Symptoms of CPTSD

Patterns of Trauma and the Symptoms of CPTSD

The symptoms of CPTSD are diverse and complicated.  Disorienting flashbacks. Unregulated emotions. Sudden, inexplicable fear responses. An inability to trust others. An inability to trust oneself… For survivors of long-term abuse, neglect, violence, or crisis, the traumas of the past can have a lasting impact on personality, emotions, and behavior. In traumatic situations or abusive relationships that feel inescapable, the patterns and “rules” of the situation can become ingrained in the victim. Even after the trauma has ended, then, survivors may continue feeling “trapped” in their own defensive patterns of behavior.

The proposed diagnosis of “Complex Post-Traumatic Stress Disorder” (CPTSD) helps to describe a set of symptoms which are common to survivors of serious, long-term traumas.

The symptoms of CPTSD have their roots in recurring psychological injury early in life. When traumas happen during childhood, they can interrupt the development of a dependable sense of self, as well as the ability to connect with others in healthy ways (Herman, 1992). Fragmented memories and traumatic early-life conditioning can result in intense flashbacks and uncontrolled surges of emotion and bodily distress (Courtois, 2014).

Formally described, CPTSD’s symptoms can be defined as, “the changes in mind, emotions, body, and relationships experienced following complex psychological trauma, including severe problems with dissociation, emotion dysregulation, somatic distress, or relational or spiritual alienation” (Courtois and Ford, 2009).


One of the key characteristic features of CPTSD, disassociation involves sudden flashbacks to traumatic situations or the feelings evoked by those situations. Whereas sufferers of PTSD may describe having felt “out of body” during a traumatic event, CPTSD sufferers have often experienced these feelings repeatedly and for prolonged amounts of time. This can cause a fractured and disoriented sense of self in the long-term (Courtois, 2014).

Emotion Dysregulation (ED)

Emotion dysregulation refers to the trouble many victims have with regulating emotions. This can mean sudden feelings of self-disdain, excessive fight-or-flight responses, trouble controlling anger, self-injury, and suicidal preoccupation (Herman, 1997).

Somatic Distress

Referring to the physical “hyperarousal in anticipation of danger,” Somatic distress eventually causes “wear and tear on both the body and the nervous system” over time (Courtois, 2014).

Relational or Spiritual Alienation

Relational or spiritual alienation refers to the way that systematic abuse, neglect, and betrayal lead to both mistrust of others and alienation from oneself. CPTSD often involves a failure to form healthy attachment styles during development (Courtois, 2014).

A Picture of CPTSD

In Complex PTSD: From Surviving to Thriving, Pete Walker uses simpler terms to describe some of the most common features of CPTSD: “emotional flashbacks, toxic shame, self-abandonment, a vicious inner critic and social anxiety” (2013). Walker also offers a helpful list of an array of symptoms that survivors may experience:

  • Emotional Flashbacks
  • Tyrannical Inner &/or Outer Critic
  • Toxic Shame
  • Self-Abandonment
  • Social anxiety
  • Abject feelings of loneliness and abandonment
  • Fragile Self-esteem
  • Attachment disorder
  • Developmental Arrests
  • Relationship difficulties
  • Radical mood vacillations
  • Dissociation via distracting activities or mental processes
  • Hair-triggered fight/flight response
  • Oversensitivity to stressful situations
  • Suicidal Ideation

This list is not exhaustive, and survivors may not experience all of these responses. CPTSD is a relatively new category — those who study it are working to better understand a set of symptoms that have not yet been adequately addressed in the field of psychology. The hope is to improve treatment for victims of long-term trauma, and to help build supportive communities for these individuals.

To better understand the importance of CPTSD as a separate category and diagnosis, please see Related Disorders.


Courtois, Christine A. It’s Not You, It’s What Happened to You: Complex Trauma and Treatment. Place of Publication Not Identified: Telemachus, 2014. Print.

Courtois, Christine A. and Julian D. Ford. Treating Complex Traumatic Stress Disorders: An Evidence-based Guide. New York: Guilford, 2009. Print.

Herman, Judith Lewis. Trauma and Recovery. New York, NY: BasicBooks, 1992. Print.

Judith L. Herman. Trauma and Recovery: The Aftermath of Violence–From Domestic Abuse to Political Terror. New York, NY: Basic Books, 1997. Print.

Walker, Pete. Complex PTSD: From Surviving to Thriving: A Guide and Map for Recovering from Childhood Trauma. N.P.: Azure Coyote, 2014. Print.