Complex PTSD Awareness

C-PTSD Awareness
Signs and Symptoms of Chronic Trauma

© Madelyn Griffith-Haynie, CTP, CMC, ACT, MCC, SCAC
from the Self-Health Series

One of the factors of PTSD is that some people seem to have severe cases while others do not — that some soldiers were more vulnerable to extreme trauma and stress than others.

As an explanation for some of these complications it has been suggested and researched that there is a form of PTSD that is called DESNOS [Disorders of Extreme Stress Not Otherwise Specified]. Another term is C-PTSD or Complex-PTSD. ~  Allan Schwartz, LCSW, Ph.D


Relatively Recent Distinction & Debate

Many traumatic events that result in PTSD are of time-delimited duration — for example, short term military combat exposure, rape or other violent crimes, earthquakes and other natural disasters, fire, etc.  However, some individuals experience chronic trauma that continues or repeats for months or years at a time.

There is currently a debate in the Mental Health community that centers around the proposed need for an additional diagnosis. Proponents assert that the current PTSD diagnosis does not fully capture the core characteristics of a more complex form – symptoms of the severe psychological harm that occurs with prolonged, repeated trauma.

Let’s DO It

One of the longest-standing proponents is Dr. Judith Herman, a professor of clinical psychiatry at Harvard University Medical School. She is well respected for her unique understanding of trauma and its victims, and has repeatedly suggested that a new diagnosis of Complex PTSD [C-PTSD] is needed to distinguish and detail the symptoms of the result of exposure to long-term trauma.

She asserts that cases involving prolonged, repeated trauma may indicate a need for special treatment considerations:

Individuals who develop PTSD as the result of chronic or long-term exposure to trauma frequently report additional and more all-encompassing symptoms.

In addition to a tendency to be revictimized, these differential characteristics include psychological fragmentation, the disappearance of a sense of safety and trust, dramatic changes in the ability to adapt to stressful events, and a severely diminished sense of self-worth.

The most dramatic difference seems to be that there is a loss of a coherent sense of self.

Let’s NOT

Apparently, because the results from the DSM-IV Field Trials indicated that 92% of individuals with C-PTSD also met diagnostic criteria for PTSD, Complex PTSD was not added as a separate classification, upheld in the DSM-5*, published in 2013.

Although it is not a diagnosis in the DSM-5*, it is supposedly planned for inclusion in the ICD-11,** now pending release in 2018.

The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, the APA’s  classification and diagnostic tool (American Psychiatric Association)
**ICD-11: The International Classification of Diseases, maintained by the World Health Organization (WHO)

In the United States at present, the official term in use that describes the set of symptoms that would characterize a formal diagnosis of C-PTSD is Disorders of Extreme Stress Not Otherwise Specified (DESNOS).

Related Post: Whatever Happened to DESNOS?

I vote YES

Throughout my own Series of PTSD articles, I will use the term Complex-PTSD [C-PTSD], not only because I want to support its approval in the next iteration of the DSM, but because I consider it much more descriptive – even though I fully realize that, at present, it is not an “official” diagnosis, merely a subtype of “regular” PTSD.

The DSM notwithstanding, many trauma therapists already conceptualize complex trauma as different from simple PTSD. Not that there is anything simple about coping with even one traumatic event! ~Dr. Kathleen Young

Remember – links on this site are dark grey to reduce distraction potential
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In support of a more full-featured distinction

Helping Psychology said, “PTSD victims tend to be in a continuous state of heightened alertness. The trauma that precipitates the disorder essentially conditions them to be ever-ready for a life threatening situation to arise at any moment … But the continuous releases of brain chemicals that accompany this reaction time – and their inability to control when this heightened reactivity will occur – take psychological and biological tolls on PTSD victims over time.” ~ quote found HERE

Where there have been multiple traumas, an individual is likely to remain in a state of hypervigilance, sometimes experiencing anxiety attacks intense enough to induce a delusional state where the effects of related traumas overlap, exacerbating the original symptoms repeatedly.

How are PTSD and C-PTSD different?

Unlike PTSD that results from a single or short-term traumatic incident, Complex Post Traumatic Stress Disorder results from chronic or long-term exposure to emotional trauma over which a victim has little or no control and from which there is little or no hope of escape.

The resulting impact may be so complete that it can affect every element of the sufferer’s life. Unlike the trigger-specific reactivation of PTSD, C-PTSD can remain active in every environment to which he or she is exposed.

