone can’t be in a permanent state of fighting off danger, running away, lying frozen on the ground or pacifying another? In actual fact, with C-PTSD they can — just often in an emotional sense rather than in a physical one.

So for instance, if you are stuck in Fight response, you might display short temperedness, controlling behaviour and a need for attention or approval from others. You could also be quite competitive and feel a need to be right all the time, plus you could show symptoms of ADHD. You might also find yourself being quite critical of people.

If you have Flight tendencies, then you might ‘run away’ from difficult feelings by distracting yourself with constant busyness. You could have OCD symptoms, plus could be a perfectionist, ‘workaholic’ or even an ‘adrenaline junkie’. You could also experience a racing mind, inability to relax and tendency to feel panicky.

If you are prone to Freeze, then you might regularly hide away from the world and fall into a state of ‘suspension’. This could include soothing painful emotions with TV binges, gaming, the internet, porn, drug use or food. You could also ‘zone out’ by daydreaming a lot, to the point where it affects your relationships and ability to complete tasks, or find that your mind frequently goes blank.

Finally, if you have ‘Fawn’ tendencies then you might be a bit of a people-pleaser — putting others’ needs before your own — and could also have boundary issues. You could feel the need to seem ‘perfect’ to others, find yourself in codependent or abusive relationships, or chase emotionally unavailable people. You might also have a habit of trying to rescue troubled individuals, sometimes at the expense of your own wellbeing and safety.

If you feel that you relate to more than one of these, then that is totally normal. People with C-PTSD can often switch into different modes, depending on the situation and triggers. But it’s important to know that with the right support, you can break out of these patterns.

Shame and isolation with C-PTSD

Because symptoms of C-PTSD can sometimes lead to negative judgement from others, this can cause social rejection and sadly, the kind of abandonment that people with the condition fear so deeply. As a result, people often describe feeling like an ‘outsider’, ‘faulty’, ‘defective’, ‘different from others’ or ‘broken’. They can also somehow feel that the trauma they suffered was somehow their fault because they were ‘weak’ or ‘unloveable’ or ‘not perfect enough’, or that they failed to somehow ‘rescue’ their parents.

Yet none of this is true — C-PTSD is a condition that you are not remotely to blame for and was caused by you having to survive and adapt to a difficult situation, often when very young. Unfortunately, some of the coping strategies that you learned as a result, such as hyper-vigilance (being constantly alert to physical, social or emotional danger), can often cause problems in later life. In other words, what helped you to get through childhood can sometimes hinder you in adulthood.

Healing from C-PTSD can mean letting go of old coping strategies and replacing them with new ones. It can also mean becoming aware of when you are having emotional flashbacks and learning to spot the initial triggers. This isn’t necessarily a quick, easy or even linear process, but it can be a life-changing one. In the words of author and trauma expert Peter Levine, ‘I have come to the conclusion that human beings are born with an innate capacity to triumph over trauma.’

What types of therapy can help with C-PTSD

Healing from C-PTSD can be a long yet rewarding process, but one thing that is absolutely crucial is finding a therapist with a good understanding of complex trauma. This is because non-trauma-based approaches don’t always work, often leaving the client feeling that they have somehow ‘failed’ at therapy or are ‘unfixable’.

However, this isn’t the case and there are various trauma-conscious approaches that can help. One of these is EMDR, a combination of both talk and body-based therapy that can work through the unprocessed experiences from the past that are continuing to impact day-to-day life as well as updating the meaning attached to them (learn more by reading about Jonathan’s EMDR experience). Another is Schema Therapy, which can help to shrink the overactive inner critic, help you become more aware of your triggers and develop more effective ways of getting your needs met now and coping with your emotions.

Additionally, CFT can help you learn to understand the trauma responses you might be still using and learn to be kinder to yourself (and also accept kindness from others), while DBT can help you to cope with difficult and painful feelings, as well as learn how to choose to respond to triggers. And finally, body-focused (somatic) approaches like Somatic Experiencing, Sensorimotor Psychotherapy and CRM use a range of techniques to release trauma trapped in the body.

Signs of C-PTSD recovery

The path to healing C-PTSD isn’t necessarily a simple or linear one. However, according to Pete Walker, some key signs of recovery include:

  1. Shrinking the inner critic and developing a compassionate inner voice.
  2. Grieving the traumas and losses of your past, including lost parts of yourself.
  3. Becoming more aware of your triggers.
  4. Recognising when you are experiencing an emotional flashback and being able to self-soothe during it. Pete Walker's 13 Steps for Managing Flashbacks can help.
  5. Learning to relax and sit with your emotions in general.
  6. Learning to receive comfort from others.

He sums this up by saying that recovery is, ‘learning to handle unpredictable shifts in our inner emotional weather’, as well as ‘becoming an unflinching source of kindness and self-compassion with yourself.’

The gifts that come with growth

On a positive note, people who have gone on the journey of healing from complex trauma sometimes say that they feel they have more emotional intelligence than the average person, have a more profound compassion for others and can eventually become capable of deeply intimate relationships.

Also, because of what they have overcome, C-PTSD survivors can also end up feeling free enough to follow their own path in life, without being weighed down by society’s expectations. As described by Peter Levine, ‘I believe not only that trauma is curable, but that the healing process can be a catalyst for profound awakening.’

It is also important to remember that recovering from an emotionally traumatic childhood is about more than learning self-soothing strategies, it is also about opening up to what can feel like the most dangerous thing of all — allowing yourself to be soothed by others, whether that is a friend or therapist. In a final reflection from Tara, ‘Connecting with other people is really hard when you have C-PTSD. But it can also be one of the most healing things that you can do.’

And sometimes, the first step of C-PTSD recovery is realising that you are not to blame for what happened in your past or the symptoms that you are facing today. You are not broken, you have just been wounded, but thankfully wounds can heal. And even though you might be feeling lost or low right now, there is support out there for you. It is possible for you to feel safe in the world, have better relationships with others and finally live life on your terms. Facing trauma can take courage but the important thing to remember is that you don’t have to do it alone.

Looking for support for C-PTSD, PTSD or trauma? Browse MTA’s expert, accredited therapists and book an in-person, online or live chat appointment.

What is Complex PTSD? Learn about the symptoms, causes and best therapies
Clinical Director
Lumo Health team
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