Complex trauma has a deep impact on the nervous system. By understanding how it develops, you can better understand how to treat it.
Most of us have a chapter in our lives we’d rather forget. Whether it’s a devastating breakup or the death of a loved one, many of us have felt the sting of heartbreak that comes with being a human.
But for those who live with complex trauma, the memories don’t just live in the past. They live in the present moment, too.
For a long time, complex trauma wasn’t well understood. Now researchers estimate that more than 3% of people meet the criteria for complex trauma, also called complex post-traumatic stress disorder (C-PTSD), in the United States. This is about the same percentage as people with traditional PTSD.
Trauma, the kind you’ve likely heard of, can develop after a distinct traumatic experience. It occurs when the brain and body are so overwhelmed that they have a hard time easing out of “fight, flight, or freeze” mode and coming back into a relaxed state.
Trauma may refer to a single incident, while complex trauma refers to a series of traumatic events that take place over a long period of time, like months or years.
First introduced in the
- feeling anxious
- having flashbacks
- avoiding circumstances that remind you of the traumatic events
In addition, complex trauma can:
- distort your sense of self
- make it difficult to control your emotions
- cause relationships challenges
How does complex trauma develop?
(Video) Complex PTSD (CPTSD) and Strategies to Cope
How does complex trauma develop?
When you experience a traumatic event, it activates the limbic system in the brain. This “fire alarm” shuts down all nonessential systems (rest, digestion, sleep) and floods your body with stress hormones, like cortisol, so you can prepare for fight, flight, or freeze.
Once the danger passes, your parasympathetic nervous system provides inner calm, otherwise known as your “rest and digest” mode.
At this point, normal cognitive function returns, and you can go back to your day with relatively few side effects, perhaps only feeling a little jittery for a while, or a bit on edge.
But for people who live with complex trauma, this balance doesn’t quite return all the way.
The limbic system stays engaged most of the time. It’s a coping mechanism to try and stay safe in the face of ongoing adversity. It’s an experience of constantly being in survival mode, or on edge.
Over time, it becomes a “new normal” for the brain and body.
In his book, “The Body Keeps the Score,” trauma expert Bessel van der Kolk, MD, describes how trauma literally becomes trapped in the body and the brain rewires itself. These lasting effects create symptoms of complex trauma.
This bodily state of your nervous system being on “high alert” can affect your thoughts, actions, and relationships.
Some symptoms of complex trauma include:
- flashbacks
- lapses in memory
- difficulty regulating emotions
- hyperarousal, or being “on alert”
- dissociation or lapses in memory
- depersonalization or derealization
- sleep disturbances or nightmares
- struggling in interpersonal relationships
- low self-esteem or negative self-perception
- avoiding people, places, or scenarios that upset you
Somatic (bodily) symptoms, like unexplained headaches or an upset stomach, are also common with complex trauma. Since the body is under chronic stress, it can lower your immune system and lead to a range of chronic health conditions.
(Video) 6 Hidden Signs of Complex PTSD (cPTSD) | MedCircle
Complex trauma can arise in any situation where you feel an ongoing sense of fear, horror, helplessness, or powerlessness over an extended period of time, with the perceived or actual inability to escape.
It usually stems from trauma you experienced in childhood, though it can develop from trauma in adulthood as well.
Some possible causes of complex trauma include:
- sexual abuse or incest
- ongoing physical or emotional abuse
- chronic neglect or abandonment
- medical abuse or medical trauma
- torture or being held captive
- enmeshment or engulfment trauma
- parentification (children taking on adult rules)
- human trafficking
- genocide campaigns
- living in a war zone or area of civil unrest
Everyone’s story is unique — and so is their trauma. What works for one person may not work for another.
Also, keep in mind that what works at one point in time may not work later on down the line.
The great news is, as more is uncovered about complex trauma, more trauma treatment therapies are emerging as well. The goal of each treatment option is to provide a corrective emotional experience for healing.
