There can be no doubt that the symptoms of complex post-traumatic stress disorder are life-altering and debilitating. In this article, we begin a series outlining the symptoms of CPTSD a few at a time to help bring understanding that the world is correct, complex post-traumatic stress disorder is important and should be included in the DSM’s next iteration so that providers of mental health services can better diagnose and treat it.

Today we are going to examine together the first six on the list of the most common symptoms listed above and conquer the rest in subsequent articles.

The Long List of Symptoms of CPTSD

There is a lot of confusion about the differences between post-traumatic stress disorder (PTSD) and complex post-traumatic stress disorder (CPTSD). However, there are some distinct differences between the two.

PTSD is mostly caused by a single event like a car accident, earthquake, or rape. CPTSD, on the other hand, forms after trauma happens repeatedly such as repeated childhood abuse or neglect.

Other traumatic events that can cause complex post-traumatic stress disorder to form are:

  • Experiencing human trafficking
  • Experiencing being a prisoner of war
  • Living in a region wracked by war
  • Experiencing or witnessing domestic abuse

The symptoms of complex post-traumatic stress disorder are too many to list in the scope of this article. However, the twenty-four most common symptoms are listed below:

  • Reliving the trauma through flashbacks and nightmares
  • Avoiding situations that remind them of the trauma
  • Dizziness or nausea when remembering the trauma
  • Hyperarousal
  • The belief that the world is a dangerous place
  • A loss of trust in the self or others
  • Difficulty sleeping or concentrating
  • Startling easy by loud noises
  • A negative self-view
  • Emotional regulation difficulties
  • Problems with relationships
  • Thoughts or actions of suicide
  • Fixating on the abuser or seeking revenge
  • Losing memories of trauma or reliving them
  • Difficulty regulating emotions that often manifest as rage
  • Depression
  • Sudden mood swings
  • Feeling detached from oneself
  • Feeling different from others
  • Feeling ashamed
  • Feeling guilty
  • Difficulty maintaining relationships
  • Seeking our or becoming a rescuer
  • Feeling afraid for no obvious reason

A Definition of CPTSD

Before we discuss the first six symptoms on our list, it is important to, once more, define complex traumatic-stress disorder.

For a good definition of CPTSD, we turned to Beauty After Bruises, an organization that offers outreach focused on adult survivors of childhood trauma who have complex PTSD with or without the presence of a dissociative disorder. Their definition of complex post-traumatic stress disorder as follows:

“Complex PTSD comes in response to chronic traumatization over the course of months or, more often, years. This can include emotional, physical, and/or sexual abuses, domestic violence, living in a war zone, being held captive, human trafficking, and other organized rings of abuse, and more. While there are exceptional circumstances where adults develop C-PTSD, it is most often seen in those whose trauma occurred in childhood. For those who are older, being at the complete control of another person (often unable to meet their most basic needs without them), coupled with no foreseeable end in sight, can break down the psyche, the survivor’s sense of self, and affect them on this deeper level. For those who go through this as children, because the brain is still developing and they’re just beginning to learn who they are as an individual, understand the world around them, and build their first relationships – severe trauma interrupts the entire course of their psychologic and neurologic development.”

That long definition gives an insight into the hell that is complex post-traumatic stress disorder.

Complex Post-Traumatic Stress Disorder (CPTSD) officially doesn’t exist in the United States as it has yet to be included as a separate diagnosis in the Diagnostic and Statistical Manual of Mental Disorders (DSM). However, CPTSD is recognized by the World Health Organization (WHO) and is included in their publication the International Statistical Classification of Diseases and Related Health Problems edition eleven (ICD-11)1 in 2018. So, while the United States lags behind in placing CPTSD in its own classification for diagnostic purposes, it is recognized by the rest of the world.

The First Six Symptoms from the List of Complex Post-Traumatic Stress Disorder

 All of the symptoms of CPTSD are life-altering and in many cases debilitating to the point of becoming a disability. Now, we are going to examine together the first six symptoms on our list of symptoms.

Reliving the trauma through flashbacks and nightmares. Reliving the fear and other emotions that accompanied the traumatic events that were the cause of forming CPTSD is extremely difficult. No one wishes to go back in time and relive the terror and entrapment, yet people living with the condition often do through flashbacks and nightmares.