C-PTSD is also characterized by attachment disorder, particularly the pervasive insecure, or disorganized-type attachment,[21] which some trauma specialists believe throws it into the category of borderline personality disorder [BPD].

The findings of a Study published in the European Journal of Psycho-Traumatology, Volume 5, 2014, supported the validity of C-PTSD as distinct and distinguishable from BPD, identifying key symptoms to aid clinicians tasked with performing differential diagnoses and treatment planning.

CLINICAL RESEARCH ARTICLE: Distinguishing PTSD, Complex PTSD, and Borderline Personality Disorder

STILL, the debate is far from over

The term PTSD itself has only been in the public consciousness since its inclusion in the DSM, following a great deal of back and forth quibbling before it gained more wide-spread acceptance as a legitimate diagnosis following the 1980 publication of the DSM-III.

Before publication, the symptoms of what is now called Post Traumatic Stress Disorder were referred to by a number of assorted terms: most often ‘shell shock’, ‘combat fatigue’, ‘traumatic neurosis’, ‘battered woman syndrome’ and ‘rape trauma syndrome’.

Unfortunately, until PTSD became a legitimate diagnosis, it was even more frequent that symptoms were dismissed or ignored by many clinicians – the very “doctors down the street” that sufferers paid for help and understanding.

IN ANY CASE, one of the goals of treatment for both the proposed C-PTSD and the extant “standard” PTSD is to help patients gain a sense of control over their emotions and over their lives.

However, C-PTSD symptoms are reported to be more persistent and difficult to treat, which will, most likely, affect recovery time considerably.

Why Recovery Time estimates are so important

How many times have you wondered when something would be over?  Kids are famous for asking repeatedly, “Are we there yet?”

Isn’t it easier to keep a metaphorical stiff upper lip about the sound of the dentist’s drill when you have some idea of how long you are going to have to endure it?

Wouldn’t you worry that something was terribly wrong should a broken bone take considerably longer to heal than projected?

  • So it only makes sense that a trauma victim’s anxiety would be heightened, worsening their symptoms, if he or she saw little improvement within the time frame they were led to expect.
  • But there’s another, even more important reason to differentiate between PTSD and C-PTSD recovery estimates: disability payments.

At present, there are a number of mental health professionals and research analysts who like to throw around the term “malingering” to describe individuals who don’t recover as rapidly as they believe they should, according to their cross-referenced statistical summaries — in particular, veterans receiving disability payments.

Those statistics are gathered from studies designed, in my opinion, in a manner that displays a degree of confirmation bias.

Confirmation bias is a term describing the unconscious tendency of people to favor information that confirms their hypotheses or closely held belief systems.

Individuals display confirmation bias when they selectively gather, note or remember information, or when they interpret it in a way that fits what they already believe.

To support their suspicions and assertions, these meta-analyses compare recovery statistics in an “apples to oranges” fashion that I believe is tantamount to accusing veterans who take longer to heal of disabilities fraud.

They cite comparisons between recovery statistics of PTST resulting from repeated and chronic exposure to trauma (including individuals with a symptom profile likely complicated by TBI — war veterans, for example), to those resulting from a one-time exposure.


A more nuanced approach to a PTSD differential diagnosis would go a long way toward explaining to those who seem to want to balance the budget on the backs of our Veterans how cruel and inaccurate their malingering point of view really is.

Related Article: 11 Reasons Combat Veterans with PTSD are Being Harmed
(Statistical gathering in Psychology Today article – be SURE to read the angry responses from vets!)

As I said in my own long comment response to the article above:

Is it psychologically consistent with the behavior of the majority of individuals who would risk death and dismemberment to fight for comfortable American lives that they would actually prefer to return to subsist on meager disability payments if they were ABLE to do more for themselves?
ALL veterans deserve better, and America owes them far more than uncontested disability payments.

NOT just Vets

Veterans of combat are not the only individuals vulnerable to PTSD or C-PTSD. We are all susceptible to suffering lingering after-effects of exposure to violence and trauma of many types.  It is beginning to be documented that the young seem to be especially vulnerable, and that children who have experienced trauma grow up to have a heightened likelihood of developing C-PTSD as a result of exposure to trauma in adulthood.  Repeated exposure to trauma leaves welts.

