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What Is PTSD?

Post-traumatic stress disorder or PTSD is a mental health disorder that some individuals experience after experiencing or seeing through a traumatic event. Fear is a natural response to danger, and in extreme cases, it can trigger changes in the body to prepare it to either face the danger or avoid it. This “fight-or-flight” response is a healthy and normal reaction that is intended to help spare an individual from harm [1].

While most individuals who experience trauma recover from symptoms and the resulting reactions naturally, others get “stuck” in that high-stress condition. Even when the danger has long passed, someone struggling with PTSD continues to feel stress and fear as though the danger were still present.

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Complex PTSD is described as an enhanced version of the current definition of PTSD, with clinical features of
PTSD plus three additional clusters of symptoms namely emotional dysregulation, negative self-cognition and interpersonal hardship,
thus resembling the clinical features commonly encountered in borderline personality disorder (BPD).

What is C PTSD?

Complex post-traumatic stress disorder, or commonly known as C PTSD occurs when someone has dealt with long-term trauma. This means the trauma happened over a long period of time or covered repeated events. Examples might include being a soldier during times of war or being a prisoner of any type: either of war, in a concentration camp or in the world of human trafficking [2]. 

Child physical or sexual abuse, which can go on for many years, is another example of complex trauma that could result in C-PTSD, as is being in an abusive relationship as an adult. Usually, the events that lead to C-PTSD involve either metaphorical or actual captivity. The victim is under the control of another and is unable to easily escape the situation.

C PTSD is a specific diagnosis originating from deficits that PTSD fails to cover. PTSD includes exposure to a single isolated traumatic event, while those who repeatedly witnessed traumatizing events often have more severe or different symptoms.

C PTSD defines symptoms related to chronic trauma. Such situations include prostitution houses, concentration camps, long-term physical abuse, long-term sexual abuse, prisoner of war camps, and child exploitation rings. Repeated abuse such as this, which might happen over months or years, has a far more devastating effect on a person than a single event usually does[3].

Symptoms of C PTSD include distortions of consciousness, including reliving or forgetting traumatic events and problems with self-perception such as helplessness, despair, hopelessness, guilt, and shame. Other problems appear in regulating emotions as well as experiencing despair, extreme sadness, suicidal thoughts, and anger. Distorted views of the perpetrator are also common, including an obsession with or giving all power to him or her. Additionally, relationships with others may also be difficult with problems of distrust, isolation, and looking for a savior in others. 

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C PTSD Symptoms and Its Causes

Any type of long-term trauma can lead to C-PTSD, but this type of mental condition seems most likely to develop in those who are abused by someone who should have protected them. This includes individuals who are survivors of human trafficking or ongoing verbal, physical, emotional or sexual abuse by a family member.

Other examples of long-term trauma that may lead to C-PTSD include:

  • Ongoing childhood neglect or abuse
  • Being a prisoner of war
  • Living in an area of war for a long period of time

C PTSD Symptoms

C PTSD symptoms are among the factors that distinguish it from PTSD. Some C PTSD symptoms are common: panic attacks caused by C-PTSD can happen, just as they can with PTSD. But complex traumas can dig even deeper into mental and emotional scars than singular traumas.

A person who is experiencing C PTSD symptoms may encounter precise changes in the way they see themselves and others. This can include:

Problems Controlling Emotions: An individual struggling with C PTSD symptoms may have hard time managing their emotion hs. This can lead to issues controlling anger, depression, and even suicidal thoughts.

Repression of Memories: A person experiencing C PTSD symptoms may avoid thinking about places or people that are connected to the events.

Dissociation or Flashbacks Experiences: In some circumstances, a person with C PTSD symptoms may undergo flashbacks that relate to memories that are beyond their understanding or control; they might respond to a specific situation instinctively because of those repressed memories and not fully understand their reaction.

Forgetfulness: A person may react or take action in times of extreme stress and not fully remember how and why they did so.

Negative Feelings: A person may feel detached, helpless, or guilty, or they may struggle with the feeling of being unable to connect with others or always feeling different from people around them.

Obsessive Thoughts: A person may become distracted with the individual or people who caused their trauma; with regular PTSD, they may feel a loss of power associated with that individual, but C PTSD can lead to an obsessive passion for revenge.

Difficulty Trusting Others: Someone may have a problem trusting others, so they self-isolate and avoid relationships and friendships.

