Complex post-traumatic stress disorder (CPTSD) can result from experiencing chronic trauma, such as prolonged child abuse or domestic violence. It’s closely related to PTSD and borderline personality disorder. CPTSD is manageable with psychotherapy (talk therapy) and medication.
Complex post-traumatic stress disorder (CPTSD, C-PTSD or cPTSD) is a mental health condition that can develop if you experience chronic (long-term) trauma. It involves stress responses, such as:
Examples of chronic trauma include:
While CPTSD is often associated with chronic trauma in childhood, adults who experience chronic trauma can also develop the condition.
Experts across the field of psychology disagree on if CPTSD is a distinct condition and diagnosis.
For example, two organizations that publish professional reference books have different opinions about CPTSD. In 2019, The World Health Organization (WHO) listed CPTSD in its 11th revision of the International Classification of Diseases (ICD-11). But the American Psychological Association (APA), which publishes the Diagnostic and Statistical Manual of Mental Disorders (DMS-5), doesn’t recognize CPTSD as a distinct condition. The DSM-5 does list a sub-type of post-traumatic stress disorder (PTSD) called dissociative PTSD that seems to encompass CPTSD symptoms.
Some experts believe that CPTSD, PTSD and borderline personality disorder (BPD) may exist on a spectrum of trauma-related mental health conditions that vary in the severity of their symptoms.
The main differences between PTSD and CPTSD are the length of trauma and the symptoms.
Traditionally, experts thought PTSD generally developed from short-term trauma, such as a vehicle accident or a natural disaster. With research, they realized that people who experience long-term, repeated trauma tend to have other symptoms in addition to the symptoms of PTSD.
Both CPTSD and PTSD involve symptoms of psychological and behavioral stress responses, such as flashbacks, hypervigilance and efforts to avoid distressing reminders of the traumatic event(s).
People with CPTSD typically have additional symptoms, including chronic and extensive issues with:
CPTSD and borderline personality disorder (BPD) share several similar symptoms, such as impulsive behavior, feelings of worthlessness and difficulty forming lasting relationships. Because of this, some experts wonder if these conditions are actually distinct.
According to existing criteria for each condition, the main difference is that chronic trauma has to be the cause of CPTSD, whereas trauma doesn’t have to be the cause of BPD. However, BPD is strongly associated with childhood trauma, such as abuse or neglect.
Another difference is that a person usually develops BPD by young adulthood. A person can develop CPTSD at any age.
As CPTSD is a newer diagnosis, research is lacking on how common the condition is. But experts estimate that it may affect 1% to 8% of the world population.
According to the ICD-11, complex PTSD includes most of the core symptoms of PTSD, such as:
In addition to the following symptoms:
According to the ICD-11, complex PTSD results from exposure to a traumatic event or series of events of an extremely threatening nature. The events are usually prolonged or repetitive and escape from the situation is impossible or dangerous.
Examples of these types of traumatic situations include:
Traumatic stress can change your brain’s chemistry and structure. Studies suggest that trauma is associated with permanent changes in key areas of your brain, including your:
Some neuroimaging studies show that brain changes are more severe in people with CPTSD compared to people with PTSD.
There’s no test to diagnose CPTSD. Instead, a healthcare provider makes the diagnosis after asking you about your:
Providers use criteria explained in WHO’s ICD-11 to diagnose CPTSD. However, as CPTSD is a newly recognized condition, some providers may not be aware of it. This may make it difficult to get an official diagnosis. A provider might diagnose you with PTSD instead of CPTSD.
This therapy takes place with a trained, licensed mental health professional, such as a psychologist or psychiatrist. It can provide support, education and guidance to you and/or your loved ones to help you function better and increase your well-being.
Trauma-focused CBT involves:
People with PTSD and CPTSD often avoid things or situations that they associate with their trauma. Because of this, they aren’t able to learn that they can manage their fear when presented with these stimuli. Therapists use exposure therapy for people who have PTSD and CPTSD. Exposure therapy slowly encourages them to enter situations that cause them anxiety and to try to stay in that situation so they can learn to cope.
Another type of trauma-focused therapy is eye movement desensitization and reprocessing (EMDR). During this treatment, you focus on specific sounds or movements your therapist introduces while you think about the traumatic event(s). It aims to make the event(s) less upsetting over time.
Cognitive processing therapy (CPT) is another type of trauma-focused therapy. This treatment focuses on addressing the distressing and often problematic thoughts and emotions that have developed since the traumatic event(s).
Currently, there are no medications approved by the U.S. Food and Drug Administration (FDA) to treat PTSD or CPTSD. However, healthcare providers may prescribe certain medications to help certain CPTSD symptoms, such as:
As CPTSD is a newly recognized condition, medical researchers haven’t been able to do long-term studies about CPTSD.
For many people, CPTSD is a lifelong condition. The good news is that psychotherapy and medication can help manage your symptoms.
Aside from seeking treatment for acute stress disorder, things you can do to help yourself include:
It’s important to see your healthcare provider and/or mental health provider regularly during treatment for CPTSD. If your symptoms get worse, call your provider.
If you’re having thoughts of harming yourself or suicide, go to the nearest emergency room or call 988 to reach the Suicide and Crisis Lifeline.
A note from Cleveland Clinic
It may be very difficult to seek help after chronic trauma. Know that treatment for complex PTSD is important, and with time, treatment can help you get better. Talk to your healthcare provider about treatment options. They’re available to help and support you.
Last reviewed by a Cleveland Clinic medical professional on 04/05/2023.
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