What Is Complex Trauma? Symptoms, Examples, and How to Heal (2022)

Complex trauma has a deep impact on the nervous system. By understanding how it develops, you can better understand how to treat it.

Most of us have a chapter in our lives we’d rather forget. Whether it’s a devastating breakup or the death of a loved one, many of us have felt the sting of heartbreak that comes with being a human.

But for those who live with complex trauma, the memories don’t just live in the past. They live in the present moment, too.

For a long time, complex trauma wasn’t well understood. Now researchers estimate that more than 3% of people meet the criteria for complex trauma, also called complex post-traumatic stress disorder (C-PTSD), in the United States. This is about the same percentage as people with traditional PTSD.

Trauma, the kind you’ve likely heard of, can develop after a distinct traumatic experience. It occurs when the brain and body are so overwhelmed that they have a hard time easing out of “fight, flight, or freeze” mode and coming back into a relaxed state.

Trauma may refer to a single incident, while complex trauma refers to a series of traumatic events that take place over a long period of time, like months or years.

First introduced in the 1990s by Judith Lewis Herman, PhD, complex trauma has a lot in common with the classic symptoms of PTSD, such as:

  • feeling anxious
  • having flashbacks
  • avoiding circumstances that remind you of the traumatic events

In addition, complex trauma can:

  • distort your sense of self
  • make it difficult to control your emotions
  • cause relationships challenges

How does complex trauma develop?

(Video) Complex PTSD (CPTSD) and Strategies to Cope

When you experience a traumatic event, it activates the limbic system in the brain. This “fire alarm” shuts down all nonessential systems (rest, digestion, sleep) and floods your body with stress hormones, like cortisol, so you can prepare for fight, flight, or freeze.

Once the danger passes, your parasympathetic nervous system provides inner calm, otherwise known as your “rest and digest” mode.

At this point, normal cognitive function returns, and you can go back to your day with relatively few side effects, perhaps only feeling a little jittery for a while, or a bit on edge.

But for people who live with complex trauma, this balance doesn’t quite return all the way.

The limbic system stays engaged most of the time. It’s a coping mechanism to try and stay safe in the face of ongoing adversity. It’s an experience of constantly being in survival mode, or on edge.

Over time, it becomes a “new normal” for the brain and body.

In his book, “The Body Keeps the Score,” trauma expert Bessel van der Kolk, MD, describes how trauma literally becomes trapped in the body and the brain rewires itself. These lasting effects create symptoms of complex trauma.

This bodily state of your nervous system being on “high alert” can affect your thoughts, actions, and relationships.

Some symptoms of complex trauma include:

  • flashbacks
  • lapses in memory
  • difficulty regulating emotions
  • hyperarousal, or being “on alert”
  • dissociation or lapses in memory
  • depersonalization or derealization
  • sleep disturbances or nightmares
  • struggling in interpersonal relationships
  • low self-esteem or negative self-perception
  • avoiding people, places, or scenarios that upset you

Somatic (bodily) symptoms, like unexplained headaches or an upset stomach, are also common with complex trauma. Since the body is under chronic stress, it can lower your immune system and lead to a range of chronic health conditions.

Examples of complex trauma

(Video) 6 Hidden Signs of Complex PTSD (cPTSD) | MedCircle

Complex trauma can arise in any situation where you feel an ongoing sense of fear, horror, helplessness, or powerlessness over an extended period of time, with the perceived or actual inability to escape.

It usually stems from trauma you experienced in childhood, though it can develop from trauma in adulthood as well.

Some possible causes of complex trauma include:

  • sexual abuse or incest
  • ongoing physical or emotional abuse
  • chronic neglect or abandonment
  • medical abuse or medical trauma
  • torture or being held captive
  • enmeshment or engulfment trauma
  • parentification (children taking on adult rules)
  • human trafficking
  • genocide campaigns
  • living in a war zone or area of civil unrest

Everyone’s story is unique — and so is their trauma. What works for one person may not work for another.

Also, keep in mind that what works at one point in time may not work later on down the line.

The great news is, as more is uncovered about complex trauma, more trauma treatment therapies are emerging as well. The goal of each treatment option is to provide a corrective emotional experience for healing.