Feeling of Hopelessness: Someone may not be able to acknowledge that people, overall, are good or enjoy positive thoughts about the future.

c ptsd symptoms
C PTSD symptoms often lead people to withdraw from friends and family. However, having a strong social support network is important for mental well-being. When you are feeling overwhelmed, angry, anxious, or fearful, reach out to a trusted friend or family member.

Loss of Motivation: Because people with C PTSD can’t maintain hope in the future, they may be unmotivated to do anything for themselves—even if they intellectually want to—today.

It’s typical for individuals with C PTSD to turn to alcohol or drug abuse as way to self-medicate. They may feel emotionally numb, out of control or unable to deal with everyday life and use alcohol or drugs to sleep, get through the day or push themselves out of a very tight comfort-zone shell so they can function in society, at least for a short amount of time. But self-medication through alcohol and drugs can result in addiction, which leaves an equally bigger issue to deal with.

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How C PTSD Differs From PTSD

Both C-PTSD and PTSD results from the experience of something profoundly traumatic and can cause nightmares, flashbacks, and insomnia. Both mental health conditions can also make someone feel extremely afraid and unsafe even though the danger has passed. However, despite these similarities, there are characteristics that differentiate C-PTSD from PTSD.

The main distinction between the two disorders is the frequency of the trauma. While a single traumatic event causes PTSD, C-PTSD is caused by long-lasting trauma that continues or repeats for months, even years (commonly referred to as “complex trauma”).

When it comes to C PTSD, the harmful effects of racism and oppression can add layers to complex trauma experienced by individuals. This is further compounded if the justice system is involved.

The developmental and psychological impacts of complex trauma early in life are often more severe than a single traumatic experience—so different, in fact, that many experts believe that the PTSD diagnostic criteria don’t adequately describe the long-lasting and wide-ranging, consequences of C-PTSD.

Complex PTSD vs. Borderline Personality Disorder (BPD)

Borderline Personality Disorder (BPD) has very identical symptoms to C-PTSD. BPD is a disorder that affects individuals differently.

The main symptoms include:

  • Emotional instability
  • Erratic behavior patterns
  • Intense feelings of emptiness

Complex PTSD is a mental condition rooted in shame. Typically, it is characterized by flashbacks to traumatic events and intense feelings of sadness, fear, shame, and worthlessness.

C-PTSD and BPD are not fully understood. BPD is connected to a history of neglect or trauma, though there could also be a genetic connection. However, Complex PTSD is formed through long-term exposure to trauma. These two conditions can be confused with one another because of their overlapping causes and symptoms, but they do differ slightly.

For example, people with both disorders tend to struggle with interpersonal skills. However, this symptom arises with BPD because there is a fear of abandonment. People with C-PTSD struggle with relationships because they feel they are broken or unlovable. Overall, BPD is primarily made up of fear as the root cause, while C-PTSD may have shame as the root cause.

Diagnosis of Complex PTSD

While the concept of C PTSD is longstanding, it is not in the fifth edition of the “Diagnostic and Statistical Manual of Mental Disorders” (DSM-5), and therefore isn’t officially recognized by the American Psychiatric Association (APA).

Although C PTSD comes with its own set of symptoms, there are a few mental health professionals who believe the condition is too similar to PTSD (and other trauma-related conditions) to warrant a separate diagnosis. As a result, the DSM-5 combines symptoms of C-PTSD together with PTSD.

Still, there are mental health professionals who do recognize complex PTSD as a separate condition because the traditional symptoms of PTSD do not fully grasp some of the unique features shown in people who have experienced repeat trauma.

Because the condition is relatively new and not recognized in the DSM-5, mental health specialists may make a diagnosis of PTSD instead of complex PTSD. Since there is not a specific test to determine the difference between the two conditions, you should keep track of the symptoms you have experienced so that you can describe them to your doctor. 

Treatment for the two conditions is similar, but you may want to discuss some of your additional symptoms of complex trauma that your doctor or therapist may also need to address.

c ptsd symptoms
Treatments for C PTSD symptoms can take time, so it is important to find ways to manage and cope with the symptoms of the condition.

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Complex PTSD and Substance Abuse

The more traumatic or distressing an experience or symptom is, the greater the association with substance abuse. Individuals with Complex PTSD who lack proper social support or psychological treatment often turn to substances to ease their symptoms. 

