Complex Posttraumatic Stress Disorder (CPTSD) was coined by Judith Herman, M.D, in 1992. What you are about to read is speculative based on rejected proposed criterion for official recognition. In medical practice, the diagnosis of CPTSD cannot be given due to nonexistence within current mental health doctrine (DSM V, ICD-10).

CPTSD is not presently a diagnosis, regardless of your location in the world, as the new criterion for PTSD now covers complex trauma under the sub-type diagnosis of Post-Traumatic Stress Disorder – With Prominent Dissociative (Depersonalization/Derealization) Symptoms. CPTSD is a term given to easily reference complex trauma in relation to PTSD. cPTSD is being included within ICD 11, due for release in 2017, and is unknown whether to be listed as a trauma and stressor or personality disorder.

CPTSD Acceptance

Complex PTSD has quickly been adopted within the mental health industry to account for the classification of complex trauma. The unofficial complex PTSD diagnosis is an amalgamation of several diagnoses into one. The American Psychiatric Association has denied this attempt for DSM V inclusion, currently classifying complex trauma under the PTSD diagnosis as a sub-type.

Complex Trauma Reality

Complex trauma is a very real and destructive form of trauma, which at present is unsubstantially captured by a diagnosis of PTSD. Complex trauma is often identified in conjunction with a dissociative and/or personality disorder. One of the most misdiagnosed of those disorders is Dissociative Identity Disorder (DID). Formerly known as Multiple Personality Disorder (MPD), DID is often indistinguishable from certain traits of Borderline Personality Disorder (BPD). This often results in a misdiagnosis for those experiencing complex trauma.

The reason a dissociative and/or personality disorder is often present in those with complex trauma is that the perceptions of reality after enduring prolonged trauma are radically altered. This perception is much different than the reality perceived without prolonged trauma. Reality becomes torn, molded, and shaped to fit within a traumatic atmosphere. Due to longevity and exposure, this distorted picture of reality becomes normalized for the patient who experiences complex trauma.

Looking toward the cycle of abuse for an example:

The abuse cycle carries from generation to generation, as it is ingrained in the abused child’s brain that the way their parents behaved toward them was perfectly natural. If you believe smacking your children across the room is normal, you will continue to pass along traumatic behavior (and thus associated psychological damage). If you break that cycle with your children, and foster an assertive, rather than traumatic, approach it changes their perception of their reality. New, healthier behaviors are normalized. This will in turn affect the way they respond to their own children.


Complex trauma is not specific to any age group. However, those whom endure complex trauma during early childhood are more prone to long-term and severe consequences – complex PTSD. The brain begins to place patterns and beliefs about the world during the first nine years of life, and is at its most susceptible during this time. The strength of early childhood is also that the brain is robust enough to process traumatic events. Though, this often creates a worse after-effect later in life as the brain matures and comprehends those events. If you put a mature adult through a heavily abusive marriage, a concentration camp or a Prisoner of War (POW) camp, the brain’s trauma-processing ability will produce as similar an outcome of consequences as those seen in early childhood trauma.

However, those who endure trauma for an extended period under the age of twelve years are proven to present more devastating results in adulthood than complex trauma afflicted upon someone whom is already an adult. This is because morality, social skills, and life skills are all taught in childhood. The child’s sense of right and wrong becomes altered, as well as their understanding of social function and their interpretation of the world around them. This can sometimes result in a personality disorder.


Statistically, complex PTSD is found to come from those who are raised within impoverished communities or households. This spreads into populations that are considered third world. Violence is statistically more prevalent within such communities and families. However, no one is exempt from complex PTSD. Even the richest and most powerful of individuals have been convicted of crimes resulting in complex PTSD. This can be seen in the growing awareness of pedophile rings and human trafficking, an example of two money-fueled criminal structures which manifest themselves in large by capturing children and forcing them into sexual acts or slavery for months or years of their childhood.

Traumatic Events

Whilst PTSD requires abnormally traumatic events as diagnostic criterion (and though complex trauma is entangled within that requirement), the PTSD diagnosis fails to concede to the longevity and duration that complex trauma encapsulates. Examples of trauma which fit the criteria for complex PTSD include:

  • Physical abuse – ongoing, typically administered within a family or by caregiver / Domestic Violence (DV).
  • Sexual abuse – ongoing, typically administered within a family or by caregiver / friends of family / DV.
  • Imprisonment – prisoner of war / incarceration / forcible confinement for long periods of time.
  • Repeated tours in combat.
  • Other possibilities.

