There’s power in having a word that can accurately reflect a nebulous, multifaceted human experience.

It’s a kind of power that helps us feel more seen, more mirrored, less alone, more clear.

And so today, believing that there is power in giving something its proper name, I wanted to share a psychoeducational essay with you on the phrase and term Complex Post Traumatic Stress Disorder, otherwise known as C-PTSD.

I want to spend this essay explaining what C-PTSD is (with illustrative examples in symptomatology and also a narrative experience of it), how it develops, and what the pathway to healing and treatment looks like if you identify as having C-PTSD.

The whole goal in today’s essay is to do what the word schadenfreude does: give form and name and clarity to what can often feel like a complex and hard-to-understand inner feeling state.

 

What is C-PTSD?

“You start with a darkness to move through, but sometimes the darkness moves through you.” ― Dean Young

I want to start this essay by explaining that C-PTSD is not a term in the current Diagnostic and Statistical Manual of Mental Disorders (the DSM – the clinical bedrock textbook of the mental health field).

The reasons why it’s not included in the Trauma and Stressor-Related Disorders section of the DSM are beyond the scope of this essay to explain, but I bring this up as folks who experience C-PTSD and who have diagnoses on their charts may be more likely to see Post Traumatic Stress Disorder (PTSD) or Other Specified Trauma and Stressor-Related Disorders appear on their charts.

I bring this up, too, because I professionally do believe that C-PTSD is a long overdue diagnosis that should be in the DSM and I don’t want anyone to feel delegitimized by its current absence in that textbook.

So what is C-PTSD and how does it differ from the other diagnoses that are included in the DSM?

C-PTSD does indeed borrow the majority of the defining symptoms from PTSD but it expands upon that experience in one primary way: PTSD usually occurs after a single traumatic incident whereas C-PTSD usually develops as a result of repeated trauma.

So what does this mean?

It means that the following symptoms – classically associated with PTSD – will likely be experienced with greater intensity, frequency, and duration than with “more straightforward” PTSD and may take a different and more nuanced treatment approach (more on that later in the essay).

Common symptoms of C-PTSD may include:

• Reliving the event(s), involuntarily, intrusively, and recurrently. This can show up as distressing dreams and nightmares, flashbacks, and strong, adverse physiological and psychological reactions when implicit or explicit triggers happen or are perceived.
• Avoiding situations that remind you of the event(s). This can include avoidance (or attempts to avoid) the actual and physical people, places, situations, and events that evoke the traumatic event(s) and it can also include attempts to avoid even thinking about the events or feeling your feelings about the event.
• Distorted, negative beliefs about yourself, others, and the world. Maladaptive beliefs about one’s capacities, safety, and ability to exist in the world may emerge (eg: “No one can be trusted.” “My whole life is ruined now.” I’m fundamentally broken.”)
• Persistent, painful mood states. Feeling states such as shame, horror, fear, anxiety, and guilt become the normative feeling states of the individual who lived through the traumatic event(s) and other feeling states (joy, ease, hope, excitement, etc) may be harder to access.
• Difficulty in relationship with others. Feeling or being estranged, cut off, detached, or generally unsafe, untrusting, and disconnected from relationships in your life.
• Fractured or forgotten memory may occur. The ability to remember, recall and give past events a cohesive narrative may be disrupted.
• A nervous system consistently outside the window of tolerance. This can include hyperarousal (easy startle response, insomnia, muscles unable to relax, feeling “on guard”) or hypoarousal (exhaustion, numbness, feeling disconnected from everyone and everything).
• Self-harming or self-destructive behaviors used to manage intolerable feelings. C-PTSD often presents with co-morbid diagnoses such as eating disorders, alcohol and drug abuse, compulsive addictive behaviors, and even cutting. All of which are often attempts to help the individual feel less of their painful internal state.

(Note: For a full, clinical list of the diagnostic criteria of PTSD included in the DSM, please see here.)

So that’s the clinical checklist, but what does C-PTSD actually feel like?

What does C-PTSD feel like?

“You need to spend time crawling alone through shadows to truly appreciate what it is to stand in the sun.” ― Shaun Hick

When thinking about how to best, narratively describe what C-PTSD and all its attendant symptoms actually feels like, the idiom “tempest in a teapot” is what came to mind, over and over again.

Tempest in a teapot is a phrase meant to describe when something feels very disproportionately large to what actually happened.

This disconnect – from reality and response – as well as the metaphor of a great storm taking place inside of a somewhat fragile shell, sums up what C-PTSD can often feel like for those living it.

With C-PTSD, exaggerated responses to perceived and actual events can feel much more intense.

With C-PTSD, one’s inner life can often feel like a raging, wind-whipped hurricane, all contained in a fragile shell of a body projecting normalcy out to the world.

With C-PTSD, even if the outer life somewhat looks normative, the inner life feels turbulent, exhausting, terrifying, stormy.

But here’s the thing about tempests in a teapot: so often you don’t even know that a storm is brewing inside of one because the “outside” looks so normal.

This leads me to want to reiterate again one of the biggest myths I hear in my work: that you can’t be high-functioning and still live with C-PTSD.

That is not the case at all. I’ve written about this before, but it’s possible to be high-functioning on paper (academics and professionally and financially) and still live with trauma symptoms, or, in this case, C-PTSD symptoms.

Sometimes the teapot with a tempest inside is a very pretty, fancy-looking teapot, but that doesn’t undermine the intensity and severity of the storm inside.

How and Why Does C-PTSD Develop?

“We must embrace pain and burn it as fuel for our journey.” ― Kenji Miyazawa

C-PTSD can develop if an individual is repeatedly exposed to traumatic events and situations.

