By We Level Up NJ Treatment Center | Editor Yamilla Francese | Clinically Reviewed By Lauren Barry, LMFT, MCAP, QS, Director of Quality Assurance | Editorial Policy | Research Policy | Last Updated: February 20, 2023
C PTSD Symptoms (C PTSD Definition)
Complex post-traumatic stress disorder (CPTSD) is closely linked to post-traumatic stress disorder (PTSD). However, it usually develops due to reprised trauma over months or years rather than a single occurrence. Most people are knowledgeable about PTSD, an anxiety disorder that results from a traumatic event, such as a natural disaster or car accident. However, a similar condition called CPTSD is becoming more widely acknowledged by doctors in recent years. Read on to earn more about the C-PTSD symptoms, C PTSD diagnostic criteria, differences from PTSD, diagnosis, treatment, and more.
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; in extreme cases, it can trigger changes in the body to prepare it to either face or avoid it. This “fight-or-flight” response is a healthy and normal reaction intended to help spare an individual from harm. 
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.
What is C PTSD?
Complex post-traumatic stress disorder, commonly known as C PTSD, occurs when someone has dealt with long-term trauma. This means the trauma happened over a long period or covered repeated events. Examples might include being a soldier during war or a prisoner of any type: in war, in a concentration camp, and cases of human trafficking. 
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 symbolic or actual captivity. The victim is under the control of another and is unable to escape the situation quickly.
C PTSD is a specific diagnosis originating from deficits that PTSD fails to cover. PTSD includes exposure to an 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. 
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 issues appear in regulating emotions and experiencing despair, extreme sadness, suicidal thoughts, and anger. Distorted views of the perpetrator are also typical, including an obsession with or giving all power to him or her. Relationships with others may also be complicated with problems of distrust, isolation, and looking for a savior in others.
Living With C PTSD Meaning & Its Causes
What causes C PTSD? Any long-term trauma can lead to C-PTSD, but this type of mental condition seems most likely to develop in those 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 episodes include the following:
- Ongoing childhood neglect or abuse
- Being a prisoner of war
- Living in an area of fighting for an extended period
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C PTSD vs PTSD Statistics
According to the International Society for Traumatic Stress Studies published by the National Center for Biotechnology Information, cumulative adulthood trauma was associated with PTSD and CPTSD; however, cumulative childhood trauma was more strongly associated with CPTSD than PTSD. Among traumatic stressors occurring in childhood, sexual and physical abuse by caregivers were identified as events related to risk for CPTSD. In contrast, sexual assault by non-caregivers and abduction were risk factors for PTSD. Adverse childhood events were associated with both PTSD and CPTSD, and equally so. Individuals with CPTSD reported substantially higher psychiatric burdens and lower levels of psychological well-being compared to those with PTSD and neither diagnosis. 
A population-based study of complex posttraumatic stress disorder in the United States reported the prevalence rates were 3.4% for PTSD and 3.8% for CPTSD.
About 12 million adults in the U.S. have PTSD during a given year.
6 out of 100
About 6 out of every 100 people (or 6% of the population) will have PTSD at some point.
C-PTSD Diagnostic Criteria Facts
Is C PTSD a Disability
What is C-PTSD? C-PTSD definition and the term “complex PTSD” first emerged in 1992 in Dr. Judith Herman’s book “Trauma and Recovery.” It’s commonly abbreviated as CPTSD or C-PTSD. CPTSD derives from trauma resulting from repeated or ongoing traumatic incidents, usually over the course of several months or years.
C-PTSD Mortality Rate & Disability
Is C-PTSD a disability? Yes. Since people with complex post-traumatic stress disorder qualify for a diagnosis of post-traumatic stress disorder, the Social Security Administration will consider them disabled.
Chronic and complex PTSD has been shown to increase the risk of various health issues and decrease life expectancy.
In civilians with PTSD, one study observed a 54% higher risk of all-cause mortality, a 72% higher risk of cardiovascular mortality, and a 2-fold increase in the risk of external-cause mortality.
All-cause mortality was significantly higher for veterans with PTSD compared to the U.S. population.
