Therapy for Complex PTSD


What is Complex PTSD?

Complex PTSD, also known as Complex Trauma or C-PTSD is a diagnosis which is relatively new and is only included in only one out of the two major diagnostic reference manuals. The ICD-11 diagnoses C-PTSD when the criteria for PTSD are met

Core Symptoms of PTSD:

  • Re-experiencing
  • Avoidance
  • Hyperarousal and reactivity

Plus, the following three disturbances is self organisation

  • Difficulty regulating emotions
  • Negative self concept (such as guilt, shame, loneliness)
  • Interpersonal problems impacting ability to build and maintain relationships

It is common that people suffering with Complex PTSD have been diagnosed with other diagnoses such as anxiety disorders, depression, eating disorders, OCD, Dissociative Disorder, substance misuse, Borderline Personality Disorder because of how they have shaped their coping strategies in response to the traumatic experiences. As CPTSD is a relatively new diagnosis, you may find professionals more likely to categorise and diagnose according to the most visible symptoms and miss the whole picture, in particular the original social context out of which the symptoms developed.

Causes of Complex Trauma

Complex Trauma results from experiencing a high level of overwhelming stress over significant periods of time, be it weeks, months or years. Due to the prolonged nature of complex trauma it often starts in childhood within the family or community environment.   Traumatic events cause feelings of helplessness, hopelessness, shock, diminish a person’s sense of self and, if truly overwhelming, will cause the nervous system to intervene with dissociation and freeze responses. For the child this causes disruption on the usual developmental process and can cause the brain to become much more sensitised and susceptible to stress. It is important to know that while CPTSD can develop out of overtly unsafe or stressful events, it can equally evolve out of many more subtle scenarios such as invalidations or a lack of parental attunement or effective mirroring by caregivers. A lack of these skills from caregivers can give rise to a deep sense of invisibility in the child leading to an overwhelming existential crisis in the development of a child’s sense of self.

Complex PTSD can equally develop outside of childhood and in a 2021 study of refugees and asylum seekers, 19.4% of the participants fit the diagnostic criteria for PTSD, and 49.5% fit the criteria for complex PTSD.

The types of traumatic events that can cause complex PTSD include:

  • childhood abuse, neglect or abandonment
  • ongoing domestic violence or abuse
  • having incarcerated family members
  • having emotionally unstable caregivers
  • death by suicide in the family
  • repeatedly witnessing violence or abuse
  • sexual abuse
  • torture, kidnapping or slavery
  • being a prisoner of war or refugee

You are more likely to develop complex PTSD if:

    • you experienced trauma at an early age
    • the trauma lasted for a long time
    • escape or rescue were unlikely or impossible
    • you have experienced multiple traumas
    • you were harmed by someone close to you.

If you’ve been affected by traumatic experiences, it’s important to remember that the symptoms and reactions you have developed are all normal reactions, even if they make your life difficult. Many of these physiological and psychological reactions are ways that your body, mind and brain are  seeking to protect you and to cope with the overwhelm. The after effects of trauma are often enduring because this is the way your body and mind attempt to resolve what is unresolvable and make sure you never have to go through a similar experience again.

Symptoms of Complex PTSD

In addition to the diagnosable symptoms described at the top of the page these are more symptoms that often for the subjective experience of a person suffering with complex trauma:

  • difficulty controlling emotions and mood states
  • feeling angry and distrustful of people and the world
  • feeling unable to cope alone or the opposite, preferring to be alone
  • feeling damaged or worthless
  • feeling easily overwhelmed
  • feeling different to other people
  • feeling empty or invisible
  • feeling disconnected from people even when in company
  • experiencing dissociative symptoms such a depersonalisation or derealisation
  • struggling to form or maintain relationships
  • physical reactions such as headaches, dizziness, gastro intestinal problems
  • suicidal feelings
  • sensory processing issues such as misphonia

Therapy for Trauma

Psychotherapy is a process that helps you to express and make sense of how you are feeling with the help of a supportive and skilled professional. The pace of therapy is always adapted to work with what you need. If looking backwards is too painful then explorations can initially be based on different ways of coping and finding safety in the here and now and learning to express emotions in a more creative and less verbal way. If you are looking to explore and make sense of the past and its ongoing effects, then psychotherapy is very beneficial for building this picture, helping you come to terms with the past and to learn to live more fully in the present.  Schema Therapy is a well researched psychotherapy and has proven helpful for working with Complex Trauma. 

NeurOptimal Neurofeedback can be very helpful in helping with the physiological effects of trauma. Trauma changes the nervous system to be much more reactive and primed for fight, flight, freeze responses that aren’t reacting appropriately to the needs of the here and now. NeurOptimal directly trains the brain to harness its ability to self regulate, so if you have been living with an overly reactive body, then it is likely that your brain and nervous system need a little help getting back to resilient functioning. The brain continues to learn and change over our lifetime and NeurOptimal harnesses your brains’ Neuroplasticity, by helping it return to flexible self-regulation as it is designed to. If you can tell that your physiological state is not matching up to the demands of a situation, because it is over or under reacting, then NeurOptimal can help train your brain back to effectiveness. 

Breathwork uses different breathing techniques to help regulate the nervous system. We know that the vagus nerve, the seat of our parasympathetic nervous system and our ability to return to calm after stress has nerve endings throughout our respiratory system and that breathing in certain ways changes activates parasympathetic activity. Breathing is also free and accessible all the time so it is a very handy way to regulate the nervous system and emotions 24/7.

Brainspotting is a therapy technique that targets how the brain processes emotions and memories. Using eye position to find activated ‘brain spots’ for emotions or sensations in the body means that the brain can be harnessed to balance the source of anxiety in the deeper brain areas.