Who Said Combat?

Military combat has been aptly associated with PTSD, and is the most recognizable cause of PTSD in mainstream society today. The problem is that troop numbers are decreasing, and those who are operationally ready are being pushed to their limits. Never seen before in prior operations, the U.S Military and allies have extended service requirements without any choice offered to combatants. Operation time-frames at their peak reached rotations of 12-15 months, with troops returning home for 2-6 months before redeployment. It was only through recognizing the diminished behavioral capacity of soldiers upon their return home that the U.S Military reverted back to its shorter six month rotation.

This cycle has been repeated by some armed forces around the world (some with willing troops, and some otherwise) many times. If you submit a child to three years of physical abuse in an otherwise safe environment and notice the child’s behavior has altered as a result, how could one expect soldiers spending long periods within hostile work environments not to develop the same distorted behaviors and reactions? It is now becoming more apparent that some troops are returning with more than just PTSD. Complex trauma is beginning to be seen and recognized in veterans due to long-term deployment exposure.

Proposed Clinical Attributes Of Complex PTSD

After much research on this topic, Wikipedia contains a more recent review from a source (Cook), on the problematic areas which isolate complex PTSD from PTSD. However, after reviewing original documents from Judith Herman (the original proponent of CPTSD), I have instead opted to list the original aspects outlined in her work. They are similar to current claims by others, except that they are listed in a diagnostic criterion rather than as regurgitated and interpretive reviews. Some so-called experts claim six unique differences, some seven. The original author claims seven characteristic differences, which are:

  1. Alterations in the regulation of affective impulses, including difficulty with modulation of anger and self-destructiveness,
  2. Alterations in attention and consciousness leading to amnesias and dissociative episodes and depersonalization,
  3. Alterations in self-perception, such as chronic sense of guilt and responsibility, and ongoing feelings of intense shame,
  4. Alterations in perception of the perpetrator, including incorporation of his or her belief system,
  5. Alterations in relationship to others, such as not being able to trust and not being able to feel intimate with others,
  6. Somatization of medical problems, and
  7. Alterations in systems of meaning, including feelings of hopelessness about finding anyone to understand his or her pain.

More recent claims and modifications to the above, explained in different wording:

  1. Attachment – “problems with relationship boundaries, lack of trust, social isolation, difficulty perceiving and responding to other’s emotional states, and lack of empathy”
  2. Biology – “sensory-motor developmental dysfunction, sensory-integration difficulties, somatization, and increased medical problems”
  3. Affect or emotional regulation – “poor affect regulation, difficulty identifying and expressing emotions and internal states, and difficulties communicating needs, wants, and wishes”
  4. Dissociation – “amnesia, depersonalization, discrete states of consciousness with discrete memories, affect, and functioning, and impaired memory for state-based events”
  5. Behavioral control – “problems with impulse control, aggression, pathological self-soothing, and sleep problems”
  6. Cognition – “difficulty regulating attention, problems with a variety of “executive functions” such as planning, judgement, initiation, use of materials, and self- monitoring, difficulty processing new information, difficulty focusing and completing tasks, poor object constancy, problems with “cause-effect” thinking, and language developmental problems such as a gap between receptive and expressive communication abilities.”
  7. Self-concept -“fragmented and disconnected autobiographical narrative, disturbed body image, low self-esteem, excessive shame, and negative internal working models of self”.

Medical Diagnosis In Lieu

With CPTSD not being an officially recognized diagnosis, it cannot be used as a medical term. This is applicable in cases such as submitting to a medical board or insurance agency, or obtaining documentation for diagnosis. There are other factors at play with given diagnoses, in that physicians will often add multiple diagnoses for legal prescribing purposes. Whilst PTSD encompasses anxiety, depression, sleep dysfunction, moods and more, it is classified as a trauma disorder. For legal purposes, you will find an associated diagnosis list for prescription of pharmaceuticals.