Here are some effective therapies for complex trauma:

  • Cognitive behavioral therapy (CBT). In this form of therapy, you explore the relationship between your thoughts, feelings, and behaviors. Once you become aware of the connections, you may be able to change your actions.
  • Eye Movement Desensitization and Reprocessing (EMDR). With this treatment, you’re guided with gentle tapping (or tones) to reprocess traumatic events and form new beliefs around them.
  • Internal family systems (IFS). With this approach, you learn how to integrate the different parts of your personality into one whole “Self” to reprocess traumatic events in a way that can no longer harm you.
  • Somatic (body) therapies. Since trauma lives in the limbic area of the brain and not the frontal cortex (the part of the brain that talks in therapy), somatic therapies or body-centered therapies can teach your body that it does not have to be prepared for trauma all the time.
  • Dialectical behavioral therapy (DBT). This approach can be effective for people who live with borderline personality disorder (BPD), which has many overlapping symptoms with complex trauma. In this treatment approach, you learn mindfulness, radical self-acceptance, and distress tolerance.

There’s also a link between complex trauma and substance use as a way to cope with symptoms. If you’d like to cut back on using drugs or drinking alcohol, support is available.

Look for a local 12-step program, like Alcoholics Anonymous (AA) or Narcotics Anonymous (NA), or SMART Recovery.

(Video) 12 signs you might be suffering from PTSD

Here are some additional resources for support:

Recovery from complex trauma can be a gradual process. But having a range of tools and self-care strategies can make the process a whole lot easier.

It’s a good idea to keep a few deep breathing exercises up your sleeve for those tough moments. This is a direct way to let your body know that you’re safe. Try these:

  • 4-7-8 breathing: Inhale for 4 seconds, hold for 7 seconds, exhale for 8 seconds.
  • Box breathing: Inhale for 4 seconds, hold for 4 seconds, exhale for 4 seconds, hold for 4 seconds.
  • Alternate nostril breathing: Place your right thumb over your right nostril. Inhale and exhale eight times through your left nostril. Repeat on the other side.

A consistent mindfulness practice can help too. A 2018 study involving veterans with PTSD found that a regular meditation practice can reduce symptoms of trauma. Yoga has shown similar results, showing that both can be an effective complement to talk therapy.

It might help to access trauma-informed yoga sessions, where the yoga instructor is aware that trauma can be stored in the body, and that some body movements can trigger emotional reactions. They can help you navigate these reactions in a healing way.

Here are some lifestyle adjustments that can make complex trauma more manageable:

  • do tai chi or dance
  • journal your feelings
  • spend time in nature
  • eat a nutritious, balanced diet
  • sleep around 8 hours a night
  • “shake off” tough emotions by literally shaking your arms or your body to release tension
  • talk through your triggers with loved ones
  • practice progressive relaxation techniques
  • exercise five times a week, even if only a few minutes a day
  • try using the flashback halting protocol to manage flashbacks

Complex trauma may feel like it’s taking over your life. Perhaps you feel alone in your experience, wondering if it will ever feel like less of a big deal.

(Video) Complex Trauma: Understanding and Treatment - Diane Langberg

Two thoughts: You’re not alone, and it will get better.

One of the best things you can do is to continue to educate yourself about complex trauma. You may be able to find a healing book club or support group in your area.

You can also join one online, like this one through the C-PTSD Foundation.

Here are some books to add to your reading list:

Also, here’s a great TED Talk on how childhood trauma affects health over a lifetime.

Finally, know that you will get through this. You’ve survived 100% of your worst days so far and, just like the other tough times, this will pass too.

You’re stronger than you know.

Suicide prevention

Complex trauma may increase your risk of self-harm. If you’re considering self-harm or suicide, help is available right now:

(Video) Integrative Treatment for Trauma and Complex PTSD

FAQs

Can you heal complex trauma? ›

Complex post-traumatic stress disorder is entirely treatable with the right combination of compassion, patience, and trust. Someone can work to disempower the trauma that cripples them and practice positive coping skills in the context of well-rounded support and guidance.

