PTSD and Complex Trauma


Many people go through traumatic experiences that continue to impact them in myriad ways. Therapy can help with both PTSD and Complex Trauma. It can also help when you have experienced both types of trauma.

Dual Diagnosis of PTSD and C-PTSD

It’s important to note that while PTSD and C-PTSD are distinct diagnostic categories, they can co-occur in individuals who have experienced both single traumatic events and prolonged, complex trauma over their lifetime. For example, someone who experienced combat trauma during military service (potentially leading to PTSD) and later experienced ongoing abusive relationships (potentially leading to C-PTSD) may present with symptoms of both conditions.

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Dual Diagnosis of PTSD and C-PTSD

Another Example of PTSD + C-PTSD in One Individual

Imagine a person who grew up in a household marked by chronic domestic violence and emotional abuse. This individual endured years of physical and emotional trauma inflicted by a parent. As a result of this ongoing, complex trauma, they developed symptoms of C-PTSD, including difficulties with self-esteem, emotion regulation, and forming healthy relationships.

Years later, this individual moves to an area prone to natural disasters, such as hurricanes. They experience a catastrophic hurricane that leads to the loss of their home and possessions, displacement, and a constant fear of future disasters. This traumatic event triggers the development of PTSD due to the acute and life-threatening nature of the natural disaster.

In this example, the individual now has both C-PTSD and PTSD:

  • C-PTSD: Resulting from the complex trauma endured during their childhood marked by domestic abuse and emotional trauma.
  • PTSD: Developed as a consequence of the acute, traumatic experience of surviving a catastrophic natural disaster.

This individual may exhibit a range of symptoms related to both C-PTSD and PTSD, including flashbacks, hypervigilance, avoidance behaviors, difficulties with trust and relationships, and emotional dysregulation. The co-occurrence of these two trauma-related conditions highlights the complex interplay of past and present traumas and underscores the need for a comprehensive and individualized treatment approach that addresses both sets of symptoms and the unique experiences associated with each trauma.

Complexity of PTSD + C-PTSD and How Therapy Helps

Complexity of PTSD + C-PTSD and How Therapy Helps

Having both Post-Traumatic Stress Disorder (PTSD) and Complex Post-Traumatic Stress Disorder (C-PTSD) can present unique challenges and complications. These two trauma-related conditions often intersect and overlap, leading to a complex clinical presentation. Here are some complications and how therapy can help:

Symptom Complexity

Individuals with both PTSD and C-PTSD may experience a wide array of symptoms, including flashbacks, nightmares, dissociation, emotional dysregulation, self-esteem issues, trust and relationship difficulties, and chronic feelings of hopelessness. This complexity can make it challenging to address all symptoms effectively.

Therapy offers a structured and comprehensive approach to addressing the broad range of symptoms associated with both conditions. Therapists can tailor treatment to target specific symptoms, using evidence-based therapies like Cognitive-Behavioral Therapy (CBT), Dialectical Behavior Therapy (DBT), and Eye Movement Desensitization and Reprocessing (EMDR) to address both PTSD and C-PTSD symptoms.

Trigger Interactions

Triggers for PTSD and C-PTSD can interact and amplify each other. For example, a current stressor may exacerbate trauma-related symptoms, leading to a cycle of distress and worsening mental health.

Therapy can help individuals identify and manage triggers effectively. Therapists teach coping strategies and emotion regulation skills to navigate both past and present triggers, reducing the impact of these interactions.

Self-Esteem and Identity Challenges

C-PTSD often involves disturbances in self-identity and self-esteem, while PTSD may lead to negative beliefs about oneself as a result of trauma. These challenges can affect self-worth and overall well-being.

Therapy focuses on rebuilding self-esteem, fostering self-compassion, and helping individuals develop a more positive self-identity. Techniques like self-affirmation, self-compassion exercises, and narrative therapy can be beneficial.

Complexity of PTSD + C-PTSD and How Therapy Helps

Relationship Difficulties

Both PTSD and C-PTSD can impact interpersonal relationships. Individuals may struggle with trust, communication, and forming healthy connections, which can lead to isolation and loneliness.

Therapists work with individuals to improve interpersonal skills, set healthy boundaries, and address trust issues. Couples or family therapy can also be beneficial to address relationship challenges.

Treatment Resistance

The presence of both conditions may lead to treatment resistance, as the complexity and severity of symptoms can make progress slower or less apparent.

Therapists use a collaborative and patient-centered approach to treatment, working closely with individuals to set achievable goals and milestones. This approach can enhance motivation and engagement in the therapeutic process.

Safety and Stabilization

Safety and stabilization are fundamental steps in trauma recovery. Individuals with both PTSD and C-PTSD may need more extensive work in these areas before addressing specific traumatic memories.

Therapy provides a safe and supportive environment where individuals can learn grounding techniques, develop emotional regulation skills, and establish a sense of safety and stability before delving into more intensive trauma processing.

What to Expect as You Start PTSD + C-PTSD Therapy

What to Expect as You Start PTSD + C-PTSD Therapy

Starting therapy for co-occurring Post-Traumatic Stress Disorder (PTSD) and Complex Post-Traumatic Stress Disorder (C-PTSD) can be an important step towards healing and recovery. Your experience will depend on the type of therapy you select, the therapist’s approach, and your own unique needs. With that in mind, here’s what you can generally expect when you begin therapy for these challenges:

Initial Assessment

The first few sessions of therapy often involve an initial assessment. Your therapist will ask questions about your background, trauma history, and current symptoms. This assessment helps the therapist gain a comprehensive understanding of your unique situation.

