Not all trauma comes from a single event. For many people, it comes from years of experiences that left them feeling unsafe, unseen or unloved, often in childhood and often in relationships they depended on. The effects can be long-lasting, and they can be hard to name.
What Is Complex PTSD?
Complex post-traumatic stress disorder (complex PTSD) is now recognized as a diagnosis in the World Health Organization’s International Classification of Diseases, 11th revision (World Health Organization, 2019). It usually follows prolonged or repeated trauma that is hard or impossible to escape, such as ongoing childhood abuse or neglect, domestic violence or captivity.
Complex PTSD includes the core symptoms of PTSD, such as re-experiencing, avoidance and a heightened sense of threat. It also includes ongoing difficulties with:
Emotion regulation: feelings that are overwhelming, or feeling shut down and numb
Self-concept: persistent feelings of shame, guilt or worthlessness
Relationships: trouble feeling close to others or trusting them
Research supports complex PTSD as distinct from PTSD, with its own pattern of symptoms (Cloitre et al., 2013). The idea builds on earlier work by psychiatrist Judith Herman, who described how prolonged trauma can shape a person’s sense of self and relationships (Herman, 1992).
Pete Walker’s Contributions
Therapist and author Pete Walker wrote about complex PTSD from both professional and personal experience in his book Complex PTSD: From Surviving to Thriving (Walker, 2013). Many people find his language validating. A few of his key ideas, summarized in our own words:
Emotional flashbacks: sudden waves of old feelings, like fear, shame or despair, that can show up without a clear memory attached. Walker suggests that recognizing “this is a flashback” can help reduce their intensity.
The inner critic: a harsh internal voice that often develops in response to early criticism or neglect.
Four survival responses: Walker describes fight, flight, freeze and fawn as patterns people may lean on to cope. The idea of “fawn,” staying safe by pleasing others, comes from his clinical writing.
Walker’s work is a clinical perspective rather than a research study, but it has helped many people put words to their experience.
Healing Is Possible
Recovery from complex trauma often happens gradually, and usually in the context of a safe, trusting therapeutic relationship. Treatment often focuses first on stability and coping skills, then on processing trauma and finally on rebuilding a sense of self and connection. Approaches such as trauma-focused therapy, EMDR and somatic therapies may all play a role.
When to Reach Out for Support
If you recognize yourself in this description, you deserve support. You don’t need to have a diagnosis, or to remember everything that happened, to begin. A trauma-informed therapist can help you move at a pace that feels safe.
References
Cloitre, M., Garvert, D. W., Brewin, C. R., Bryant, R. A., & Maercker, A. (2013). Evidence for proposed ICD-11 PTSD and complex PTSD: A latent profile analysis. European Journal of Psychotraumatology, 4, 20706.
Herman, J. L. (1992). Trauma and recovery. Basic Books.
Walker, P. (2013). Complex PTSD: From surviving to thriving. Azure Coyote.
World Health Organization. (2019). International classification of diseases for mortality and morbidity statistics (11th rev.). World Health Organization.
How Core Psychology Can Help
At Core Psychology, our clinicians offer trauma therapy, EMDR therapy and individual therapy, in person in Marda Loop, Calgary, and online across Alberta.
We offer a complimentary 15-minute phone consultation to answer your questions and help you find the right fit. You can also reach us at info@corepsychology.com.
If you’re in crisis or thinking about suicide, call or text 988 any time, or call 911.
This article is for general information only and is not a substitute for professional assessment or therapy.
