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    The best treatment interventions for complex PTSD

    Published on July 18, 2022

    Most people have likely heard of a condition called post-traumatic stress disorder, a type of anxiety disorder that can occur after a traumatic event, such as the death of a loved one or a natural disaster.

    Although there is much discussion about post-traumatic stress disorder (PTSD) in many circles, there is little discussion around Complex – PTSD (sometimes referred to as C-PTSD) despite the conditions being closely -related.

    Complex post-traumatic stress disorder

    Complex post-traumatic stress disorder or complex PTSD develops from repeated or chronic trauma over months or years, unlike PTSD, which often results from a single event trauma.

    What are the causes of C-PTSD?

    Experts say that C-PTSD develops as a result of long-term or ongoing trauma.

    There are various life circumstances and events that can trigger complex trauma.

    However, researchers say the most prevalent cause of C-PTSD occurs in young children who experience abuse by their parents or caregivers, the people they are supposed to trust most in the world.

    Other causes

    There are various other causes of C-PTSD or complex trauma, including:

    • Being a prisoner of war
    • Being exposed to war over a long period, such as living in a war-torn area
    • Ongoing physical, sexual or emotional abuse
    • Chronic childhood neglect
    • Slavery
    • Abandonment
    • Sex trafficking and exploitation

    Complex PTSD symptoms

    WRM PTSD Lack of Sleep

    Since the symptoms of PTSD and C-PTSD can share similar features – it might be pertinent to outline the signs and symptoms of both conditions as shown below.

    PTSD symptoms

    The symptoms of PTSD can be similar to those experienced in C-PTSD; however, complex trauma includes an additional cluster of symptoms.

    Post-traumatic stress disorder can occur due to exposure to or learning about a significantly traumatic event.

    People may experience PTSD symptoms due to witnessing or experiencing a terrifying or shocking event such as being involved in a car accident or witnessing a physical assault.

    Traumatic events

    PTSD symptoms typically get grouped into four categories; avoidance, intrusive thoughts, adverse changes in thinking or mood, and changes in emotional and physical reactions to things.

    Broadly, the symptoms of PTSD include:

    • Flashbacks – include reliving a traumatic event as if it were happening again
    • Upsetting nightmares or dreams about the event
    • Extreme emotional and physical reactions to something that reminds you of the traumatic event
    • Unwanted, recurring thoughts or distressing memories related to the traumatic event
    • Avoiding people, places or activities that remind you of the event
    • Avoiding talking or thinking about the traumatic event
    • Negative thoughts about yourself, other people, or the future
    • Feeling detached from family and friends
    • Hopelessness about the future
    • Trouble maintaining close relationships
    • Memory problems – including not remembering important details about the traumatic event
    • Feeling emotionally numb and empty
    • Being easily startled or always being on edge or jumpy
    • Trouble sleeping
    • Angry outbursts or aggressive behaviour
    • Risky behaviour such as substance abuse or dangerous driving
    • Overwhelming shame or guilt

    When to speak to a doctor or mental health professional


    If you think you are experiencing the symptoms of PTSD, you must speak to a doctor or medical professional who can advise you on what to do next.

    If you have upsetting or disturbing thoughts related to a traumatic event that are severe or persist for over a month, make sure you speak to your doctor or mental health professional.

    Seeking early treatment intervention for PTSD might help you feel better sooner and may prevent the condition from worsening.

    Complex PTSD symptoms

    While complex post-traumatic stress disorder may occur in adults, it is usually observed in children and adolescents.

    As mentioned, PTSD and C-PTSD share similar symptoms; however, complex trauma includes additional features – C-PTSD is a response to ongoing, repeated trauma that lasts for months or years.

    Complex trauma often occurs in individuals who have experienced ongoing trauma in their early life.

    Moreover, C-PTSD can be significantly complex, especially if the trauma survivor is still in contact with the abuser or if they were harmed by a trusted family member or caregiver in childhood.

    Developmental trauma

    It might be easier to explain complex trauma as a developmental trauma, which is widely different from PTSD that generally (but not always) develops in adulthood.

    The trauma paradigm states that children who experience ongoing physical, sexual or emotional abuse and neglect are at higher risk of developing C-PTSD.

    The traumatised brain

    Dr Sarah Ullman describes complex trauma as:

    ”A developmental trauma, also known as complex trauma denoted as C-PTSD, is a psychological trauma that is incurred during childhood and is developmental such that the traumatic event or events were of sufficient severity to alter the trajectory of the child’s development as a consequence of structural and neurochemical impairment (The Traumatised Brain, Dr Sarah Ullman, LLC).

    Traumatic stress disorder C-PTSD

    Dr Sarah Ullman states that C-PTSD is often ”diagnostically indistinguishable from another mental disorder called Borderline Personality Disorder”.

    Studies show that Borderline Personality Disorder patients also have C-PTSD, which can be passed down intergenerationally in historical and collective trauma (The Traumatised Brain; Dr Sarah Ullman, LLC).