Flashbacks aren’t just remembering what happened so long ago, they are like time-warps pulling one back into the traumatic events. When triggered, a person living with complex post-traumatic stress disorder relives the event, not just remembers it, with all the emotions they felt then.

Nightmares of what happened during traumatic events with CPTSD is not uncommon and sometimes medications are needed to help survivors sleep.

Avoiding situations that remind them of the trauma. The original trauma was so horrible for some folks that even walking past a building or smelling an odor that reminds them of what happened can cause a reaction. These reactions usually involve anxiety, and in some survivors panic.

The avoidance behavior resulting from traumatic events can become so pronounced in survivors who have CPTSD, that they cannot work or leave their homes for fear they will have a panic attack.

Dizziness or nausea when remembering the trauma. It should be no surprise to anyone that survivors living with the diagnosis of CPTSD would have physical reactions to triggers. Reliving what happened can cause dizziness, nausea, vomiting, heart palpitations, and many more physical reactions.

Hyperarousal. Many who have survived severe and repeated traumatic events often find themselves always on high alert waiting and watching subconsciously for any signs of danger. Unfortunately, this hyperarousal means they are easily triggered into a panic attack when the danger they have perceived is not real or benign.

The belief that the world is a dangerous place. After being a victim of highly traumatizing events, survivors have a tough time reconciling their current safety when contrasted against their vulnerability in their past. Because of the flashbacks and hyperarousal these folks experience, survivors feel they are unsafe all the time and that the world is dangerous. Often, survivors do not just feel endangered but that they do not fit into the world or have a place in it.

A loss of trust in the self or others. Trust isn’t easily given by survivors living with complex post-traumatic stress disorder as it was violated badly during the trauma they experienced. Survivors feel that the people around them are not to be trusted even if those people were not involved at all in what happened to them.

Survivors may also lack trust in themselves and second guess or delay decisions on just about anything important in their lives. It is uncertain whether this lack of trust in oneself comes from the way they were victimized and their inability to escape or if their self-image was severely damaged. Either way, a lack of trust in oneself and others is highly debilitating as it can become impossible to secure and hold onto any type of relationship.

The Severity of These Six Symptoms

Reading the symptoms above it is easy to see how someone might say that they can be alleviated easily through self-talk or self-awareness. However, conquering such symptoms is much harder than it may seem.

Having flashbacks, reliving the trauma, and avoiding situations that may cause either or both of them is disabling. People who do all three, as they go together, have a challenging time holding down a steady job, dealing with others, or socializing with others.

Hyperarousal and the dizziness with nausea that often accompany it hold survivors back from being able to relax as they live in fear all the time. It is because of these symptoms that survivors may feel the world is too dangerous and that they must hide by isolating, dissociating, or avoidance behavior.

There is a Silver Lining to These Cloudy Symptoms   

While complex post-traumatic stress disorder is curable per se, it is highly treatable. With the right care from a qualified therapist, CPTSD need not be a life-long, incapacitating disorder. There is a multitude of treatments available and once one has admitted they have a mental health condition and recognize its causes, healing can and will begin.

It is also important to remember that you are not alone. It is believed that 7-8% of Americans experience CPTSD. There are approximately 327 million people in the United States so that means approximately 23-26 million people experience the symptoms of complex post-traumatic stress disorder.

If you or someone you know is experiencing any of these symptoms, please, seek out the help of a qualified mental health professional. The moment you pick up the phone to make your first appointment your healing journey will begin. It may be a long, dark, and difficult road but along the journey you will find not only the end of the symptoms that plague you but yourself as well.

When you’re telling a story, the best stories, every character has an arc. Every single one. And that arc is usually about finding yourself or about at least finding something about yourself that you didn’t know. ~ Roy Conli


  1. Rosenfield, P. J., Stratyner, A., Tufekcioglu, S., Karabell, S., Mckelvey, J., & Litt, L. (2018). Complex PTSD in ICD-11: A case report on a new diagnosis. Journal of Psychiatric Practice®, 24(5), 364-370. Retrieved from:


Want to learn more? Check out our informational blog series on “What is CPTSD?”