Complex PTSD Symptoms & When to Seek Help

Understanding Complex PTSD (C-PTSD)

What Is Complex PTSD?

Complex post-traumatic stress disorder (C-PTSD) is a severe, multifaceted condition that can develop after prolonged or repeated trauma. 

While PTSD is often associated with single-event traumas – such as an incident, combat-related experience, or natural disaster – C-PTSD typically follows long-term interpersonal trauma (for example, chronic childhood abuse or ongoing domestic violence, or repeated exposure to high-stress environments like military service).

Can C-PTSD Develop at Any Age?

Yes, the symptoms of C-PTSD can occur at any age.

The symptoms of C-PTSD in childhood and in adulthood. Often, severe, traumatic events like domestic violence, childhood abuse, or an ongoing event such as deployment can trigger the symptoms.

Is C-PTSD the Same as PTSD?

No, the two are not the same.

While both C-PTSD and PTSD are linked to trauma and psychological stress, the difference between the symptoms of PTSD and C-PTSD is the length of the trauma, if it’s repeated trauma, and the severity of the traumatic event. 

Individuals with PTSD often develop symptoms after experiencing a one-time traumatic event like a natural disaster. 

Symptoms of PTSD include:

• Flashbacks
• Nightmares
• Hypervigilance

While individuals with C-PTSD experience the symptoms associated with PTSD, they also experience additional symptoms, including other complexities such as:

• Emotional challenges
• Relationship difficulties

While the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) doesn’t recognize C-PTSD as a diagnosis, it does acknowledge that some individuals can have severe symptoms of PTSD.

Is C-PTSD Common Among Veterans?

Yes, C-PTSD is common among veterans, particularly those who experienced prolonged or repeated combat, military sexual trauma, or other service-related chronic stressors.

Research indicates C-PTSD is common among veterans – sometimes exceeding 80% in studies of veterans already diagnosed with PTSD. C-PTSD, which often arises from chronic severe trauma, is associated with greater functional impairment than PTSD. 

Veterans may experience C-PTSD differently than civilians due to repeated deployments, exposure to morally injurious events, tight unit bonds, and the stresses of military culture and reintegration; these factors can shape symptoms and needs. 

Appropriate care for veterans is important because it can help reduce symptoms, improve emotion regulation and relationships, and lower risks of depression, substance use, and suicidal thoughts – helping veterans reclaim daily functioning, purpose, and connection. 

At Ocean View, we recognize that combat and repeated service‑related trauma can cause C‑PTSD, and we partner with TriWest to ensure service members, retirees, and their families have access to care options and benefits.

What Does a C-PTSD Episode Look Like?

Those who are experiencing a C-PTSD episode can experience dissociation from reality or detachment from their environment.

Understanding and recognizing a C-PTSD episode is vital for intervention and support from loved ones. 

Some of the common symptoms of C-PTSD include:

• Intense feelings of panic or anxiety
• Emotional flashbacks or persistent, intrusive memories of traumatic experiences
• Crushing sense of despair or sadness
• Profound sense of irritability or emotional sensitivity (emotional dysregulation)

Ocean View Psychiatric Health Facility provides evidence-based care that helps you understand and recognize the symptoms of C-PTSD. 

We understand that when individuals can recognize their symptoms, they can use coping skills to manage them in their daily life. Knowing and understanding the symptoms of C-PTSD increases your ability to explain to your loved ones the support you need.

Causes of C-PTSD

What Causes Complex PTSD Symptoms?

The International Classification of Diseases (ICD-11) states that C-PTSD results from a series of extremely threatening events.

The traumatic events associated with C-PTSD are usually prolonged or repetitive, and escaping from these events can be dangerous or impossible. 

A few examples of repetitive or prolonged traumatic situations are:

• Torture
• Childhood physical or sexual abuse
• Prolonged domestic violence
• Combat exposure or repeated military deployments

Traumatic events often create stress that changes the brain’s structure and chemistry. 

Trauma is connected with permanent changes in key parts of the brain, including the:

• Amygdala: This part of the brain processes emotions, especially fear. It evaluates sensory information and decides on reactions (fight-or-flight)
• Hippocampus: The section of the brain mainly responsible for memory and learning.
• Prefrontal cortex: This part of the brain is responsible for functions like expressing your personality and controlling social behavior.

In some neuroimaging studies, it is shown that the brain changes in individuals with C-PTSD are more severe than in those with PTSD.

What Is the Root Cause of Complex PTSD?

While there are several causes of C-PTSD, the root cause is prolonged or repeated trauma that can last for several weeks, months, or years.

C-PTSD is often the result of a series of traumatic events or one prolonged event that occurs during an individual’s childhood. However, severe traumatic events that happen during an individual’s adulthood can also cause C-PTSD. For example, combat or serious training accidents can cause C-PTSD.