Risk Factors for C-PTSD Development

According to the National Center for PTSD individuals likely to develop Complex PTSD include those who have experience long term or chronic trauma in any of the following situations:

  • Concentration camps or Prisoner of War camps
  • Long-term domestic violence, and/or long-term child physical
    and/or sexual abuse
  • Prostitution brothels
  • Organized child exploitation rings

The following, more comprehensive list comes primarily from the Out of the Fog website.   The list on their site included more detail, along with a list of a great many more  traumatic situations that might result in C-PTSD:

  • long term imprisonment and torture
  • domestic or childhood emotional, physical or sexual abuse
  • repeated violations of personal boundaries
  • long-term objectification and/or exposure to gaslighting & false accusations
  • entrapment, kidnapping, slavery and/or enforced labor
  • long-term exposure to inconsistent, push-pull, splitting (in the black and white thinking sense) or alternating “go away” raging & manipulative “don’t leave me” behaviors
  • long-term care-taking of mentally ill or chronically sick family members
  • long term exposure to crisis conditions (including repeated deployment)

The above site also describes the thoughts of the traumatized in an evocative manner:

When people have been trapped in a situation over which they had little or no control at the beginning, middle or end, they can carry an intense sense of dread even after that situation is removed. This is because they know how bad things can possibly be. And they know that it could possibly happen again. And they know that if it ever does happen again, it might be worse than before.

It makes sense that their nervous systems would be left in a state of hypervigilance – where the “threat detection” mechanism in the brain remains on high alert.

This can easily leave an individual in an enhanced state of sensory sensitivity accompanied by an exaggerated intensity of behaviors and heightened anxiety.

The constant scanning of the environment for threats can lead to a variety of obsessive behaviors, producing difficulties with social interaction and relationships.

Recent research on PTSD in the military indicates that there is no such thing as “uncomplicated” PTSD. Although explanations point to the classic “chicken and egg” problem, it is clear that each symptom complicates and exacerbates the presentation of the others.

Comparing PTSD and C-PTSD

BOTH can experience hypervigilance (the constant scanning of the environment for threats) but with C-PTSD there can be a preoccupation with/rumination about the abuser or experience.

BOTH can experience flashbacks when triggered, but with C-PTSD flashbacks are more likely to occur without warning, seemingly out of nowhere.


  • PTSD: Avoidance of triggers and trauma reminders vs.
    C-PTSD: withdrawal and isolation, possibly due to the fear of flashbacks without warning and/or increasing discomfort in social situations, or heightened anxiety around others
  • PTSD: Nightmares vs.
    C-PTSD: night terrors and chronic insomnia (among other sleep disorders)
  • PTSD: Anxiety and depression vs.
    C-PTSD: social isolation, relationship avoidance
  • PTSD: Exaggerated startle reflex vs.
    C-PTSD: severe alterations in affect regulation (no filter, easily overwhelmed)
  • PTSD: Some dissociation vs.
    C-PTSD: fragmented sense of self

Identifying or Diagnosing C-PTSD

Six clusters of symptoms have been suggested for diagnosis of C-PTSD.

  1. alterations in regulation of affect and impulses;
  2. alterations in attention or consciousness;
  3. alterations in self-perception;
  4. somatization;
  5. alterations in systems of meaning, and
  6. alterations in relations with others.

These clusters imply the possibility of the following problems & behaviors:

  1. Emotional Regulation Problems – including symptoms such as a profound and persistent state of unease or dissatisfaction, chronic suicidal preoccupation, self injury, explosive anger (or, conversely, extremely inhibited emotions), and compulsive and/or extremely inhibited sexuality.
  2. Variations in consciousness – including forgetting/blocking out traumatic events, reliving experiences (either in the form of intrusive PTSD symptoms like flashbacks, or in persistent rumination) and/or episodes of dissociation or derealization.
  3. Changes in self-perception – such as learned helplessness/inability to activate, displaced shame, guilt and self-blame, a sense of defilement or stigma, and/or a sense of feeling detached, like no one else in the world and completely alone.
  4. The repeated experience of unexplainable physical problems and illnesses – somatization.
  5. Changes in how the sufferer views the world and life itself – Loss of/significant changes in one’s value systems, faith in humanity; chronic despair and/or a sense of hopelessness about the future, which may include a loss of formerly sustaining religious faith.
  6. Problems with relationships – including persistent distrust and/or a search for a rescuer (sometimes through repeated self-protection failures), relationship disruptions as a result of isolation and withdrawal.