Here are some effective therapies for complex trauma:
- Cognitive behavioral therapy (CBT). In this form of therapy, you explore the relationship between your thoughts, feelings, and behaviors. Once you become aware of the connections, you may be able to change your actions.
- Eye Movement Desensitization and Reprocessing (EMDR). With this treatment, you’re guided with gentle tapping (or tones) to reprocess traumatic events and form new beliefs around them.
- Internal family systems (IFS). With this approach, you learn how to integrate the different parts of your personality into one whole “Self” to reprocess traumatic events in a way that can no longer harm you.
- Somatic (body) therapies. Since trauma lives in the limbic area of the brain and not the frontal cortex (the part of the brain that talks in therapy), somatic therapies or body-centered therapies can teach your body that it does not have to be prepared for trauma all the time.
- Dialectical behavioral therapy (DBT). This approach can be effective for people who live with borderline personality disorder (BPD), which has many overlapping symptoms with complex trauma. In this treatment approach, you learn mindfulness, radical self-acceptance, and distress tolerance.
There’s also a link between complex trauma and substance use as a way to cope with symptoms. If you’d like to cut back on using drugs or drinking alcohol, support is available.
Look for a local 12-step program, like Alcoholics Anonymous (AA) or Narcotics Anonymous (NA), or SMART Recovery.
Here are some additional resources for support:
Recovery from complex trauma can be a gradual process. But having a range of tools and self-care strategies can make the process a whole lot easier.
It’s a good idea to keep a few deep breathing exercises up your sleeve for those tough moments. This is a direct way to let your body know that you’re safe. Try these:
- 4-7-8 breathing: Inhale for 4 seconds, hold for 7 seconds, exhale for 8 seconds.
- Box breathing: Inhale for 4 seconds, hold for 4 seconds, exhale for 4 seconds, hold for 4 seconds.
- Alternate nostril breathing: Place your right thumb over your right nostril. Inhale and exhale eight times through your left nostril. Repeat on the other side.
A consistent mindfulness practice can help too. A 2018 study involving veterans with PTSD found that a regular meditation practice can reduce symptoms of trauma. Yoga has shown
It might help to access trauma-informed yoga sessions, where the yoga instructor is aware that trauma can be stored in the body, and that some body movements can trigger emotional reactions. They can help you navigate these reactions in a healing way.
Here are some lifestyle adjustments that can make complex trauma more manageable:
- do tai chi or dance
- journal your feelings
- spend time in nature
- eat a nutritious, balanced diet
- sleep around 8 hours a night
- “shake off” tough emotions by literally shaking your arms or your body to release tension
- talk through your triggers with loved ones
- practice progressive relaxation techniques
- exercise five times a week, even if only a few minutes a day
- try using the flashback halting protocol to manage flashbacks
Complex trauma may feel like it’s taking over your life. Perhaps you feel alone in your experience, wondering if it will ever feel like less of a big deal.
Two thoughts: You’re not alone, and it will get better.
One of the best things you can do is to continue to educate yourself about complex trauma. You may be able to find a healing book club or support group in your area.
You can also join one online, like this one through the C-PTSD Foundation.
Here are some books to add to your reading list:
- “The Body Keeps the Score” by Bessel van der Kolk, MD
- “Healing the Fragmented Selves of Trauma Survivors: Overcoming Internal Self-Alienation” by Janina Fisher, PhD
- “Trauma & Recovery” by Judith Lewis Herman, MD
- “The Complex PTSD Workbook” by Arielle Schwartz, PhD
- “Waking the Tiger” by Peter Levine, PhD
- “Trauma and the Body” by Pat Ogden, PhD
- “The Body Heals Itself” by Emily Francis
- “What Happened to You? Conversations on Trauma, Resilience, and Healing” by Bruce D. Perry, MD, PhD, and Oprah Winfrey
Also, here’s a great TED Talk on how childhood trauma affects health over a lifetime.
Finally, know that you will get through this. You’ve survived 100% of your worst days so far and, just like the other tough times, this will pass too.
You’re stronger than you know.
