What Exactly is Complex Trauma

You have likely heard of Borderline Personality Disorder and PTSD.

Then there’s Complex Trauma (Complex PTSD or CPTSD). CPTSD is a newer diagnostic framing, and can be a valuable concept to make sense of a certain cluster of symptoms related to problems with trusting self and others, maintaining a positive sense of self, and managing emotions.

Trauma is a lasting emotional response caused by severely distressing/harmful or life-threatening events. It results in overwhelming physiological responses and significantly changes one’s sense of safety & trust in the world for the worse.

PTSD typically develops in people after more of a singular traumatic event, while CPTSD develops from repeated, often relational trauma (and frequently in early in life). In CPTSD, prolonged neglect or abuse results in poor sense of self (excessive guilt, feeling like you are a bad person, or sense of failure); interpersonal difficulties; and emotional dysregulation.

The World Health Organization recognizes Complex PTSD as a diagnosis in its latest International Classification of Diseases (ICD-11). The U.S. medical system still uses UCD-10 and there is not a definitive date for the switch to ICD-11, so CPTSD cannot currently be used as diagnosis to bill for services using health insurance in the U.S. A diagnosis is required for billing insurance for psychotherapy.

CPTSD often causes “emotional flashbacks.” This is different from “flashbacks” alone which are experienced in PTSD and involve feeling as if a past experience is happening in the present. Emotional flashbacks can be a bit more ambiguous. It’s the experience of having the feelings that were experienced during trauma, often in childhood, resulting in having big emotional responses that seem like an outsized response to the current situation. Pete Walker, MFT, a therapist who writes thoughtfully about surviving and treating complex trauma explains, explains emotional flashbacks in the following:

[Emotional] Flashbacks take us into a timeless part of the psyche that feels as helpless, hopeless and surrounded by danger as we were in childhood…. Emotional flashbacks are sudden and often prolonged regressions (‘amygdala hijackings’) to the frightening circumstances of childhood. They are typically experienced as intense and confusing episodes of fear and/or despair – or as sorrowful and/or enraged reactions to this fear and despair. Emotional flashbacks are especially painful because the inner critic typically overlays them with toxic shame, inhibiting the individual from seeking comfort and support, isolating him in an overwhelming and humiliating sense of defectiveness.

Relatedly, some CPTSD and PTSD symptoms overlap with Borderline Personality Disorder (BPD) symptoms (other diagnoses might share some symptoms, too). It is considered specific to BPD to have an extreme fear of real or perceived abandonment, resulting in behaviors/efforts to avoid or prevent it, as well as a more pronounced sense of emptiness. I think it’s important to note that studies show “anywhere between 30% and 90% of those with BPD meet criteria for a trauma-based disorder or report a history of trauma.” And in my clinical experience, I see that people who fit BPD diagnosis almost always have histories resulting in complex trauma.

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Early in my career, a therapist told me that people who survive trauma often minimize it, downplaying the personal impact and comparing it to others’ experiences. This minimization can be a way to have a sense of control and may last for so long before it can’t hold any longer. Of course we live in a more trauma aware world than ever, even leading to the term ‘trauma’ being misused. Yet I find that many people still minimize their history of trauma. You might consider this if you find yourself having to continually convince yourself ‘it wasn’t that bad.’ Acknowledging trauma may be one step to recovery.

Recovery for Complex Trauma is possible: living a more self-directed life, less encumbered by big emotional reactions. It involves establishing safety, improving sense of trust in self, grieving traumatic past, and reducing the “inner critic.” I think it’s crucial to consider that diagnosis can be valuable to some people, while others may not find meaning from using diagnoses. A cluster of phenomena can be just that, and can be addressed without having an official diagnosis.