Complex PTSD (C-PTSD) can develop after trauma that was prolonged or repeated, especially when it happened in childhood or in relationships where escape wasn’t possible. This might include emotional abuse, neglect, or growing up in a home that didn’t feel safe.

I prefer to think of C-PTSD as a natural response to what happened to you, rather than something wrong with you. Therapists like Lucy Johnstone encourage us to ask “What happened to you?” instead of “What’s wrong with you?” Many of the symptoms below began as ways of surviving.

Signs and symptoms of C-PTSD

C-PTSD includes the symptoms of PTSD, such as flashbacks, nightmares, avoidance and feeling constantly on guard. It also affects how you see yourself and relate to others. Common signs include:

Emotional flashbacks: sudden waves of fear, shame or despair that feel out of proportion to the present moment
Difficulty managing emotions: feelings that swing quickly or feel overwhelming, or a sense of numbness
A harsh inner critic and a negative sense of self: shame, worthlessness or feeling fundamentally flawed
Struggles in relationships: difficulty trusting, fear of closeness, or pulling away or clinging on
Hypervigilance and sleep problems: feeling on edge even when you’re safe
Physical symptoms: tension, chronic pain or stomach issues
Fight, flight, freeze or fawn responses: the survival patterns Pete Walker describes

You don’t need to recognise every item on this list. Everyone’s experience is different.

How is C-PTSD diagnosed?

C-PTSD is recognised as a separate diagnosis in the World Health Organization’s ICD-11. It isn’t a separate diagnosis in the DSM-5, the manual used in the US. Many people live with C-PTSD for years without a name for it, and it is sometimes mistaken for other conditions, including borderline personality disorder (BPD), because some symptoms overlap. A therapist who understands trauma can help you make sense of what you’re experiencing, whether or not you want a formal diagnosis.

Therapy for complex PTSD

Healing from C-PTSD is possible, and it tends to work best when it’s gradual and paced by you. Approaches I draw on include EMDR, Internal Family Systems (IFS) and body-based, trauma-informed work. The first step is usually building safety and trust, and only later, when you’re ready, gently processing what happened.

If any of this sounds familiar, you’re welcome to get in touch. A first conversation carries no pressure.