Changes in how the victim regards the perpetrator – an individual with Complex PTSD may feel like the perpetrator has complete power in a relationship, which may certainly be true at the time of the ongoing trauma, but the victims can maintain that they have NO power, even when the perpetrator can no longer affect their lives (as when abused children grow up).

In Complex PTSD, some individuals may also become preoccupied with a perpetrator; i.e., constant thoughts of revenge or, conversely, idealization of or gratitude toward the perpetrator (similar to Stockholm Syndrome), including a rationalization of a perpetrator’s belief system, etc.

PTSD Underpinnings & Complications

In PTSD articles to come, we’ll take a closer look at some of the neurological underpinnings of PTSD, some problems created by the overlap of co-occurring conditions (ie., TBI/ABI, anxiety, depression, sleep disorders, etc.) treatment options currently available and treatment options that are being explored for future use — so STAY TUNED.

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If you are (or love) a veteran of combat, make sure you investigate what the Armed Services have put into place to help — and check out the links below, and on the right sidebar (scroll DOWN to the TBI links for the Bob Woodruff Foundation – also check out The Coming Home Project.)

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You might also be interested in some of the following articles
available right now – on this site and elsewhere.

For links in context: run your cursor over the article above and the dark grey links will turn dark red;
(subtle, so they don’t pull focus while you read, but you can find them to click when you’re ready for them)
— and check out the links to other Related Content in each of the articles themselves —

Related articles right here on
(in case you missed them above or below)

Other supports for this article – on

Related Articles ’round the net

Related Informational Articles


A few PTSD/C-PTSD Support Sites


BY THE WAY: Since is an Evergreen site, I revisit all my content periodically to update links — when you link back, like, follow or comment, you STAY on the page. When you do not, you run a high risk of getting replaced by a site with a more generous come-from.

About Madelyn Griffith-Haynie, MCC, SCAC
Award-winning ADD Coach Training Field founder; ADD Coaching field co-founder; [life] Coaching pioneer -- Neurodiversity Advocate, Coach, Mentor & Poster Girl -- Multi-Certified -- 25 years working with EFD [Executive Functioning disorders] and struggles in hundreds of people from all walks of life. I developed and delivered the world's first ADD-specific coach training curriculum: multi-year, brain-based, and ICF Certification tracked. In addition to my expertise in ADD/EF Systems Development Coaching, I am known for training and mentoring globally well-informed ADD Coach LEADERS with the vision to innovate, many of the most visible, knowledgeable and successful ADD Coaches in the field today (several of whom now deliver highly visible ADD coach trainings themselves). For almost a decade, I personally sponsored and facilitated seven monthly, virtual and global, no-charge support and information groups The ADD Hours™ - including The ADD Expert Speakers Series, hosting well-known ADD Professionals who were generous with their information and expertise, joining me in my belief that "It takes a village to educate a world." I am committed to being a thorn in the side of ADD-ignorance in service of changing the way neurodiversity is thought about and treated - seeing "a world that works for everyone" in my lifetime. Get in touch when you're ready to have a life that works BECAUSE of who you are, building on strengths to step off that frustrating treadmill "when 'wanting to' just doesn't get it DONE!"

71 Responses to Complex PTSD Awareness

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  9. CalicoJack says:

    Howdy Madelyn!

    Your blog continues to be a valued resource for me! I really appreciate the accurate information that you have published. I’m always glad to link to one of your articles.

    And, complex PTSD should be distinguished from PTSD. It is one thing to be in a car accident and end up with PTSD, it is another to spend ten to twenty years with a gaslighter or other abuser. I’ve seen it both in my personal life and professional. The needs of the two populations are different.


    Liked by 1 person

    • Thanks so much for ringing in, Jack. I do the best I can to check credible sources and update older info that new studies impact. Comments like this are especially appreciated from someone like you (who does the same thing)! We are on the same page where C-PTSD is concerned. Wonder when medical science it going to catch up with us – lol.

      Liked by 1 person

  10. When living with PTSD, we do what we can — one day at a time, and if we are not alone and have support, that makes each day easier to get through.

    Liked by 1 person

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  20. Reblogged this on Courage Coaching and commented:
    Great explanation of the difference between CPTSD & PTSD.

