complex ptsd treatment
October 05, 2023 By Leah Malone

Understanding Complex PTSD (CPTSD)


Anyone can develop a trauma-related mental health disorder after experiencing emotionally distressing events. Trauma affects the body’s ability to cope with and manage stress. Experiencing or witnessing traumatic events over a prolonged period of time may cause individuals to develop post-traumatic stress disorder (PTSD) or complex PTSD (CPTSD). Some individuals have more severe reactions to trauma, leading to the additional symptoms and side effects of CPTSD. According to the World Journal of Psychiatry, CPTSD includes “clinical features of PTSD plus three additional clusters of symptoms namely emotional dysregulation, negative self-cognitions and interpersonal hardship.” Early intervention and treatment is the best way to reduce the risk of developing CPTSD and co-occurring disorders. 

Individuals diagnosed with CPTSD benefit from having a deeper understanding of how their condition affects their thoughts, beliefs, and behaviors. Having context for clusters of severe symptoms makes it easier to manage them long-term. Grace & Emerge Recovery offers women a safe space to heal from complex trauma and substance abuse or mental health disorders. Our care team uses a whole-person approach to care and trauma-informed treatments to ensure the best possible outcomes. 

Historical Background

Throughout history, PTSD has been known by many names, including: 

  • Nostalgia
  • Soldier’s heart
  • Railway spine
  • Battle fatigue
  • Combat stress reaction (CSR)

Medical professionals in America first began recognizing trauma responses as a distinct mental illness in the 1860s during the Civil War. However, PTSD was not officially recognized until the American Psychiatric Association (APA) added it to the Second Diagnostic and Statistical Manual of Mental Disorders (DSM-II) in 1968. Twenty years later, in 1988, Dr. Judith Herman of Harvard University noted some individuals with PTSD tended to have clusters of more complex symptoms. Those clusters of symptoms were referred to as complex PTSD or disorders of extreme stress not otherwise specified (DESNOS). 

According to the Department of Veterans Affairs (VA), “Because results from the DSM-IV Field Trials indicated that 92% of individuals with Complex PTSD/DESNOS also met criteria for PTSD, Complex PTSD was not added as a separate diagnosis.”

Defining CPTSD

The current standards for clinically diagnosing PTSD come from the DSM-IV. To be diagnosed with PTSD, a person must have experienced or witnessed serious injury, sexual violence, or a life-threatening situation. According to the previously mentioned article by the World Journal of Psychiatry, “Complex PTSD is related to complex trauma which is defined by its threatening and entrapping context, generally interpersonal in nature.” Most people diagnosed with CPTSD experienced trauma at the hands of a family member or domestic partner. 

To be diagnosed with CPTSD, people must generally meet the minimum criteria for PTSD with additional clusters of symptoms. According to Trauma-Informed Care in Behavioral Health Services by the Substance Abuse and Mental Health Services Administration (SAMHSA), “The following criteria apply to adults, adolescents, and children older than 6 years” diagnosed with PTSD:

  • “Recurrent, involuntary, and intrusive distressing memories of the traumatic event(s)” 
  • “Dissociative reactions (e.g., flashbacks) in which the individual feels or acts as if the traumatic event(s) were recurring”
  • “Recurrent distressing dreams in which the content and/or affect of the dream are related to the traumatic event(s)”
  • “Intense or prolonged psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event(s)”
  • “Avoidance of or efforts to avoid distressing memories, thoughts, or feelings about or closely associated with the traumatic event(s)”
  • “Marked physiological reactions to internal or external cues that symbolize or resemble an aspect of the traumatic event(s)”
  • “Avoidance of or efforts to avoid external reminders (people, places, conversations, activities, objects, situations) that arouse distressing memories, thoughts, or feelings about or closely associated with the traumatic event(s)” 
  • “Negative alterations in cognitions and mood associated with the traumatic event(s), beginning or worsening after the traumatic event(s) occurred”
  • “Marked alterations in arousal and reactivity associated with the traumatic event(s), beginning or worsening after the traumatic event(s) occurred”

Symptoms must be present for at least four weeks and cause significant emotional distress. 

PTSD and CPTSD are similar enough that the DSM-5 does not have separate criteria for complex PTSD. In general, CPTSD occurs due to prolonged traumas taking place over months or years, while PTSD is often caused by acute trauma. 

Causes and Triggers

CPTSD is caused by prolonged exposure to traumatic events. Often, multiple traumas are experienced simultaneously or consecutively. For example, children in abusive homes may be exposed to domestic violence and substance abuse. The effects may be cumulative. Individuals who experience more traumas often have more severe symptoms and more severe co-occurring disorders. Children exposed to long-term traumatic events are more likely to develop physical and psychological health issues later in life. 

Childhood abuse and trauma directly impact how a person reacts to everyday stressors and their sense of self. Individuals without a support system may use maladaptive coping mechanisms to manage trauma triggers, including: 

  • Substance abuse 
  • Self-harming behaviors
  • Risk-taking behaviors

Relationship-based traumas experienced during childhood or adulthood are common causes of CPTSD. A history of interpersonal traumas may affect a client’s ability to trust their care team during treatment. Lack of personal boundaries often causes relationship traumas. Treatment programs help clients build healthy social boundaries and address underlying traumas. 

