Most people are familiar with the term PTSD, or post-traumatic stress disorder. PTSD refers to a traumatic event that the individual has witnessed or experienced that they have great difficulty overcoming emotionally. Complex PTSD or C-PTSD refers to ongoing trauma, such as childhood abuse, domestic violence, multiple combat deployments, being the victim of sex trafficking, or being kidnapped for a prolonged time—situations that were ongoing, harmful and abusive, and where the victim feels trapped.

Because of the protracted period of suffering at the hands of another, treating C-PTSD is different from treating a one-time traumatic event. Those who have endured ongoing abuse at the hands of someone they should have been able to trust, such as a spouse or a parent, may have developed deep trust issues, attachment disorder, dissociative disorder, and developmental problems as a result. For this reason, treatment for C-PTSD requires a multi-modal approach.

What is Complex PTSD (C-PTSD)?

Complex post-traumatic stress disorder (C-PTSD), also referred to as complex trauma disorder, is a psychological disorder caused by repetitive and prolonged trauma, such as sustained physical or sexual abuse, at the hands of a loved one or other relationship featuring an unequal power dynamic. The resulting psychological damage reflects the distortion of the victim’s core identity and can manifest in similar dysfunctional patterns seen in borderline personality disorder, dissociative disorder, somatization disorder, and PTSD. Those with C-PTSD are left feeling fundamentally flawed and unworthy of love, especially when the prolonged and repeated abuse was perpetrated by an attachment figure, like a parent.

This impact on the victim’s sense of self-worth is what differentiates C-PTSD from PTSD the most. Aside from the ongoing nature of the abuse or trauma, C-PTSD affects the individual’s core sense of self, where PTSD tends to cause symptoms related to the exposure to trauma. The low self-esteem that can result from protracted abuse can lead to a lifetime of mental health issues.

Symptoms of C-PTSD

Someone with C-PTSD has experienced prolonged victimization under the control of another, and may exhibit the following emotional or developmental difficulties:

• Self-perception. Viewing oneself as distinctly different from other people, and having feelings of helplessness, guilt, shame, and stigma
• Problems with emotional regulation. Exhibiting explosive emotions, such as angry outburst, or persistent sadness, suicidal thoughts, or repressed anger
• Distorted view of the perpetrator. Distorted perceptions of the abuser include conceding all power to them, being preoccupied with the relationship with the abuser, or preoccupied with getting revenge
• Somatic and/or medical problems. Certain somatic reactions and medical ills can be directly related to the type of abuse that occurred, involving all major body systems, pain syndromes, and illnesses.
• Altered consciousness. Either reliving or forgetting the traumatic events or dissociative feelings of detachment from one’s body or mind processes
• Interpersonal difficulties. Problems with feelings of isolation, deep distrust, or constantly searching for a rescuer
• Loss of faith in others. A sense of hopelessness and despair, and a loss of sustaining faith in others or spiritually
• Self-isolation. After prolonged and routine emotional or physical abuse, the individual may retract and become avoidant of any interpersonal relationships as a defense mechanism

Substance abuse is a common co-occurring disorder with C-PTSD, as the individual attempts to self-medicate or numb the thoughts and feelings that have resulted from the prolonged trauma. If a substance use disorder coexists with the C-PTSD, both disorders must be treated. Dual diagnosis is a specialized realm within the mental health field and should be treated and managed by a provider with that particular area of expertise.

3 Stages of Complex PTSD Recovery

The resulting effects of experiencing chronic abuse and trauma include a profound sense of helplessness and isolation, and the feeling of having no control over one’s life. Having ceded power to the abuser, the victim feels powerless. Because the traumatic events were repetitive, prolonged, and cumulative, recovering from C-PTSD takes time and patience.

Healing from C-PTSD can take place within a safe, trusting relationship if the victim feels empowered in that relationship. The relationship can be a romantic partner, a family member, a close friend, co-worker, an adult child, or a clinician. There are a variety of psychotherapy treatment modalities that can be used in C-PTSD recovery. These include:

• Experiential and emotionally focused therapy. Includes types of therapy or activities that involve expressive tools to aid patients in processing or describing painful events
• Cognitive behavioral therapy (CBT). Focuses on identifying the maladaptive thought patterns that lead to self-destructive behavioral responses, and changing them
• Psychodynamic therapy. A longer-term therapy that explores childhood and developmental history in depth
• Family systems therapy. Helps families identify dysfunctional elements of the family dynamic and resolve problems
• Internal family systems therapy. Attachment-focused therapy that helps resolve interpersonal problems within the family
• Sensorimotor psychotherapy. A body-centered therapy used often for PTSD or treatment for trauma by exploring traumatic experiences trapped in the body
• Dialectical behavior therapy (DBT). A form of CBT that uses mindfulness and distress tolerance to focus on emotion management issues stemming from chronic childhood trauma
• Eye movement desensitization and reprocessing therapy (EMDR). Involves patient following a back and forth stimulus with their eyes while concurrently processing the traumatic event to desensitize them from the emotional intensity of the trauma
• Transcranial Magnetic Stimulation also known as TMS Therapy is a non-invasive treatment option for those who have not responded to anti-depressants or therapy. TMS for PTSD is an alternative treatment option.

Recovery from C-PTSD is a long slog, with survivors sometimes requiring more than ten years of psychotherapy for resolution. There are some C-PTSD programs offered through residential psychiatric programs that offer specialized treatment for this disorder and accompanying dissociative disorders. Following treatment, many find solace and purpose in helping others who suffer.

The 3 stages of C-PTSD recovery include:

Stage I: Establishing Safety

The initial phase of treatment focuses on establishing a sense of stability and safety and forming an alliance with the therapist. The therapist will teach the client about the elements of trauma and how people respond to trauma as a foundation upon which to teach the recovery skills. The client will learn how to self-nurture and self-soothe, as well as how to modulate emotions. The therapist will teach the client how to better manage the symptoms of PTSD, such as flashbacks or nightmares, in addition to teaching how to set healthy boundaries, assertiveness training, and stress reduction techniques such as yoga, deep breathing, meditation, and mindfulness exercises. In addition, the client will benefit from antidepressants and anti-anxiety medication.

Stage II: Remembrance and Mourning for What Was Lost

The middle phase of treatment begins after the client has successfully integrated the stabilization skills taught in Stage I. During the middle phase those stabilization skills will be needed, as the client revisits and processes the traumatic events and experiences intense emotional response to the memories. Also, the middle phase involves the task of exploring and mourning what has been lost as related to the trauma, and to grieve the loss. As with PTSD treatment, prolonged or graduated exposure therapy is often utilized. Other therapies that are effective during this phase include cognitive processing therapy, narrative exposure, EMDR, cognitive restructuring, and reprocessing.

Stage III: Reconnecting with Community and Society

The final phase of treatment involves creating a new sense of self and setting sights on a new future. During this last stage of recovery, the client accepts the trauma as just a part of their life story, but no longer allows it to define who they are or what they can become. This phase develops a sense of personal empowerment and a feeling of control over their future. Self-identity is newly defined, and new interpersonal skills are developed. The client will review the people in their life and decide whether to retain those relationships in light of new insights and boundaries. For some, taking on a mission to help others, or a survivor mission, following the end of treatment is a constructive way to help others and continue to heal and grow.