The typical diagnoses given for someone with complex PTSD are usually presented as: Posttraumatic Stress Disorder, Major Depressive Disorder, or possible depersonalization disorder/dissociative amnesia. It is also common for those with CPTSD to be diagnosed with a personality disorder. (Avoidant, Dependent, Obsessive-Compulsive, Schizoid, Paranoid, Narcissistic, Antisocial, Borderline, etc.) The fail-safe for CPTSD is another unapproved diagnosis, Disorders of Extreme Stress, Not Otherwise Specified (DESNOS).

Treatment Options

Whilst treatment for complex PTSD is similar to that of PTSD, there are some unique differences. This is due to the nature of CPTSD in that patients will have sustained multiple or enduring trauma. There is also the potential for the patient to have developed a personality disorder they may or may not be aware of. The patient’s cognition will have been programmed incorrectly over an extended duration of time as a result of trauma.

Eye Movement Desensitization and Reprocessing (EMDR) may suffice to some degree, though caution must be used due to the likelihood of unknown/suppressed memories that may overwhelm and cause brain dysfunction. EMDR has been proven ineffective at retraining cognitive deficits resulting from extreme and enduring trauma. Most trauma will respond well with EMDR treatment, and often can respond better to EMDR than to CBT, but EMDR is not capable of addressing the long-term issues that complex PTSD brings to the table.

Cognitive Behavioral Therapy (CBT) is the optimal method for dealing with CPTSD to achieve long-term cognitive restructuring. With complex PTSD, CBT is the treatment of choice for long-term results versus short-term results. It is not uncommon for trauma therapists to use a combination of both EMDR and CBT to target traumatic aspects uniquely, depending on emotional severity and sensitivity. CBT includes Dialectic Behavioral Therapy (DBT), as DBT is a varied form of CBT.

One of the largest problems when dealing with complex PTSD is that the sufferer has a high risk of suicidality or self-injurious behavior. Therapists are often stuck between a rock and a hard place with many CPTSD sufferers, due to the legal obligation in treatment to ensure that their patient does not harm themselves or someone else. This can limit how hard they push to achieve the results needed for change.

It is not unusual for those with complex PTSD to be medicated for long durations. This is due to cognitive restructuring, to the extent of undoing personality traits and constructed core beliefs about the world. This can take time to achieve, though that time is subjective to a case-by-case basis. With an excellent trauma therapist, it can be achieved within a reasonable time of one to two years of hard work. The first six to twelve months should be the worst if performed correctly by a good trauma specialist. The complexity, combined with personal factors, will detail the overall time of recovery.

DSM V Theories

The American Psychiatric Association (APA) has rejected complex PTSD as a viable diagnosis in the upcoming DSM V, declaring all proposed options infeasible in objectively covering the broad spectrum of symptoms presented by complex trauma sufferers within clinical practices.

Complex trauma aspects has now been included for diagnosis as a sub-type within the PTSD diagnosis. This diagnosis is now official and legal upon publication of the DSM V. You could call it PTSD-DS (PostTraumatic Stress Disorder – Dissociative Symptoms).


My own personal opinion of complex PTSD is that all involved in compiling it, to date, failed to establish the relevance of this diagnosis the moment they tried attaching it to PTSD. The proposed criterion for CPTSD, and those for PTSD, are vastly different in nature, thus the proposed criterion should not be trying to attach to PTSD as a complex version and instead standalone within the new trauma and stressor category as something more befitting, such as Complex Traumatic Stress Disorder (CTSD), as the criterion just don’t match a complex version of the current PTSD criterion.

The ICD 11 is reviewing to include a CPTSD diagnosis, though at this time it merely points to another already existing personality diagnosis. It is expected in 2017 that the ICD will make complex PTSD official.


