Show Medically Reviewed by Dan Brennan, MD on April 12, 2021 You may have heard of post-traumatic stress syndrome or PTSD, but you may not be familiar with complex PTSD, sometimes known as c-PTSD. Complex PTSD is caused by prolonged or chronic trauma. Those with complex PTSD usually have at least some of the symptoms of PTSD, but they could also have other symptoms. Most people experience at least one traumatic event during their lives, and about a fourth go on to develop PTSD. No one knows how many people have complex PTSD. People who experience trauma may feel its effects for days. If the symptoms last weeks or longer, and if they disrupt your life, you may have PTSD. See a trained mental health professional if you're worried that you might have PTSD. Symptoms of PTSD usually fall into three categories. Re-experiencing symptoms. Flashbacks and nightmares are probably the best-known PTSD symptoms. Memories of the trauma may trigger powerful emotions. The person may relive the sights, smells, and sounds of the traumatic event. Sense-of-threat symptoms. Those with PTSD often feel that they must be on their guard. They may be hypervigilant (over aware of their surroundings), jumpy, and easily startled. Avoidance symptoms. Those with PTSD spend a lot of energy avoiding triggers — people, places, or situations that remind them of the trauma they experienced. They may self-medicate with drugs or alcohol. Besides the symptoms of PTSD, those with complex PTSD may also have other symptoms. Problems with self-esteem. Those with complex PTSD may feel worthless or blame themselves for their trauma. They may believe bad things happen because of something in them. Emotional dysfunction. Those with complex PTSD often experience intense emotions, which are sometimes inappropriate. Besides anger and sadness, they may feel like they're living in a dream. They may have trouble feeling happy. Relationship problems. Complex PTSD can make it difficult to trust others. Some people stay in unhealthy relationships because the situation is familiar. If their trauma involved abuse, their feelings about their abuser may be complicated. Or they may obsess about their abuser or focus on revenge. Originally used to describe the results of childhood trauma, complex PTSD now includes other kinds of chronic trauma. There are also additional risk factors for complex PTSD. A Harvard researcher coined the term "complex PTSD" in 1988. Mental health professionals today may use other terms. Enduring Personality Changes After Catastrophic Events (EPCACE). To have a diagnosis of EPCACE, the person needs to have a personality change that lasts for 2 years after trauma. EPCACE is no longer recognized by the World Health Organization, which uses complex PTSD instead. Some mental health professionals prefer EPCACE and still use it. Disorders of Extreme Stress Not Otherwise Specified (DESNOS). This term sometimes is used to mean the same thing as complex PTSD, especially in the United States. The risk factors and symptoms are very similar. Borderline Personality Disorder (BPD). The symptoms of complex PTSD and BPD are similar, but BPD does not require a history of trauma. Some researchers believe that genetics or brain function could be at the root of BPD. Some authorities consider complex PTSD a subtype of BPD, but others believe they're two separate conditions. Because complex PTSD is a relatively new diagnosis, mental health professionals are still working on treatment options. There are still some options that may help.
Some therapists use a relatively new therapy called eye movement desensitization and reprocessing (EMDR). It may be helpful for complex PTSD too. In EMDR, the subject remembers a trauma while following a bilateral stimulus (one that switches from one side of the body to the other) that leads to a back-and-forth eye movement. The stimulus could be one they see such as a finger moving back and forth or a sound. EMDR is effective for PTSD, but experts debate if the bilateral stimulation is really important or if the process could happen without it. It’s easy to confuse post-traumatic stress (PTS) and post-traumatic stress disorder (PTSD). In addition to sharing similar names, there’s considerable overlap in symptoms between the two conditions. Both PTS and PTSD are associated with feeling fearful and/or nervous, avoiding the activity or place associated with the traumatic event, and nightmares. However, there are significant differences in symptom intensity, duration, and treatment. Post-traumatic StressPTS is a common, normal, and often adaptive response to experiencing a traumatic or stressful event. Common occurrences, like car accidents, can trigger PTS as well as more unusual events like military combat or kidnapping. Almost everyone who experiences a scary situation will show at least a few signs of post-traumatic stress. That’s because our brains are hard-wired to tell our bodies to tense our muscles, breathe faster, and pump more blood when we’re under intense stress. This is the “fight-or-flight” response that prepares your body to deal with a threat or challenge in the environment by pumping more blood and oxygen to your muscles, and it shuts down non-critical functions like digestion. This fight-or-flight response is a normal reflex during and sometimes even after a traumatic event, which is why PTS is considered a normal reaction and not a mental illness. PTS Symptoms and BehaviorsIf you’re experiencing post-traumatic stress, your heart may race, hands shake, you may sweat or feel afraid and nervous. After the stressful event, you might avoid or be leery of engaging in that activity again, you may have a bad dream about the event you just experienced, or you may feel nervous in a situation that reminds you of the unpleasant event. Although they can be momentarily intense, symptoms of PTS usually subside a few days after the event and won’t cause any prolonged meaningful interference with your life. One positive outcome of experiencing PTS may be that you behave more carefully in a potentially dangerous situation in the future. PTS TreatmentSince post-traumatic stress is not a mental disorder, treatment is not required as the symptoms will likely improve or subside on their own within a month. However, you should talk to a healthcare provider if you feel troubled by your symptoms — if they’re interfering with your work, school, or relationships or if you’re engaging in reckless behavior such as drinking or using drugs to cope with symptoms. Post-Traumatic Stress DisorderPTSD is a clinically-diagnosed condition listed in the Diagnostic and Statistical Manual of Mental Disorders, the recognized authority on mental illness diagnoses. The fifth revision, released May 2013, includes the latest diagnostic criteria for post-traumatic stress disorder. Anyone who has experienced or witnessed a situation that involves the possibility of death or serious injury, or who learns that a close family member or friend has experienced a traumatic event, can develop post-traumatic stress disorder, although most people don’t. It’s still not completely understood why some people who are exposed to traumatic situations develop PTSD while others don’t. PTSD Symptoms and BehaviorsCommon symptoms of post-traumatic stress disorder include reliving a traumatic event through nightmares, flashbacks, or constantly thinking about it. You might avoid situations or people that remind you of the event, have only negative thoughts or emotions, and constantly feel jittery, nervous, or “on edge.” Although some of these symptoms sound similar to PTS, the difference is the duration and intensity. Symptoms that continue for more than one month, are severe, and interfere with your daily functioning are characteristic of PTSD. Behaviors that indicate professional intervention is needed may include drinking or smoking more than usual as attempts to reduce anxiety or anger, and aggressive driving. Service members who have experienced combat can be especially nervous driving under overpasses and past litter on the roadside — behavior learned in Iraq and Afghanistan where insurgents hide improvised explosive devices in garbage and use overpasses to shoot at vehicles. Other behaviors that indicate that help may be needed can include being wary of crowds, showing reluctance to go to movie theaters, crowded stores, or nightclubs, and avoiding news that addresses overseas combat or getting angry at the reports. PTSD TreatmentsCertain medications and therapies are widely accepted by healthcare providers as effective treatments for post-traumatic stress disorder. Sertraline and Paroxetine are two medications the U.S. Food and Drug Administration approved for treatment. Trauma-focused psychotherapy techniques such as prolonged exposure therapy and cognitive processing therapy have also been proven to be effective and widely used. Overall Key Points
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