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 hostile 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
- 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 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 that nothing was going to end the distress I was feeling, experiencing more than 10 flashbacks a day of the abuse I suffered as a child. 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 What are flashbacks? and tips for coping with flashbacks for more information.)
What causes complex PTSD?
Some people develop PTSD after a single traumatic event, or it can be the result of experiencing a number of stressful situations over a longer period of time.
You are particularly 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.
The types of traumatic events that can cause complex PTSD include:
- torture, kidnapping or slavery
- ongoing domestic violence or abuse
- childhood abuse, neglect or abandonment
- being forced to become a sex worker
- repeatedly witnessing violence or abuse
- being a prisoner of war.
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. Memories I don't wish to bury but that are in my mind more than I can control.
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. It's also possible to experience both complex PTSD and BPD at the same time.
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.)
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. The treatment you are offered may depend on what's available in your local area. (See our treatments page for more about seeking help for PTSD or complex PTSD.)
This information was published in May 2017. We will revise it in 2020.