What is complex PTSD?

Complex post-traumatic stress disorder (complex PTSD, sometimes abbreviated to c-PTSD or CPTSD) is a condition where you experience some symptoms of PTSD along with some additional symptoms, such as:

• difficulty controlling your emotions

• feeling very hostile or distrustful towards the world

• constant feelings of emptiness or hopelessness

• feeling as if you are permanently damaged or worthless

• feeling as if you are completely different to other people

• feeling like nobody can understand what happened to you

• avoiding friendships and relationships, or finding them very difficult

• often experiencing dissociative symptoms such as depersonalisation or derealisation

• regular suicidal feelings.

What is complex PTSD?


Understanding Complex Trauma, Complex Reactions, and Treatment Approaches

Cumulative adversities faced by many persons, communities, ethno-cultural, religious, political, and sexual minority groups, and societies around the globe can also constitute forms of complex trauma. Some occur over the life course beginning in childhood and have some of the same developmental impacts described above. Others, occurring later in life, are often traumatic or potentially traumatic and can worsen the impact of early life complex trauma and cause the development of complex traumatic stress reactions. These adversities can include but are not limited to:
◦ Poverty and ongoing economic challenge and lack of essentials or other resources
◦ Community violence and the inability to escape/re-locate
◦ Homelessness
◦ Disenfranchised ethno-racial, religious, and/or sexual minority status and repercussions
◦ Incarceration and residential placement and ongoing threat and assault
◦ Ongoing sexual and physical re-victimization and re-traumatization in the family or other contexts, including prostitution and sexual slavery
◦ Human rights violations including political repression, genocide/”ethnic cleansing,” and torture
◦ Displacement, refugee status, and relocation
◦ War and combat involvement or exposure
◦ Developmental, intellectual, physical health, mental health/psychiatric, and age-related limitations, impairments, and challenges
◦ Exposure to death, dying, and the grotesque in emergency response

Understanding Complex Trauma, Complex Reactions, and Treatment Approaches

Shrinking the Inner Critic in Complex PTSD

As the quest for perfection fails over and over, and as sustaining attachment remains elusive, imperfection becomes synonymous with shame and fear. Perceived imperfection triggers fear of abandonment, which triggers self-hate for imperfection, which expands abandonment into self-abandonment, which amps fear up even further, which in turn intensifies self-disgust…on and on it goes in a downward spiral of fear and shame encrusted abandonment. It can go on for hours and days…weeks in environmentally exacerbating conditions…and for those with severe PTSD, can become their standard mode of being.


Looping/ Over-Futurizing I will not repetitively examine details over and over. I will not jump to negative conclusions. I will not endlessly second-guess myself. I cannot change the past. I forgive all my past mistakes. I cannot make the future perfectly safe. I will stop hunting for what could go wrong. I will not try to control the uncontrollable. I will not micromanage myself or others. I work in a way that is “good enough”, and I accept the existential fact that my efforts sometimes bring desired results and sometimes they do not. “God grant me the serenity to accept the things I cannot change, the courage to change the things I can, and the wisdom to know the difference” – The Serenity Prayer

Shrinking the Inner Critic in Complex PTSD

Frequently Asked Questions About Complex PTSD

One common clue that we are in a flashback occurs when we notice that we feel small, helpless, hopeless and so ashamed that we are loath to go out or show our face anywhere.
Another common clue that we are flashing back is an increase in the virulence of the inner or outer critic. This typically looks like increased drasticizing and catastrophizing, as well as excessive self-criticism or judgementalness of others. A very common example of this is lapsing into extremely polarized, all-or-none thinking – and most especially into only noticing what is wrong with yourself and/or others.

Frequently Asked Questions About Complex PTSD

People-pleasing can be a result of trauma. It’s called ‘fawning’ — here’s how to recognize it.

Most people know about fight, flight, and freeze — but another trauma response, “fawn,” is at the core of what people-pleasing is actually about.

To avoid conflict, negative emotions, and re-traumatization, people who “fawn” when triggered will go out of their way to mirror someone’s opinions and appease them in order to deescalate situations or potential issues.

For me, this meant that the more invested I was in an emotional connection, the less likely I was to criticize that person, vocalize when my boundaries were crossed, express unhappiness with their behavior, or share anything that I felt might damage that relationship.