Existential Psychiatry Blog

Beyond PTSD: Understanding the Depth of Trauma and Complex PTSD

December 16, 2023
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In recent years, we've seen significant progress in how we care for trauma survivors. Thanks to more research and open conversations about the lasting effects of chronic trauma, we now have a better grasp of complex post-traumatic stress disorder (CPTSD).

Although CPTSD has not yet been included in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) as an official clinical diagnosis (unlike PTSD), a deeper understanding of this syndrome can lead to improved treatment and more community support for those impacted by trauma. It also means that survivors’ experiences might be better validated and normalized.

Understanding Complex PTSD

CPTSD is a mental health condition that develops as a result of prolonged exposure to trauma. This often involves interpersonal relationships, such as emotional, physical, or sexual abuse. It can be ongoing trauma or multiple traumatic events over time. For example, an individual may experience childhood physical abuse while another person endured sexual assault as a child and domestic violence as an adult.

CPTSD Symptoms

Both complex PTSD and PTSD have symptoms of hypervigilance, flashbacks, and avoidance of trauma triggers. They differ in that CPTSD also involves a broader range of symptoms including:

Chronic Trauma

The type of trauma a person with CPTSD experiences varies, but common examples include:

The Impact of Prolonged Trauma

Extended exposure to trauma can significantly impact your health. This is especially true during crucial developmental stages. Enduring prolonged trauma often disrupts your ability to regulate emotions, form and maintain relationships, and develop a stable sense of self. This can lead to anxiety, depression, and chronic physical health issues. It may also shape your worldview, and negatively affect your sense of safety and ability to trust yourself and others.

Trauma and Identity

People with CPTSD often find it hard to have a clear sense of who they are. You may have trouble putting together different parts of your life, emotions, and memories and feel unsure about who you are. You might feel empty or ashamed, or have trouble coping and maintaining relationships. These experiences may also lead to difficulties with decision-making.

The Relationship Between CPTSD and Other Conditions

Trauma, complex PTSD, and other mental health conditions are often interconnected. Chronic and severe trauma can impact various aspects of your life. This disruption may lead to the development or worsening of other health conditions. A recent study found that 36% of outpatient psychiatric patients had co-occurring CPTSD.

CPTSD and Mood Disorders

There is often a significant overlap between CPTSD and mood disorders such as depression and anxiety. One study found that participants with CPTSD reported higher rates of depressive and psychotic symptoms. The emotional dysregulation, heightened stress response, and hypervigilance involved in CPTSD may contribute to the onset or worsening of anxiety and mood disorders.

CPTSD and Dissociative Disorders

Dissociation is a coping mechanism commonly seen in chronic trauma survivors. Research has found that individuals with complex PTSD reported higher rates of dissociative symptoms.

When dissociating, individuals detach from their thoughts, feelings, or sense of identity.You might struggle to remember things, feel like your surroundings aren't real, or feel disconnected from your body.

CPTSD and Substance Use Disorders

Individuals with CPTSD are at a higher risk for substance use disorders. People often use alcohol or drugs as a way to cope with the emotional distress caused by trauma. This may lead to the development or worsening of a substance use disorder.

Person in Black Pants and Black Shoes Sitting on Brown Wooden Chair in Seattle talking about complex PTSD treatment

Complex PTSD Treatment

Effective treatment for CPTSD addresses trauma's physical, mental, emotional, and social impacts. Treatment plans will typically include a combination of therapy, medication, mindfulness practices, and community-based support. Speak to your provider about each of your options to determine which works best for you.


Therapy, particularly trauma-focused therapies, is considered a cornerstone in the treatment of CPTSD. EMDR (Eye Movement Desensitization and Reprocessing) and DBT (Dialectical Behavior Therapy) have shown promise in helping individuals process traumatic memories. They also help survivors regulate emotions and improve their relationships.


Certain symptoms of complex PTSD can be alleviated with prescribed medications. However, the FDA has not approved any specific medications for CPTSD. Antidepressants, like SSRIs or SNRIs, are considered first-line to pharmacologically treat typical PTSD, mood, and anxiety symptoms often associated with CPTSD. Adrenergic and sleep medications may also be used.

Integrative Approaches

Interventions that center the mind-body connection, build support and honor cultural beliefs promote holistic healing. These may include mindfulness-based techniques, such as grounding and breathing exercises.

Treatment plans might also involve community organizations and peer or therapy groups.  Communities and support networks play a vital role in CPTSD recovery. They offer spaces for sharing experiences and coping strategies, as well as foster a sense of belonging.

Looking for Complex PTSD Treatment in Seattle?

At Existential Psychiatry, we understand that there isn't a “one size fits all” approach to trauma treatment. That's why Dr. David Zacharias prioritizes building strong and collaborative relationships with his patients. He implements trauma-informed practices at each stage of treatment.

You'll receive client-centered and effective care, whether it's diagnostic assessment, medication management, or therapy. We're not only here to treat you; we're here to walk alongside you on your journey to recovery. Reach out today for a free consultation – let's chat about how we can support you.

Written by Existential Psychiatry Staff