C-PTSD symptoms can be triggered by traumatic memories and other factors, such as:

• Environmental surroundings: Your environment can produce stimuli that can bring back past trauma. Certain locations, smells, or sounds can create severe anxiety or negative thoughts.
• Relationship issues: Relationships are complex and can trigger a C-PTSD episode. Often, those with C-PTSD find trusting and being intimate with their loved ones is difficult.
• Internal thoughts: Feelings of shame or harmful memories can cause an episode. 

Is C-PTSD Caused by a Brain Injury?

No, a brain injury is not the cause of C-PTSD.

C-PTSD commonly develops from prolonged or repeated exposure to chronic trauma, like childhood physical and sexual abuse. While a traumatic brain injury (TBI) can occur during a traumatic event or similar events, C-PTSD is a psychological condition linked to psychological and emotional issues.

Symptoms of C-PTSD

What Are Some Common Symptoms of Complex PTSD?

Common symptoms of C-PTSD include psychological behaviors such as:

• Feeling guilt
• Feelings of shame
• Self-blame
• Anger 
• Extreme sadness

Additionally, individuals who are experiencing psychological symptoms can have troubles in their interpersonal relationships, which can lead to:

• Social isolation
• Withdrawal from enjoyable activities
• Feelings of loneliness

Individuals with C-PTSD can also have physical symptoms such as:

• Increased heart rate 
• Headaches
• Muscle tension
• Fatigue (exhaustion)
• Gastrointestinal issues

Sometimes, individuals may feel like they’re in an uncontrollable cycle of harmful psychological and physical symptoms, which can make them feel emotionally distressed. Whether the symptoms are psychological or physical, they can take a toll on overall well-being. 

An effective strategy to help reduce the physical and psychological toll that the symptoms of C-PTSD can take is to discuss your feelings with a mental health professional and learn healthy coping mechanisms. 

At Ocean View Psychiatric Health Facility, our mental health professionals can help you to understand how complex trauma affects a person’s life.

​What Do Complex PTSD Symptoms Look Like in Adults?

Adults who experience the symptoms of C-PTSD often have the same symptoms as those with PTSD.

Often, individuals don’t know that the feelings they are experiencing are signs of C-PTSD. 

Being able to recognize the following symptoms can increase early intervention:

• Intrusive and recurrent dreams or thoughts
• Physical and mental triggers or reminders of the traumatic event
• Flashbacks
• Memory loss
• Social isolation

To help manage an acute psychiatric crisis, the mental health professionals at Ocean View guide individuals to recognize when they are feeling:

• Detachment
• Recklessness
• Hypervigilance
• Thoughts of self-harm

With appropriate care, an individual can effectively manage their symptoms and maintain their overall well-being.

​What Are Complex PTSD Dissociation Symptoms?

Individuals experiencing C-PTSD dissociation symptoms will feel detached from their thoughts, memories, feelings, or sense of self.

Dissociation is a natural response to a prolonged traumatic event or a series of traumatic events. 

The main symptoms connected to C-PTSD include:

• Feeling detached from yourself
• Feeling like the world is unreal or dreamlike
• Unexplained gaps in memory
• Disconnection from your emotions or feelings of emptiness
• Re-experiencing traumatic events like they’re happening in the present

Since everyone is different, the symptoms can be more intense or frequent from one person to the next. Furthermore, they are triggered by varying past trauma. In some cases, symptoms can even be triggered by media content related to war or anniversaries of traumatic events.

​What Are Some Complex PTSD Physical Symptoms?

Individuals with C-PTSD can have difficulty with sleep, fatigue, and physical illness, such as headaches.

The effects of prolonged or repeated trauma can take a toll on your physical health. It’s not uncommon for individuals with C-PTSD to experience several physical symptoms that C-PTSD causes. 

A few examples of the health problems connected with C-PTSD include:

• Persistent exhaustion that doesn’t improve with sleep
• Insomnia, disrupted sleep, and nightmares
• Heightened state of alertness
• Heart palpitations, shaking, or sweating
• Chronic pain
• Digestive issues
• Lightheadedness or nausea

Recognizing and understanding the symptoms and their link with C-PTSD can improve your physical and mental well-being.

​Is There a Connection Between Complex PTSD and ADHD Symptoms?

Yes, there is a connection between the symptoms of ADHD and C-PTSD.

Both conditions’ symptoms can include challenges with:

• Attention
• Impulsivity
• Emotional regulation

Since the symptoms can overlap, some individuals are misdiagnosed with one or the other. For this reason, you must seek a diagnosis from a professional who is trained in diagnosing mental health disorders. Once you have a diagnosis of C-PTSD, you can learn about your type of trauma.

What Are Complex PTSD Somatic Symptoms?

Common somatic symptoms of C-PTSD can include digestive issues, fatigue, chronic pain, and muscle tension.

Somatic symptoms of C-PTSD are your body’s response to prolonged or a series of traumatic events. The symptoms severely affect your daily life and disrupt your physical health. However, with psychiatric care, you can begin to learn how to manage and recognize the symptoms.