How long does it take to treat complex trauma? ›

Recovery from C-PTSD is a long slog, with survivors sometimes requiring more than ten years of psychotherapy for resolution. There are some C-PTSD programs offered through residential psychiatric programs that offer specialized treatment for this disorder and accompanying dissociative disorders.

How do you calm Cptsd? ›

Relaxation techniques such as meditation, deep breathing, massage, or yoga can activate the body's relaxation response and ease symptoms of PTSD. Avoid alcohol and drugs. When you're struggling with difficult emotions and traumatic memories, you may be tempted to self-medicate with alcohol or drugs.

How long does Cptsd take to heal? ›

Some people recover within 6 months, while others have symptoms that last much longer. In some people, the condition becomes chronic. A doctor who has experience helping people with mental illnesses, such as a psychiatrist or psychologist, can diagnose PTSD.

How do you know you've healed from trauma? ›

"Looking forward to the future and being able to create a renewed sense of self. The traumatic event is no longer the primary event in one's life. Therefore, being able to reconnect with oneself and embrace the future without feeling overwhelmed is also a positive sign in trauma healing," Dr Parul told HT.

How does a person with complex PTSD Act? ›

If you have complex PTSD you may be particularly likely to experience what some people call an 'emotional flashback', in which you have intense feelings that you originally felt during the trauma, such as fear, shame, sadness or despair.

What are the 17 symptoms of complex PTSD? ›

The 17 Most Common Symptoms of PTSD
  • Vivid Flashbacks. A PTSD flashback is when you relive your traumatic experience, and it feels like it is happening all over again right in that moment. ...
  • Nightmares. ...
  • Self-Isolation. ...
  • Depression. ...
  • Substance Abuse. ...
  • Emotional Avoidance. ...
  • Feeling on Edge, or Hyperarousal.
1 Feb 2021

What happens if complex PTSD is left untreated? ›

Untreated PTSD can cause permanent damage to the brain due to the person living in a hyper-aroused state. Patients with PTSD may have a co-occurring mental health issue such as one of the following: Depression. Anxiety disorder.

What are three unhealthy coping skills for PTSD? ›

Ginger Mercer: How Treatment Helps Me
  • Substance abuse. Taking a lot of drugs or alcohol to feel better is called substance abuse. ...
  • Avoiding others. ...
  • Staying always on guard. ...
  • Avoiding reminders of the trauma. ...
  • Anger and violent behavior. ...
  • Dangerous behavior. ...
  • Working too much.

How do you snap out of PTSD episodes? ›

How to break out of a PTSD episode
  1. Breathe deeply. When anxiety strikes, we often take quick, shallow breaths, which can exacerbate the symptoms of an intense PTSD episode. ...
  2. Talk yourself down. ...
  3. Get moving. ...
  4. Connect with others. ...
  5. Manage your PTSD through healthy living. ...
  6. Get treatment for PTSD at Alvarado Parkway Institute.
28 Jun 2018

When is complex PTSD triggered? ›

Complex PTSD triggers

For example, it could be something you picked up with one of your five senses when the trauma was taking place. Some common triggers include: specific physical sensations or pain. intense emotions like fear, sadness, or anger.

Do you ever heal from CPTSD? ›

There is no cure for PTSD, but some people will see a complete resolution of symptoms with proper treatment. Even those who do not, generally see significant improvements and a much better quality of life.

What is the best medication for complex PTSD? ›

What are the best medications to treat PTSD?
  • Sertraline (Zoloft) is FDA-approved for treating PTSD, and it's one of the most common medications prescribed for this condition. ...
  • Paroxetine (Paxil) is the only other FDA-approved medication for PTSD. ...
  • Fluoxetine (Prozac) is used off-label for treating PTSD.
6 Jul 2021

How do you process trauma on your own? ›

Coping with traumatic stress
  1. Lean on your loved ones. Identify friends or family members for support. ...
  2. Face your feelings. It's normal to want to avoid thinking about a traumatic event. ...
  3. Prioritize self-care. Do your best to eat nutritious meals, get regular physical activity, and get a good night's sleep. ...
  4. Be patient.
30 Oct 2019

What should you not say to a complex PTSD? ›

10 Things Not To Say To Someone With CPTSD
  • It wasn't that bad, was it?
  • That happened in the past, why are you still upset?
  • Calm down.
  • You're overreacting. It's been years now. Get over it.
  • You're too much right now.
  • What's wrong with you?
  • I don't believe anything you're saying.
  • You are crazy. You are dramatic.

