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The term trauma means an overwhelming and shocking event, but if you have been exposed to difficult events over a long period of time, you may have developed complex PTSD. It can be helped and here we describe what it means and how it can be treated.

What is complex PTSD?

Complex post-traumatic stress disorder (C-PTSD) is a form of post-traumatic stress disorder that can develop after experiencing repeated and prolonged traumatic events. It includes symptoms found in PTSD with re-experiencing traumatic events, avoidance of reminders and heightened vigilance but there are also problems with self-perception, where symptoms can show up in emotion regulation, negative self-image and difficulties in relationships.

Complex PTSD can occur in situations such as domestic violence, childhood sexual abuse, war situations or torture. Studies have shown that maybe as high as one in eight of the Irish population has the problem. It is a difficult condition that requires prolonged treatment, but it is treatable.

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Is complex PTSD an official diagnosis?

You can read a lot about complex ptsd on the internet and many people recognise themselves in the description.

The World Health Organization has included complex PTSD in the latest version of the ICD-11 diagnostic manual. Nevertheless, this does not mean that there is no suffering if you have symptoms.

It may take years for the symptoms of complex PTSD to be recognised. Because of this, a child’s development can be affected as they get older.Adults with complex PTSD may lose their trust in people and feel separated from others.

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Symptoms of complex PTSD

In complex PTSD, you have the same symptoms as in simple PTSD, but you have some additional symptoms that mainly relate to your relationship with yourself and others. People suffering from PTSD may experience:

  • Re-experiencing the trauma through nightmares or flashbacks
  • avoidance of feelings, places and situations that remind them of the trauma
  • Impact on thoughts and feelings with numbness, difficulty remembering things, negative feelings such as guilt, shame and anger, as well as impact on self-image and negative thoughts about the world.
  • Overexcitement where there is increased activity in the nervous system, which can lead to insomnia, irritation and difficulty concentrating.

Complex PTSD also has these additional symptoms:

  • More severe problems with self-esteem, self-confidence and a negative self-image. You may feel worthless.
  • Problems with interpersonal relationships where you may have difficulty establishing and maintaining healthy relationships. You may feel powerless if you are reminded of traumatic events. There are also often problems with trust, attachment and social interaction.
  • Changes in emotion regulation which may include problems with impulse control, self-harm or substance abuse as a way of coping with difficulties.

Complex ptsd and relationships

In complex PTSD, the impact on relationships is often significant. If you have experienced prolonged and often repeated trauma, your relationships with others may change, but you may have difficulty with trust and closeness. You may have been in a violent relationship where there was a threat to leave, and in these situations a lot of support is needed from, for example, women’s shelters and social services.

Children who are exposed are in a dependent position in a different way and here a great deal of support and help is needed from both Social Services and healthy adults in the child’s vicinity. Children, but also adults to some extent, tend to shame and blame themselves and it is important to get the right help in order to improve their self-image and build trust. Safe, supportive relationships are important for people with all forms of complex PTSD. It is possible to regain control of your life and have better relationships.

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Complex PTSD treatment

There is little research on complex PTSD but there are some methods that can be helpful. Judith Herman is an American psychiatrist at Harvard Medical School who has worked extensively with severe trauma and has written the book ‘Trauma and recovery‘. She says that long-term counseling is important. This is because longer contact may be needed to rebuild trust in relationships.

Trauma-focused cognitive behavioral therapy or other treatments used for PTSD can also be helpful. It is important to get a coherent narrative of your life and to process memories related to difficult events. It is also important that you have a secure relationship with the therapist, get a grounded sense of reality and develop a stable self-image. So this may take a little longer, but it is possible to feel better.

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If you or someone you know is experiencing the symptoms and feelings described, it may be a good idea to talk to a psychologist or therapist. You can easily book an initial session with one of our experienced staff today to take the first step towards treatment.

12 frequently asked questions about complex ptsd

What is complex PTSD?

Complex post-traumatic stress disorder (C-PTSD) is a form of post-traumatic stress disorder (PTSD) that develops after experiencing repeated and prolonged traumatic events.

