Complex PTSD

Some traumas are called "complex": they went on for a long time, happened during childhood, or involved harm from another person, especially someone you trusted. After trauma like this, people may develop the symptoms of PTSD along with other lasting difficulties. When you couldn't escape a harmful situation, it makes sense that trusting people, feeling good about yourself and managing strong emotions can become hard.

Repeated childhood trauma makes complex PTSD more likely, but it isn't the only path. Any type of trauma can lead to it.

Common signs, in plain language

• The signs of PTSD: reliving the trauma, avoiding reminders, and feeling on edge or under threat
• Emotions that feel very intense or hard to calm
• Feeling deeply worthless or defeated, or carrying guilt and shame about the trauma
• Trouble feeling close to people, or pulling away from them
• Feeling disconnected from yourself or your surroundings, sometimes called dissociation
• Acting in self-destructive ways when emotions run high

These signs are a general guide, not a checklist for diagnosis.

If you're in crisis or thinking about harming yourself, call or text 988 (Suicide & Crisis Lifeline), any time, day or night. In an emergency, call 911 or go to the nearest emergency room.

There are two main diagnostic systems. The World Health Organization's ICD-11 lists complex PTSD as its own diagnosis. The U.S. system doesn't; its PTSD diagnosis already covers many of these symptoms. So in the U.S., complex PTSD is often diagnosed as PTSD, and some providers use the terms in place of each other. What matters most is understanding your symptoms clearly.

You won't need to describe the details of what happened. A careful evaluation looks at:

• The kinds of experiences you've been through, in broad terms
• Your current symptoms, and how they affect your relationships, work and daily life
• Conditions that often come with it, such as depression, anxiety, substance use, dissociation or borderline personality disorder
• Your health, medications and goals

This is part of a comprehensive psychiatric evaluation. Your first evaluation is up to 90 minutes in length. Some people need more time, some less, and we take the time you need. Follow-up visits are typically 20 to 30 minutes, and extended follow-ups are available.

The best research so far shows that PTSD treatments work well for complex PTSD. Trauma-focused therapy, which works directly with the memory of the trauma or what it means to you, is a good place to start. Some therapists use "phase-based" approaches that build skills for emotions and relationships first; researchers don't yet know if these work better.

Medication. We focus on the medication side of care. Because complex PTSD overlaps so much with PTSD, the medication options are the same ones used for PTSD. Medication can also treat the depression, anxiety and sleep problems that often come with it. We explain every choice and adjust carefully.

Support in every visit. Visits include supportive therapy, education about how trauma affects you, and DBT skills such as emotion regulation and distress tolerance.

Trauma-focused therapy. We don't offer trauma-focused therapy such as EMDR ourselves. We don't offer standalone weekly therapy, but we're happy to help you find a therapist and, with your permission, we'll coordinate with them.

Regular follow-ups. Once PTSD symptoms improve, some people still need help with concerns like depression or relationships, and we keep checking in and adjusting over time.