“I’ve been in therapy for years, and I keep hearing that I have ‘trauma responses,’ but I don’t have PTSD. I was never in a war or a car accident. Nothing really bad happened to me. So why do I feel this way?”
This is something I hear often from clients who are struggling with the effects of childhood trauma, emotional abuse, neglect, or other forms of prolonged, repeated trauma. They’ve been told—or have convinced themselves—that their experiences don’t “count” as trauma because they don’t fit the traditional picture of Post-Traumatic Stress Disorder (PTSD).
What they’re experiencing, though, may be Complex PTSD (C-PTSD)—a form of trauma that comes not from a single traumatic event, but from prolonged, repeated experiences that chip away at a person’s sense of safety, worth, and identity.
What Is Complex PTSD?
Complex PTSD develops when someone experiences ongoing trauma over months or years, particularly during childhood or in situations where escape feels impossible. This might include:
• Childhood emotional, physical, or sexual abuse
• Chronic neglect or emotional unavailability from caregivers
• Growing up with alcoholic or mentally ill parents
• Being in an abusive relationship
• Experiences of domestic violence
• Being a prisoner of war or held captive
• Living in a war zone or refugee situation
• Being subjected to torture or ongoing oppression
The key difference between PTSD and C-PTSD is that C-PTSD comes from repeated trauma—often within relationships—that fundamentally disrupts a person’s developing sense of self, safety, and ability to trust others.
PTSD vs. Complex PTSD: What’s the Difference?
While PTSD and C-PTSD share some symptoms, there are important distinctions. Understanding these differences helps explain why traditional treatments for PTSD don’t always fully address the needs of people with C-PTSD.
PTSD (Post-Traumatic Stress Disorder)
PTSD is recognized in the DSM-5 (the Diagnostic and Statistical Manual of Mental Disorders) and typically develops after exposure to a single traumatic event or a series of similar events, such as:
• Combat or military service
• A serious accident
• A natural disaster
• A single assault or violent attack
• Witnessing death or serious injury
Symptoms of PTSD include:
• Intrusive memories, flashbacks, or nightmares about the traumatic event
• Avoidance of reminders of the trauma
• Negative changes in thoughts and mood
• Heightened reactivity (being easily startled, difficulty sleeping, irritability, hypervigilance)
Complex PTSD (C-PTSD)
C-PTSD, while not included in the DSM-5, is recognized in the International Classification of Diseases (ICD-11) and by trauma experts worldwide. It includes all the symptoms of PTSD, plus additional difficulties that stem from prolonged trauma:
1. Difficulties with Emotional Regulation
People with C-PTSD often struggle to manage their emotions. They might experience:
• Intense emotional reactions that seem out of proportion to the situation
• Difficulty calming down once upset
• Emotional numbness or feeling disconnected from their emotions
• Rapid mood swings
• Chronic feelings of sadness, anxiety, or rage
2. Negative Self-Concept
Prolonged trauma, especially in childhood, deeply affects how we see ourselves. People with C-PTSD often struggle with:
• Persistent feelings of shame, guilt, or worthlessness
• Believing they are fundamentally damaged or “bad”
• Difficulty accepting compliments or recognizing their own worth
• A sense of being different from other people
• Chronic self-blame, even for things that weren’t their fault
3. Difficulties in Relationships
When our earliest relationships are sources of trauma, it fundamentally affects how we relate to others. People with C-PTSD may:
• Have difficulty trusting others
• Struggle with intimacy or maintaining close relationships
• Feel isolated, even when surrounded by people
• Experience patterns of codependency or people-pleasing
• Oscillate between being overly dependent and pushing people away
• Have difficulty setting or maintaining healthy boundaries In essence, while PTSD is about recovering from discrete traumatic events, C-PTSD is about healing from a traumatic way of life—one that shaped your very sense of self and how you relate to the world.
Why Isn’t C-PTSD in the DSM?
You might be wondering: if C-PTSD is real and recognized by trauma experts, why isn’t it in the DSM-5?
The short answer is that the DSM is a living document that evolves as our understanding of mental health conditions grows. C-PTSD was only officially recognized in the ICD-11 (published by the World Health Organization) in 2018. Many clinicians and researchers are advocating for its inclusion in future editions of the DSM.
In the meantime, therapists like me diagnose C-PTSD based on the presentation of symptoms, even if we have to use other diagnostic codes for insurance purposes. (While I am not a provider for any insurance plans, I do offer superbills that can be submitted for insurance reimbursement.) What matters most is not the label, but understanding your experience and finding the right treatment approach.
Why My Therapeutic Approaches Work Well for C-PTSD
C-PTSD requires a different treatment approach than traditional PTSD therapy. Because C-PTSD affects your sense of self, your emotional regulation, and your relationships—not just your memories of specific events—effective treatment must address all of these areas.
The therapeutic approaches I use—EMDR, Internal Family Systems (IFS), Brainspotting, and sandtray therapy—are particularly well-suited to treating C-PTSD. Here’s why:
EMDR (Eye Movement Desensitization and Reprocessing)
EMDR is an evidence-based therapy originally developed for PTSD, but it’s equally powerful for C-PTSD. Here’s how it helps:
• It processes trauma at the neurological level. EMDR helps your brain reprocess traumatic memories so they’re stored as “in the past” rather than feeling like they’re still happening. This is crucial for C-PTSD, where early trauma can feel ever-present.
• It addresses both “big T” and “little t” traumas. While a single assault or accident is a “big T” trauma, C-PTSD often comes from an accumulation of “little t” traumas—the daily emotional neglect, invalidation, or criticism. EMDR can help process both.
• It helps change negative self-beliefs. EMDR specifically targets the negative beliefs that formed during trauma (“I’m worthless,” “I’m not safe,” “I can’t trust anyone”) and helps install more adaptive, positive beliefs.
