(Part 2 of 4 Trauma Series)
Most people picture trauma as a big, dramatic event, something that hits you all at once and leaves no doubt. But that’s not always how it goes. Sometimes, trauma sneaks in quietly, bit by bit. Complex trauma doesn’t come from a single moment; it grows from experiences that happen again and again.
When the signs come slowly, it’s easy to miss what’s really going on. People with complex PTSD (CPTSD) often minimize or ignore their struggles. They may believe they are just feeling anxious, a bit down, or simply being too sensitive. But those emotional patterns often come from years of stress or being hurt by people they trusted.
In the second article of Wise Mind Centre’s four-part blog series on trauma, we’re going to clear up what CPTSD is and how trauma-informed, evidence-based therapy can support your healing.
Check out Part 1 of 4 Trauma Series: Do I Have Trauma? Signs You Might Not Know to Look For
What is Complex PTSD?
Complex post-traumatic stress disorder (CPTSD) happens when someone goes through chronic, prolonged, or repeated trauma, especially in relationships or environments where safety and stability were expected but not consistently present.
This may include situations like growing up with constant criticism, emotional neglect, abuse (physical or sexual), unpredictable parents, domestic violence, or living in chaos for a long time. It’s often tied to childhood, but adults can develop CPTSD too if they’re exposed to repeated trauma.
Complex PTSD vs PTSD
PTSD usually comes from a single, overwhelming event, like a serious accident or assault. CPTSD, on the other hand, builds up over time from repeated relational trauma. Both bring anxiety, flashbacks, nightmares, avoidance, and intense emotional reactions. However, people with CPTSD often struggle to manage their emotions, feel deep shame, question their own worth, and find it hard to trust or connect with others.
Complex PTSD vs Borderline Personality Disorder (BPD)
Complex PTSD and borderline personality disorder (BPD) share several symptoms, such as intense emotions, impulsive behaviours, and difficulties maintaining stable relationships. However, CPTSD has a background of trauma. BPD doesn’t require trauma for a diagnosis and usually shows up in early adulthood. CPTSD can happen at any age.
Research shows that CPTSD includes PTSD symptoms plus added challenges with self-identity, emotion regulation, and feeling safe with others, features that overlap with BPD. Since these conditions can blur together, it’s important to see a trained clinician for an accurate assessment and effective treatment.
Getting a Complex PTSD Diagnosis
CPTSD is still a relatively new diagnosis, and not all clinicians or diagnostic systems agree on exactly what it means. The World Health Organization (WHO) does recognize it in its ICD-11 manual, but there’s no official test for CPTSD. CPTSD is not a recognized diagnosis in the current DSM-5-TR, a manual that provides diagnostic criteria for various psychological disorders published by the American Psychiatric Association (APA).
Clinicians usually start by asking about your symptoms, your history, and your relationships. If you’ve had PTSD symptoms for at least a month and also struggle with your identity or relationships, they might diagnose CPTSD. That said, given that most psychologists trained in graduate programs in North America learn the DSM-5-TR classification system rather than the ICD-11, it could be a challenge to find a psychologist to properly assess and diagnose CPTSD in North America.
Complex PTSD and the Nervous System
When someone grows up surrounded by constant threat, or is living in a situation where leaving isn’t an option, their nervous system learns one thing: survival comes first. That’s what happens with complex trauma, like living through years of domestic violence or ongoing childhood abuse. The body stays on high alert for so long that it starts to treat this constant vigilance as the new normal.
Research shows that long-term trauma can affect how the brain works: the amygdala, which becomes highly sensitive to fear; the hippocampus, which may struggle with memory and distinguishing past from present; and the prefrontal cortex, which can have difficulty with focus, decision-making, and emotional regulation.
These shifts can be more pronounced in CPTSD than in single-incident PTSD. As a result, many people with CPTSD live with a nervous system that reacts quickly, either by going on high alert or by shutting down, to protect them from perceived danger.
Signs of Complex PTSD
Complex PTSD often develops gradually, especially when someone deals with ongoing trauma or old wounds that never fully healed. Everyone’s story looks a little different, but there are a few common signs of Complex PTSD.