Suicide prevention
Complex trauma may increase your risk of self-harm. If you’re considering self-harm or suicide, help is available right now:
- Call a crisis hotline, such as the National Suicide Prevention Lifeline at 800-273-8255.
- Text HOME to the Crisis Text Line at 741741.
FAQs
Can you heal complex trauma? ›
Complex post-traumatic stress disorder is entirely treatable with the right combination of compassion, patience, and trust. Someone can work to disempower the trauma that cripples them and practice positive coping skills in the context of well-rounded support and guidance.
How do you get rid of complex trauma? ›If you have complex PTSD, you may be offered therapies used to treat PTSD, such as trauma-focused cognitive behavioural therapy (CBT) or eye movement desensitisation and reprocessing (EMDR). You'll also be offered treatment for other problems you may have, such as depression or alcohol addiction.
How long does it take to treat complex trauma? ›Recovery from C-PTSD is a long slog, with survivors sometimes requiring more than ten years of psychotherapy for resolution. There are some C-PTSD programs offered through residential psychiatric programs that offer specialized treatment for this disorder and accompanying dissociative disorders.
What does complex trauma do to a person? ›Emotional Responses
Children who have experienced complex trauma often have difficulty identifying, expressing, and managing emotions, and may have limited language for feeling states. They often internalize and/or externalize stress reactions and as a result may experience significant depression, anxiety, or anger.
CPTSD is a serious mental health condition that can take some time to treat, and for many people, it's a lifelong condition. However, a combination of therapy and medication can help you manage your symptoms and significantly improve your quality of life.
How long does Cptsd take to heal? ›Some people recover within 6 months, while others have symptoms that last much longer. In some people, the condition becomes chronic. A doctor who has experience helping people with mental illnesses, such as a psychiatrist or psychologist, can diagnose PTSD.
What therapy is best for complex trauma? ›The current method for treating complex trauma is a combination of talk therapy, cognitive behavioral therapy, and exposure therapy.
What is the best treatment for CPTSD? ›For PTSD, cognitive therapy often is used along with exposure therapy. Exposure therapy. This behavioral therapy helps you safely face both situations and memories that you find frightening so that you can learn to cope with them effectively. Exposure therapy can be particularly helpful for flashbacks and nightmares.
How do you know you've healed from trauma? ›"Looking forward to the future and being able to create a renewed sense of self. The traumatic event is no longer the primary event in one's life. Therefore, being able to reconnect with oneself and embrace the future without feeling overwhelmed is also a positive sign in trauma healing," Dr Parul told HT.
What are the 17 symptoms of complex PTSD? ›- Intrusive Thoughts. Intrusive thoughts are perhaps the best-known symptom of PTSD. ...
- Nightmares. ...
- Avoiding Reminders of the Event. ...
- Memory Loss. ...
- Negative Thoughts About Self and the World. ...
- Self-Isolation; Feeling Distant. ...
- Anger and Irritability. ...
- Reduced Interest in Favorite Activities.
Is CPTSD worse than PTSD? ›
The difference between CPTSD and PTSD is that PTSD usually occurs after a single traumatic event, while CPTSD is associated with repeated trauma. Events that can lead to PTSD include a serious accident, a sexual assault, or a traumatic childbirth experience, such as losing a baby.
How do you process trauma on your own? ›- Lean on your loved ones. Identify friends or family members for support. ...
- Face your feelings. It's normal to want to avoid thinking about a traumatic event. ...
- Prioritize self-care. Do your best to eat nutritious meals, get regular physical activity, and get a good night's sleep. ...
- Be patient.
Complex post-traumatic stress disorder (C-PTSD; also known as complex trauma disorder) is a psychological disorder that is theorized to develop in response to exposure to a series of traumatic events in a context in which the individual perceives little or no chance of escape, and particularly where the exposure is ...
What can cause Cptsd? ›- being involved in a car crash.
- being raped or sexually assaulted.
- being abused, harassed or bullied - including racism, sexism, homophobia, biphobia or transphobia, and other types of abuse targeting your identity.
