Complex PTSD, or CPTSD, is a relatively new term. So much so that there is still debate among the professional Psychiatric community regarding whether it is a form of PTSD or a separate condition entirely. Moreover, Complex PTSD isn’t recognised in the Diagnostic and Statistical Manual of Mental Disorders (DMS-5) and lacks condition-specific treatment guidelines as a result.
With that said, mental health professionals still do recognise and treat Complex PTSD despite the condition still being largely in discovery.
In this article, we’re going to cover what the 17 symptoms are, whether or not they’re debated, and what other bodies of research say about Complex PTSD symptoms. If you affiliate yourself with the symptoms we cover, we encourage you to reach out to your GP or speak to one of our doctors at MedReleaf Clinics.
The 17 symptoms of Complex PTSD
Pete Walker’s book ‘Complex PTSD: From Surviving to Thriving’ popularised the 17 symptoms of Complex PTSD that we’ll cover below¹. Please note that while professionals may reference this list to aid in their diagnosis or for educational purposes, it’s not a binding authority nor is it conclusively agreed upon in the mental health professional community.
The list of 17 CPTSD symptoms is as follows.
- Chronic feelings of emptiness: A persistent sense of inner void or emotional numbness.
- Difficulty regulating self-esteem: Experiencing swings in self-worth, often feeling either excessively competent or completely inadequate based on external feedback or internal judgments.
- Emotional flashbacks: Intense — and often sudden — emotional responses that are disproportionate to the current situation but linked to past trauma.
- Impaired sense of agency: Feeling powerless or having a diminished sense of control over one’s life.
- Difficulty with emotional attachment: Challenges in forming secure and healthy relationships due to emotional attachment factors and styles.
- Cognitive distortions: Persistent negative thoughts about oneself, others, and the world that skew rational thinking and perception, influenced by traumatic experiences.
- Emotional dysregulation: Struggles with managing and stabilising intense emotional responses, leading to rapid mood changes and difficulty maintaining emotional balance.
- Interpersonal difficulties: Persistent challenges in forming and maintaining healthy relationships.
- Hypervigilance: An enhanced state of sensory sensitivity geared towards threat detection, which can make one excessively alert to potential dangers, even in objectively safe settings.
- Survival strategies: Behavioural patterns developed to cope with trauma that may have been adaptive during traumatic periods but are maladaptive in other contexts.
- Negative self-concept: Persistent feelings of shame, guilt, or worthlessness, often deriving from negative treatment in traumatic contexts.
- Somatic symptoms: Physical manifestations of psychological distress, such as chronic pain, gastrointestinal problems, or other bodily symptoms that lack a clear medical cause.
- Distorted perception of the perpetrator: Alternating views of the abuser, ranging from idealisation to demonization, complicating the survivor’s ability to form a coherent perspective of the abuser.
- Difficulty with emotional expression: Challenges in effectively expressing feelings and needs.
- Sleep disturbances: Problems with sleep, including difficulty falling or staying asleep, nightmares, or restless sleep, often related to anxiety or traumatic memories.
- Self-destructive behaviour: Engaging in harmful activities such as substance abuse, self-harm, or other risky behaviours, typically as a coping mechanism to relieve psychological pain.
- Sense of foreshortened future: A pervasive pessimism about the future, often accompanied by a belief that life will be prematurely shortened due to the impact of trauma².
Remember that these symptoms are one development in today’s increasing body of research on Complex PTSD. The World Health Organisation’s 11th revision of the International Classification of Diseases (ICD-11) provides a different framework.
The ICD-11 states that a Complex PTSD diagnosis requires the presence of three core Post Traumatic Stress Disorder (PTSD) symptoms alongside three symptoms that are exclusive to Complex PTSD³. The three PTSD symptoms are:
- Flashbacks.
- Avoidance.
- Heightened sense of threat (hypervigilance).
The three CPTSD-exclusive symptoms are:
- Emotional dysregulation.
- Interpersonal difficulties.
- Negative self-concept.