How does complex trauma develop?

Complex PTSD can develop in situations such as domestic violence, childhood sexual abuse, war situations or torture. What these situations have in common is the frequent exposure to severe trauma that often lasts for a long time.

What are the most common symptoms of complex PTSD?

The symptoms of complex PTSD include the symptoms of simple PTSD with re-experiencing, avoidance behaviour and heightened vigilance, but there are also difficulties with self-organization that manifest themselves in negative self-perception, difficulties with emotion regulation and problems with interpersonal relationships.

How is complex PTSD diagnosed?

Complex PTSD is not a recognised diagnosis in Ireland, as Ireland adheres to the latest edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), partly due to its overlap with symptoms of PTSD. Until then, you can talk to your therapist or psychologist about your problems and get help to manage your symptoms based on available treatments.

Can complex PTSD be cured?

There is currently little research on treatment for complex PTSD but there are treatments such as trauma-focused cognitive behavioral therapy (CBT), supportive counseling and medication that can help manage symptoms.

How are relationships affected by complex PTSD?

In complex PTSD, the impact on relationships is often significant. If you experience prolonged and often repeated trauma, your relationships with others may change, but you may have difficulty with trust and closeness. You may feel useless and powerless in different situations. It is possible to improve with long-term contact with a therapist or psychologist whom you trust and rely on.

Can personality changes occur after trauma?

If you experience trauma, your thoughts, feelings and behaviors can change so that you act in ways you wouldn’t otherwise. It is possible to get help with this in therapy.

What is the difference between PTSD and complex PTSD?

In complex PTSD you have the symptoms of simple PTSD but you also have additional difficulties with negative self-perception, emotion regulation and interpersonal relating.

Can children have complex PTSD?

Children can suffer from complex PTSD just like adults and it is important to get the right help. This may involve contacting social services if necessary and support from healthy adults close to the child, but also treatment by qualified professionals with extensive experience.

Is complex PTSD related to depression?

Yes, you can have complex PTSD and depression. Many people with complex PTSD also have other mental health problems and may develop problems such as self-harm and substance abuse to cope with their emotions.

Are there many people with untreated complex PTSD?

It is difficult to say how many people have untreated complex PTSD, but about approximately 1 in 8 people have the condition. Among healthcare professionals, about 50% of all patients have complex PTSD so it is common for those who seek help.

How can you seek help?

If you or someone you know is suffering from complex PTSD or trauma, it is important to seek professional help. You can book an appointment with a psychologist or therapist via our website. We make the difficult easier by offering opportunities for online and in-person sessions. If necessary, we can also refer you to specialist care.

Can you get rid of complex ptsd?

It is possible to work through severe trauma and complex PTSD, but it takes some time. You often need a lot of support and a therapist or psychologist who is well versed in the problem and whom you trust and rely on. You cannot undo what has happened, but you can work through it so that it no longer affects you as much in everyday life. Through therapy, you can become better at identifying triggers, managing emotions, and improving your self-confidence and self-image. So it is possible to feel better.

More support for complex PTSD

Even if you have experienced things that have led to complex PTSD, it doesn’t mean you can’t live a good life, but you may need more support. Therapy, friends, family, and organizations and associations can be helpful. It is also important to focus on activities that you enjoy and that feel meaningful.

Getting a coherent life story in therapy can also help you to relate to what you have been through in a way that allows you to focus on the future, where your problems will not be as big an obstacle in your life. Although it can feel uncomfortable, or even overwhelming, therapy has many benefits. It gives you a safe place to express and explore your feelings, which can significantly help the recovery process. It takes strength to take the first step towards recovery.

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Written by Ellen Lindgren

Licensed psychologist

Ellen is a licensed psychologist and has experience mainly in clinical psychology where she has worked with various conditions such as stress, anxiety, depression, insomnia, crises and trauma in primary care and psychiatry. She has also worked with research while studying in the US and with affective disorders and insomnia at Karolinska Institutet, Sweden.