Complex PTSD: The Invisible Aftermath of Prolonged Trauma
“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
A Gentler Approach to New Year’s Resolutions
“This year I’m going to lose 30 pounds, exercise every single day, completely reorganize my house, stop procrastinating, be more patient with everyone, read 50 books, and finally become the perfect version of myself!” Sound familiar? Every January, so many of us set ourselves up for failure with ambitious, all-or-nothing resolutions. By February (or sometimes even mid-January), we’ve already “failed,” and that familiar sense of shame and disappointment settles in. We tell ourselves we should have tried harder, should have had more willpower, should have been better. But here’s the thing: the problem isn’t you. The problem is the way we’ve been taught to think about resolutions. What if, instead of setting rigid goals that leave no room for being human, we approached the new year with gentleness, flexibility, and self-compassion? The Problem with Traditional Resolutions Traditional New Year’s resolutions are often: • Too rigid and all-or-nothing • Focused on what we’re doing “wrong” rather than what we want to grow toward • Shame-based (“I need to lose weight because I’m not good enough as I am”) • Set up for failure because they don’t account for the messy reality of being human As Dr. Christopher W.T. Miller, an associate professor of psychiatry at the University of Maryland School of Medicine, points out, “There’s something that’s a bit demanding about resolutions. It automatically creates an expectation.” When we inevitably fall short of those expectations, we feel bad about ourselves—which is the exact opposite of what we were hoping to achieve. Enter the “Nudge Word” Instead of setting specific, rigid resolutions, consider choosing a single word to guide you through the year—what some people call a “nudge word.” This is a word that reflects your values, intentions, and hopes for how you want to show up in the world. As Dr. Miller explains, a nudge word “is meant to be harmonizing and centering and help us feel grounded.” It’s more fluid, softer, and gentler than a resolution. Some examples of nudge words: • Peace • Balance • Playful • Gratitude • Vitality • Clarity • Compassion • Courage The beauty of a nudge word is that it’s not pass/fail. You can’t “mess it up.” If you choose “peace” as your word and find yourself stressed and anxious in March, you haven’t failed—you’ve just been given another opportunity to reconnect with your intention. You can ask yourself, “What would peace look like in this moment?” or “What small choice could I make right now that would bring me closer to peace?” How to Choose Your Nudge Word Take some quiet time to reflect on these questions: 1. What made you happy this past year? What felt good? When did you feel most like yourself? 2. What parts of your life could be better? What causes you stress or drains your energy? 3. How is your physical health? Your mental well-being? Your relationships? 4. If you could feel one way more often, what would you want it be? Let yourself sit with these questions without judging your answers. You’re not trying to find what you “should” want or what sounds impressive. You’re listening to what your heart actually needs. Resolutions as Living Intentions If you do want to set some concrete goals for the year, that’s wonderful! Just approach them differently. Think of your resolutions as living intentions that can be re-evaluated and modified as the year goes on. Instead of: “I will exercise for 60 minutes every single day without exception.” Try: “I want to move my body in ways that feel good to me, and I’ll check in with myself each month about what that looks like.” Instead of: “I will never eat sugar again.” Try: “I want to nourish my body with foods that make me feel good, while still allowing myself to enjoy treats without guilt.” Instead of: “I will completely eliminate my anxiety.” Try: “I want to develop better tools for managing my anxiety when it shows up.” Notice how the gentler versions: • Allow for flexibility and adjustment • Focus on moving toward something positive rather than running from something “bad” • Leave room for being human • Can be revisited and modified as you learn more about what works for you Permission to Adjust Life changes. You change. What felt important in January might not feel as relevant in June, and that’s perfectly okay. Give yourself permission to check in with your intentions throughout the year: • Is this still serving me? • What have I learned about myself that might shift this intention? • How can I adjust this to better fit who I’m becoming? Modifying your resolutions isn’t failure—it’s wisdom. It’s listening to yourself and responding with compassion. The Research Backs This Up Setting intentions isn’t just feel-good fluff—it’s backed by research. Studies show that our intentions, which are essentially guiding principles on how to show up in the world, can play a key role in determining how we behave, including in pursuit of our health goals. Setting intentions can be a potent way to shift our behaviors. And here’s something that might help if you do “slip up”: In the recovery community, some people reframe relapse as “doing more research.” Instead of seeing a setback as proof that you’ve failed, you can see it as gathering more information about what works and what doesn’t. “I tried that approach and learned it doesn’t work for me, so now I’m going to try something else.” A Therapist’s Perspective In my 20+ years as a therapist, I’ve seen countless clients beat themselves up for not living up to impossible standards they’ve set for themselves. Many of them grew up in families where they learned that their worth was tied to their achievements, or where they had to be perfect to feel safe. Traditional, rigid resolutions just reinforce that old, painful pattern. Choosing a gentler approach to the new year—whether through a nudge word or flexible intentions—can actually be an act of healing. You’re telling that