This can, of course, look like external, systemic events such as living through wars, living in poverty, and/or being a refugee and experiencing displacement, food insecurity, insufficient housing, and safety.

But C-PTSD can also develop in the context of relational trauma, where a child or adolescent experiences abuse and neglect from their caregivers, and/or an adult experienced repeated abuse from their romantic partners.

Whether an externalized event or a relational event, whether the person experiencing it is a child or an adult, what makes the event traumatic is that it eclipses the individual’s subjective ability to cope with the stressor(s).

When this happens, the symptoms of C-PTSD may begin to show as the individual attempts to cope and organize their experience as best they can with their limited resources and supports.

For instance, a young girl who, because of the relational trauma she suffered and with no safe, secure, attuned parent to turn to for comfort, may start to turn to food. Without a safe relational attachment, she begins to attach to food and the seeds of her bulimia journey are sown.

Another example: a boy, having experienced abuse at the hands of his caregivers, may grow up believing that no one can be trusted, relationships are not safe, and may be disposed to react to every perceived and actual slight and conflict with rage and a fighting disposition. He grew up unsafe and powerless, and so he now guards himself greatly from being unsafe and getting hurt again.

C-PTSD and all its attendant symptoms are, in their own way, an individual’s body and mind organizing itself around the trauma and its impacts in the way it knows best to keep the individual safe.

And for a while, the ways that C-PTSD manifests itself can keep someone safe and functioning for some time.

But then, usually, it stops working so well. The safeguards, the symptoms of C-PTSD, that guarded against danger and intolerable feelings in the first place stop working so well.

The young woman’s health is threatened by her compulsive bingeing and purging.

The young man lives in depressive isolation, lonely for lack of any real, connected relationships in his life.

And at this point, when the symptoms of C-PTSD stop working so well, most people tend to seek out help.

And help is absolutely possible if you live with C-PTSD.

What is the treatment for C-PTSD?

“Sometimes our light goes out, but is blown again into instant flame by an encounter with another human being.” ― Albert Schweitzer

For individuals dealing with C-PTSD and the clinicians who work with them, it can be, quite frankly, sometimes hard to identify and understand that what you are dealing with is C-PTSD.

Not only is the diagnosis not included in the DSM as explained earlier, but so often many of the clustered symptoms of C-PTSD overlap with mood and personality disorders and may even be missed if a comorbid disorder (like bulimia or panic disorder) exists, or if a trauma background is dismissed or diminished by either party (again: it is possible to be high-functioning and come from a trauma background and still live with the symptoms).

It’s important if you think that you see yourself in this article or in this concept of C-PTSD, to talk to your therapist about it (or if you don’t have a therapist, to seek a trauma-informed therapist out).

When we shine a light on things as they really are, when we give something its proper name, it gives us a better chance to work with them and to heal them.

Because, in recovering from C-PTSD, there is plenty of work to be done and healing is possible.

Recovery from C-PTSD is and will be, for many, multi-dimensional work as the wounding itself is multi-dimensional.

There’s the relational wounding component and the need for relational healing which, I believe, can happen in the context of a safe, supportive, attuned, and reparative experience with a trained professional (like a therapist) or with a dear friend or securely attached romantic partner.

There is the somatic level of the work, the need to regulate and retrain the nervous system and body that the world is safe and to help it calm down and respond appropriately versus in default.

There is the cognitive level of the work which includes recalling, narrating, and making meaning and sense of memories and history as well as forming and internalizing newer, more constructive beliefs about oneself, others, and the world.

There is the emotional level of the work, learning or relearning emotional regulation, emotional expression, even being able to identify emotions in the body.

And there is, I believe, life skills work that may have been missed or impeded by the complexity of the relational trauma.

Work like managing money wisely, seeking out and nurturing a fulfilling career, practicing self-supporting hygiene and personal care habits, learning the myriad complex logistical skills that can lead to a whole and fulfilled adult life.

The best way, I truly believe, to begin recovering from C-PTSD is to seek out professional support, ideally with a clinician who is well-versed in trauma and C-PTSD.

I also believe that psychoeducation can be a wonderful and helpful tool in the recovery process and so, to that end, I have included some curated resources for you at the end of this essay if you’d like to explore more about C-PTSD, childhood trauma, and recovery.

But, for now, I’d love to hear from you in the comments:

Have you heard the term C-PTSD before? When you read this essay, did you feel seen and validated by how I explained C-PTSD? What is one or two of the biggest tools you’ve used in your own C-PTSD recovery journey?

If you feel so inclined, please leave a comment below so our community of 20,000 blog readers can benefit from your wisdom.

If you would personally like support around this and you live in California or Florida, please feel free to reach out to me directly to explore therapy together.

Or if you live outside of these states, please consider enrolling in the waitlist for the Relational Trauma Recovery School – or my signature online course, Hard Families, Good Boundaries, designed to support you in healing your adverse early beginnings and create a beautiful adulthood for yourself, no matter where you started out in life.

And until next time, please take very good care of yourself. You’re so worth it.

Warmly, Annie

Further Resources

Other articles of mine that may complement this one in your recovery from C-PTSD:

• Dispelling the myth of child abuse.
• How to recover from growing up with a narcissistic parent.
• The playing field wasn’t level to begin with: on childhood trauma and the fruitless comparison game.
• The power of being the black sheep in your family.
• What does it mean to remother yourself and why is it so critical for our growth as women?
• The five healing tasks of the un- and under-parented.
• Yes, sweetheart. You do actually get to grieve this.
• 5 Familiar Experiences When You Come From a Relational Trauma Background.
• 10 Years Later: Reflections On Relational Trauma Recovery Work.