What is Complex Trauma and Complex PTSD?
Trauma can affect us in many ways, but for some, the impact is deeper and more far-reaching than what we might initially understand. Complex trauma and its related diagnosis, Complex Post-Traumatic Stress Disorder (C-PTSD), are terms that are gaining more recognition in the mental health field, yet they are still often misunderstood. As a mental health counselor, I’ve worked with individuals who have experienced chronic trauma, and I've witnessed firsthand the profound effects it can have on mental health and daily functioning.
In this blog post, we’ll explore what complex trauma is, what distinguishes it from traditional PTSD, and what therapy options are available for those suffering from its effects. Understanding these concepts can help those affected feel seen, validated, and empowered to seek the healing they deserve.
What is Complex Trauma?
At its core, complex trauma refers to prolonged or repeated exposure to traumatic events, often during critical developmental years. These events can be physical, emotional, or sexual abuse, neglect, or ongoing interpersonal violence. Unlike a single traumatic event (such as a car accident or a natural disaster), complex trauma involves repeated exposure to traumatic experiences that disrupt the individual’s sense of safety and trust.
People who have endured complex trauma often face emotional and psychological struggles that are deeply ingrained, affecting their relationships, self-esteem, and ability to regulate their emotions. Over time, the repeated trauma can alter the way a person views the world and themselves, leaving them feeling fundamentally unsafe or unworthy.
Examples of complex trauma include:
Childhood abuse or neglect
Living in an abusive household
Witnessing domestic violence or other forms of interpersonal violence
Chronic emotional, physical, or sexual abuse over an extended period
What is Complex PTSD?
Complex PTSD, or C-PTSD, is a diagnosis used to describe the psychological effects of chronic trauma, particularly when that trauma occurs over long periods and in close relationships (e.g., in the home or intimate relationships). Unlike standard PTSD, which is often triggered by a single traumatic event, C-PTSD encompasses a broader range of symptoms and challenges that stem from prolonged exposure to trauma.
In C-PTSD, the trauma isn’t just about a specific event, but the cumulative impact of continuous distressing experiences. The diagnostic criteria for C-PTSD, as outlined by the World Health Organization (WHO), include the following symptoms:
Reliving the Trauma: Flashbacks, intrusive memories, or nightmares related to past abuse or violence.
Avoidance: Avoiding reminders of the trauma, which may include places, people, or even certain emotions or thoughts.
Negative Mood and Cognition: Feelings of hopelessness, guilt, shame, or anger. The trauma may result in a loss of trust in others or a negative self-image.
Dysregulated Emotions: Difficulty managing emotions, including anger outbursts, emotional numbness, or chronic sadness.
Interpersonal Struggles: Difficulty forming or maintaining healthy relationships due to mistrust or fear of betrayal.
Alterations in Consciousness: Feelings of dissociation, being detached from one's own body, or having a sense of being "out of control."
Complex trauma can manifest in a variety of ways, and because it stems from prolonged exposure to trauma, its effects can often be harder to identify and treat. It may not be immediately apparent to those who are suffering from C-PTSD, especially when the trauma is long past or the person has been coping with it for many years.
Therapeutic Approaches to Treat Complex Trauma and C-PTSD
When it comes to healing complex trauma, it’s important to recognize that there is no one-size-fits-all solution. Recovery is a deeply personal journey, and the approach must take into account the unique nature of the trauma and the person’s individual needs. Fortunately, there are several therapeutic modalities that have been shown to be effective in treating complex trauma and C-PTSD.
1. Trauma-Focused Cognitive Behavioral Therapy (TF-CBT)
Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) is a structured, evidence-based therapy designed to help individuals process and heal from trauma. While it’s often used to treat children, it can also be highly effective for adults with complex trauma or C-PTSD.
The therapy focuses on changing negative thought patterns and behaviors that have developed in response to trauma. In the case of complex trauma, TF-CBT helps individuals reframe negative beliefs about themselves and the world, while also teaching coping strategies to manage overwhelming emotions. TF-CBT also helps clients face their trauma in a safe, controlled manner, reducing avoidance behaviors that may hinder healing.