Symptoms and Manifestations

CPTSD physically affects the brain and interferes with emotion regulation. Some of the symptoms and manifestations of CPTSD include: 

  • Dissociative events and symptoms, including flashbacks and memory loss
  • Negative self-perception
  • Relationship challenges, including trust issues and conflict avoidance
  • Distorted perceptions of perpetrators
  • Loss of systems of meanings

Most areas of a person’s life and sense of self are affected by untreated CPTSD. Grace & Emerge Recovery helps women with CPTSD address unresolved traumas and build healthy life skills to replace maladaptive behaviors. Managing the symptoms of CPTSD often requires multiple therapeutic modalities and extended professional mental health treatment. Our clinical team can provide continued mental health support to alumni with CPTSD.

The Brain and CPTSD

Trauma changes how the body processes memories, emotions, stress, and other aspects of everyday life. Many of the most severe and long-lasting neurological changes are caused by adverse childhood experiences (ACEs). However, adults who experience prolonged trauma also report significant neurological changes. 

Some known changes to the brain in individuals with CPTSD include:

  • The hippocampus is smaller and less active 
  • Focal neurological deficits affecting vision, muscle strength, and speech 
  • The prefrontal cortex has difficulty regulating fear and other emotions 
  • In some cases, the amygdala becomes hyperactive

Childhood trauma directly affects the development of gray matter and brain activity. In most cases, prolonged trauma associated with PTSD and CPTSD begins in adolescence when the brain is still developing. According to Dialogues in Clinical Neuroscience, “Symptoms of PTSD are hypothesized to represent the behavioral manifestation of stress-induced changes in brain structure and function.” 

Treatment Approaches

Trauma treatment generally involves a mixture of psychotherapy, peer support, and prescription medications. Clients in treatment are guided through reprocessing trauma. CPTSD involves clusters of severe symptoms and side effects. Treatment must address all primary and underlying issues related to CPTSD and co-occurring disorders to ensure long-term positive mental health. 

Some of the most common treatment options for CPTSD include: 

  • Trauma-focused cognitive-behavioral therapy (CBT)
  • Eye-movement desensitization and reprocessing (EMDR)
  • Dialectical behavior therapy (DBT)

Some clients may require prescription medications to treat severe symptoms. Sleep disturbances, anxiety, and depressive symptoms are often managed with sleep aids and antidepressants. Medications are meant to help stabilize individuals in treatment and are not a permanent solution. Our care team at Grace & Emerge Recovery uses medications to help women struggling with more complex and severe symptoms of PTSD. 

Coping Mechanisms

Treatment provides people with CPTSD the tools they need to establish healthy coping mechanisms. Below are some of the ways people learn to cope with the symptoms and side effects of CPTSD: 

  • Join a support group and regularly interact with peers who have similar life experiences 
  • Choosing to focus on positive experiences 
  • Spending time outdoors or in quiet contemplation
  • Practicing positive self-talk 
  • Muscle relaxation or deep breathing exercises 

Grounding Techniques

People use grounding techniques to manage stress responses and reduce the severity of specific symptoms, including the following: 

  • Dissociative events 
  • Anxiety or panic attacks 
  • Depression

Some of the most common grounding techniques focus on either a specific sense, like breathing, or all the senses. For example, people who want to feel grounded may scan the space around them and identify specific things they can see, touch, taste, smell, and hear. Grace & Emerge Recovery helps clients establish personalized grounding techniques to reduce stress and increase self-awareness. 

Mindfulness and Meditation

Trauma affects how people process and experience the present. Often, symptoms of CPTSD make it difficult for people to stay objective and in the moment. Mindfulness and meditation are a few useful tools for regaining self-awareness. 

According to the VA, mindfulness practice has two “key” parts:

  • “Paying attention to and being aware of the present moment”
  • “Accepting or being willing to experience your thoughts and feelings without judging them”

Meditation and mindfulness also increase the effectiveness of traditional talk therapy and other treatments. 

Building a Support System

Support systems are essential to long-term recovery. Most people with CPTSD find it challenging to create healthy social connections. Fear, shame, embarrassment, sadness, distrust, and many other emotions may interfere during social interactions. Our care team prioritizes helping clients build healthy support systems during treatment. 

Support systems can involve many people or only a handful of trusted individuals. Some of the individuals who make up a support system include: 

  • Therapists, counselors, and other medical professionals
  • Family members 
  • Close friends 
  • Coworkers 
  • Peers in the recovery community
  • Roommates 

Anyone who plays a vital role in someone’s recovery may become part of their trusted support system. 

Healing and Recovery

Resiliency allows people to move forward, heal, and grow after experiencing a traumatic event. Post-traumatic growth (PTG) is what happens when people find ways to gain strength from their adverse experiences. PTG doesn’t deny the damage caused by ACEs and other traumas. Instead, it encourages people in recovery to embrace changes, use healthy coping skills, and recognize personal growth. 