- being kidnapped, held hostage or any event in which you fear for your life.
Delayed responses to trauma can include persistent fatigue, sleep disorders, nightmares, fear of recurrence, anxiety focused on flashbacks, depression, and avoidance of emotions, sensations, or activities that are associated with the trauma, even remotely.
What happens if complex PTSD is left untreated? ›Psychological effects of untreated PTSD
Without treatment, the psychological symptoms of PTSD are likely to worsen over time. Along with severe depression and anxiety, other serious outcomes may include: Increased suicidal ideation. Problems managing anger and aggression.
PTSD can be considered a disability by the SSA if the criteria for Listings 12.15 or 112.15 Trauma- and stressor-related disorders are met by the applicant. If your symptoms of PTSD are so severe that you are unable to work, the SSA will consider you disabled and you will be able to get disability with PTSD.
What does a complex PTSD episode look like? ›Living with complex post-traumatic stress disorder (C-PTSD) might mean behaving recklessly or having feelings of hostility or dissociation that make daily life difficult. You may feel like you've lost your sense of spirituality or feel overwhelmed by shame.
What should you not say to a complex PTSD? ›- It wasn't that bad, was it?
- That happened in the past, why are you still upset?
- Calm down.
- You're overreacting. It's been years now. Get over it.
- You're too much right now.
- What's wrong with you?
- I don't believe anything you're saying.
- You are crazy. You are dramatic.
- Give yourself time. ...
- Talk about the event. ...
- Speak to others that have experienced the same thing as you. ...
- Ask for support. ...
- Avoid spending lots of time alone. ...
- Stick to your routine. ...
- Consider seeking professional help. ...
- Notice how you're feeling.
How do you deal with complex PTSD triggers? ›
- Know what your triggers are. Knowing what situations are likely to trigger you can help increase your sense of control.
- Have a specific plan to regulate yourself. ...
- Tell your loved ones. ...
- Use your tools. ...
- Get into therapy with a Complex PTSD (C-PTSD) specialist.
...
Doctors will usually start with medications that affect the neurotransmitters serotonin or norepinephrine (SSRIs and SNRIs), including:
- Fluoxetine (Prozac)
- Paroxetine (Paxil)
- Sertraline (Zoloft)
- Venlafaxine (Effexor)
Complex trauma is treated through a combination of psychotherapy (talk therapy), eye movement desensitization and reprocessing (EMDR), medications, and the development of strong coping mechanisms.
What medications are used to treat complex PTSD? ›Antidepressants are often used to treat complex PTSD, including Prozac (fluoxetine), Paxil (paroxetine), and Zoloft (sertraline).
What is the best mood stabilizer for PTSD? ›While no single pharmacological agent has emerged as the best treatment for PTSD, research and testimonials strongly recommend serotonin reuptake inhibitors (SRIs). The FDA has only approved two SRIs for the treatment of PTSD: sertraline and paroxetine.
What is the most common drug prescribed for PTSD? ›- Sertraline (Zoloft)
- Paroxetine (Paxil)
- Fluoxetine (Prozac)
- Venlafaxine (Effexor)
behavior therapy, or TF-CBT, is considered the gold standard treatment for children and adolescents with PTSD.
Where is guilt stored in the body? ›Body and Mind
The positive emotions of gratefulness and togetherness and the negative emotions of guilt and despair all looked remarkably similar, with feelings mapped primarily in the heart, followed by the head and stomach.
The three key areas in the body that have the potential to be most affected by emotional forces are the pelvic floor, the diaphragm, and the jaw. Many of you have experienced tension in your neck and jaw and tightness in your low back.
Can trauma change your personality? ›A person may experience a change in their demeanor after experiencing a traumatic situation or witnesses an unpleasant event. These behavioral changes may be caused by a mental health condition, such as: Anxiety: Anxiety occurs when a person feels nervous or uneasy about a situation.
