Complex PTSD, or CPTSD, is a diagnosis for a pattern that can follow prolonged or repeated trauma. It includes all the core features of PTSD, plus severe difficulty managing emotions, a persistently negative view of oneself, and lasting difficulty in relationships.
Key points
- Complex PTSD adds three lasting difficulties to the core features of PTSD: managing emotions, a negative view of self, and relationships.
- It is a diagnosis in ICD-11, the World Health Organization's current classification. It is not in DSM-5-TR, the American manual.
- It usually follows prolonged or repeated trauma that was hard to escape, such as childhood or domestic abuse.
- Symptoms overlap heavily with borderline personality disorder, and how cleanly the two can be told apart is still argued over.
Symptoms
- Difficulty managing emotions: anger or irritability that is hard to settle, numbness, dissociation.
- A negative view of oneself: persistent beliefs about being diminished, defeated or worthless; deep shame or guilt.
- Difficulty in relationships: persistent difficulty keeping relationships going, avoiding closeness, finding trust hard.
- Plus the core PTSD symptoms: re-experiencing, avoidance, and a persistent sense of current threat.
Causes and risk factors
- Events that were prolonged, repeated, or hard to escape: torture, prolonged domestic violence, repeated childhood abuse, neglect.
- Not everyone exposed to prolonged trauma develops complex PTSD, and there is no way to predict who will.
Treatment
- Individual trauma-focused CBT more than a month after a traumatic event, and EMDR more than three months after non-combat trauma.
- For complex needs, NICE recommends extra time to develop trust, by increasing the length or number of sessions.
- Venlafaxine or an SSRI can be considered for adults who prefer drug treatment; antipsychotics only for severe unresponsive symptoms.
When to speak to a professional
- Symptoms are affecting work, study or family life, especially more than a month after a traumatic event.
- You are dissociating often enough to be unsafe, using alcohol or drugs to cope, or having thoughts of harming yourself.
If you need help now: Samaritans, call 116 123, free, 24/7. Shout, text SHOUT to 85258. NHS 111, then choose the mental health option. Call 999 if anyone is in immediate danger.