Is complex PTSD permanent? ›

CPTSD is a serious mental health condition that can take some time to treat, and for many people, it's a lifelong condition.

What happens when trauma is triggered? ›

Initial reactions to trauma can include exhaustion, confusion, sadness, anxiety, agitation, numbness, dissociation, confusion, physical arousal, and blunted affect.

Does crying heal trauma? ›

It won't rid you of PTSD and your fears, but let your tears flow and you'll maybe feel a little better afterwards. 'Crying for long periods of time releases oxytocin and endogenous opioids, otherwise known as endorphins. These feel-good chemicals can help ease both physical and emotional pain.

Where is guilt stored in the body? ›

Guilt, Fishkin says, is associated with activity in the prefrontal cortex, the logical-thinking part of the brain. Guilt can also trigger activity in the limbic system. (That's why it can feel so anxiety-provoking.)

What does complex trauma look like in adults? ›

Symptoms of complex PTSD

feelings of worthlessness, shame and guilt. problems controlling your emotions. finding it hard to feel connected with other people. relationship problems, like having trouble keeping friends and partners.

What is living with complex PTSD like? ›

Living with complex PTSD can trigger intense emotional flashbacks, making it difficult to control emotions, leading to severe depression, suicidal thoughts, or difficulty managing anger.

How does complex PTSD affect daily life? ›

Complex PTSD can make it difficult to trust others. Some people stay in unhealthy relationships because the situation is familiar. If their trauma involved abuse, their feelings about their abuser may be complicated. Or they may obsess about their abuser or focus on revenge.

Can trauma change your personality? ›

A person may experience a change in their demeanor after experiencing a traumatic situation or witnesses an unpleasant event. These behavioral changes may be caused by a mental health condition, such as: Anxiety: Anxiety occurs when a person feels nervous or uneasy about a situation.

What is worse PTSD or CPTSD? ›

The difference between CPTSD and PTSD is that PTSD usually occurs after a single traumatic event, while CPTSD is associated with repeated trauma. Events that can lead to PTSD include a serious accident, a sexual assault, or a traumatic childbirth experience, such as losing a baby.

What does PTSD do to the brain? ›

PTSD causes your brain to get stuck in danger mode. Even after you're no longer in danger, it stays on high alert. Your body continues to send out stress signals, which lead to PTSD symptoms. Studies show that the part of the brain that handles fear and emotion (the amygdala) is more active in people with PTSD.

Can complex PTSD cause brain damage? ›

According to recent studies, Emotional Trauma and PTSD do cause both brain and physical damage. Neuropathologists have seen overlapping effects of physical and emotional trauma upon the brain.

Is complex PTSD a chemical imbalance? ›

Experiencing a traumatic event can cause life-long anxiety problems, called posttraumatic stress disorder. Researchers now show that people with posttraumatic stress disorder have an imbalance between two neurochemical systems in the brain, serotonin and substance P.

What should you not do with PTSD? ›

Communication pitfalls to avoid

Stop your loved one from talking about their feelings or fears. Offer unsolicited advice or tell your loved one what they “should” do. Blame all of your relationship or family problems on your loved one's PTSD. Give ultimatums or make threats or demands.

How serious is complex trauma? ›

Complex trauma describes both children's exposure to multiple traumatic events—often of an invasive, interpersonal nature—and the wide-ranging, long-term effects of this exposure. These events are severe and pervasive, such as abuse or profound neglect.

What does complex trauma feel like? ›

Those with complex PTSD often experience intense emotions, which are sometimes inappropriate. Besides anger and sadness, they may feel like they're living in a dream. They may have trouble feeling happy. Relationship problems.

Is complex trauma a mental illness? ›

Complex post-traumatic stress disorder (complex PTSD, sometimes abbreviated to c-PTSD or CPTSD) is a condition where you experience some symptoms of PTSD along with some additional symptoms, such as: difficulty controlling your emotions. feeling very angry or distrustful towards the world.

