All too often, chronically traumatised people suffer in silence; but if they complain at all, their complaints are not well understood. They may collect a virtual pharmacopeia of remedies: one for headaches, another for insomnia, another for anxiety, another for depression. None of these tend to work very well, since the underlying issues of trauma are not addressed.
Judith Herman M.D. (1992)
Complex PTSD validates the survivor’s experience: the personality adaptations – frequently overlooked as weaknesses or character defects, resulting from multiple relational traumas over a lifetime. Whereas PTSD symptoms can be attributed to a single trauma, such as a car accident, single rape, exposure to a natural disaster or short-term military combat, life changing Complex PTSD was until recently more likely to go unnoticed or labelled as a personality disorder such as BPD (Borderline Personality Disorder) or GAD (Generalised Anxiety Disorder).
While PTSD is acutely distressing and also life-changing, different neuro-biological and psychological characteristics have been found in people who have been exposed to multiple traumas of a prolonged, interpersonal nature.
In June 2018, the World Health Organisation (WHO) confirmed Complex PTSD as an official diagnosis in the 11th Revision of the International Classification for Diseases (ICD), the global standard for diagnostic health.
There is no single universally accepted definition for Complex PTSD, despite its widespread acceptance among clinicians as a diagnosis. Here, Dr Christine Courtois explains the syndrome in simple language.
'Complex traumatic events and experiences can be defined as stressors that are: (1) repetitive, prolonged, or cumulative (2 ) most often interpersonal, involving direct harm, exploitation, and maltreatment including neglect/abandonment/antipathy by primary caregivers or other ostensibly responsible adults, and (3) often occur at developmentally vulnerable times in the victim's life, especially in early childhood or adolescence, but can also occur later in life and in conditions of vulnerability associated with disability/ disempowerment/dependency/age /infirmity, and so on.'
Dr Courtois adds: 'Such complex stressors are often extreme due to their nature and timing: some are actually life-threatening due to the degree of violence, physical violation, and deprivation involved, while most threaten the individual's emotional mental health and physical well-being due to the degree of personal invalidation, disregard, deprivation, active antipathy, and coercion involved.' Read more
Neuroscience shows brain adapts to trauma
Today the stigmatising brain disease model of Complex PTSD is giving way to a more enlightened understanding thanks to developments in neuroscience. Brain imaging studies show that a different nervous system develops in response to ongoing trauma. A large portion of a survivor's energy will typically be expended on the suppression of their inner turmoil (known as 'dysregulation'), and this can lead to a range of autoimmune diseases such as chronic fatigue and fibromyalgia. The good news, says Harvard psychiatrist, Bessel Van Kolk in his book, The Body Keeps The Score, is that we can change our own physiology and re-balance our internal world by means other than drugs.
Anna L. Bragga 21/10/2020
Dr Christine Courtois
Horrifying events can be hard to talk about, or may be blocked out and forgotten. It may take years for the symptoms of complex PTSD to be recognised.
Complex PTSD is more severe if:
CLOITRE, M. et al. April 2020. Evidence for the coherence and integrity of the complex PTSD (CPTSD) diagnosis: response to Achterhof et al., (2019) and Ford (2020). European Journal of Psychotraumatology. Available from:
COURTOIS, C. A. 2004. Complex Trauma, Complex Reactions: Assessment and Treatment.
Psychotherapy: Theory, Research, Practice, Training. Vol. 41, No. 4, 412–425.
FORD, J. and COURTOIS , C. A. July 2014. Complex PTSD, affect dysregulation, and borderline personality disorder. BiodMedCentral Journal. Available from:
HERMAN, J. 1992. Trauma and Recovery: The Aftermath of Violence – from domestic abuse to political terror. Basic Books.
PAPPAS, M. November 2019. What is Complex Post-Traumatic Stress Disorder (CPTSD)? ACES Connection web article.
SPERMON, D. et al. 2010. Psychodynamic psychotherapy for complex
trauma: targets, focus, applications, and outcomes. Psychology Research and Behavior Management. Dovepress. Available from:
VAN DER KOLK, B. 2014. The Body Keeps the Score: Mind, Brain and Body in the Transformation of Trauma. Penguin. Random House UK.
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