Defining Complex Trauma

Published On: November 16, 2023|Categories: Trauma|
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Traumatic experiences that lead to the onset of post-traumatic stress disorder (PTSD) aren’t always one-time, short-term events such as car accidents or natural disasters. In some cases, trauma repeats or continues for months or years, leading to severe psychological harm. For individuals with a long-term history of trauma, the diagnostic criteria for PTSD may not accurately or fully describe their symptoms and experiences. This scenario has led to the development of a separate diagnosis known as complex PTSD, or CPTSD.

Complex trauma symptoms in adults

Adults with a chronic history of trauma may present with signs and symptoms beyond the scope of a classic PTSD diagnosis. Symptoms that tend to be unique to complex trauma and PTSD are as follows.

Behavioral challenges

Individuals with complex trauma might behave in ways that are unusually impulsive or aggressive. They might abuse alcohol and/or drugs or engage in self-destructive behavior.

Emotional difficulties

People who have experienced a long history of trauma might experience volatile emotions that they have difficulty regulating, such as rage, depression, and panic.

Cognitive issues

Individuals with CPTSD might dissociate, or feel disconnected from the world around them. They might have a rapidly shifting sense of personal identity, with changing core values, career goals, beliefs, and relationships.

Interpersonal struggles

It might be difficult for people with complex trauma to form and maintain healthy connections with others, leading to patterns of chaotic or toxic friendships, romantic relationships, and family lives.


A history of chronic trauma can manifest in the body as somatic symptoms, such as fatigue, nausea, diarrhea, constipation, pain, headaches, or heart palpitations. Individuals with complex PTSD might frequently seek medical attention for recurring symptoms that have no obvious cause.

People exhibiting this group of symptoms may also receive a diagnosis known as Disorders of Extreme Stress Not Otherwise Specified (DESNOS).-[‘/

Causes of complex trauma disorder

Research shows that the duration of the traumatic event or exposure is most strongly linked to the development of complex PTSD. Examples of ongoing traumatic situations or events that can lead to complex trauma include:

  • Long-term childhood physical or sexual abuse
  • Long-term domestic violence
  • Being a refugee
  • Concentration camps
  • Prisoner of War camps
  • Exploitation and trafficking

Experiences that lead to complex trauma usually involve being either physically or emotionally held captive and controlled by an abuser or perpetrator.

The brains of individuals with this kind of prolonged trauma were forced to adapt to unnatural conditions to survive. When the human brain perceives the inability to escape from danger, these emotions and fears are stored in the central nervous system so that when that individual encounters an unsafe situation in the future, they will be on high alert. This is known as hypervigilance.

Complex trauma and PTSD in veterans

Through their experiences during deployment and combat, veterans have a heightened risk of exposure to events associated with complex trauma. One study found that 80 percent of war veterans seeking treatment for PTSD were likely to have CPTSD. The veterans in the study who met the diagnostic criteria for CPTSD were also more likely to have trouble functioning in their daily lives and suffer from co-occurring generalized anxiety disorder.

Veterans with CPTSD might also struggle with the following:

  • Sadness, anger, or suicidal thoughts
  • Forgetting or reliving traumatic events
  • Flashbacks
  • Feeling disconnected from others
  • Guilt, shame and helplessness
  • Being preoccupied with thoughts of revenge on the perpetrator of the trauma
  • Isolation
  • Distrusting or feeling skeptical toward others
  • Loss of meaning and significant moral injury

If you or someone you love is a veteran who may be struggling with complex trauma or PTSD, please don’t despair. Although the psychological wounds resulting from complex trauma run deep, specialized care is available and recovery is possible.

Complex trauma treatment for veterans

Veterans with complex trauma can benefit from therapies that are evidence-based for the treatment of PTSD, such as cognitive behavioral therapy (CBT) and Acceptance & Commitment Therapy (ACT). Fortunately, these therapies are also effective for conditions that commonly occur alongside complex PTSD and in veterans with PTSD, such as substance use disorders and sleep problems.

However, veterans with complex PTSD may need more intensive treatment than those with a classic PTSD diagnosis or may have unique symptoms that require traditional therapies to be modified. At Pyramid Military Therapy & Recovery Programs, we take a flexible, person-centered approach to PTSD treatment, meeting each client exactly where they are and crafting personalized treatment plans to support their needs and goals. Contact us today to learn more.

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