    Liked by 1 person

  21. Reblogged this on Art by Rob Goldstein and commented:
    This is the best explanation I’ve read of the difference between Complex PTSD and PTSD.

    Liked by 1 person

  22. Thank you for this informative article.

    I am diagnosed with C-PTSD.

    The fragmented sense of self that you describe is one of my primary symptoms. As far as professionals who hurl the word malingering at people with severe and in some cases chronic illnesses: I find our Behavioral Health System with its emphasis on drugs and short-term therapies toxic and classist. It is ersatz psychiatry done by technicians without the ethics or humanity.

    When we end this regressive for profit system based on Dale Carnegie and Alcoholics Anonymous we will re-discover that the solution to the homelessness of people with chronic mental illness is long-term treatment in structured inpatient and outpatient settings.

    It is hard to recover from such a painful illness at such a dark and abusive time in our nation’s history.

    Liked by 1 person

    • You are preaching to MY choir in this comment! Check out my Staff Sergeant Brown article [Rarely Proud to be an American Anymore] in my Monday Grumpy Monday series (it’s a short one – a quick read that makes a sad but clear point about our lack of humanity toward homelessness generally and homeless vets in particular).

      My heart goes out to you as I read that you are struggling with C-PTSD, but I’m relieved to hear that you have found a doc willing and able to give you the dx.

      Thanks for reading and taking time out of your life to leave a comment (and again for the reblog).

      Liked by 1 person

      • I was diagnosed with C-PTSD and DID by Kaiser’s psych services which is a Behavioral Health Service. Kaiser was part of the ACE Study which was a study of the effects of Trauma. I am lucky to have my therapist. She’s one of the few who treats DID.

        Liked by 1 person

        • DID is a difficult disorder – tricky to diagnose OR treat – so when you say you are fortunate to have found one of the “few” therapists who work with it, that is almost an understatement.

          I’m not telling you anything new, I’m sure, but many therapists don’t believe DID exists or don’t/won’t/can’t treat it — which used to be the case with Borderline Personality Disorder not too many years ago as well. As you noted in the intro to your DID post I read last night, the exaggerated media and film exposure certainly hasn’t helped!

          I used to be close to a person who suffers from depersonalization and derealization, but it has never been disclosed to me that there was any awareness of alters, nor was there a PTSD dx of any type in place. The coping method was self-harm for many years, and it was disclosed to me (and others) only years after I had relocated and we were no longer spending regular time together. (sorry for the awkward phrasing – avoiding pronouns).

          Years ago I spent considerable time talking with a woman with a clear dx (“multiple personality disorder” at that time). The venue was a small weekend seminar using Arts Therapy as a healing technique for a number of issues. My many conversations with her were eye opening, kindling my interest in/understanding of some of the many difficulties of living with the disorder. But I would never go so far as to say I’m well-versed in DID or qualified to work with it.

          This particular woman was unusual in that all of the alters were aware of each other, could “cross-communicate” and were willing to attempt to cooperate. They chose to live as “a family” rather than attempting to “integrate,” and had a system of rules respecting the strengths and challenges of each that seemed to work well for them (like the kids can’t shop, for example – and only one handled family finances. etc.). They actually traveled around the country teaching therapists about this method.

          Only a few had artistic gifts, but they were considerable – one was a talented poet, another a painter, one was gifted musically – and one did an excellent job at public speaking, presenting the talents of all (without their appearance). Except for what she was disclosing, she seemed well integrated and emotionally centered.

          Both mind and brain are amazing things – and I fear that it will be many years before we understand that the current meaning of “mental health” is too narrow.

          I’m not convinced that additional DSM caucuses are likely to help much – especially in the manner it is handled now – but I would like to see future versions differentiate clearly between PTSD, C-PTSD, and Borderline Personality Disorder for the benefit of differential diagnosis and the development of effective treatment protocols and healing time-frames.

          I look forward to having the time to read more of what you have written about it. Thanks again for the reblog – and for taking the time to comment here.


    • Thank you so very much for the reblog, Lloyd. It is always dangerous to attempt to ring in where one does not have personal experience with the challenges one is attempting to describe – so the fact that YOU reblogged it allows me to believe that I managed to cover the issues in a manner that was at least adequate (and caused no additional harm through under-valuing the difficulties).

      We do what we CAN, right?

      Liked by 1 person

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