Complex PTSD (cPTSD) Explained: Everything You Need to Know

When it comes to trauma, we all tend to think of post-traumatic stress disorder (PTSD), and why wouldn’t we? But a lesser-known but equally valid form of trauma is complex post-traumatic stress disorder (cPTSD). But what is this lesser-known form of trauma, and how can we overcome it? Well, that’s what this article is going to try to answer.

 

 

What Is cPTSD?

 

Most of us are aware of PTSD, thanks to our exposure to the condition in the media, such as in war films or cop shows. So it’s easy for us to think of trauma as being the result of a specific and distinct experience, like in the wake of an accident, a natural disaster, or being attacked (Sheldon-Dean, n.d.).

 

cPTSD, on the other hand, arises from prolonged, repetitive, or inescapable trauma, such as interpersonal violence like childhood abuse (e.g. bullying), domestic violence, and torture. It is characterised by a constellation of symptoms that go beyond those of PTSD. Because of this subtle difference, cPTSD was proposed to capture this form of trauma (Resick et al., 2012).

 

According to Nestgaard Rød and Schmidt (2021), cPTSD is a severe mental health condition that was formally introduced as a distinct diagnosis to PTSD in the revised ICD-11 (the eleventh revision of the International Classification of Diseases) to fill that void next to PTSD.

 

However, cPTSD isn’t recognised in the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, 5th Edition) as a separate mental health condition (Sheldon-Dean, n.d.), creating ongoing diagnostic divergence between the two major classification systems and cultures. For example, the UK, the US, and a handful of countries use the DSM-5. Whereas significantly more countries use the ICD-11.

 

There’s even a link between cPTSD and borderline personality disorder (BPD). According to Ford and Courtois (2021), cPTSD was, in part, defined and proposed as an alternative diagnosis to BPD. I’ve often wondered over the years if I had cPTSD rather than BPD because of this fact.

 

However, the understanding now is that they’re distinct conditions that overlap a lot (Salandanan, 2026). The key difference is that BPD can come from a mixture of places, including genetics and unstable caregiving or emotional invalidation (Pastorious, 2026) that doesn’t reach the level of trauma. In short, uncaring and distant parents.

 

Symptoms of cPTSD

 

Emotional dysregulation

Someone with cPTSD might find they have intense emotions that can be difficult to manage, leading to mood swings, anxiety, depression, or feelings of emptiness. This can also lead to intense outbursts, numbness, or emotional detachment.

 

Interpersonal difficulties

Another thing that someone with cPTSD can struggle with is forming and maintaining healthy relationships; they may develop trust issues, have difficulties with intimacy, and have problems with attachment.

 

The difference between cPTSD and BPD in this regard is that someone with cPTSD is likely to avoid relationships, whereas someone with BPD will seek them out but fear losing them (Pastorious, 2026).

 

Difficulty with emotional processing

Those with cPTSD can experience difficulties in processing and integrating traumatic experiences, leading to intrusive thoughts, nightmares, or flashbacks.

 

 

Negative self-perception

cPTSD can also lead to feelings of shame, guilt, worthlessness, and a distorted self-image due to the prolonged trauma experienced. Whereas someone with BPD will have an unstable self-perception, rather than a straight negative one (Pastorious, 2026).

 

Hypervigilance and avoidance

With experiencing constant trauma, we can develop constant alertness, hypervigilance, or avoidance behaviours as a coping mechanism to prevent further trauma.

 

Dissociation

Like with PTSD, people with cPTSD can experience detachment from reality or from their thoughts or emotions, often as a coping mechanism to escape overwhelming feelings.

 

Somatic symptoms

For some with cPTSD, they can experience physical problems like chronic pain, fatigue, or digestive issues that may not have a clear medical explanation.

 

 

Causes Of cPTSD

 

cPTSD is typically caused by prolonged, repeated trauma that occurs during childhood, but it can also develop in adulthood as a result of domestic abuse or bullying in the workplace.

 

Chronic abuse

Prolonged physical, sexual, or emotional abuse in the home or school can lead to the development of cPTSD.

 

Neglect

People failing to provide for our basic needs when we’re a child, such as not knowing if we’ll have something to eat, lack shelter, lack clothing, or experience a lack of emotional support.

 

Exposure to violence/abuse

Witnessing or experiencing violence in the home or community can also lead to cPTSD. This can include watching other people being bullied at school, as it creates a sense of fear in a space that should be safe.

 

Living in a war zone

People, especially children who grow up in war zones, are often exposed to extreme violence, displacement, loss, and a general sense of instability and impending doom.

 

 

Overcoming cPTSD

 

Breathing and grounding exercises

Breathing and grounding exercises can help us regulate our mood, as well as help us when it comes to having a flashback and bringing ourselves back to the present moment. Something as simple as a textured object we can hold can fulfil the role of grounding.

 

Triggers

Getting to know our triggers can help us manage our cPTSD. For example, a specific location could be a trigger or a certain smell or date. When we know our triggers, we can formulate a plan to help manage them. However, for long-term recovery, avoidance should be avoided.

 

Avoidance

It can be easy to isolate ourselves as a result of having cPTSD. We may not go that far, but we may avoid areas associated with our trauma. The problem with the former is that isolation erodes our mental wellbeing further, and with the latter (both really), we’re unintentionally reinforcing the trauma.

