What is Complex Trauma and C-PTSD?

What is Complex Trauma and C-PTSD?

by Talia Bina, MSEd, MPhil, MHC-LP

Complex Trauma, sometimes called Complex Post-Traumatic Stress Disorder (C-PTSD), develops from repeated or prolonged exposure to traumatic experiences, often beginning in childhood. Contrarily to PTSD, which is typically linked to a single traumatic event, Complex Trauma is usually the result of ongoing trauma such as abuse, neglect, domestic violence, or growing up in an unstable or unsafe environment. Over time, this repeated exposure can deeply affect a person’s sense of self, relationships, and ability to feel safe in the world. People with C-PTSD may struggle with emotional regulation, self-esteem, trust, and may experience intense feelings of shame, guilt, or worthlessness.
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The interesting thing about C-PTSD is that it is not actually recognized in the DSM-5 (the manual most clinicians use in the U.S. to diagnose individuals). However, it has been recognized by the World Health Organization since 2018 in the ICD-11 (the international classification of diseases).

What are the signs and symptoms of C-PTSD?

The following list describes some of the signs and symptoms of C-PTSD. You may notice that some of the symptoms overlap with other medical and mental health conditions.

Trauma and Memory

• Intrusive flashbacks
• Emotional reliving of past experiences
• Gaps in childhood memories​​

Emotional and Cognitive

• Chronic shame or guilt
  
• Difficulty regulating emotions
  
• Dissociation
  
• Perfectionism
  
• Persistent overthinking

Interpersonal

• Trust issues
  
• Social anxiety
  
• People-pleasing behaviors rooted in fear of conflict or rejection

Physical

• Chronic pain
  
• Sleep problems
  
• Digestive issues
  
• Body tension linked to prolonged stress

Behavioral

• Avoidance of trauma triggers
  
• Overexplaining or apologizing excessively
  
• Self-soothing through food, substances, or other coping behaviors

Hyperarousal

• Hypervigilance
  
• Exaggerated startle responses
  
• Reliance on the “Four F’s” of survival (Fight, Flight, Freeze, Fawn)

These patterns don’t just shape emotions—they ripple into the body, relationships, and daily life. Many people with Complex Trauma continue to navigate the world in survival mode, long after the original trauma has ended. Since C-PTSD affects multiple areas of functioning—emotional regulation, cognition, relationships, and behavior—people often experience symptoms that overlap with other mental health conditions, such as depression, anxiety disorders, ADHD-like symptoms, dissociation, substance use, and/or eating disorders. They may not meet the full criteria for these individual diagnoses but still exhibit aspects of them as a direct result of trauma. In the U.S., clinicians may note co-occurring diagnoses because C-PTSD itself is not officially recognized in the DSM-5. Recognizing these overlapping patterns helps capture the full impact of trauma and guide effective treatment.
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For example, an individual with Complex Trauma might experience OCD-like symptoms such as intrusive thoughts or rumination, ADHD-like symptoms like distractibility, difficulty focusing, or impulsivity, eating-related issues such as emotional eating, and mood or anxiety symptoms including persistent worry, panic, low mood, or irritability. In some cases, these experiences may not meet the full criteria for separate diagnoses, reflecting trauma-related patterns rather than distinct disorders. In other cases, an individual may meet the full criteria for one or more co-occurring conditions, meaning that the trauma has contributed to clinically significant impairments that warrant a formal diagnosis and targeted treatment.

What are the most common co-occurring disorders with C-PTSD?

Mood Disorders

Depression and persistent low mood are very common, as trauma erodes self-worth and hope. Emotional ups and downs may resemble bipolar traits, though often tied more to trauma reactivity than a mood disorder itself.

Anxiety and OCD

Chronic worry, panic attacks, or obsessive thinking can grow out of trauma. Some survivors develop compulsive behaviors (like checking or rituals) as attempts to create a sense of safety or control.

ADHD-Like Symptoms

Trauma can affect attention, memory, and impulse control, leading to distractibility or difficulties with focus that may look like ADHD.

Body-Focused Repetitive Behaviors (BFRBs)

Hair pulling, skin picking, or nail biting may develop as tension-release or self-soothing strategies.

Dissociative Symptoms

Many people with C-PTSD experience spacing out, feeling detached from their body, or memory gaps. In severe cases, this can overlap with dissociative disorders.

Substance Use Disorders

Alcohol or drugs may be used to numb pain, reduce hyperarousal, or escape intrusive memories

Eating Disorders

Restrictive eating, bingeing, or purging can emerge from shame, trauma-related body image issues, or attempts to regain a sense of control over the body.

Moving Forward: Healing from Complex Trauma

Healing from Complex Trauma is possible, though it often takes time and support. Effective treatment usually involves a combination of approaches that address emotional regulation, trauma processing, and rebuilding trust and safety:

Therapy for C-PTSD

Treatment for Complex Trauma often involves a combination of approaches. Behavioral therapies focus on managing symptoms, building coping skills, and regulating emotions. Insight-oriented or psychodynamic therapies explore childhood experiences, relational patterns, and the underlying causes of trauma. Body-based therapies help process trauma stored in physical sensations, while psychoeducation provides understanding of how trauma affects the mind and body.

Medication for C-PTSD

May be used to manage symptoms such as depression, anxiety, or sleep difficulties, under the guidance of a psychiatrist.

Support Groups for C-PTSD

Peer support can reduce isolation and provide validation for experiences. You can search for local C-PTSD  

If you or someone you know is living with trauma, reaching out to a licensed mental health professional can be an important first step toward recovery and regaining a sense of safety and self.

What are some resources to help with C-PTSD?

Books that Address C-PTSD

• The Body Keeps the Score by Bessel van der Kolk
  
• Complex PTSD: From Surviving to Thriving by Pete Walker
  
• Healing from Hidden Abuse by Shannon Thomas

Organizations & Websites Focused on C-PTSD

• International Society for Traumatic Stress Studies (ISTSS): https://istss.org – Research, professional resources, and educational materials.
  
• CPTSD Foundation: https://cptsdfoundation.org – Peer-led support groups, education, and community for C-PTSD survivors.
  
• Complex Trauma Resources: https://www.complextrauma.org – Curated collection of books, videos, and educational materials for survivors and caregivers.

About the Author

Talia Bina, MSEd, MPhil, MHC-LP, is a clinician at Healing & Growth Counseling, providing in-person counseling services in Massapequa Park. Working with clients with complex trauma is a specialty focus area in her practice. Her understanding of the complexities that occur for people who have struggled with complex trauma histories helps her to provide individualized treatment to those that she works with. She takes the opportunity to link clients with resources, such as those listed above, to help support the work being done in therapy.

Interested in learning more about Talia? See her Bio Page here.

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