  1. I have suffered PTSD since I was born in 1961. My father, went through Korean war and 2 tours of Vietnam. He was very aggresive and abusive toward my mother and us 4 children. I moved from home at 15. I had to get away from it. I was married and had 2 awesome children. My husband got on drugs and shot his self in front of my children and I. The physician keeps telling my I am a manic depression. I have horrable fits of rage. I look myself in my room for long periods of time. Now I have the guilt of passing this to my 2 adult children. Some days I just want to die so I don’t have to go through these up and down days anymore. I can not hold down a job. I am at my last straw of what is next. I can’t get any help

  2. Dear Bridget, I guess your father probably had PTSD also? I understand about the pain, I actually have 3 plans on how to kill myself for the last couple of months, I don’t know how things got so bad lately. My father also screwed my sister and brother and me up really bad. He was a sociopath and I was his “favorite” and his only real kid so he trreated me “special” if you know what I mean. My other family, all of them, hated and hate me because this went on from my birth too. He was a rageaholic and very sexually and psychologically abusive, using me like a little experiment. He had no capacity for love, but I didn’t see this until a few years ago, and I’m 50 now. I too had the most beautiful daughter, who is about to be 18, some days, I think she doesn’t need me anymore so I can finally stop pretending to be happy,(I am happy sometimes). She was taken by CPS four years ago because I was a poor single mom and I didn’t let them in the house because I thought it was too messy. It broke my heart into millions of pieces, and her doctors, who didn’t like me, worked up a big bunch of BS (Actual disgusting lies) so I lost almost my only child. Life really is short. God will take you when its time, your kids need you, and you need to find ANYTHING to be a little bit happy about. A craft and a new puppy? The fact that you can make your kids laugh? Your dad was sick, that doesn’t make it forgiveable. But try to cast your vision into the future, you look for the good, plan for and get something you’ve always wanted. Love your children. They will always need you.

  3. Hi Bridget, SeaMonkey and Becky, I’ve had complex PTSD for 40 years (I’m now 46). I’m on federal disability and also can’t work. What has helped me the most was cognitive restructuring and meditation. I couldn’t find a therapist who was competent so I taught myself. Being able to separate my thoughts and emotions from my physical experience is what saved me psychologically. Understanding what is happening in my body, that my “flight or fight” response is constantly “on” and that my triggers amplify this state allowed me to see CPTSD as two-fold. One, it is a biological injury to my brain that causes an increased stress (fight/flight) response (and all that goes with that: dissociation, depersonalization, chronic pain, chronic fatigue, and other distressing and sometimes intolerable physical symptoms) and two, it’s a psychological disorder caused by the biological injury that affected how I see the world: my thoughts, beliefs, perspective, etc. The meditation helped me to begin to see those thoughts and beliefs as false and change them into positive, self-loving, compassionate beliefs of survival. I survived my life the only ways I knew how. But now that I can see that, I can be vigilant about when those thoughts come into play and stop them and see them as just coping beliefs that I needed to survive. Self-awareness, which came from meditation and active cognitive restructuring has allowed me to heal most of this part of CPTSD. The physical part is now what I’m focusing on and even though it is all still a struggle every day, I no longer get suicidal. I’ve tried all the treatments available and the last one was Somatic Experiencing, which I believe can be very effective for some. It’s about teaching your sympathetic nervous system (fight/flight) to re-regulate itself. For me, it just increased my flight/fight activation. Now, I am applying for an appointment with Dr. Eugene Lipov who is conducting an experimental treatment in Chicago that “turns off” or resets the fight or flight response. He has a 75% success rate and even severely disabled people with PTSD are having success. By success, I mean that it returns the brain’s fight/flight response to a pre-trauma state. Keep your hope alive and love yourself as best as you can. Most of our suffering comes from the way we cope with the symptoms. Once we begin to understand our coping mechanism (thoughts, beliefs, actions) and how our bodies are affected by trauma, then we become empowered to make changes. Without self-awareness, we remain stuck in the cycle of surviving with a warped perspective. Blessings to you all!

  4. I come from a family of 5 generations of the military who have seen active service, patterns repeat from one generation to the next. Systematic domestic abuse which leads that children to run away and without other options join the military and so it goes on. Although I served 12 years I have been to at least break the cycle.

    I tried to improve my mental health through therapy, getting an education and through mixing with middle class professionals, however, I have found this to be a major struggle. Trauma survivors are highly empathetic to the suffering of others, whereas the middle classes are very individualistic and don’t like being made to feel bad. Consequently, I am unemployed and have had about 10 jobs in the last 15 years. Having no income despite veteran status, means stress and anxiety levels are high, being able to take time out on welfare might not be the first choice, but trying to survive and find/start new jobs every 18 months as well as find ways to recover from CPTSD is nigh on impossible. I think a lot of us – certainly those on primarily CPTSD forums, struggle and there is evidence of a downward spiral which occurs around the mid 40’s seems to make things worse. being able to take time out to focus on recovery would be a luxury most of us only dream of.