Emotional and Internal CPTSD Symptoms
- Persistent feelings of shame, worthlessness, or deep sadness
- Difficulty identifying, regulating, or expressing emotions
- Sudden waves of overwhelm or emotional flooding
- Emotional numbing or feeling “shut down”
- Trouble soothing yourself or returning to calm after distress
Relational and Attachment CPTSD Symptoms
- Fear of abandonment or rejection
- Difficulty trusting others, even those who feel safe
- People-pleasing, caretaking, or “fawning” to avoid conflict
- Conflict avoidance, withdrawal, or keeping emotional distance
- Feeling disconnected from loved ones
Cognitive and Identity-Related CPTSD Symptoms
- Negative self-beliefs (e.g., “I’m broken,” “I’m the problem”)
- Rumination, overthinking, or chronic self-blame
- Feeling “never good enough,” regardless of achievements
- Dissociation or feeling detached from emotions or identity
- Confusion about who you are beyond the trauma
Physical and Nervous System CPTSD Symptoms
- Chronic tension, headaches, or digestive discomfort
- Persistent exhaustion, burnout, or a sense of collapse
- Sleep problems, including nightmares or difficulty staying asleep
- Feeling disconnected from your body, especially during stress
- Heightened physiological reactivity to perceived threats
How Complex PTSD Is Treated: Evidence-Based Approaches at Wise Mind Centre
Healing from complex PTSD takes time and the right therapeutic supports. At Wise Mind Centre, therapy is grounded in evidence-based approaches and a strong emphasis on safety, collaboration, and compassion.
Cognitive Behavioural Therapy (CBT)
CBT is one of the most widely used therapies for trauma. It helps identify and shift entrenched patterns of self-blame, guilt, or “I’m not good enough” beliefs shaped by CPTSD. CBT gives you tools to challenge those thoughts and get better at managing your emotions, and symptoms like anxiety or depression start to lose their grip.
Eye Movement Desensitization and Reprocessing (EMDR)
EMDR is another effective approach for trauma processing. It involves recalling aspects of a tough memory while performing specific movements (bilateral stimulation), such as following the therapist’s finger or tapping gently. This helps your brain start to process and file away the old pain. The memories might not disappear, but their effects aren’t as intense. You end up feeling more present, grounded and less ruled by your past.
Healing from complex PTSD is absolutely possible. You don’t have to do it alone. If you’re wondering whether trauma therapy could help you, we invite you to book a session or reach out for a free consultation.
References
Cleveland Clinic. (2023, April 5). CPTSD (Complex PTSD). Cleveland Clinic. https://my.clevelandclinic.org/health/diseases/24881-cptsd-complex-ptsd
Gilles, G. (2018, January 26). Understanding Complex Post-Traumatic Stress Disorder. Healthline; Healthline Media. https://www.healthline.com/health/cptsd
Giourou, E., Skokou, M., Andrew, S. P., Alexopoulou, K., Gourzis, P., & Jelastopulu, E. (2018). Complex posttraumatic stress disorder: The need to consolidate a distinct clinical syndrome or to reevaluate features of psychiatric disorders following interpersonal trauma? World Journal of Psychiatry, 8(1), 12–19. https://doi.org/10.5498/wjp.v8.i1.12
Li, D., Luo, J., Yan, X., & Liang, Y. (2023). Complex Posttraumatic Stress Disorder (CPTSD) as an Independent Diagnosis: Differences in Hedonic and Eudaimonic Well-Being between CPTSD and PTSD. Healthcare, 11(8), 1188–1188. https://doi.org/10.3390/healthcare11081188
NHS. (2021). Complex PTSD — Post-traumatic stress disorder. Nhs.uk. https://www.nhs.uk/mental-health/conditions/post-traumatic-stress-disorder-ptsd/complex/
Smith, S., & Vale, W. (2006). The role of the hypothalamic-pituitary-adrenal axis in neuroendocrine responses to stress. Dialogues in Clinical Neuroscience, 8(4). https://doi.org/10.31887/dcns.2006.8.4