What does PTSD do to the brain? ›
PTSD causes your brain to get stuck in danger mode. Even after you're no longer in danger, it stays on high alert. Your body continues to send out stress signals, which lead to PTSD symptoms. Studies show that the part of the brain that handles fear and emotion (the amygdala) is more active in people with PTSD.
How do you get diagnosed with 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.
Do I have C-PTSD? ›Symptoms of C-PTSD
Flashbacks and nightmares in which the trauma is relived. Avoiding people, places, and situations that remind them of the trauma. Dizziness or nausea when remembering the trauma. Hyperarousal.
Living with Complex PTSD can create intense emotional flashbacks that provide challenges in controlling emotions that may provoke severe depression, suicidal thoughts, or difficulty in managing anger. C-PTSD can also create dissociations, which can be a way the mind copes with intense trauma.
What are examples of complex trauma? ›- sexual abuse or incest.
- ongoing physical or emotional abuse.
- chronic neglect or abandonment.
- medical abuse or medical trauma.
- torture or being held captive.
- enmeshment or engulfment trauma.
- parentification (children taking on adult rules)
- human trafficking.
- Movement and Exercise. As trauma disrupts your body's natural equilibrium, exercise and movement can help repair your nervous system. ...
- Connect with Others. ...
- Ask for Support. ...
- Volunteer.
- Recognize the trauma. The adult must acknowledge this certain childhood experience as trauma. ...
- Be patient with yourself. Self-criticism and guilt can be very common when it comes to adults who have lived through a traumatic childhood. ...
- Reach out for help.
- Substance abuse. Taking a lot of drugs or alcohol to feel better is called substance abuse. ...
- Avoiding others. ...
- Staying always on guard. ...
- Avoiding reminders of the trauma. ...
- Anger and violent behavior. ...
- Dangerous behavior. ...
- Working too much.
In 1980, the American Psychiatric Association (APA) added PTSD to the third edition of its Diagnostic and Statistical Manual of Mental Disorders (DSM-III) nosologic classification scheme (2). Although controversial when first introduced, the PTSD diagnosis has filled an important gap in psychiatric theory and practice.
Does medication work for complex PTSD? ›Some medications for depression may reduce the symptoms of complex PTSD. These medicines may be especially effective in combination with psychotherapy. A person may take the medication for the short- or long-term, depending on the severity of their symptoms and the effectiveness of therapy.
Is PTSD the same as complex trauma? ›
Complex trauma and Complex PTSD
Complex Post Traumatic Stress Disorder, or Complex PTSD, is a formal diagnosis of a mental health disorder. Complex trauma is a series of events and processes, not a diagnosis. Experiencing complex trauma does not mean that an individual will develop Complex PTSD.
Feeling jittery, nervous or tense.
Women experiencing PTSD are more likely to exhibit the following symptoms: Become easily startled. Have more trouble feeling emotions, experience numbness. Avoid trauma reminders.
Posttraumatic stress disorder (PTSD) is a psychiatric disorder that may occur in people who have experienced or witnessed a traumatic event such as a natural disaster, a serious accident, a terrorist act, war/combat, or rape or who have been threatened with death, sexual violence or serious injury.
Why do clients smile when talking about trauma? ›Smiling when discussing trauma is a way to minimize the traumatic experience. It communicates the notion that what happened “wasn't so bad.” This is a common strategy that trauma survivors use in an attempt to maintain a connection to caretakers who were their perpetrators.
How is trauma stored in the body? ›The energy of the trauma is stored in our bodies' tissues (primarily muscles and fascia) until it can be released. This stored trauma typically leads to pain and progressively erodes a body's health. Emotions are the vehicles the body relies on to find balance after a trauma.
What therapy approach is best for trauma? ›Trauma-Focused Cognitive Behavioral Therapy (TF-CBT)
TF-CBT is one of the most effective trauma therapy methods available to help youth recover from Post-Traumatic Stress Disorder. TF-CBT addresses other trauma-related challenges like anxiety, depression, and behavior problems.
- flashbacks.
- nightmares.
- repetitive and distressing images or sensations.