 

A way to overcome this is to try out exposure therapy, which we can do ourselves in the form of little experiments. This makes for a good journaling exercise. Create a fear hierarchy by thinking about the situations that can trigger the response we’re trying to avoid. Then order them from least to most triggering. 

 

Working with the least triggering scenario, we can then develop little experiments to help us overcome our cPTSD. For example, if we experience a lot of discrimination and abuse in a former workplace, we could set up experiments like walking onto the grounds of the workplace for one minute.

 

For a more detailed guide on how to use exposure therapy, you can find my article archive on exposure therapy by clicking here, and my second edition exposure workbook by clicking here.

 

 

Thought challenges

It can be useful to use techniques like reframing, cognitive reappraisal, and putting our thoughts on trial to help us tackle the unwanted intrusive thoughts caused by our cPTSD. For example, using reframing, we can look for a neutral or positive alternative to the thought.

 

Social support network

Talk to the people in our social support network, or expand our social support network by looking for peer support groups to attend. We all benefit from having safe spaces to open up.

 

Memories

Our memories of our trauma are often the most difficult part of having cPTSD. Unfortunately, the best way to tackle them is to stop avoiding these memories, as in extreme cases, this avoidance can lead to substance dependency.

 

Processing our memories and turning them from hot memories into cold memories is the gold standard for this. This could be done through journaling about our memories, using my modified narrative exposure therapy (M-NET), talking to others about our experiences, or attending therapy to talk about it.

 

Therapy

Treatment for cPTSD typically involves psychotherapy that has a focus on trauma, such as eye movement desensitisation and reprocessing (EMDR) and cognitive behavioural therapy (CBT). These therapies aim to address trauma-related symptoms, improve coping mechanisms, and help us rebuild a sense of safety and self-empowerment.

 

Self-compassion

As always, remember to treat ourselves with compassion when navigating any issues with our mental wellbeing. Overcoming cPTSD isn’t going to be an easy road, so being kind to ourselves is an important part of our recovery journey if we don’t want to give up.

 

 

Summary

 

Although most people are aware of PTSD, cPTSD does a better job of explaining and supporting those who have experienced trauma over a longer period of time. Whereas PTSD may happen after a single event, cPTSD is the result of prolonged exposure to trauma. In a lot of cPTSD cases, think of it like the last straw that broke the camel’s back.

 

cPTSD can have a profound impact on our lives, affecting our daily functioning, relationships, and overall wellbeing. It can lead to social isolation, occupational difficulties, and even self-harm or suicidal thoughts.

 

Recovery from cPTSD is a gradual process, and it may take months or even years to see significant improvement. However, with the right treatment and support, most people with cPTSD can learn to manage their symptoms and live fulfilling lives.

 

After researching and writing this article, I think it’s not an issue of whether I had cPTSD instead of BPD, but that they were co-occurring. Because that better explains my issues. BPD explains my attachment issues and my identity crisis growing up, with the cause coming from neglect and lack of much-needed emotional support at home. I was emotionally unbalanced even at the age of four.

 

Whereas cPTSD explains the harm from bullying and other abuse outside of the home, which eventually scarred my mind in my mid-teens.

 

As always, leave your feedback in the comments section below. Also, please share your experiences with cPTSD and trauma in the comments section below as well. Don’t forget, if you want to stay up-to-date with my blog, you can sign up for my newsletter below. Alternatively, click the red bell icon in the bottom right corner to get push notifications for new articles.

 

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References

 

Ford, J. D. & Courtois, C.A. (2021). Complex PTSD and borderline personality disorder. Borderline Personality Disorder and Emotion Dysregulation, 8:16. Retrieved from https://d-nb.info/124089340X/34 and https://doi.org/10.1186/s40479-021-00155-9.

Nestgaard Rød, Å., & Schmidt, C. (2021). Complex PTSD: what is the clinical utility of the diagnosis?. European Journal of Psychotraumatology, 12(1), 2002028. Retrieved from https://www.tandfonline.com/doi/pdf/10.1080/20008198.2021.2002028.

Pastorious, C. (2026, June 22). CPTSD vs BPD: What’s the Difference?. Brightside. Retrieved from https://www.brightside.com/blog/cptsd-vs-bpd.

Resick, P. A., Bovin, M. J., Calloway, A. L., Dick, A. M., King, M. W., Mitchell, K. S., Suvak, M. K., Wells, S. Y., Stirman, S. W., & Wolf, E. J. (2012). A critical evaluation of the complex PTSD literature: Implications for DSM‐5. Journal of Traumatic Stress, 25(3), 241-251. Retrieved from https://www.emdr-magazine.nl/2013-1/2013-1-w11.pdf.

Sheldon-Dean, H. (n.d.). What Is Complex Trauma?. Child Mind Institute. Retrieved from https://childmind.org/article/what-is-complex-trauma.

Salandanan, K. (2026, June 3). How to recognize the overlap between complex trauma and BPD. Crisis & Trauma Resource Institute. Retrieved from https://ctrinstitute.com/blog/overlap-between-complex-trauma-and-bpd.