CPTSD vs BPD
CPTSD and BPD are two different disorders. Complex Post-Traumatic Stress Disorder (CPTSD) is a mental health condition that can develop in response to a traumatic event while Borderline Personality Disorder (BPD) is characterized by a continual pattern of relationship instability and intense but brief periods of extreme emotion.
C-PTSD and Interpersonal Relationships
How do C-PTSD and dissociation affect relationships?
- Difficulty trusting others
- Feeling unsafe
- Using drugs, alcohol, or behaviors to numb anxiety or distress
- Avoiding friends, loved ones, or activities you used to enjoy.
“It becomes difficult to deal with everyday life because you have hid your soul in a dark corner so it doesn’t have to face the dangerous world of the Trauma. Without your soul, you are only half a person, a machine who is constantly running from reality.”
– Another common manifestation of PTSD is avoiding certain events and feelings, fearing they will trigger an episode. In Art With Impact’s exclusive interview with Amy Oestreicher, a Broadway performer who endured severe medical trauma, she discusses how she completely turned off her artistic side for a time. You may also find many helpful C-PTSD books from your therapist’s recommendations.
Brain C PTSD Symptoms & C-PTSD and Relationships
What is C PTSD symptoms? These are among the factors that distinguish it from PTSD. Some C PTSD symptoms are familiar: panic attacks caused by C-PTSD can happen, just as they can with PTSD. But complex traumas can dig 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 a hard time managing their emotions. 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 connected to the events.
Dissociation or Flashback Experiences: In some circumstances, a person with C PTSD symptoms may undergo flashbacks that relate to memories 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: People 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, struggling to connect with others or constantly feeling different from the people around them.
Obsessive Thoughts: A person may become distracted by 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 difficulty 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.
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 a 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 more significant issue to deal with.
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How C PTSD Differs From PTSD? C-PTSD vs PTSD
C-PTSD and PTSD resulting 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 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): CPTSD vs BPD
Borderline Personality Disorder (BPD) has very similar almost identical symptoms to C-PTSD. BPD is a disorder that affects individuals differently.
CPTSD vs BPD Common 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, guilt, and worthlessness.
Understanding CPTSD vs BPD
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 because of their overlapping causes and symptoms, but they differ slightly.
CPTSD vs BPD Symptoms
CPTSD vs BPD symptoms with both disorders includes difficulty with interpersonal skills. However, this symptom arises with BPD because of a fear of abandonment. People with C-PTSD struggle with relationships because 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.
CPTSD often includes symptoms of persistent fear, ongoing emotional distress, changes in moods and difficulties in regulating emotions, flashbacks, and intrusive memories. People with BPD may experience wildly fluctuating emotions, have difficulty regulating those emotions, and display impulsive behavior, unstable interpersonal relationships, and a distorted sense of self-image. In either case, treatment may involve talk therapy, medication, and other strategies to manage symptoms.
Diagnosis of Complex PTSD C&P Exam Tips
The C&P exam sometimes called the VA’s PTSD test, verifies that the veteran has PTSD, even if he or she has already received a PTSD diagnosis from a qualified medical professional. Additionally, the C&P determines whether PTSD is service-related and the severity of the condition. No C&P exam for PTSD can be done outside accredited platforms. To pass the exam, Give examples of problems you had with work, school, or relationships. Describe your difficulty adjusting to civilian life. Talk about if you were no longer interested in activities you once enjoyed. Give specific examples of your C PTSD symptoms.
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 symptoms, a few mental health professionals believe it is too similar to PTSD (and other trauma-related disorders) to warrant a separate diagnosis. As a result, the DSM-5 combines symptoms of C-PTSD with PTSD.
Still, there are mental health professionals who do recognize complex PTSD as a particular condition because the classic symptoms of PTSD do not fully grasp some of the unique features shown in people who have experienced repeated 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 no 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.
Do I have PTSD or CPTSD Quizzes?