According to Frontiers in Psychology, “[R]esilience focuses on adapting and adjusting to adversity with or without struggling, whereas, PTG focuses on transformative changes resulting from psychological struggle caused by shattered beliefs or worldview.” Resiliency and PTG help people in recovery establish a sense of safety and empowerment. The skills people learn to build resiliency and personal growth improve the mind-body connection and stabilize emotions.

Overcoming Stigmas

Stigmas related to mental health and treatment can potentially stop vulnerable individuals from seeking help. Fear of judgment, embarrassment, and other feelings may prevent people from letting others know about their struggles. Reducing internalized stigmas is an integral part of building resiliency.

Some common stigmas surrounding mental health and CPTSD include: 

  • Only certain types of people experience CPTSD or mental health disorders 
  • People with CPTSD choose not to get better 
  • CPTSD is a cry for attention and not a real disorder
  • People with mental health disorders are a lost cause 
  • Individuals with CPTSD are dangerous, violent, and unpredictable

Societal misconceptions about CPTSD often leave people feeling uncertain about revealing their diagnosis to friends and family. However, educating others is the best way to raise awareness and combat misinformation. Clients in treatment use family therapy and other services to educate loved ones and help them come to terms with the realities of trauma, treatment, and recovery from CPTSD.


Significant life stressors and traumatic events cause PTSD and CPTSD. Early intervention and treatment reduce the risk of the trauma developing into PTSD or CPTSD. 

Women struggling with CPTSD benefit from participating in professional mental health treatment. Recovery programs provide them with the tools and resources they need to improve resiliency. Our care team also empowers clients by inspiring them to hope for a better life and work toward a healthier future. 

Frequently Asked Questions (FAQs)

Many individuals and families struggle to understand when a loved one is diagnosed with trauma-related mental health disorders. Learning more about the disorder and treatment options helps families heal and grow. Below are some frequently asked questions about trauma and CPTSD. 

How is CPTSD different from traditional PTSD?

Specific traumatic events generally cause traditional PTSD, while CPTSD is caused by prolonged exposure to trauma. Living in an unsafe environment, being repeatedly sexually or physically abused, and neglect are common causes of prolonged trauma.  

Can children develop CPTSD?

Children can develop PTSD due to prolonged trauma. CPTSD is still a new diagnosis and is not currently recognized as separate from PTSD in the DSM-5. However, children younger than six can meet the criteria for PTSD and CPTSD. Early intervention and treatment is the best way to address childhood PTSD or CPTSD. Generally, children who have been through severe and prolonged trauma require therapy and other forms of treatment to heal. 

Are there specific events that lead to CPTSD?

Any prolonged emotionally or physically distressing events may contribute to the development of CPTSD. 

The most common events to trigger CPTSD include: 

  • Childhood physical, emotional, or sexual abuse 
  • Neglect 
  • Domestic abuse 
  • Witnessing or experiencing prolonged trauma

How can loved ones support someone with CPTSD?

People diagnosed with CPTSD have severe reactions to triggers within their environment. Loved ones can support someone with CPTSD by providing a loving, safe, and comfortable space for them to heal and grow. Family therapy is also helpful for many people in treatment for trauma-related issues. Often, prolonged traumas involve maladaptive or toxic family dynamics. Family therapy allows all members of the family to heal together. 

Loved ones can also provide practical support, including: 

  • Providing transportation to medical appointments 
  • Giving medication reminders 
  • Joining support groups for loved ones of individuals with CPTSD 

Families and friends show their love and support by educating themselves about CPTSD and trauma. 

Is full recovery from CPTSD possible?

There is no “cure” for CPTSD. However, individuals with CPTSD can reach a point where their condition goes into remission, and they no longer meet the criteria for the disorder. In most cases, it takes many years of therapy and other treatments to process and learn to manage the condition. 

“Full recovery” may mean something different for everyone. For example, one person may feel they have fully recovered when they reach a point where they are living a happy, fulfilling, and functional life even if they still experience some symptoms. Other individuals may believe full recovery means an absence of all symptoms and side effects. The clinicians at Grace & Emerge Recovery use psychoeducation and other tools to help clients set realistic recovery goals. 

Individuals who have lived through prolonged exposure to trauma may develop PTSD or CPTSD. Not everyone exposed to chronic traumatic situations develops CPTSD. People with a history of childhood abuse, neglect, or sexual abuse have a higher risk. Early intervention and treatment is the best way to avoid long-term side effects and symptoms of trauma. Grace & Emerge Recovery uses evidence-based methods, trauma-informed care, and personalized treatment plans to help clients heal from the impact of trauma. CPTSD can be successfully treated and managed long-term. Our dedicated care team at Grace & Emerge Recovery helps women and their families recover from severe and complex mental health disorders. To learn more about our programs and services, contact us today.

About Author

Leah Malone

Learning to sit with uncomfortable feelings can be painful and disturbing at times. When Leah was able to see her behavior patterns and decided there was enough pain to be disturbed, she became motivated to make changes and accept the work that needed to be done to heal. She needed direction and had no clue how to heal on her own. Through a connection with God, authentic connection with others, honesty, willingness, and humility, Leah is now in recovery from addiction and trauma.

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