complex trauma

Many of us are familiar with post-traumatic stress disorder (PTSD), a condition that occurs following a traumatic event such as sexual abuse, a natural disaster, combat, or domestic violence.[1] Trauma comes in a number of forms, namely Acute, Chronic, and Complex. Acute trauma refers to the experiencing of trauma symptoms following a single traumatic event, where symptoms show up within weeks of the experience and last for at least three days.[2] Chronic trauma is what we usually consider PTSD (Post-Traumatic Stress Disorder). This can come on following a diagnosis of acute trauma (Acute Stress Disorder, or ASD).

The third type – complex trauma – is also PTSD. It is usually referred to as C-PTSD. While chronic and complex trauma are similar, C-PTSD is usually diagnosed when the experience of traumatic events happened repeatedly over an extended period of time, especially when the perpetrator of the traumatic experience was someone close to the individual, such as a parent or caregiver who abused or neglected their child.[3]

What causes Complex Trauma?

The causes of C-PTSD can be obvious or subtle. Repeated physical or sexual abuse by a family member or carer, or sustained domestic violence are just some examples[4]. In such cases, the individual becomes overwhelmed, paralysed with fear, and sees no means of escape.

A less obvious but no less destructive cause could be childhood neglect, where a person did not feel heard or validated as a child. This can lead to C-PTSD because they were not loved and accepted for who they are, meaning early childhood needs were not met.

What are the Symptoms of C-PTSD?

Recent guidelines outlined by the World Health Organisation (WHO) regarding C-PTSD symptoms are as follows[5]:

  •  Persistent perception of threat

The individual feels that threat is always present or looming. There may actually be a threat, or it could just be imagined, but the feeling is the same. Due to this persistent feeling, individuals will be constantly hypervigilant and have an exaggerated startle response.

  • Re-experiencing the trauma

Any reminder of the trauma (known as a trigger) creates a vivid emotional flashback of the traumatic events. The present moment is seen through the lens of the past and individuals feel that their previous experiences are happening again in the here and now.

  • Avoidance of triggers

Individuals will go to great lengths to avoid exposure to triggers (reminders of the trauma). This could involve withdrawing from friends, using substances to mask certain feelings and sensations, or dissociating when faced with a situation that reminds the person of their past experiences.

The next three common symptoms of Complex PTSD (C-PTSD) are known as ‘disturbances in self-organisation’. These include:

  • Poor emotional regulation

Any strong emotion may lead the individual to overreact, observable as extreme mood swings. A person with C-PTSD might move from anger to hysterical sadness to an outburst of rage in a short amount of time.

  • Negative feelings About oneself

Sufferers of C-PTSD may feel bad about themselves and exhibit low self-worth, with a deep feeling of emptiness. The sense is that one is damaged beyond repair and hope is lost.

  • Relationship Difficulties

When C-PTSD emerges from experiences of neglect or abandonment, a person may feel inherently unlovable. Relationships, both romantic and platonic, are difficult to maintain as the individual finds it hard to trust others, and may sabotage the relationship, abandoning one’s partner before they get abandoned. This is usually an effort to achieve a sense of control over one’s life.

C-PTSD and Addiction

If the person chooses to use substances for the purposes of self-medication against the symptoms of C-PTSD, their body will build up a tolerance to the effects. As a result, more of the chosen substance is needed to achieve the desired effects. When more is taken, in higher doses and at a higher frequency, there is a significantly increased likelihood of dependence, where normal daily functioning seems impossible without drugs or alcohol.

Substance dependence can be challenging to treat but it is especially difficult to treat when it co-occurs with complex trauma. Further, dependence is likely to lead to addiction, where stopping intake of the substance causes highly undesirable withdrawal symptoms, which can vary depending on the substance used and for how long it was used.

 The Benefits of Therapy for Complex Trauma

It is important for sufferers of C-PTSD to understand and accept there is no overnight fix for their condition. Therapy is available and begins the healing process by supporting clients in developing a sense of autonomy, shedding light on their experiences, and by using tools and techniques to reduce the severity of symptoms.

  • Safety

In therapy, which should only be carried out by a professional, licensed therapist, clients are compassionately guided in exploring healthy ways to feel safe in the world. Sufferers of C-PTSD are at a high risk of substance abuse and other destructive coping behaviours, so it is important and even essential to develop healthier ways of coming into a sense of safety. Furthermore, for therapy to be in any way effective, the client must feel safe and supported.[6]

  • Healthy Relationships

Therapists attune to C-PTSD clients and offer a compassionate ear. This cultivates a healthy, reparative relationship, which may be lacking in the client’s life. The feeling of being heard and validated on a regular basis can be a rich point of focus for clients and can be further examined in sessions.

  • Emotional Regulation

Therapy can offer clients effective tools and techniques for better emotional regulation. Very often, those suffering with C-PTSD engage in unhealthy coping methods when faced with triggers. In therapy, healthier and more effective coping strategies can be learned and applied.

C-PTSD is a complex condition to both live with and to treat, but treatment options are available. When a person is suffering from C-PTSD, the symptoms themselves and the potential onset of other conditions can take a serious toll on one’s overall health and well-being. Treatment should be sought as soon as possible to give the person a chance at full recovery.


Get in touch

If you have a client, or know of someone who is struggling to heal from psychological trauma, including Complex Trauma,  reach out to us at Khiron Clinics. We believe that we can improve therapeutic outcomes and avoid misdiagnosis by providing an effective residential program and out-patient therapies addressing underlying psychological trauma. Allow us to help you find the path to realistic, long-lasting recovery. For information, call us today. UK: 020 3811 2575 (24 hours). USA: (866) 801 6184 (24 hours).





[1] Mann SK, Marwaha R. Posttraumatic Stress Disorder. [Updated 2020 Jul 6]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan-. Available from:

[2] Center for Substance Abuse Treatment (US). Trauma-Informed Care in Behavioral Health Services. Rockville (MD): Substance Abuse and Mental Health Services Administration (US); 2014. (Treatment Improvement Protocol (TIP) Series, No. 57.) Chapter 3, Understanding the Impact of Trauma. Available from:

[3] Giourou, Evangelia et al. “Complex posttraumatic stress disorder: The need to consolidate a distinct clinical syndrome or to reevaluate features of psychiatric disorders following interpersonal trauma?.” World journal of psychiatry vol. 8,1 12-19. 22 Mar. 2018, doi:10.5498/wjp.v8.i1.12

[4] Giourou, Evangelia et al. “Complex posttraumatic stress disorder: The need to consolidate a distinct clinical syndrome or to reevaluate features of psychiatric disorders following interpersonal trauma?.” World journal of psychiatry vol. 8,1 12-19. 22 Mar. 2018, doi:10.5498/wjp.v8.i1.12

[5] Cloitre, M., Hyland, P., Bisson, J., Brewin, C., Roberts, N., Karatzias, T. and Shevlin, M., 2019. ICD‐11 Posttraumatic Stress Disorder and Complex Posttraumatic Stress Disorder in the United States: A Population‐Based Study. Journal of Traumatic Stress, 32(6), pp.833-842.

[6] Firestone, L., 2016. The Importance Of The Relationship In Therapy. [online] Psychology Today. Available at: <> [Accessed 24 October 2020].

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