Establishing Goals

Together with your therapist, you’ll establish treatment goals and priorities. These goals may include reducing the frequency and intensity of symptoms, improving daily functioning, and working on specific issues related to trauma, such as emotional regulation or self-esteem.

Building Trust

Trust is crucial in therapy, especially when addressing trauma. Your therapist will work to create a safe and nonjudgmental space where you can openly discuss your experiences and feelings. Building a trusting therapeutic relationship is a gradual process.


Your therapist will provide education about PTSD, C-PTSD, and trauma-related symptoms. This helps you understand what you’re experiencing and how therapy can help you manage and eventually alleviate these symptoms.

Developing Coping Strategies

Therapy often begins with the development of coping strategies to manage distressing symptoms. These strategies may include relaxation techniques, mindfulness exercises, and grounding techniques to manage anxiety and flashbacks.


For many individuals, especially those with complex trauma histories, therapy may initially focus on achieving stabilization. This involves managing crisis situations, ensuring safety, and establishing emotional regulation skills.

Types of Therapy for PTSD + C-PTSD

Exploring Trauma History

As therapy progresses, you’ll gradually explore your trauma history. This may involve talking about and processing traumatic memories. Therapists use evidence-based trauma therapies like Cognitive-Behavioral Therapy (CBT), Eye Movement Desensitization and Reprocessing (EMDR), or Dialectical Behavior Therapy (DBT) to help with this process.

Addressing Co-Occurring Issues

If you have co-occurring conditions such as depression, anxiety, or substance use disorders, therapy will address these issues alongside your trauma symptoms.

Challenging Negative Beliefs

Therapy often involves challenging and reframing negative beliefs that have developed as a result of trauma. This includes addressing self-blame, guilt, and feelings of worthlessness.

Integration and Recovery

Over time, therapy aims to help you integrate the traumatic experiences into your life story and promote recovery. This may involve regaining a sense of control, developing a more positive self-identity, and improving your overall quality of life.

Healing from PTSD and C-PTSD is a gradual process. It’s normal to experience ups and downs along the way. Therapy provides ongoing support as you work towards recovery.

Types of Therapy for PTSD + C-PTSD

Types of Therapy for PTSD + C-PTSD

The choice of therapy should be based on individual preferences, the severity and nature of symptoms, and the therapist’s expertise. It’s common for therapists to use a combination of these approaches or adapt them to meet the specific needs of the individual. Here are some common types of therapy for PTSD + C-PTSD:

Cognitive-Behavioral Therapy (CBT)

CBT is one of the most widely researched and effective treatments for PTSD and C-PTSD. It focuses on identifying and challenging negative thought patterns and behaviors related to trauma. CBT helps individuals develop healthier coping strategies and beliefs, making it particularly helpful for addressing distorted cognitions and managing symptoms like flashbacks and anxiety.

Dialectical Behavior Therapy (DBT)

DBT is effective for individuals who struggle with emotional regulation and self-destructive behaviors often associated with C-PTSD. It emphasizes mindfulness, emotion regulation, distress tolerance, and interpersonal effectiveness. DBT can help individuals manage intense emotions, improve relationships, and build resilience.

Eye Movement Desensitization and Reprocessing (EMDR)

EMDR is a specialized therapy designed to process traumatic memories and reduce their emotional impact. It is highly effective for individuals with PTSD and C-PTSD, as it helps desensitize distressing memories and reprocess them in a more adaptive way, leading to symptom reduction and emotional healing.

Somatic Therapies

Somatic therapies, such as Somatic Experiencing and Sensorimotor Psychotherapy, focus on the mind-body connection and the physical manifestations of trauma. These therapies can be particularly helpful for individuals with C-PTSD, as they address bodily sensations, tension, and somatic symptoms that often accompany complex trauma.

Types of Therapy for PTSD + C-PTSD

Expressive Art Therapy

Expressive art therapy provides a creative outlet for individuals to process and express their emotions related to trauma when words alone may be insufficient. Art, music, or dance can help individuals explore and communicate their feelings, which can be especially useful for those who struggle to verbalize their trauma experiences.

Mindfulness-Based Therapies

Mindfulness practices, such as Mindfulness-Based Stress Reduction (MBSR) or Mindfulness-Based Cognitive Therapy (MBCT), can enhance self-awareness and emotional regulation. These approaches are effective for individuals with PTSD and C-PTSD, as they teach individuals to stay present and manage distressing thoughts and emotions.

Psychedelic Therapy

Emerging research suggests that psychedelic-assisted therapy, using substances like MDMA or psilocybin, can show promise in treating PTSD and C-PTSD. These therapies may promote deep emotional processing and healing, although they are currently in clinical trials and not widely available.

Equine Therapy

Equine-assisted therapy involves working with horses to build trust, improve communication, and develop emotional regulation skills. For individuals with trauma-related difficulties in trust and attachment, equine therapy can provide a unique and powerful therapeutic experience.

Types of Therapy for PTSD + C-PTSD

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