Complete the following quizzes to get an assessment of the likelihood that you are showing signs of CPTSD or PTSD. The questions below relate to problems and complaints that people sometimes have in response to traumatic life experiences, sometimes diagnosed as either PTSD or CPTSD. When the underlying trauma is repeated or ongoing, mental health professionals may diagnose C-PTSD. Complex post-traumatic stress disorder shares many of the symptoms of PTSD. However, there are additional symptoms that are unique to C-PTSD. If your Childhood Trauma questions responses score 50 points or more, feel free to reach out to one of our specialists for further support. If your Do I have PTSD or CPTSD Quizzes questions responses score 50 points or more for each quiz, feel free to reach out to one of our specialists for further support.
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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. 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 decline 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 more extended recovery period.
The use of mind and mood-altering substances frequently leads to dependence and addiction. There is hope regardless of the substance of choice or length of using them.
Programs, services, and treatments vary. We Level Up rehab facilities do not provide EMDR therapy. Because patient stability should come before 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 all behavioral health disorders, including related secondary illnesses, to improve long-term recovery outcomes. Get a free substance abuse and mental health assessment and determine the treatment options that most suit 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 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 initially 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, ensuring every person has support. The third level involves staff members working with young people to build strong relationships. Finally, young people can engage with and disclose current or historical trauma once those bridges are built.
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?.” Trauma-informed care aims to provide necessary services to support the patient and avoid triggering the patient.
Cognitive Behavioral Therapy
Cognitive-behavioral therapy (CBT) is a psychotherapeutic treatment that helps clients identify and change destructive thought patterns that negatively influence their behaviors or emotions. CBT focuses on flashbacks, triggers, and the persistent feeling of shame that happens with Complex PTSD. CBT replaces these adverse reactions with positive ones and beneficial coping methods.
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 what they are afraid of. Over time, exposure decreases avoidance and reduces fear.
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What Is Dual Diagnosis?
The definition of dual diagnosis (also referred to as co-occurring disorders) can differ between institutions. However, it is generally defined as simultaneously treating someone diagnosed with a substance abuse disorder and a mental health disorder. 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.
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).
Find the Right Treatment Plan at We Level Up New Jersey
C PTSD and relationships are challenging to manage with proper mental health treatment. But we need each other’s support. Dating with C-PTSD can be problematic — and frustrating — for many reasons. You want to take away their pain, but you’re also dealing with guilt at needing to care for yourself. Maybe, as someone who has a loved one with PTSD, you’re the one looking for help, or “C PTSD therapists near me?” You might give all you can to help your loved one, but the issues surrounding C PTSD symptoms that needed to be addressed called for dedicated commitment, time, and the help of a professional.
The primary C PTSD symptoms treatment is psychotherapy, but it can also include medication. Combining these treatments can help improve your symptoms.
Searching for a “C-PTSD therapist near me?” or a C-PTSD therapy center? 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 and 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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10 Most C-PTSD Meaning & C-PTSD Test Frequently Asked Questions
How to explain C-PTSD to someone who doesn’t have it?
People can end up with PTSD after being in all sorts of situations — war, crises, car crashes, terrorist attacks, sexual assault, abuse, medical procedures, activism, and advocacy, to name a few. Living with C-PTSD, or Complex post-traumatic stress disorder means that you weren’t traumatized by an isolated event, but by an ongoing situation.
Why does the C&P exam for PTSD increase get denied?
VA will deny your case if the C&P examiner does not think you meet the diagnostic criteria for DSM C-PTSD. Sometimes the C&P examiner diagnoses a veteran with a different psychiatric disorder. In this case, VA will deny the PTSD case. The C&P examiner’s opinion is what VA usually considers the most persuasive.
Can a C&P examiner and C and P exam for PTSD diagnose PTSD?
PTSD C&P exam worksheet sometimes called the VA’s C&P exam PTSD, verifies that the veteran has PTSD, even if he or she has already received a PTSD diagnosis from a qualified medical professional. Additionally, the PTSD C&P exam questions determine whether the PTSD is service-related and the severity of the condition.
What is the gold standard for diagnosing C-PTSD criteria?