    I would be interested to know what Dr. Lipov is doing to reset the F/F response, reminds me of those old MKUltra experiments on psychiatric patients where they hoped to reset their minds.

  5. I have studied PTSD for years though named many other things back in the day……This being the reason I could not connect the dots to my spouse with CPTSD. Diagnosed with PTSD my spouse simply was not fitting accurately and EMDR was a nightmare trial. So with the help of a very well qualified therapist we came across CPTSD, as to why this is taking so long to appear in the DSM I have NO IDEA. It is VERY different than PTSD. I hope for those suffering that the association rolls the ball a bit faster and begins to accept this. Call it whatever one wants but it is exactly what is being seen under the current diagnosis of CPTSD…..

  6. Anthony, what a grea article. As a supprter of someone who fits alll of the criteria llisted above I can onlysay I wish I had found it 8 years ago.It goes a long way in explaining what My family and I live with every day.


  7. Hi I’m Danny I have complex PTSD and find it hard to talk about as I think I’ve had it for many years as a result of child abuse and people really don’t no what’s going on in your head and how it makes you feel they see a weak person who is fighting for there life because you have no emotion and no feelings for anything I’m now not work as a result of this which I think makes it worse as you have more time to think about it with no where to run

  8. I was under the impression that the newest inclusion in the DSM-V would be DES-NOS (Disorders of Extreme Stress Not Otherwise Stated), which cPTSD would be a part of…maybe not, though?

    • The problem is… there is no DESNOS. It didn’t make it into the DSM V, as it too was rejected. This is the issue with the world wide web. Someone says its true, so you may believe it. The problem is… that same person hasn’t actually looked in the DSM V.

      I have it sitting in front of me, and I can factually state, DESNOS or any variation of, does not exist within the DSM V. All mistruths… don’t believe everything you read online, even this website. Websites are full of opinions and half truths. Ask for the source and whether they actually have that source in front of them.

      Purely to prove my point, if you’re a member… you can see me right now holding the DSM V in hand, assuring you that DESNOS is not within it:

  9. I am certain I have CPTSD. For my childhood, I was in emotionally, psychologically, and spiritually abusive circles. These were churches, homeschool groups, and the home. I recently got out of these circles and am recovering from the shock. I am in seminary. I found out about the abuse there. I am in therapy now. My therapist said she thinks I wasn’t making progress because it was an excuse to stay the way that I am. Simply no. It would have been dangerous to change too much while I was still in the home. Also, this last time, I had to tell her that therapy with its artificial and pushy qualities was not safe. She assumed it was for everyone until I told her no. It is working better with pastors who I know in many contexts and who don’t push as hard. Perhaps I could pretend they were with me when I went to see my therapist. It is so painful to try to feel and when I think I almost have it, it evades me. I am frustrated because all of this is interfering with every aspect of my life. I am terrified that people will stop giving me grace and won’t be imaginative enough to see what I could do without this problem. I am a nearly completely opposite person than what I have been before. I am afraid to let this new person out because I don’t want to get hurt or embarrassed. My nature is to be very good with people but this was buried deep because of the abuse. My survival techniques are what people react to. These point to that I am not good with people. Because I was brainwashed very badly, I will say things like I was trained to say them and not how they really are which only confirms people’s negative perceptions of me. I am learning but this is so maddening. I want to be free. I am making good progress but it is very slow. I am wondering if I ever will be fully healed. I want to use all this for reaching out to people in a compassionate ministry but right now I need to focus on myself and heal. I need to do the things I know to do and trust that the rest will come.

  10. I am glad to hear they are bringing the topic to the table officially so maybe something more can be done. I so feel I will never live without it after being treated almost all my life.

  11. Hey there. My name’s Jenny. When last I blinked and felt more “normal” I used to be a writer and read voraciously, was the student work study secretary in the English Department of my university, I studied abroad in England junior year, traveled to various countries using England as a base the year thereafter, and was planning to enter seminary to study theology. When last I blinked and felt more “normal,” I contributed to a poetry journal, was studying three languages, and felt invincible. So invincible….walking around with Keats and Milton and Hans urs von Balthasar and Kerouack elevating my soul and spirits to the point of levitation. God. All the hope and potential in the world.

