Complex Post-Traumatic Stress Disorder (CPTSD)

Post-traumatic stress disorder (PTSD) can occur when someone experiences a traumatic event, such as a car accident, assault, or natural disaster. Complex post-traumatic stress disorder (CPTSD), while similar to PTSD, is a response to ongoing, repetitive traumatic experiences, such as childhood abuse.

What is CPTSD?

CPTSD is a psychiatric disorder that can occur after experiencing ongoing traumatic events over an extended period, typically months or years.

Someone with CPTSD might have some of the same symptoms as someone with PTSD, including flashbacks and insomnia. CPTSD can also affect your overall outlook on life and relationships. Someone with CPTSD might have a negative view of themselves, others, and the world in general. CPTSD can cause low self-esteem, issues trusting or connecting with others, and emotional swings like extreme sadness or anger. People experiencing CPTSD may obsess over the abuser or traumatic events that caused the disorder.


CPTSD and PTSD are similar but have somewhat different symptoms and causes. PTSD is typically caused by a single traumatic event, such as a rape or sexual assault, natural disaster, or car crash. CPTSD is caused by an ongoing traumatic experience, such as recurring childhood abuse.

Someone suffering from PTSD can be triggered by things that remind them of the traumatic event, such as sights or smells. Because CPTSD typically stems from trauma in a relationship that was supposed to be safe, relationships can be triggering for people with CPTSD. In addition to symptoms typically associated with PTSD, people with CPTSD can have issues with trust and forming relationships.

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Causes of CPTSD

Causes of CPTSD include long-term traumatic events, such as:

  • Childhood abuse or trauma
  • Living with close family members with mental health disorders or substance-use disorder
  • Growing up in an unstable or dangerous environment
  • Economic hardship or poverty during childhood
  • Fleeing war or escaping from a similarly dangerous environment (Ipekci, 2022)
  • CPTSD signs and symptoms

Signs and symptoms of CPTSD can include:

  • Flashbacks or reliving trauma or abuse, triggered by certain sights, sounds, smells, or environments
  • Avoiding situations reminiscent of traumatic experience(s)
  • Physical sensations like nausea or dizziness when remembering traumatic experience(s)
  • Hyperarousal, feeling jittery, or otherwise feeling on high alert for a sustained period
  • Insomnia
  • Difficulty concentrating
  • Issues trusting others
  • A sense of detachment or amnesia about the traumatic experience(s)
  • Difficulty regulating emotions
  • Emotional extremes like anger and sadness
  • Negative outlook
  • Low self-esteem
  • Sense of obsession about their abuser(s), potentially including thoughts of revenge

How is CPTSD diagnosed?

A mental health clinician can diagnose CPTSD. During an evaluation, the clinician may ask about symptoms, review family history, and discuss any past instances of trauma or abuse.

Signs and symptoms of separation anxiety

Separation anxiety and separation anxiety disorder share similar signs and symptoms. However, symptom intensity may be more acute with the disorder and result in a greater disruption to everyday life. Symptoms of separation anxiety and separation anxiety disorder can include:

  • Extreme distress over the absence of a particular person, place, animal, or object
  • Extreme fear, worry, or concern about this absence
  • Excessive fear, worry, or concern that something will happen that will result in the separation
  • Reluctance to separate
  • Difficulty sleeping or having nightmares
  • Physical symptoms that can include nausea, headaches, upset stomach, tightness of breath, and chest pains
  • Panic attacks or other anxiety-related episodes

What causes separation anxiety?

Separation anxiety can have different causes. For children, early relationships with authority figures like parents or caregivers may contribute to the development of separation anxiety. This may happen if the parenting or care style is overprotective, critical, negative, or neglectful (Weinfield et al. 1997, Başbuğ et al. 2016). For adults, genetics and a family history of separation anxiety may also contribute to developing separation anxiety (Yaklaşımlar, 2022). Traumatic events, such as losing a parent, can also cause separation anxiety (Alkın, 2010).

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Treatments for CPTSD

Seek treatment for CPTSD when symptoms disrupt daily life or when symptoms occur for a month or longer.

Therapy and medication are the treatment options most widely used to alleviate CPTSD symptoms and allow patients to work through their trauma.


Therapy can help patients identify negative thinking patterns and develop healthy coping mechanisms. Therapists can help patients process their trauma or abuse, form healthier relationships with others, and address issues around self-esteem and depression.

Therapy for CPTSD can take different forms depending on the patient’s needs. It may involve one-on-one discussions with a clinician or group sessions. A clinician may use cognitive behavioral therapy (CBT), which works to identify and replace negative thoughts with more positive alternatives. Clinicians may also use dialectical behavioral therapy (DBT), which can address symptoms of stress, self-harm, and suicidal behaviors or urges.

Eye movement desensitization and reprocessing (EMDR) is another therapeutic technique clinicians use. During EMDR, patients discuss troubling events while focusing on an external stimulus to help process traumatic experiences and lessen their sensitivity to them.


Clinicians can prescribe medication, typically antidepressants, for CPTSD.

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  • Franco, F. Understanding and Treating C-PTSD. Journal of Health Service Psychology 47, 85–93 (2021).
  • Ipekci, B. Predicting PTSD and Complex PTSD among Iraqi and Syrian Refugees. Community Mental Health Journal (2022).