rippleranch_logo-200x101-1-q6144w15aqyeb8bcxqq9ctly80oko5dqv2hqwrlz40 (1)

What Is Complex Trauma?

Learn about complex trauma, how it is diagnosed, and the best treatment options in this informative article.

What Is Trauma?

Trauma is a lasting emotional response related to experiencing a distressing event.  Some events or experiences that may result in trauma include abuse, neglect, serious injury, combat, and the loss of a loved one. Experiencing trauma often leads to feelings of helplessness, shame, fear, and powerlessness.

There are various types of trauma depending on the number of incidents, how often it occurred, and how it was experienced. For example, vicarious trauma occurs when a person witnesses someone else’s trauma. Acute trauma develops through one traumatic event, and chronic trauma develops through repeated and prolonged trauma.

Complex Trauma
Table of Contents

Learn More About Ripple Ranch Recovery Center

Our team is standing by to discuss your situation and options. Your call is fully confidential, and no obligation is required

What Is Complex Trauma?

Similar to chronic trauma, complex trauma results from long-term exposure to a traumatic event. However, the difference is that complex trauma develops through experiencing multiple traumatic events. Further, this trauma type usually occurs within a personal relationship in which the person cannot easily escape. For example, childhood neglect and domestic violence.

Factors that Cause Complex Trauma

The main factors that cause complex trauma include the following:1
  • Repeated or ongoing
  • Difficult to escape from
  • Starts during childhood
  • Within a personal relationship
  • Kept secret or denied

What Is Complex PTSD?

Complex post-traumatic stress disorder (complex PTSD or c-PTSD) is a mental health disorder that involves the symptoms of PTSD and complex trauma. Both c-PTSD and PTSD involve exposure to a traumatic event that is distressing enough to impact one’s functioning. But, where PTSD is generally related to a single event, c-PTSD is related to the trauma brought about by long-term exposure to trauma.

Complex PTSD vs. PTSD

Complex PTSD includes many symptoms of PTSD, such as flashbacks, detachment, and environmental triggers. The primary difference that sets them apart is disturbances in self-worth, which stems from complex trauma. Several studies suggest that prolonged trauma presents different symptoms. This is due to how the brain develops and adapts to coping with repeated exposure to traumatic incidents. Personality changes and dysregulation of emotional processing are key factors of complex trauma.2

Additionally, the nature of complex trauma generally stems from personal relationships. This social form of trauma causes disturbances in self-organization (DSO), significantly affecting identity and relational capacities.3

Signs and Symptoms of Complex Trauma

The symptoms of complex trauma may include:
  • Anger, irritability
  • Avoiding people, places, and situations that remind one of the event
  • Dissociation
  • Feeling on edge
  • Flashbacks
  • Guilt, shame
  • Interpersonal relationship difficulties
  • Loss of sense of self
  • Low self-esteem
  • Nightmares, sleep disturbances

Symptoms of C-PTSD

Complex trauma and c-PTSD have similar signs and symptoms. Along with the symptoms above, someone with c-PTSD may experience the following:
  • Changes in beliefs
  • Difficulty controlling emotions
  • Hyperarousal
  • Isolation
  • Trouble concentrating
  • Trust issues

How Is Complex PTSD Diagnosed?

Currently, complex PTSD is not recognized in the Diagnostic and Statistical Manual for Mental Disorders, Fifth Edition (DSM-5). But, it is recognized in the ICD-11 (International Classification for Diseases). According to the ICD-11, a diagnosis of c-PTSD can only be made after an individual meets all criteria for traditional PTSD.
The criteria to be diagnosed with PTSD include:4
  • Exposure to a traumatic event or situation
  • One or more symptoms of reliving the event
  • One or more symptoms of avoiding
  • Two or more symptoms of negative mood or thoughts related to the event
  • Two or more reactivity symptoms, such as aggression, irritability, difficulty sleeping, and heightened startle response
  • These symptoms must last for longer than one month

c-PTSD Diagnostic Criteria

Besides meeting the criteria for PTSD, the diagnosis of c-PTSD may also include
  • Anger outbursts
  • Constant hopelessness
  • Constant feelings of worthlessness, guilt, or shame
  • Difficulty forming relationships or feeling connected to others
  • Feeling out of body
  • Mistrust of others
  • Suicidal thoughts
  • Trouble controlling emotions

Misdiagnosis of Complex Trauma

Complex trauma and c-PTSD can be easy to misdiagnose, as it shares many symptoms with other mental health disorders. The understanding of complex trauma is also new, increasing the likelihood of overlooking its symptoms. Two of the most common disorders that complex trauma gets mistaken for are:

Borderline Personality Disorder

Borderline personality disorder (BPD) and c-PTSD can be confused due to the overlap in symptoms. Both BPD and c-PTSD have symptoms that are related to prolonged childhood traumas. A staggering 30% to 90% of borderline personality disorder cases result from childhood abuse and neglect.5

BDP and c-PTSD Shared Symptoms

c-PTSD and BPD share the following symptoms:
  • Anxiety
  • Depression
  • Dissociation
  • Emotional outbursts
  • Negative self-worth 
  • Suicidal thoughts 
  • Unstable relationships
The two major differences between c-PTSD and BPD are emotional regulation and relationship issues. With complex trauma, individuals struggle with self-calming and relational detachment. Those with BPD struggle with profound emotional dyscontrol and intense relational hostility.6

Traumatic Grief

Traumatic grief occurs after a sudden, unexpected loss of a loved one. It is different from normal grief that happens after an expected death. Traumatic grief is related to prolonged grief. This involves constant thoughts and longing that disrupt daily life.
Symptoms of traumatic grief are similar to those of complex PTSD. These include nightmares, flashbacks, fear, and guilt. Though there are many overlaps between these two conditions, the most significant difference is the primary emotion involved. With traumatic grief, the main emotion is longing—longing for the missed loved one. While with c-PTSD, the main emotions are fear and powerlessness.
Traumatic grief and c-PTSD can occur at the same time. But because they are so similar, it can be difficult to distinguish between the two.
Treatments for Complex Trauma

The Connection Between PTSD and Addiction

Substance abuse and post-traumatic stress disorder often occur together. About 40% of people who experience PTSD also struggle with addiction.7

Substance Abuse as Self-Medication

The high rate of these disorders co-occurring may be associated with the use of drugs and alcohol to self-medicate. People who experience trauma try to avoid thoughts, feelings, and situations related to the trauma. To escape the uncomfortable feelings, they may turn to substances.

How the Two Disorders Contribute to One Another

Misusing drugs and alcohol to suppress unwanted emotions can create a cycle. Substance use can worsen PTSD symptoms, while the symptoms can influence substance use. This can lead to developing a dependency on the drug, which can progress to a substance use disorder.

Self-medicating is a dangerous cycle that leaves the mind and body vulnerable to co-occurring disorders. Unfortunately, it is a common occurrence among those with mental health issues. Data shows that individuals who seek treatment for PTSD are fourteen times more likely also to be diagnosed with a substance use disorder.8

Treatments for Complex Trauma With Ripple Ranch Recovery

There are many treatment options for complex trauma. The most common include:
At Ripple Ranch Recovery, we provide high-quality, evidenced-based programs to treat addiction and trauma. With the use of our trauma-informed care program, we provide holistic and individualized care to help you achieve your recovery goals.

Reach Out to Ripple Ranch Recovery Today

For more information about treatment options, contact us at 830.494.4717 or visit