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Complex post-traumatic stress disorder (complex PTSD)

Explains what complex PTSD is, including possible causes and how you can access treatment and support.

What is complex PTSD?

Complex post-traumatic stress disorder (complex PTSD, sometimes abbreviated to c-PTSD or CPTSD) is a condition where you experience some symptoms of PTSD along with some additional symptoms, such as:

  • difficulty controlling your emotions
  • feeling very angry or distrustful towards the world
  • constant feelings of emptiness or hopelessness
  • feeling as if you are permanently damaged or worthless
  • feeling as if you are completely different to other people
  • feeling like nobody can understand what happened to you
  • avoiding friendships and relationships, or finding them very difficult
  • often experiencing dissociative symptoms such as depersonalisation or derealisation
  • physical symptoms, such as headaches, dizziness, chest pains and stomach aches
  • regular suicidal feelings.

Other terms for complex PTSD

Complex PTSD is a fairly new term. Professionals have recognised for a while that some types of trauma can have additional effects to PTSD, but have disagreed about whether this is a form of PTSD or an entirely separate condition, and what it should be called.

For example, you may find some doctors or therapists still use one of the following terms:

  • enduring personality change after catastrophic experience (EPCACE)
  • disorders of extreme stress not otherwise specified (DESNOS) – this term is more common in America than the UK.

"At times I felt nothing was going to end the distress, experiencing more than 10 flashbacks a day... It was a long process of recovery, with lots of bumps along the road, but the right medication and long-term therapy with someone I came to trust, has changed my life."

Complex PTSD and emotional flashbacks

If you have complex PTSD you may be particularly likely to experience what some people call an 'emotional flashback', in which you have intense feelings that you originally felt during the trauma, such as fear, shame, sadness or despair. You might react to events in the present as if they are causing these feelings, without realising that you are having a flashback.

See our sections explaining what flashbacks are and tips for coping with flashbacks for more information.

What causes complex PTSD?

The types of traumatic events that can cause complex PTSD include:

  • childhood abuse, neglect or abandonment
  • ongoing domestic violence or abuse
  • repeatedly witnessing violence or abuse
  • being forced or manipulated into prostitution (trading sex)
  • torture, kidnapping or slavery
  • being a prisoner of war.

You are more likely to develop complex PTSD if:

  • you experienced trauma at an early age
  • the trauma lasted for a long time
  • escape or rescue were unlikely or impossible
  • you have experienced multiple traumas
  • you were harmed by someone close to you.

"Developing PTSD after experiencing domestic violence was not something I was prepared for. Physically I left my old home. Mentally I am still there. The prison is no longer that house – it is my mind. My thoughts. My memories."

Misdiagnosis with BPD

Some of the symptoms of complex PTSD are very similar to those of borderline personality disorder (BPD), and not all professionals are aware of complex PTSD.

As a result, some people are given a diagnosis of BPD or another personality disorder when complex PTSD fits their experiences more closely. Professionals disagree about when it's helpful to diagnose someone with a personality disorder or when another diagnosis or description is better. To find out more see our page on why personality disorders are controversial?

If you're worried that the diagnosis you've been given doesn't fit the way you feel, it's important to discuss it with a mental health professional so you can make sure you're getting the right treatment to help you.

See our pages on borderline personality disorder and personality disorders for more information on these diagnoses.

Our pages on seeking help for a mental health problem provide information on how to make sure your voice is heard, and what you can do if you're not happy with your doctor.

Drawing with the words 'I am enough' on it.

Coping with complex PTSD in the pandemic

"My PTSD is rooted in the abuse I received as a teenager, and I have spent most of my adult life running away from it... I have suffered from anxiety and depression as a consequence."

Read Clare's story

What treatments are there?

The National Institute for Health and Care Excellence (NICE) – the organisation that produces guidelines on best practice in health care – has not yet developed recommendations specifically for complex PTSD. They caution that the existing guidelines for PTSD weren't developed for this kind of diagnosis.

You may find standard treatments for PTSD helpful, but many people with complex PTSD need more long-term, intensive support to recover. As part of your treatment you should also be offered support for other problems you experience, such as depression, drug and alcohol use or dissociation. The treatment you are offered may depend on what's available in your local area.

See our treatment for PTSD page for more about the treatments available, which may be useful for complex PTSD. Or visit our page on self-care for PTSD for tips on how to look after yourself when you have complex PTSD.

We also have a page for friends and family of someone with PTSD, with ideas on supporting someone who is struggling.

This information was published in January 2021. We will revise it in 2024.

References are available on request. If you would like to reproduce any of this information, see our page on permissions and licensing.

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