2. Brainspotting
Brainspotting is a relatively new therapeutic approach that has shown great promise in treating trauma, especially C-PTSD. Developed by Dr. David Grand, Brainspotting is similar to EMDR in that it utilizes the connection between the brain and the eyes to access traumatic memories stored in the brain. However, while EMDR uses bilateral stimulation (often through eye movements), Brainspotting focuses on identifying "brainspots"—specific points in the visual field where the brain holds traumatic memories.
Brainspotting allows the therapist to guide the client’s eye movements toward areas of tension or emotional disturbance, helping them process trauma stored in the brain and body. It can be particularly effective for individuals with complex trauma because it works with the body’s natural healing abilities, helping to release trapped emotions and facilitate a deep processing of trauma.
One of the benefits of Brainspotting is that it allows for the direct processing of trauma, even when the client cannot verbally articulate the traumatic experience. This method is often used when clients feel overwhelmed or blocked by trauma that is difficult to express.
3. Dialectical Behavior Therapy (DBT)
Dialectical Behavior Therapy (DBT) was originally developed to treat individuals with borderline personality disorder, but it has proven effective for individuals with complex trauma as well. DBT emphasizes emotion regulation, mindfulness, and distress tolerance skills, which are critical for individuals whose emotional responses may feel chaotic or out of control due to past trauma.
DBT helps individuals develop healthier ways of coping with intense emotions, reducing self-destructive behaviors and improving their ability to manage interpersonal relationships. It is especially useful for individuals who struggle with self-harm, impulsivity, or dissociation, all of which can be common in those with C-PTSD.
4. Psychodynamic Therapy
Psychodynamic therapy focuses on uncovering how unresolved conflicts from past relationships influence present-day behavior and emotional patterns. In the context of complex trauma, this approach helps individuals explore how early traumatic experiences, particularly in childhood, may have shaped their worldview, self-image, and relationship dynamics.
While psychodynamic therapy may take longer to show results compared to more structured approaches like TF-CBT, it can be very effective for individuals who are ready to explore deep-rooted issues from their past. This therapy aims to create a stronger, more integrated sense of self, as individuals work through emotional conflicts and establish healthier relationship patterns.
5. Polyvagal Theory and Trauma-Informed Therapy
Polyvagal Theory, developed by Dr. Stephen Porges, focuses on the role of the vagus nerve in regulating the body’s response to stress and trauma. This theory suggests that the autonomic nervous system (ANS), which controls involuntary bodily functions like heart rate and digestion, is deeply affected by traumatic experiences. Trauma can trigger an overactive stress response, causing individuals to remain stuck in a state of hyperarousal (fight or flight) or dissociation (freeze), which interferes with their ability to regulate emotions and respond to daily stressors in a healthy way.
Therapists who integrate Polyvagal Theory into their practice focus on helping clients regulate their nervous system through specific techniques like grounding, breathwork, and mindfulness exercises. The goal is to help the individual shift out of a trauma-driven fight or flight response and into a state of safety and calm, facilitating healing. Polyvagal-informed therapies can be especially helpful for individuals with complex trauma, as they focus on restoring self-regulation and the body's innate ability to heal from stress and trauma.
Conclusion
Complex trauma and C-PTSD are powerful and often misunderstood conditions, but with the right therapeutic support, individuals can heal and rebuild their lives. Recognizing the signs of complex trauma and seeking professional help is the first step toward recovery. It’s also important to remember that healing is not linear—there will be ups and downs—but with the right tools and support, a person can regain a sense of safety, stability, and empowerment.
If you or someone you know is struggling with complex trauma, I encourage you to reach out to a mental health professional trained in trauma-informed care. There is no shame in seeking help, and you deserve to live a life free from the shadow of past pain.
Take care,
Jane Klingberg
References
van der Kolk, Bessel A. The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma. Viking, 2014.
Herman, Judith L. Trauma and Recovery: The Aftermath of Violence—from Domestic Abuse to Political Terror. Basic Books, 1997.
Shapiro, Francine. Eye Movement Desensitization and Reprocessing (EMDR): Basic Principles, Protocols, and Procedures. Guilford Press, 2018.
Linehan, Marsha M. DBT Skills Training Manual. Guilford Press, 2014.
Ogden, Pat, Kekuni Minton, and Clare Pain. Trauma and the Body: A Sensorimotor Approach to Psychotherapy. W.W. Norton & Company, 2006.