What is complex PTSD?

If you’ve been through a lot – not just one traumatic event, but years of stress, abuse or instability – you might read about PTSD and think:

“Some of that fits… but it doesn’t quite describe what’s happening to me.”

That’s where complex post‑traumatic stress disorder (complex PTSD or CPTSD) comes in.

In this guide we’ll cover:

• What complex PTSD actually is
• How it’s different from PTSD
• Common symptoms and causes
• How complex PTSD is diagnosed and treated
• What recovery can look like, and how Augmentive can support that journey

It’s here to give you clarity – not to replace proper medical advice.

Quick answer: what is complex PTSD?

Complex PTSD is a trauma‑related mental health condition that develops after prolonged, repeated or inescapable trauma, such as ongoing childhood abuse, domestic violence, captivity or living in a war zone.

The World Health Organisation’s ICD‑11 (the main diagnostic system used in the NHS) classifies complex PTSD as a type of PTSD with three extra clusters of symptoms: difficulties regulating emotions, negative beliefs about yourself, and persistent problems in relationships.

So in simple terms:

PTSD = reaction to trauma
Complex PTSD = PTSD plus long‑term impact on self‑esteem, emotions and relationships

Complex PTSD vs PTSD: what’s the difference?

The core PTSD symptoms

To understand complex PTSD, it helps to start with “standard” PTSD. In ICD‑11, PTSD includes three main clusters of symptoms:

1. Re‑experiencing
   • Intrusive memories
   • Nightmares
   • Flashbacks or “reliving” the trauma
2. Avoidance
   • Avoiding thoughts, feelings, people or places that remind you of what happened
3. Sense of current threat
   • Feeling constantly “on guard” (hypervigilant)
   • Being easily startled
   • Irritability or anger

These symptoms need to last for several weeks or more and significantly affect day‑to‑day life.

The extra features of complex PTSD

Complex PTSD includes all of the above plus ongoing problems sometimes called “disturbances in self‑organisation” (DSO).

1. Emotional dysregulation
   • Intense anger, shame or sadness
   • Sudden emotional “shutdown” or numbness
   • Feeling like your emotions are out of control
2. Negative self‑concept
   • Feeling deeply worthless, defeated or “broken”
   • Persistent shame or guilt (“It was my fault”, “I should have left sooner”)
3. Relationship difficulties
   • Struggling to trust others
   • Feeling disconnected or distant, even from people you love
   • Repeating painful relationship patterns or avoiding closeness altogether

These patterns often develop when trauma happens in the context of relationships – for example, abuse or neglect from caregivers or partners.

Useful explainer pages:

• NHS: Complex PTSD
• UK Trauma Council: PTSD and complex PTSD
• Mind: What is complex PTSD?

What causes complex PTSD?

Complex PTSD is usually linked to trauma that is:

• Prolonged or repeated
• Hard or impossible to escape
• Often interpersonal (caused by other people)

Examples include:

• Long‑term childhood physical, emotional or sexual abuse
• Severe neglect or growing up in a very unsafe, unstable home
• Ongoing domestic abuse or controlling relationships
• Being forced into sex work, trafficking, slavery or captivity
• Living in a war zone, under political terror or chronic community violence

The NHS notes that people who repeatedly experience traumatic situations such as severe neglect, abuse or violence may be diagnosed with complex PTSD, especially when the trauma starts early in life.

Not everyone who goes through these experiences will develop CPTSD – people’s responses to trauma vary – but prolonged, inescapable trauma does significantly increase risk.

Common symptoms of complex PTSD

Everyone’s experience is different, but people with complex PTSD often recognise a mix of the following.

PTSD‑type symptoms

• Intrusive memories, flashbacks or nightmares about the trauma
• Feeling like it’s happening again in the present
• Avoiding thinking or talking about what happened
• Avoiding places, people or situations that are reminders
• Feeling constantly on edge, jumpy or easily startled
• Sleep problems – trouble falling asleep, staying asleep or early waking

These symptoms are similar to PTSD.

Additional CPTSD‑specific symptoms

From NHS, Mind and UK Trauma Council resources, extra features associated with complex PTSD include:

• Emotions
  • Intense anger, often over seemingly small things
  • Overwhelming shame or guilt
  • Emotional numbness – feeling cut off from your feelings
• Self‑beliefs
  • Persistent feelings of worthlessness or failure
  • Feeling permanently damaged or broken
  • Believing you are completely different to other people
• Relationships
  • Difficulty trusting others
  • Feeling unsafe even in “safe” relationships
  • Avoiding friendships and intimacy, or clinging to unsafe people
• Dissociation
  • Feeling detached from your body or surroundings
  • Periods of “zoning out” or losing time

If you’re reading this thinking, “That sounds like me”, it doesn’t automatically mean you have CPTSD – but it’s a sensible reason to reach out for professional support.