Is complex trauma and PTSD the same thing? ›

The main difference is that PTSD is generally related to a single event or series of events within a short period of time, while complex PTSD is related to a series of events that repeatedly occurred over an extended period of time.

What does complex trauma do to a person? ›

Emotional Responses

Children who have experienced complex trauma often have difficulty identifying, expressing, and managing emotions, and may have limited language for feeling states. They often internalize and/or externalize stress reactions and as a result may experience significant depression, anxiety, or anger.

What is the best medication for complex PTSD? ›

What are the best medications to treat PTSD?
  • Sertraline (Zoloft) is FDA-approved for treating PTSD, and it's one of the most common medications prescribed for this condition. ...
  • Paroxetine (Paxil) is the only other FDA-approved medication for PTSD. ...
  • Fluoxetine (Prozac) is used off-label for treating PTSD.
6 Jul 2021

What are the 17 symptoms of complex PTSD? ›

The 17 Most Common Symptoms of PTSD
  • Vivid Flashbacks. A PTSD flashback is when you relive your traumatic experience, and it feels like it is happening all over again right in that moment. ...
  • Nightmares. ...
  • Self-Isolation. ...
  • Depression. ...
  • Substance Abuse. ...
  • Emotional Avoidance. ...
  • Feeling on Edge, or Hyperarousal.
1 Feb 2021

Why does CPTSD happen? ›

Post-traumatic stress disorder (PTSD) can develop after a very stressful, frightening or distressing event, or after a prolonged traumatic experience. Types of events that can lead to PTSD include: serious accidents. physical or sexual assault.

What can cause CPTSD? ›

What can cause PTSD?
  • being involved in a car crash.
  • being raped or sexually assaulted.
  • being abused, harassed or bullied - including racism, sexism, homophobia, biphobia or transphobia, and other types of abuse targeting your identity.
  • being kidnapped, held hostage or any event in which you fear for your life.

What is an example of complex trauma? ›

Examples of complex trauma

sexual abuse or incest. ongoing physical or emotional abuse. chronic neglect or abandonment. medical abuse or medical trauma.

What happens when complex PTSD is triggered? ›

Complex PTSD triggers

For example, it could be something you picked up with one of your five senses when the trauma was taking place. Some common triggers include: specific physical sensations or pain. intense emotions like fear, sadness, or anger.

What happens if complex PTSD is left untreated? ›

Untreated PTSD can cause permanent damage to the brain due to the person living in a hyper-aroused state. Patients with PTSD may have a co-occurring mental health issue such as one of the following: Depression. Anxiety disorder.

Can trauma change your personality? ›

A person may experience a change in their demeanor after experiencing a traumatic situation or witnesses an unpleasant event. These behavioral changes may be caused by a mental health condition, such as: Anxiety: Anxiety occurs when a person feels nervous or uneasy about a situation.

What does a complex PTSD episode look like? ›

Survivors with Complex PTSD have a very difficult time with emotions -- experiencing them, controlling them, and for many, just being able to comprehend or label them accurately. Many have unmanaged or persistent sadness, either explosive or inaccessible anger, and/or suicidal thoughts.

What should you not say to a complex PTSD? ›

10 Things Not To Say To Someone With CPTSD
  • It wasn't that bad, was it?
  • That happened in the past, why are you still upset?
  • Calm down.
  • You're overreacting. It's been years now. Get over it.
  • You're too much right now.
  • What's wrong with you?
  • I don't believe anything you're saying.
  • You are crazy. You are dramatic.

Videos

1. DBT-PTSD – A New Treatment for Complex PTSD
(McLeanHospital)
2. 6 ways to heal trauma without medication | Bessel van der Kolk | Big Think
(Big Think)
3. Childhood Trauma and the Brain | UK Trauma Council
(Anna Freud NCCF)
4. 6 Signs of Complex Post Traumatic Stress cPTSD Diagnosis in the ICD-11
(Doc Snipes)
5. Complex Trauma in Children | Counselor Toolbox Episode 116
(Doc Snipes)
6. Complex PTSD Treatment and Updates from ICD - Marylene Cloitre
(APA Division 56 - Trauma Psychology)

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