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  • Writer's pictureMartha Witkowski

What is Complex PTSD (C-PTSD)?

Many people are familiar with the term Post Traumatic Stress Disorder (PTSD) and perhaps even have an image of what they think that looks like in their mind. PTSD is a mental health condition that comes from experiencing a trauma and having lasting impacts of that trauma. These symptoms can look like experiencing nightmares, flashbacks, social withdrawal and isolation, mood swings, or avoiding certain triggers that remind a person of the specific trauma.


Complex trauma is, well, complex. It is harder to diagnosis and harder to pinpoint because it symptomology is not tied to one specific traumatic event. CPTSD is a trauma response to prolonged trauma. This is generally in the form of childhood trauma which is usually from experiencing things like abuse. More common and included in this category is a trauma response to experiencing what we call attachment trauma.


What is attachment trauma?


Attachment trauma occurs when we have an attachment rupture. Simply put, as human beings we are hard-wired to attach to our adult caretakers as infants. There is what we could consider a golden period of attachment, which most professionals would argue occurs in the first 3 years of life (although, we consider it to be most relevant up to age 5 and beyond). When healthy attachment does not occur during this time, attachment rupture occurs instead. This is usually as result of:

  • having an abusive parent

  • having an emotionally unavailable parent (this can be due to mental illness on their part, addiction or alcoholism on their part, OR things like excessive working)


It is an absolutely crucial part of development that we have a caregiver that we connect with. In fact, when we look at research of children who have been through other traumas such as extreme poverty or war, the children who have a healthy attachment and emotional support from adults in those situations are far less likely to develop CPTSD.


How do I know if I have CPTSD?


You are probably reading this because there is something going on that makes you think you may have complex trauma. And if that’s the case, you are probably right. Unfortunately, many individuals with CPTSD struggle for many years to find an accurate diagnosis and instead are misdiagnosed with several other mental health disorders.

Some common misdiagnoses and co-occurring disorders include:

  • anxiety and depression

  • personality disorders (especially Borderline Personality Disorder or BPD)

  • substance use disorders

  • eating disorders


These various diagnoses although treated on their own, are generally in response to, or alongside with C-PTSD.


Most commonly, individuals come to us for therapy when they are experiencing chronic relationship struggles. Problems in relationships are common when suffering from C-PTSD. Remember, this is an attachment trauma at its core, and so it is only natural that this type of trauma would surface in our adult attachments to others. Therefore, unhealthy relationship dynamics and common conflict are common amongst individuals with complex trauma. C-PTSD causes various attachment disorders/types, including anxious or avoidant attachment styles. C-PTSD also shows itself as codependency in adult relationships.


If you are interested to learn about your attachment style, you can take our quiz here


Although not previously recognized as a mental health diagnosis, in 2019 the World Health Organization (WHO) did finally list it in the ICD-11 as a recognized mental health disorder. It is not yet listed in the DSM-5, although, there is a subtype (dissociative PTSD) in the DSM-5 under PTSD that seems to have similar characteristics of complex PTSD. Additionally, many professionals believe that borderline personality disorder is always complex trauma.

Borderline Personality Disorder vs. C-PTSD

One thing that is important to understand is that borderline personality disorder is always trauma based. No one is born with BPD. Therefore, one could argue that BPD is always C-PTSD. Generally speaking, individuals who have been diagnosed with BPD or have BPD traits are suffering from untreated trauma. Many individuals who have a previous diagnosis feel a sense of relief when learning about C-PTSD which many times fits them much better as an overall diagnosis, and to have a better understanding of themselves.

What are the symptoms of C-PTSD?


Complex trauma symptoms vary from person to person. As mentioned above, everyone’s C-PTSD shows up differently depending on what their triggers are from childhood. Some of the misdiagnoses are listed above.


One defining characteristic of C-PTSD is emotional flashbacks. These generally show up in the form of relationship struggles. For example, it is possible that your partner may somehow trigger you in a way that your parent did in childhood. In that moment, you may act differently whether that be more withdrawn, more anxious, more conflict-seeking, or more people-pleasing.


For more information on what are called the 4 F-types and a more comprehensive list of C-PTSD click here.


Can my C-PTSD get better?


There is hope. Many individuals who have complex trauma believe they are damaged for life. While every individual who has trauma is forever changed by that trauma, we all have the ability to grow and thrive. The strongest protective factor and best thing you can do to move forward with processing your trauma so that you are able to heal from it is finding an individual therapist that you are able to connect with and trust. Through this connection, you should feel as though you are in a safe space where exploring these difficult parts of your life are possible. Overtime, you will find that triggers happen less often and with less intensity.


Some professionals recommend CBT or Trauma informed CBT, however, we find that deeper styles of therapy such as attachment-based practices allow for more room to explore deeper emotional processes. Here at Root Counseling, we do attachment-based therapy and this is our highest recommendation for therapy style when it comes to treating C-PTSD. In this therapy style, your relationship with your therapist is absolutely everything. The trust between you and them is crucial to your healing. Through a reparenting process you will be able to access parts of yourself that you need to heal, and, through practicing building trust with another human being, you will also find you are more able to do so in your personal life with others.


In addition to talk therapy, consider a somatic style of healing. Eye movement desensitization and reprocessing (EMDR) is a therapy technique that uses bilateral stimulation to reprocess trauma. In simple terms, we use different techniques such as tapping or eye movement to help your brain recategorize traumas so that you are more easily able to heal from them. You can learn more about this evidence-based practice here


Lastly, love yourself enough to learn more about yourself. It can be really scary to delve into what you may feel are the darkest depths of what makes you you. But sometimes, the only way out is through. And in moving through, you will find the healing you are seeking.


Complex trauma can feel very isolating, but it doesn’t need to. Many individuals have undiagnosed complex trauma, and therefore, many people out there know exactly how you are feeling. You are not alone.


At Root Counseling, all of our therapists conduct therapy from an attachment-based lens and help clients work through their trauma type to develop healthy responses to triggers. If you're interested in setting up an appointment, you can visit our therapists here.

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