- physical sensations, such as pain, sweating, feeling sick or trembling.
Complex trauma describes both children's exposure to multiple traumatic events—often of an invasive, interpersonal nature—and the wide-ranging, long-term effects of this exposure. These events are severe and pervasive, such as abuse or profound neglect.
What does complex trauma feel like? ›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.
Is complex trauma a mental illness? ›Complex post-traumatic stress disorder (C-PTSD; also known as complex trauma disorder) is a psychological disorder that is theorized to develop in response to exposure to a series of traumatic events in a context in which the individual perceives little or no chance of escape, and particularly where the exposure is ...
Is complex trauma and PTSD the same thing? ›
The main difference is that PTSD is generally related to a single event or series of events within a short period of time, while complex PTSD is related to a series of events that repeatedly occurred over an extended period of time.
How do you know if you have complex trauma? ›Complex PTSD and emotional flashbacks
If you have complex PTSD you may be particularly likely to experience what some people call an 'emotional flashback', in which you have intense feelings that you originally felt during the trauma, such as fear, shame, sadness or despair.
- Sertraline (Zoloft) is FDA-approved for treating PTSD, and it's one of the most common medications prescribed for this condition. ...
- Paroxetine (Paxil) is the only other FDA-approved medication for PTSD. ...
- Fluoxetine (Prozac) is used off-label for treating PTSD.
- Intrusive Thoughts. Intrusive thoughts are perhaps the best-known symptom of PTSD. ...
- Nightmares. ...
- Avoiding Reminders of the Event. ...
- Memory Loss. ...
- Negative Thoughts About Self and the World. ...
- Self-Isolation; Feeling Distant. ...
- Anger and Irritability. ...
- Reduced Interest in Favorite Activities.
The difference between CPTSD and PTSD is that PTSD usually occurs after a single traumatic event, while CPTSD is associated with repeated trauma. Events that can lead to PTSD include a serious accident, a sexual assault, or a traumatic childbirth experience, such as losing a baby.
What does a complex PTSD episode look like? ›Living with complex post-traumatic stress disorder (C-PTSD) might mean behaving recklessly or having feelings of hostility or dissociation that make daily life difficult. You may feel like you've lost your sense of spirituality or feel overwhelmed by shame.
Can trauma change your personality? ›A person may experience a change in their demeanor after experiencing a traumatic situation or witnesses an unpleasant event. These behavioral changes may be caused by a mental health condition, such as: Anxiety: Anxiety occurs when a person feels nervous or uneasy about a situation.
How does complex trauma develop? ›Complex trauma is associated with exposure to multiple traumatic events, usually over a series of months or years. This type of trauma is thought to develop from ongoing stress in situations that are inescapable, like being held captive or experiencing repeated abuse during childhood.
What happens if complex PTSD is left untreated? ›Psychological effects of untreated PTSD
Without treatment, the psychological symptoms of PTSD are likely to worsen over time. Along with severe depression and anxiety, other serious outcomes may include: Increased suicidal ideation. Problems managing anger and aggression.
- It wasn't that bad, was it?
- That happened in the past, why are you still upset?
- Calm down.
- You're overreacting. It's been years now. Get over it.
- You're too much right now.
- What's wrong with you?
- I don't believe anything you're saying.
- You are crazy. You are dramatic.
How can I help someone with complex PTSD? ›
- Avoid Retraumatization. Don't underestimate the danger and intensity of your adult child reliving their original traumatic memories and suffering. ...
- Lead with Listening. ...
- Discuss the Triggers and Work Together. ...
- Learn About the Options for Treatment.
Complex trauma therapy utilizes several modalities to address different symptoms. The current method for treating complex trauma is a combination of talk therapy, cognitive behavioral therapy, and exposure therapy.
How does complex PTSD affect the brain? ›Proven structural changes include enlargement of the amygdala, the alarm center of the brain, and shrinkage of the hippocampus, a brain area critical to remembering the story of what happened during a traumatic experience. Functional changes alter activity of certain brain regions.