How is complex PTSD diagnosed?

In the UK, complex PTSD is diagnosed using ICD‑11 criteria, which:

• Require that you meet the PTSD criteria (re‑experiencing, avoidance, sense of threat)
• And have the extra difficulties with emotional regulation, self‑concept and relationships we described earlier
• And that these problems significantly interfere with life (work, relationships, daily functioning)

A proper diagnosis is usually made by a:

• Psychiatrist, clinical psychologist or other mental health specialist experienced in trauma
• Following a detailed clinical assessment, which may include structured questionnaires, but should always involve a conversation about your history and current symptoms

The NICE PTSD guideline (NG116) emphasises the importance of:

• Taking a full trauma history
• Looking at how symptoms affect everyday life
• Considering complex PTSD and other co‑existing conditions (such as depression, substance use, personality difficulties or neurodivergence)

Because symptoms overlap with other conditions (for example, borderline personality disorder, depression or ADHD), it’s important that assessment isn’t rushed or based on a single questionnaire.

Is complex PTSD a “real” diagnosis?

Yes – in many health systems, including the NHS.

• Complex PTSD has been formally recognised in ICD‑11 since 2018.
• It is explicitly mentioned in NHS and NHS Inform guidance and self‑help resources.

The DSM‑5 (used more commonly in the US) doesn’t list CPTSD as a separate diagnosis; instead, those symptoms may be captured under PTSD plus other conditions.

So if you see mixed messages online, that’s why. In the UK context, complex PTSD is very much part of mainstream trauma thinking.

How is complex PTSD treated?

The hopeful bit: complex PTSD is treatable. Recovery is rarely quick or linear, but many people do see significant improvements with the right support.

Trauma‑focused psychological therapies

In the UK, NICE recommends trauma‑focused psychological therapies as first‑line treatment for PTSD in adults, including those with complex needs.

These include:

• Trauma‑focused cognitive behavioural therapy (TF‑CBT)
  • Helps you understand how trauma has affected your thoughts, feelings and behaviours
  • Supports you to gradually process traumatic memories in a safe, structured way
• EMDR (Eye Movement Desensitisation and Reprocessing)
  • Uses sets of eye movements or other bilateral stimulation while you briefly bring trauma memories to mind
  • Aims to help the brain “re‑file” traumatic memories so they become less distressing

There’s strong evidence that these therapies reduce PTSD symptoms and can have lasting effects.

For complex PTSD, therapy often:

• Spends more time on stabilisation and emotional regulation before diving into trauma processing
• Focuses on self‑esteem, shame and relationship patterns, not just single events
• May be longer term than standard PTSD treatment

Medication

Medication doesn’t “cure” complex PTSD, but it can help with associated conditions such as:

• Depression
• Anxiety
• Sleep problems

NICE advises that medication should not replace trauma‑focused therapy as the main treatment for PTSD, but can be considered if someone doesn’t want, can’t access, or hasn’t fully responded to therapy.

Common options include certain antidepressants under specialist guidance.

Self‑help and lifestyle support

Alongside professional help, many people find benefit from:

• Guided self‑help programmes, such as the NHS Inform PTSD & CPTSD self‑help guide
• Peer support groups (online or in person) for people living with trauma
• Gentle movement, grounding practices and creative activities
• Building routines around sleep, food and movement – not as a “fix”, but as extra scaffolding for a nervous system that’s been through a lot

Living with complex PTSD: what it can look like day to day

Complex PTSD doesn’t just show up in therapy sessions. It can touch every part of life:

• Work or studies
  • Concentration and memory problems
  • High stress around feedback, conflict or perceived criticism
  • Burnout from overworking to prove your worth
• Relationships
  • Finding it hard to trust, even when someone is safe and kind
  • Feeling “too much” or “not enough” and expecting others to leave
  • Staying in unsafe relationships because that feels familiar
• Sense of self
  • Struggling to know who you are beyond survival
  • Feeling fundamentally different from other people
  • Questioning whether you’re “overreacting” or if your trauma “counts”

A key part of recovery is rebuilding a stable, compassionate sense of self – seeing your reactions as understandable responses to what you’ve lived through, rather than as proof that you’re broken.