​Is There a Connection Between Complex PTSD Symptoms and Childhood Trauma?

Yes, there is a link between childhood trauma and C-PTSD.

Childhood traumatic events, such as chronic neglect or abuse, can disrupt a child’s emotional development. This disruption can lead to long-term psychological issues, which include C-PTSD. 

Often, children and adults who are diagnosed with C-PTSD have difficulties in their:

• Relationships
• Self-identity
• Emotional regulation

Some individuals may find it difficult to form healthy attachments to others or maintain stable relationships. 

Do Complex PTSD Symptoms Progress?

Yes, the symptoms of C-PTSD can progress over time.

The symptoms can continue and progress, especially if an individual is in a situation where they’re continuously experiencing the trauma or if they’re left untreated. Since the symptoms can evolve, individuals who experience them often have a range of symptoms, varying in intensity and type. 

What Are the Common Triggers for Complex PTSD Symptoms?

C-PTSD common triggers can include certain sights, sounds, and intense emotions.

Other triggers can include:

• Anniversaries of the traumatic events
• Specific situations that create negative thoughts or feelings
• Sensations

The triggers of C-PTSD symptoms can call up deep, emotional wounds from prolonged or a series of traumatic events, such as loud noises (fireworks) or crowded areas that are similar to past places that remind people of traumatic experiences. Whether the triggers are internal or external, understanding and recognizing them is crucial for your mental well-being.

C-PTSD and Relationships

How Does C-PTSD Impact Relationships?

The symptoms of C-PTSD can hurt relationships.

Individuals who have C-PTSD often have difficulties in their interpersonal relationships. For example, individuals who have experienced prolonged or repeated physical or sexual abuse may find it difficult to connect with people because they struggle to trust others or build relationships that include intimacy. 

Can Someone With C-PTSD Have a Relationship?

Yes, those with C-PTSD can have relationships.

While individuals with C-PTSD can have relationships, they may find it challenging to overcome their emotional dysregulation, intimacy, or trust issues. 

Those who are in a relationship with an individual with C-PTSD can help their loved one by being patient, understanding, and providing support when needed.

How Hard Is C-PTSD to Live With?

For many individuals, living with C-PTSD can be extremely challenging.

The symptoms of C-PTSD include harmful and persistent feelings that can disrupt day-to-day life, making it hard to manage emotions and stress. Additionally, it can be difficult to maintain personal and social relationships.

Untreated C-PTSD

What Happens if C-PTSD Goes Untreated?

If the symptoms of C-PTSD are left untreated, they are more likely to worsen over time.

When C-PTSD is left untreated, an individual can develop severe emotional distress, difficulties in maintaining stable relationships, and may withdraw from social situations. 

For example, if left untreated, an individual can experience:

• Severe depression
• Anxiety
• Suicidal thoughts
• Thoughts of self-harm
• Substance abuse

What Are the Short-Term Effects of C-PTSD?

Many individuals with C-PTSD can develop psychological issues like anxiety, flashbacks, and the inability to control their emotions.

Individuals can also experience cognitive, physical, and behavioral symptoms, including:

• Impulsivity
• Difficulty concentrating
• Memory issues

What Are the Long-Term Effects of Complex PTSD?

Those diagnosed with C-PTSD often develop chronic mental health issues and physical health problems.

Often, an individual with C-PTSD can have the following health risks or issues:

• Chronic pain
• Heart disease issues
• Depression

Diagnosis of C-PTSD

How Is Complex PTSD Officially Diagnosed?

Trained mental health professionals perform a comprehensive evaluation to diagnose C-PTSD.

Mental health providers evaluate the symptoms that are occurring to see if they are related to chronic trauma and disruptions in self-organization or emotional regulation.

How Can You Tell if You Have Complex PTSD?

Determining if you have C-PTSD can be difficult, but you can look for symptoms like relationship issues, flashbacks, and emotional difficulties.

The most effective way to determine if you have C-PTSD is to consult with a mental health professional.

Can You See Complex PTSD on a Brain Scan?

Yes, you can see neurological changes in your brain structure and function connected with C-PTSD on a brain scan.

Scans, such as CTs, can detect changes in your brain’s amygdala, hippocampus, and prefrontal cortex.

Help for C-PTSD Symptoms

Are C-PTSD Symptoms Hard to Manage?

Yes, Complex PTSD (C-PTSD) symptoms can be considered difficult to manage because they stem from long-term, chronic trauma and often affect a person’s core identity, emotional stability, and relationships.

How Does Ocean View Help with C-PTSD Symptoms?

Certain symptoms of C-PTSD such as anxiety, depression and insomnia are addressed using medication.

How Can You Help Your Loved One?

You can help a loved one with C-PTSD by providing a safe and stable place in their life.

When you provide social support, are a good listener, and encourage and support their decision to seek appropriate help, you can help them feel understood and valued.  It’s also important to let them know that you are there for them and respect their boundaries.