    Something happened. Two nondescript words that, for me, carry in them the crushing weight of my current world. I’m sorry to all of you for your own “something” that “happened”. Somethings bad continued to happen thereafter;born from the one bad thing….
    and now…I can say that I changed immediately after being raped. For five years I existed altered without realizing that my new behavior bore clinical name and pattern…I can say now that Stockholm behavior can affect even the valedictorian intellect. The heart knows a reason that reason knows not of kinda thing. Staying in a severely mentally, sexually, and thus physically abusive experience is soOoo denaturing. I can say that I finally broke free and that there’s an ocean between us. I can say that I understand everyone here who feels trapped in the “repetitive theme of self”, your memories replaying to mock you, your better self disassociating, seeing a marionette and knowing, even, what pulls the strings…but not how to quite sever all strings and walk strong again. Trauma survivors live with that Harry Potter-ian lightening bolt scar…that sears when evil is near…but, I’m going to find out how to rise up and out of the evil that is being stuck in a thick negative soup. It sucks to have to realize that you have to rise up and grab your sense of self back…when you feel so affronted and unconsulted on the matter of it having been taken…but you do…we do. Jerry Garcia once had to entirely re-learn guitar. One of the greatest noodleers could no longer noodle and it filled him with rage. His special gift, his connection with divinity, his outlet for creativity, his preferred voice to the world, the vibrations that offered perhaps the best window into his heart and soul….taken away. He had to decide whether or not to fight for it…and got stuck in depression and heroin avoidance games. A man came to his house to inspire and push him…a man came to give him his gift back…but he is the one who had to sit there and take it back whilst feeling embarrassed, small, like it was beneath him, angry, sad…the whole gamut we feel. But………..he’s one of the ones who knew he couldn’t be happy alive without recreating himself. He wasn’t happy staying broken, in between things….and neither am I.

    If you guys are willing to help me to not feel so alone and foreign from the world…I’m willing to help you as well.

    I had to leave my master’s degree programme unfinished in 2012
    …I walked away after having completed all of the classes and had nothing left to do but sit for the three week period of exams. PTSD burst onto the scene in full glory and my mind could hardly work on translating obscure latin when my mind could no longer see a light at the end of the tunnel. I’ve always been optimistic and extroverted like crazy…I’m tired of being afraid and I’m tired of feeling small when I know what it’s like to feel big. I think I need to talk about my life with people who have PTSD…it’s one thing I have not done in all this time…talk to the only people who are gripped with the same faceless terror. I need to read your words…in exchange I’ll offer mine and all resources/insight I have learned in my fight thus far. So….I’m sending out a beacon…here I am. I wish you all a peaceful, happy, beautiful evening. -Jenny

  12. Hi all, I was diagnosed c-ptsd 6 years ago. I asked as a kid, what’s shell shock? I was told only soldiers get that. I knew my emotional system was shattered, but accepted the answer, I was 11, and my abuse carried on. Child sex abuse, severe beatings, bullying etc, but I walked in faith. Now 51, I am now coming to terms with the extent of damage I received, I had alters as a kid, voices in my head spoke to, holes in my memory, the list is endless. After being diagnosed, I learned that, c-ptsd is caused by covert narcissism. How does that work? Covert narcissism is the perpetual reminding of abuses by a narcissist. My narc, younger brother, constantly reminded me of my traumas, he got me beaten as a kid, telling lies, shattering my spirit, causing alters. My mind fragmented, soon after was sexually abused, and voices appeared, my younger brother, who I told, then knew my wounds. He spiritualised every emotional wound, and would constantly remind me of the injustices I suffered. For 42 years I suffered covert narcissism, during which time, my brother, had me put in prison, slept with my girlfriend, told people I’d been sexually abused, all to keep me in perpetual pain. For me, ptsd is a one off trauma, c-ptsd is years of covert narcissism, and the media perpetuates it too, people spiritualise when reading media coverage of trauma, which is not empathy, but the knowing of spiritual laws, and manipulation. Pure utter evil.