What is complex PTSD?

Post-traumatic stress disorder (PTSD) is a mental health problem. It can develop after experiencing, witnessing or learning about a traumatic or life-threatening event.

Complex PTSD, also known as CPTSD, is another mental health problem. It is similar, but separate to PTSD. CPTSD can develop after experiencing traumatic events repeatedly or over a long period of time. Often, CPTSD is caused by trauma experienced as a child.

What are the symptoms of complex PTSD?

CPTSD can cause many different symptoms. This includes symptoms of PTSD, such as:

• re-experiencing the trauma — you might have flashbacks
• avoiding things that remind you of the trauma
• constantly feeling on edge or on alert— you may startle easily

CPTSD can cause mental and emotional symptoms. You may feel distressed when you are reminded of the trauma, or sometimes for no obvious reason. You may also:

• feel strong emotions and find it hard to control them
• feel worthless, helpless, guilty or ashamed
• feel numb
• have trouble with your memory
• feel distracted
• self-harm and have suicidal thoughts

If you have CPTSD, you may also dissociate. Dissociation can make you:

• lose track of time
• feel like you are not in your body
• feel disconnected from your surroundings

CPTSD can make you feel on edge around others, which means it's harder to maintain healthy relationships. You may:

• have difficulty trusting other people
• have difficulty communicating with others
• avoid relationships completely
• become involved in abusive or toxic relationships

CPTSD can also cause physical symptoms, like:

• chronic pain
• chronic fatigue
• irritable bowel syndrome

What causes complex PTSD?

CPTSD is caused by repeated or long-term trauma. This is because trauma can change the way your brain works. Trauma can change:

• how you process your feelings — you may find it hard to control your emotions
• how you process your memories — you may suddenly be reminded of traumatic memories
• how you see the world — you may easily feel threatened in situations where others do not

Trauma in childhood can also affect brain development. This can:

• prevent a child from learning to manage their emotions
• impact the development of a child's social skills and behaviours
• cause long-term feelings of shame — a child may think that the problem is their fault

CPTSD can be caused by any type of long-term trauma, including:

• exploitation
• domestic violence
• war
• torture
• emotional abuse
• child abuse or neglect

If you have experienced trauma, other stressful things can make your symptoms worse. This can include things like bullying and harassment.

When should I see my doctor?

If you or someone you know is experiencing symptoms of CPTSD, talk to a doctor. They can refer you to a mental health professional. Such as a psychiatrist or psychologist with experience in trauma care.

Your doctor can help you make a mental health treatment plan.

When to seek urgent care

CPTSD can be very distressing. If you feel like you are experiencing a mental health crisis, seek urgent care. Reaching out to a family member or a friend may help. You can also call a mental health helpline for support.

If someone you know has CPTSD, you can read more about how to support people with a mental illness.

If you, or someone you know, is having suicidal thoughts and is in immediate danger, call triple zero (000). For help and support, call Lifeline on 13 11 14.

How is complex PTSD diagnosed?

CPTSD was first recognised as a mental health condition by the World Health Organization in 2018.

It can be difficult to diagnose. It may be confused with other mental health problems, such as:

• other forms of PTSD
• depression
• borderline personality disorder

To diagnose CPTSD, your doctor or mental health professional will ask you about:

• what you have experienced
• what your symptoms are and how long you've had them for
• how your symptoms affect your life

How is complex PTSD treated?

The main form of treatment for CPTSD is psychological therapy. This is done in a calm, safe environment to help you:

• make sense of why you are having certain feelings and reactions
• learn how trauma affects your mind and body
• find ways to respond to your symptoms and traumatic memories
• regain your trust in others and form healthy relationships
• change the way you think about yourself and the world around you

There are different types of psychological therapy that can help. These include:

• cognitive behaviour therapy (CBT)
• dialectical behaviour therapy (DBT)
• exposure therapy
• eye movement desensitisation and reprocessing (EMDR)

EMDR involves doing a series of eye movements while thinking about the trauma. This can help your brain to process your memories better. Sometimes, tapping on your body can be done instead of eye movements.

Medicines are not usually used to treat CPTSD. For some people, antidepressant medicines can be helpful while you are beginning psychological therapy.

Look for a psychiatrist or psychologist with experience in treating people who have been through trauma.

What are the complications of complex PTSD?

Having CPTSD can also increase your chance of having another mental health problem, like:

• depression
• an anxiety disorder
• a personality disorder
• a substance abuse disorder
• psychosis
• suicidal thoughts

It can also increase your chance of having physical health conditions, such as:

• heart problems
• dementia
• problems with your immune system

Can complex PTSD be prevented?

If you experience something traumatic, CPTSD can be prevented by seeking help early. Getting support early can help you learn:

• how to process the trauma
• healthy coping strategies
• how to access social support

Resources and support

For more information and support for complex PTSD, there are organisations that can help.

• Lifeline is a 24-hour counselling, suicide prevention and mental health support service — you can call on 13 11 14 for crisis support.
• Phoenix Australia is the National Centre of Excellence in Posttraumatic Mental Health — visit the website for more information about recovery and treatment.
• Blue Knot is an organisation that provides training and resources about complex trauma — you can visit the website for information about trauma and trauma-informed care.

You can also access SANE's range of free mental health supports on their website.

Call Medicare Mental Health on 1800 595 212 for advice and to get connected to local mental health services. Check the operating times. You can also visit the Medicare Mental Health website for information on trauma and PTSD.

Support for young people

Headspace provides mental health assistance for individuals aged 12 to 25 and provides fact sheets specific to young people.

The ReachOut website has information about complex PTSD for young people — you can also chat online with a peer support worker.

Support for veterans and their families

Open Arms has information on PTSD for veterans and their families. You can also call them on 1800 011 046 for 24-hour crisis support.

The Australian Government offers resources and wellbeing support for members of the Australian Defence Force (ADF), veterans or their families. You can also call their support line on 1800 624 608.

Languages other than English

You can find information about trauma in plain English and in languages other than English at Blue Knot.

You can also visit the Embrace Multicultural Mental Health website for information in languages other than English.

Information for Aboriginal and/or Torres Strait Islander peoples

You can visit the 13YARN website for information about trauma — you can also call on 13 92 76 to speak to an Aboriginal & Torres Strait Islander Crisis Supporter.

The Centre of Best Practice in Aboriginal and Torres Strait Islander Suicide Prevention also has a fact sheet on intergenerational trauma.

You can also call the healthdirect helpline on 1800 022 222 (known as NURSE-ON-CALL in Victoria). A registered nurse is available to speak with you 24 hours a day, 7 days a week.