• It builds resources. Before processing trauma, EMDR helps you develop internal resources like a safe place, a nurturer, a protector, and a wise figure—things you may not have had during the original trauma. For people with C-PTSD, EMDR provides a structured yet flexible way to work through layers of trauma without having to verbally recount every detail of painful experiences.
Internal Family Systems (IFS)
IFS therapy is particularly powerful for C-PTSD because it directly addresses the fragmentation that often occurs with prolonged trauma. Here’s how:
• It recognizes and works with protective parts. When we experience chronic trauma, especially as children, different parts of us take on protective roles—the perfectionist who tries to avoid criticism, the people-pleaser who tries to keep everyone happy, the critic who tries to keep you safe by making you small. IFS helps you understand these parts, appreciate their protective intent, and help them find new, healthier roles.
• It honors the younger parts carrying the trauma. IFS recognizes that the wounded, scared parts of you from childhood are still present and still need care. Rather than trying to “get rid of” these parts or their pain, IFS helps you develop a compassionate relationship with them, giving them the attention and care they didn’t receive when the trauma occurred.
• It strengthens your core Self. IFS is built on the belief that everyone has a core Self that is naturally curious, compassionate, calm, and confident. With C-PTSD, this Self often gets overwhelmed by protective and wounded parts. IFS helps you access and strengthen your Self so you can lead your internal system with compassion and wisdom.
• It addresses relationship difficulties. Because IFS works with the parts of you that developed in response to relational trauma, it naturally helps improve your relationships with others. As you develop a healthier internal relationship with your parts, your external relationships often improve as well.
• It provides a non-pathologizing framework. IFS doesn’t view your symptoms as “disorders” but as protective strategies that made sense given what you experienced. This helps reduce shame and self-blame—major components of C-PTSD. I use IFS both as a standalone therapy and as part of my IFS-informed EMDR work. When combined, these approaches allow us to work with your protective parts to ensure they feel safe enough to allow trauma processing, while also directly addressing the traumatic memories themselves.
Brainspotting
Brainspotting is a newer brain-based therapy that’s particularly effective for C-PTSD because:
• It accesses deeper brain processing. Brainspotting works with the subcortical brain—the part that holds trauma below conscious awareness. For people with C-PTSD, some of the earliest trauma may have occurred before they could form verbal memories. Brainspotting can access and process this preverbal material.
• It’s gentle and follows your pace. Unlike some trauma therapies that follow a set protocol, Brainspotting is highly attuned to your nervous system’s capacity. It allows processing to unfold naturally at a pace that feels safe. This is crucial for people with C-PTSD, who often need to go slowly to avoid being overwhelmed.
• It doesn’t require extensive verbal processing. Many people with C-PTSD struggle to put their experiences into words, or they’ve told their story so many times it no longer carries meaning. Brainspotting allows healing to occur without requiring detailed narration of traumatic events.
• It works well for highly sensitive people. Many people with C-PTSD are highly sensitive, and traditional talk therapy or more structured approaches can feel overwhelming. Brainspotting’s quiet, attuned process often feels more comfortable for sensitive individuals.
• It can be combined with IFS. Brainspotting works beautifully alongside IFS. We can use Brainspotting to help specific parts release their burdens, or to process traumatic material while helping protective parts to feel safe.
Sandtray Therapy
Sandtray therapy might seem like child’s play, but it’s a powerful tool for C-PTSD treatment because:
• It bypasses verbal limitations. C-PTSD, especially from childhood, often exists in parts of the brain that don’t have language. Creating scenes in the sandtray allows you to express and explore experiences that are difficult or impossible to put into words.
• It externalizes internal experience. Sandtray makes your internal world visible and tangible. When working with IFS, you can use miniatures to represent your parts and see how they interact. This creates distance from overwhelming emotions while still engaging with them.
• It engages the body. C-PTSD is stored in the body as much as in the mind. The tactile experience of working with sand and choosing miniatures engages your body in the healing process.
• It allows for safe exploration of the past and present. You can create representations of your family of origin, your current relationships, or the contrast between how things felt versus how you wish they had been. This helps make sense of complex relational dynamics that contributed to C-PTSD.
• It integrates beautifully with EMDR and IFS. I often use sandtray to develop EMDR resources (safe places, nurturers, protectors, and wise figures) or to help IFS parts feel seen and understood. The sandtray becomes a bridge between different therapeutic modalities.
You Don’t Have to Heal Alone
If you recognize yourself in this description of C-PTSD, I want you to know several things:
First, your experiences count. You don’t need to have survived a single catastrophic event to have trauma. Prolonged emotional abuse, neglect, or growing up in an environment where you didn’t feel safe or valued is traumatic, period.
Second, the symptoms you’re experiencing make sense. The emotional dysregulation, the difficulty trusting others, the negative self-beliefs—these are all normal responses to abnormal circumstances. They’re not character flaws or signs of weakness.
Third, healing is possible. C-PTSD is treatable. With the right therapeutic approach—one that addresses not just traumatic memories but also your sense of self, your emotional regulation, and your relationships—you can recover.
The therapeutic approaches I use—EMDR, IFS, Brainspotting, and sandtray therapy—are specifically designed to address the complex layers of C-PTSD. Together, we can help you:
• Process traumatic memories without being retraumatized
• Develop healthier relationships with your internal parts
• Strengthen your core Self
• Build better emotional regulation skills
• Challenge and change negative self-beliefs
• Improve your relationships with others
• Finally give yourself what you didn’t receive growing up
You’ve survived what happened to you. Now it’s time to heal from it. If you’d like to explore whether therapy might help you heal from C-PTSD, please call or text me at 410-888-0590 or email me at JenniferBeall.LCPC@gmail.com.