Individuals with such severe symptoms are usually desperate for comfort. Alcohol, stimulants, opioids – whatever helps lessen the pain at the moment. The tendency to reach for something to get through a challenging moment is understandable – as a society we are taught that alcohol and other drugs are the answer to almost every problem. So if we look to a drink at the end of a hard day, the reaction of numbing oneself in response to overwhelming trauma makes sense.

Self-medicating, however, can lead to worsening symptoms and the development of new symptoms. Insomnia, anxiety, and depression, for instance, all tend to get worse in the aftermath of mind or mood-altering substances. This is because the brain’s biological processes are thrown off balance by introducing drugs and alcohol, causing a short-term high followed by a longer recovery period.

The use of mind and mood-altering substances frequently leads to dependence and addiction. Regardless of the substance of choice or length of use, there is hope.

Programs, services, and treatments vary. We Level Up rehab facilities do not provide EMDR therapy. Because patient stability should come prior to EMDR treatment. That’s why EMDR therapy to process trauma for patients actively drinking and abusing drugs should await their stability phase of treatment. EMDR phases 3 – 8 therapy is best enacted for patients that feel and experience a safer, trustful connection with their treatment team.

We Level Up rehab centers treat the entirety of behavioral health disorders including secondary corresponding illnesses to improve long-term recovery outcomes. Get a free substance abuse and or mental health assessment and find out what treatment options are most suitable for you. Call to learn more.

Treatments for Complex PTSD and Substance Use Disorder

It is crucial to seek treatment for co-occurring substance use disorder complex post-traumatic stress disorder. There are several different types of treatment options that someone can pursue.


Eye Movement Desensitization and Reprocessing therapy (EMDR) “is an interactive psychotherapy technique used to relieve psychological stress. During these sessions, the therapist has the patient relive traumatic experiences while directing the patient’s eye movements. This kind of therapy allows a person to be exposed to memories without having a strong psychological response.

Trauma Recovery Model

The trauma recovery model was originally intended to help children work through C-PTSD. There are four levels of the trauma recovery model.

The first level is based on the fact that every person is redeemable. The second level follows Maslow’s hierarchy of needs, making sure that every person has support. The third level involves staff members working with young people to build strong relationships. Finally, once those bridges are built, the young people can engage with and disclose current or historical trauma.

Trauma-Informed Care

Trauma-informed care is a psychological approach that assumes an individual most likely has a history of trauma. This approach focuses on responding appropriately to trauma’s effects. Instead of asking, “What is wrong with this person?” they will ask “What has happened to this person?.” The goal of trauma-informed care is to provide any necessary services to support the patient and to avoid triggering the patient.

Cognitive Behavioral Therapy

Cognitive-behavioral- therapy (CBT) is a psychotherapeutic treatment that helps clients learn how to identify and change destructive thought patterns that have a negative influence on their behaviors or emotions. CBT focuses on flashbacks , triggers, and the persistent feeling of shame that happens with Complex PTSD. CBT replaces these negative reactions with positive ones and beneficial coping methods.

Exposure Therapy

The main goal of exposure therapy is to help individuals confront their fears. Individuals tend to avoid things when they are afraid of them. During exposure therapy, psychologists create a safe environment to help “expose” individuals to the things they are afraid of. Over time, exposure decreases avoidance and reduces fear.

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What Is Dual Diagnosis?

The exact definition of dual diagnosis (also referred to as co-occurring disorders) can differ between institutions. However, it is generally defined as the specific treatment of someone who has been diagnosed with having a substance abuse disorder and a mental health disorder at the same time. There is no distinction of whether the mental condition led to substance abuse or vice versa. 

Addiction treatment professionals understand that mental health and substance abuse have a complex relationship that is difficult to extricate from one another.

While there is no single best treatment for comorbid complex PTSD and addiction, research has shown that successful dual-diagnosis treatment uses an integrated approach. Standard therapeutic approaches include cognitive-behavioral therapy (CBT), cognitive processing therapy (CPT), and prolonged exposure therapy (PET).

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If you or someone you love is struggling with C PTSD symptoms, get them the safest help they need and deserve. We Level Up NJ offers a Dual Diagnostic approach to secondary PTSD illness along with a primary addiction treatment program related to C-PTSD. Contact our team at We Level Up NJ today to learn more!

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[1] NIMH –

]2] NCBI –

[3] US Department of Veterans Affairs –