The IDC-11’s framework for diagnosing Complex PTSD serves as a greater authority than Pete Walker’s 17 symptoms. However, as it currently stands, the American Psychiatric Association (APA) — which publishes the DSM-5 — disagrees with both. While the DSM-5 doesn’t recognise Complex PTSD, it recognises PTSD and includes a subtype called dissociative PTSD which encompasses some of the symptoms covered by the IDC-11⁴.
If you think you may be experiencing PTSD or CPTSD, we encourage you to speak with your GP, or one of our MedReleaf Clinics doctors.
Complex PTSD: An overview
According to the ICD-11, complex PTSD arises from prolonged and repeated trauma³. These events are typically long-term, with the affected individuals finding it highly difficult to leave.
Examples of such traumatic situations include exposure to:
- Torture.
- Prolonged domestic violence.
- Sexual abuse.
- Physical abuse.
- Childhood trauma.
- Slavery.
Complex PTSD differs from PTSD because it is specifically associated with chronic exposure to trauma rather than a single, acute incident³. This extended exposure can lead to a more severe impact on an individual’s emotional and psychological state, which is reflected in the broader range of symptoms and difficulties in emotional regulation, self-concept, and interpersonal relationships seen in those with CPTSD³.
Treatment options for CPTSD
Psychotherapy is the main form of Complex PTSD treatment. Two common types of psychotherapies that doctors and psychologists adopt to treat Complex PTSD patients are Cognitive Behavioural Therapy (CBT) and Exposure Therapy.
- Cognitive Behavioural Therapy involves addressing and altering dysfunctional thoughts, feelings, and behaviours. Specifically, CBT helps individuals identify and challenge unhelpful patterns and replace them with more constructive thoughts and actions. This can be particularly effective in addressing distorted self-perceptions and maladaptive behaviours stemming from prolonged trauma.
- Exposure Therapy involves gradual, repeated exposure to trauma-related stimuli in a safe and controlled environment. This helps reduce the fear and avoidance behaviours that often accompany CPTSD, allowing patients to gain control over their trauma responses rather than being overwhelmed by them. This type of therapy is often conducted alongside relaxation exercises to help manage anxiety in response to these exposures.
Your doctor may also prescribe certain medicines, if required, which they will inform you about. While there’s no one-size-fits-all medicinal solution for Complex PTSD treatment, your doctor will work with you to ensure your prescription is accurate and effective based on your specific symptoms. Moreover, your GP may also recommend that you engage in other lifestyle enhancing practices/health interventions, such as dietary changes, moderate to intense exercise, and sleep pattern adjustments, among other possible natural measures.
How MedReleaf Clinics can help
Even though Complex PTSD is amid debate, you can still receive treatment if you’re experiencing symptoms. However, diagnosing and treating Complex PTSD can often prove difficult, therefore patients need to rely on the expertise of experienced, highly-qualified doctors who can apply a holistic, patient-centred approach to healthcare.
MedReleaf Clinic doctors have experience supporting patients with Complex PTSD.
We provide holistic, comprehensive, and patient-centred treatment plans and ongoing support. In fact, we are highly experienced in providing consultations related to pain management, sleep disorders and mental health — and we do so Australia-wide.
Here’s how it works: Start by making a booking online. Our team of doctors will then look at your condition, existing illnesses, and other relevant factors, and create an individualised treatment plan for you. From there, our team keeps a close eye on your progress and makes adjustments as required.
Don’t battle your symptoms alone. If you have, or think you may have, Complex PTSD, then we encourage you to book a free pre-screening call with our team.
Learn more about MedReleaf Clinics.
Reference list
- Walker, P. Frequently asked questions about complex PTSD. https://pete-walker.com/fAQsComplexPTSD.html
- Walker, P. (2013). Complex PTSD: From surviving to thriving. CreateSpace Independent Publishing Platform.
- World Health Organization. (2022). ICD-11: International Classification of Diseases 11th Revision. International Statistical Classification of Diseases and Related Health Problems (ICD). https://icd.who.int/en
- American Psychiatric Association. (2022). Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR). American Psychiatric Association. https://www.psychiatry.org/psychiatrists/practice/dsm
