While many of us have heard of posttraumatic stress disorder (PTSD) and understand that it comes from experiencing traumatic events, fewer people are familiar with the unique causes and effects of complex PTSD (CPTSD).

To shed light on what makes CPTSD unique, let’s take a look at what it is, what the signs and symptoms are, and how it’s treated.

What Is CPTSD?

CPTSD is a specific form of PTSD that stems from repeated, ongoing abuse from someone you trust and depend on. While most cases of CPTSD are rooted in childhood abuse, it can come from any situation where someone is repeatedly harmed and feels powerless against their abuser.

The most common situations that can lead to CPTSD include:

• Domestic violence
• Childhood abuse
• Sexual abuse
• Sex trafficking and slavery
• Living in captivity
• Being part of a cult 

These prolonged, traumatic experiences can rewire how someone’s nervous system responds to stress. Over time, someone may feel as if they’re in a constant state of danger, even if there isn’t an immediate threat present.

Read our related article to learn about the different types of trauma responses.

PTSD vs. CPTSD

PTSD can stem from a wide range of traumatic events, including car accidents, assaults, or combat. These traumatic events are usually isolated or temporary, and they cause someone to be on constant alert for similar events. 

What makes CPTSD unique is that it comes from ongoing trauma involving an abuser and a victim. Where PTSD is rooted in a single, specific event, CPTSD is rooted in a repeated pattern of traumatic abuse.

As a result, someone with CPTSD may not only experience the symptoms that come with PTSD, but they may also experience additional symptoms that affect their self-identity and how they relate to others.

Borderline Personality Disorder vs. CPTSD

Although borderline personality disorder (BPD) and CPTSD are two distinct mental health disorders, there are several similarities in both their symptoms and their underlying causes.

Both disorders are often rooted in prolonged, interpersonal trauma. This leads to the development of similar symptoms, such as emotional dysregulation, depression, and harmful coping mechanisms.  

However, there are some key differences between BPD and CPTSD when it comes to how they relate to others. For example, many of the interpersonal difficulties that come with BPD are due to a strong fear of abandonment, which is the telltale sign of BPD. In those with CPTSD, their interpersonal issues are often the result of a lack of trust and staying connected to others.   

Read our related guide for more information on borderline personality disorder.

Signs and Symptoms of CPTSD

Those with CPSTD will usually share many of the common signs and symptoms of those with PTSD, including:

• Trauma triggers
• Hypervigilance
• Flashbacks and nightmares
• Intrusive thoughts
• Avoidance behaviors
• Anxiety and depression

In addition to these signs and symptoms, CPTSD also comes with unique symptoms in the form of lowered self-esteem, emotional dysregulation, and relationship difficulties. This is due to the repeated nature of their trauma between them and their abuser.

Lowered Self-Esteem

Unlike PTSD, CPTSD stems from traumatic events that are deeply personal and specific to the victim. This type of trauma can drastically distort how someone views themselves and how they believe others view them. 

It’s common for someone with CPTSD to have low self-esteem and experience negative self-beliefs, such as:

• Shame
• Guilt
• Worthlessness
• Flawed
• Powerlessness
• Inadequacy

These self-esteem issues are usually a result of an abuse victim internalizing their trauma and rationalizing their abuse by putting the blame on themselves. They may believe that there is something fundamentally wrong with themselves, and they can’t trust their own thoughts, beliefs, and emotions. 

Emotional Dysregulation

Repeated, prolonged trauma can significantly disrupt the brain’s ability to regulate emotions, especially if the trauma was experienced during childhood. This is often due to being in a constant state of stress, where someone must suppress their feelings and emotions to mitigate the damage of their ongoing abuse.

Emotional dysregulation in those with CPTSD can manifest as:

• Sudden mood swings
• Uncontrollable panic
• Emotional numbness
• Dissociation
• Difficulty identifying emotions

It’s common for those suffering from CPTSD to develop unhealthy coping mechanisms to deal with their uncontrollable emotions. They may do this through substance abuse, self-harm, or excessive eating.

Read our related article for more information on trauma and emotional dysregulation.

Relationship Difficulties

Since CPTSD comes from traumatic, abusive relationships, it can be extremely difficult for someone with CPTSD to feel safe and secure around others. This can lead to several long-lasting relationship difficulties, including:

• Believing others are inherently dangerous
• Developing unhealthy attachment styles
• Putting up emotional walls
• Exacerbating interpersonal conflicts
• Frequently misunderstanding others or feeling misunderstood
• Frequently feeling detached from others

Long after the abusive relationship has ended, someone with CPTSD can still carry deep emotional scars that remind them of the pain and fear that they once endured. This not only makes it hard for someone with CPTSD to get close to others, but it also prevents others from getting close to them.

Read our related article to discover the different types of avoidant attachment styles.

Treatment for Complex PTSD

Although CPTSD can have a deep and profound impact on nearly every aspect of someone’s life, they can experience a drastic improvement in their symptoms by seeking professional help and treatment.

Treating CPTSD usually involves a variety of trauma-focused therapies. The most common therapies used to treat CPTSD are cognitive behavioral therapy (CBT), dialectal behavior therapy (DBT), and eye movement desensitization and reprocessing therapy (EMDR).

Cognitive Behavioral Therapy (CBT)

CBT is a common form of psychotherapy that helps someone bridge the gap between their thoughts, emotions, and behaviors.

Those with CPTSD often have negative perceptions about themselves and the world around them as a result of their prolonged trauma. This often leads to troubling emotions that fuel self-destructive behaviors.

CBT helps those with CPTSD  challenge their negative perceptions, which in turn, leads to positive emotions and healthier behaviors. It can help them regain their sense of control over their lives and teach them how to cope with trauma triggers in a healthier way.

Dialectal Behavior Therapy (DBT)

DBT was initially developed for individuals with BPD, but it can also be used to help those with any type of emotional dysregulation, including those with CPTSD. It teaches people how to accept and work with their intense emotions, rather than fight them.

The four pillars of DBT are:

• Mindfulness—helps you bring yourself to the present and be deliberate with your thoughts and behaviors
• Interpersonal Effectiveness—helps you respect and love yourself in order to maintain healthy relationships
• Emotional Regulation—helps you understand overwhelming emotions and how to manage them effectively
• Distress Tolerance—helps you navigate the difficulties that previously lead to unhealthy patterns

DBT can be particularly helpful to those with CPTSD, as it helps them build emotional resilience and respond to stress without becoming overwhelmed or shutting down.

Eye Movement Desensitization and Reprocessing (EMDR)

EMDR is a unique form of trauma therapy that helps someone release their repressed trauma in a controlled, healthy way. 

EMDR uses the mechanics of rapid eye movement (REM) sleep to help people relive and correctly process traumatic memories. Bilateral stimulation is also used to relax the mind and body, while also opening necessary pathways to memory storage.

This form of therapy releases the trauma that’s stored in the brain and nervous system, which allows someone to integrate and heal from their past without being overwhelmed by it.

Break Free From Your Trauma

Reclaiming your life from the burden of trauma can be difficult to navigate, but you don’t have to do it alone.

At Sequoia Behavioral Health, our team of mental health experts can help you heal from your trauma and live life on your own terms. We take a holistic approach to healing that not only addresses your CPTSD symptoms, but also resolves your trauma at its core.

Reach out today to get in contact with our team of compassionate professionals and take the first steps on your healing journey.