    Symptoms of C-PTSD


    C-PTSD involves the symptoms of PTSD but with an additional cluster of features, such as:

    • Changes in consciousness – people with C-PTSD often experience changes in consciousness such as dissociation (feeling detached from themselves and their surroundings) and amnesia (problems with memory)
    • Negative self-perception – C-PTSD may cause a person to experience guilt, shame, self-loathing and a negative self-image. People with C-PTSD often report feeling different to others or inadequate in some way.
    • Troubled relationships – Many people with C-PTSD have troubled relationships; some may have unhealthy associations or remain in abusive relationships for too long. Others struggle with trust and social withdrawal.
    • Distorted perceptions or ideas about the abuser – Complex trauma may result in people having a destructive or unhealthy relationship with their abuser, while others become preoccupied with revenge.
    • Emotional dysregulation – People with C-PTSD often struggle to regulate emotions such as depression, anger or suicidal thoughts. Individuals may engage in risky behaviours such as unprotected sex, reckless driving or substance abuse.
    • Loss of systems of meaning – Those with C-PTSD may experience a loss of religious beliefs, core values or faith and instead have a sense of despair and hopelessness.

    Diagnosing C-PTSD

    While C-PTSD is not currently a diagnosis in the diagnostic and statistical manual of mental disorders (DSM-5), C-PTSD includes additional clusters of symptoms that may help mental health professionals make an accurate diagnosis.

    Complex trauma is likely present when an individual exhibits the following symptoms:

    • Negative self-image or self-concept
    • Interpersonal difficulties
    • Emotional dysregulation

    Specific behaviours linked to C-PTSD

    Researchers noted specific behaviours that might be associated with complex trauma, including:

    • Self-harm – or self-injury – means a person may hurt themselves purposefully due to emotional or mental distress.
    • Avoidance behaviours – is when a person stays away from people, places or activities that remind them of a traumatic event. For example, creating distance from people or things that may induce upsetting emotions is emotional avoidance.
    • Substance misuse – Studies show a profound connection between trauma and substance misuse. Several theories suggest that people use drugs and alcohol as coping mechanisms to numb emotional pain.

    Treatment and psychological interventions

    Although treatment for C-PTSD is similar to PTSD, treatment usually lasts longer with complex trauma.

    Treatment interventions for complex trauma may include one therapy or a combination of therapies, such as:

    Eye Movement Desensitization Reprocessing (EMDR)

    EMDR is a pioneering trauma treatment that involves eye movements and psychotherapy combined.

    Treatment initially focuses on building a foundation of trust between therapist and patient and teaching eye movement techniques.

    EMDR allows trauma survivors to briefly concentrate on a specific traumatic memory and process it until it no longer causes disturbance or distress.

    Processing difficult memories

    depression treatment and hope

    EMDR aims to help trauma survivors process a traumatic memory that didn’t get fully processed during the event.

    During a crisis, your mind and body are too busy trying to help you survive whatever is happening in your environment, which in many ways, is good as the stress response known as ‘fight, flight and freeze’ takes over.

    Stored trauma

    However, sometimes disturbing or traumatic memories get trapped in the body and become stored in places like the brain and the central nervous system.

    The above might explain why people often experience random PTSD symptoms such as intrusive flashbacks or nightmares.

    Such symptoms might be due to saved memory material suddenly discharging, which might be the brain’s way of trying to process what happened in the past.

    EMDR helps to release trapped memories

    People with trapped trauma usually require the help of an EMDR therapist who can help them relieve or discharge any trapped trauma in the mind and body.

    In other words, after processing a problematic memory with EMDR therapy, you will still remember and have access to the memory. Still, it will not cause you as much distress or disturbance.


    Recovering from addiction

    Psychotherapy, sometimes called talk therapy, is an effective trauma treatment.

    However, the recommendation is to find a trauma-informed psychotherapist when seeking a therapist.

    Psychotherapy’s primary goal is to help you identify and understand destructive thoughts and behaviours, develop coping mechanisms that lead to a healthier lifestyle, and decrease your symptoms.

    Other trauma therapies

    Other effective treatments for complex trauma include:

    Coping methods

    Other alternative methods of coping with complex trauma may include journaling, practising mindfulness, seeking a solid support system, including friends and family, attending church, and joining support groups.

    Contact White River Manor

    We specialise in treating trauma and other mental health disorders, including depression, anxiety and substance abuse at White River Manor.

    We understand that reaching out to a mental health professional can be daunting for many, but getting proper treatment and support will help you feel better sooner.

    Contact our team today if you need a friendly person to talk to or think you may have any of the symptoms mentioned in this article.

    Helpful resources

    About Giles Fourie

    Giles Fourie is the director and co-founder of White River Manor. He is dedicated to providing the best care for clients seeking recovery from substance abuse, anxiety, depression, or co-occurring disorders.