Are you asking yourself, “Do I have C PTSD?” The CAPS is the gold standard in PTSD assessment. The CAPS-5 is a 30-item structured interview that can be used to make a current (past month) diagnosis of PTSD. The CAPS was designed to be administered by clinicians and clinical researchers who have a working knowledge of PTSD but can also be administered by appropriately trained paraprofessionals. The full interview takes 45-60 minutes to help. It stands for Clinician-Administered PTSD Scale for DSM-5 (CAPS-5 or C-PTSD DSM).
What questions do they ask for the C-PTSD narcissistic abuse test?
Narcissistic victim syndrome is a term that collectively describes the specific and often severe effects of selfish manipulation. While this isn’t a recognized mental health condition, many experts acknowledge narcissistic abuse can have a profound, long-lasting impact on mental health. If you think you have C-PTSD from narcissistic abuse, connect with an accredited therapist or a mental health professional expert with PTSD. PTSD assessment may begin using a self-screen. However, a more in-depth C PTSD test is required to diagnose C PTSD narcissistic abuse.
How do I get the highest disability rating for the VA C&P exam for PTSD?
A 100 percent rating is the highest the VA will award for PTSD or other conditions. To qualify for a 100 percent rating, a veteran with PTSD must have a total occupational and social impairment. They must be completely unable to hold down a job or maintain normal, healthy relationships.
How do I get a 100 percent PTSD C and P exam rating?
Self-injurious behaviors and suicide attempts are also consistent with a 100% rating. In addition to this suicidality, a 100% PTSD rating also includes homicidal ideation, in which a veteran might have thoughts of harming others.
What qualifies as a traumatic event for the 2nd C&P exam for PTSD?
Types of events that can lead to PTSD include serious accidents. physical or sexual assault. abuse, including childhood or domestic abuse.
Is there a C&P exam for sleep apnea secondary to PTSD?
For the VA to consider disability benefits for sleep apnea, you must file a claim. The VA will usually request a Compensation and Pension exam. The examining physician will likely request you perform a sleep study and ask questions about your service.
How to pass a PTSD C&P exam?
No C&P exam for PTSD can be done outside accredited platforms. To pass the exam, Give examples of problems you had with work, school, or relationships. Describe your difficulty adjusting to civilian life. Talk about if you were no longer interested in activities you once enjoyed. Give specific examples of your C PTSD symptoms. Discuss your unique situation if you think you have C-PTSD and autism, PTSD-C, and addiction to your examiner.
Search We Level Up NJ C PTSD Symptoms & Mental Health Topics & Resources
 Post-Traumatic Stress Disorder – NIMH/National Institute of Mental Health
 Giourou E, Skokou M, Andrew SP, Alexopoulou K, Gourzis P, Jelastopulu E. Complex posttraumatic stress disorder: The need to consolidate a distinct clinical syndrome or to reevaluate features of psychiatric disorders following interpersonal trauma? World J Psychiatry. 2018 Mar 22;8(1):12-19. DOI: 10.5498/wjp.v8.i1.12. PMID: 29568727; PMCID: PMC5862650.
 Complex PTSD – U.S. Department of Veterans Affairs
 Cloitre M, Hyland P, Bisson JI, Brewin CR, Roberts NP, Karatzias T, Shevlin M. ICD-11 Posttraumatic Stress Disorder and Complex Posttraumatic Stress Disorder in the United States: A Population-Based Study. J Trauma Stress. 2019 Dec;32(6):833-842. DOI: 10.1002/jts.22454. Epub 2019 Dec 4. PMID: 31800131.
 Recognizing and Treating Child Traumatic Stress – Substance Abuse and Mental Health Services Administration
 Controversy Over Repressed Memories – Office of Justice Programs
 Post-Traumatic Stress Disorder – National Institute of Mental health
 De Bellis MD, Zisk A. The biological effects of childhood trauma. Child Adolesc Psychiatr Clin N Am. 2014 Apr;23(2):185-222, vii. DOI: 10.1016/j.chc.2014.01.002. Epub 2014 Feb 16. PMID: 24656576; PMCID: PMC3968319.
 Kleber RJ. Trauma and Public Mental Health: A Focused Review. Front Psychiatry. 2019 Jun 25;10:451. DOI: 10.3389/fpsyt.2019.00451. PMID: 31293461; PMCID: PMC6603306.