How Augmentive approaches complex PTSD

At Augmentive, our whole model is built around a simple idea:

Understanding your mind is powerful. Turning that understanding into action is life‑changing.

Here’s what that looks like if you’re dealing with complex PTSD (often alongside other things like ADHD, autism, anxiety or depression):

1. Deep, joined‑up assessment

We work with consultant psychiatrists on the specialist register, all with substantive NHS experience, plus therapists and coaches who specialise in divergent minds and trauma. That means:

• Space to explore your full story – not just tick‑box symptoms
• Careful thinking about CPTSD alongside neurodivergence and other conditions, rather than treating each in a silo
• A clear explanation of what your clinician thinks is going on and why

2. A diagnosis that becomes an action plan

We see a diagnosis as the start of a plan, not the end of the conversation.

Depending on your needs, that might include:

• Trauma‑focussed therapy (for example CBT or EMDR) with clinicians experienced in complex trauma
• Thoughtful use of medication, where helpful, to reduce symptom load so you can engage in therapy and daily life
• Coaching and practical strategies to rebuild routine, relationships and self‑care

3. Support that’s built for “limitless thinkers”

Our community is full of people whose minds are curious, expansive and creative – but who’ve also been shaped by trauma and by systems that weren’t built for them. We design our support around:

• Clarity – plain language, clear next steps, minimal jargon
• Action – small, realistic steps that move you from “stuck in survival mode” towards a life that actually feels like yours
• Respect for difference – we don’t expect you to fit a standard template of recovery; we work with the brain and body you actually have

If you do decide to use us, you can layer our support on top of NHS care – for example while waiting for trauma therapy locally, or to access more joined‑up help with co‑existing ADHD or autism.

What to do if you think you might have complex PTSD

You don’t need to have everything neatly explained before you ask for help. A few useful steps:

1. Note down what you’re experiencing

Capture:

• Your main symptoms – thoughts, emotions, body sensations, sleep, nightmares, flashbacks, dissociation
• Any traumas or long‑term stressors you feel comfortable mentioning
• How this is affecting your work, relationships and everyday life

This can help you feel more grounded in appointments, especially if you tend to blank or minimise when you’re face‑to‑face with someone.

2. Speak to your GP

Tell your GP:

• That you’re concerned about PTSD or complex PTSD
• What life is like day‑to‑day
• Any safety concerns (self‑harm, suicidal thoughts, substance use, ongoing abuse)

You can bring or share links like:

• NHS: Complex PTSD
• NICE PTSD guideline (NG116)

Ask about:

• Referral for trauma‑focussed psychological therapy
• Whether local services recognise and work with complex PTSD
• What support is available while you wait (for example, IAPT/psychological therapies, community mental health teams, voluntary sector organisations)

3. Explore reputable information and support

Some UK‑based resources:

• Mind: PTSD and complex PTSD
• PTSD UK: Complex PTSD
• UK Trauma Council
• NHS Inform: Complex PTSD
• Augmentive: PTSD Care

4. Check in with your safety

If you feel at risk of harming yourself or someone else:

• Call 999 or go to your nearest A&E.
• You can contact Samaritans 24/7 on 116 123 or via their website.

You deserve support that takes the full complexity of your story into account. Complex PTSD isn’t a sign that you’re weak or “too sensitive”; it’s a sign that you’ve survived a lot – and that your brain and body now need care, not criticism.

FAQs about complex PTSD

Is complex PTSD the same as borderline personality disorder?

No, they’re different diagnoses, although they can look similar and sometimes co‑exist. Both can involve emotional swings, relationship difficulties and self‑harm. Complex PTSD is specifically linked to trauma history and the PTSD symptom clusters; BPD focuses more on long‑standing patterns of identity disturbance, instability and impulsivity. A skilled clinician will explore both possibilities carefully.

Can complex PTSD develop years after the trauma?

Yes. PTSD and complex PTSD symptoms can appear soon after trauma or emerge years later, sometimes triggered by life events that echo past experiences.

Can you recover from complex PTSD?

Many people with complex PTSD see major improvements in symptoms, self‑esteem and relationships with trauma‑focussed therapy, appropriate medication and good support. Recovery doesn’t usually mean “never thinking about it again”; it means the trauma is no longer running your life.

If you’re here because you typed “what is complex PTSD” at 2am, you’re already doing something important: trying to understand what’s happening to you.

From here, the next step is to bring that question into a conversation – with your GP, a trusted professional, or a service like Augmentive – so you can move from surviving on your own to having a plan that fits your mind, your history and your future.