Complex PTSD:
Struggling in Silence? You Are Not Alone
By Ashwini Anand (Ash), Clinical Psychologist, Chethana Psychology, Melbourne
Introduction
If you’re reading this, you might be carrying heavy questions, worries, or even a quiet hope for understanding. Maybe you’ve been through a lot, or someone close to you has, and you want to make sense of it all. Many people feel lost or overwhelmed by their experiences. My aim is to offer compassionate information, so you feel seen and supported as you learn more about yourself or a loved one.
Complex Post-Traumatic Stress Disorder (cPTSD) is becoming more familiar in mental health care. Unlike traditional PTSD, often linked to a single traumatic event, cPTSD develops after long-term or repeated trauma, usually in relationships or environments where someone feels powerless. Many seeking support for anxiety, depression, or relationship struggles may find complex trauma as the deeper root. The better we understand cPTSD, the easier it is to offer the right support and reduce misdiagnosis (Cloitre et al., 2020; Giourou et al., 2018).
What is Complex PTSD?
cPTSD shares PTSD symptoms such as reliving memories, avoiding reminders, and feeling on edge. However, it also includes persistent emotional struggles, deep shame or guilt, and difficulty in relationships (Cloitre et al., 2020; Herman, 2022). cPTSD typically arises from long-term trauma in situations where someone feels powerless, such as childhood abuse or ongoing domestic violence.
Overlap and Comorbidity with Other Conditions
Complex PTSD and Autism Spectrum Disorder (ASD):
The emotional regulation difficulties and social challenges present in cPTSD may also be observed in ASD, which can complicate differential diagnosis. There is significant symptom overlap and co-occurrence of autism spectrum disorder (ASD) with trauma, which makes diagnosis and treatment more challenging. Recent research highlights the importance of careful assessment to distinguish symptoms related to trauma from those related to ASD (Krause et al., 2022).
Complex PTSD and Attention Deficit Hyperactivity Disorder (ADHD):
Symptoms such as inattention, impulsivity, and restlessness occur in both ADHD and cPTSD. Trauma can impact concentration and executive functioning in cPTSD, which can lead to frequent misdiagnosis, especially in women (Sáez-Francàs et al., 2023). Differentiating between the two requires considering trauma history and symptom onset (Giourou et al., 2018).
Complex PTSD and Borderline Personality Disorder (BPD):
Emotional instability, impulsivity, and relationship difficulties are features of both cPTSD and BPD (Herman, 2022). However, cPTSD is rooted in prolonged trauma and is characterised by symptoms such as emotional numbing, persistent negative self-concept, and avoidance of trauma reminders, whereas BPD is defined more by a pervasive pattern of unstable relationships, identity disturbance, and intense fear of abandonment (Ford & Courtois, 2021). Because of these overlaps, some symptoms of cPTSD might be misidentified as BPD, or vice versa. Recent studies suggest cPTSD criteria may better explain some presentations previously labelled as BPD, highlighting the need for careful, trauma-informed assessment (Ford & Courtois, 2021).
Obsessive-Compulsive Disorder (OCD):
People with cPTSD may experience intrusive thoughts and compulsive behaviours, which can look similar to symptoms seen in OCD. Sometimes, if trauma is not considered, these symptoms might be mistaken for OCD alone, and the underlying trauma history may go unrecognised (Ford et al., 2021; Giourou et al., 2018).
Other Mood Disorders:
Mood disorders such as depression and anxiety frequently co-occur with cPTSD, often as a result of chronic stress and difficulties with emotional regulation. These symptoms can sometimes mask the underlying trauma, making it important to consider the full context of a person’s experience (Brewerton, 2022; Cloitre et al., 2020).
The Challenge of Misdiagnosis, Especially for Women
Women are at particular risk of having cPTSD misdiagnosed as depression, anxiety, BPD, or ADHD (Moor & Anderson, 2019; Ford et al., 2021). This risk stems from overlapping symptoms, gender biases in assessment, and under-recognition of sustained trauma's impact. Recent research stresses the importance of thorough trauma assessment, especially when clients present with multiple, overlapping symptoms (Giourou et al., 2018).
Stereotype: People with complex PTSD are always dysfunctional.
Fact: Many people with complex PTSD appear to function decently in daily life. It is common for individuals to “overcompensate” by working hard to manage responsibilities, succeed in their careers, or maintain relationships, sometimes to the point of exhaustion. However, this apparent functionality can perpetuate misconceptions about the disorder and contribute to societal stigma, as outward competence may be misinterpreted as evidence that trauma has not had a significant impact. Research shows that complex PTSD can be masked by high achievement, perfectionism, or people-pleasing, so symptoms may go unnoticed by others (Giourou et al., 2018; Herman, 2022). This invisibility not only delays diagnosis and appropriate support but may also reinforce the internalised belief that seeking help is unjustified or a sign of weakness, compounding psychological distress (Herman, 2022).
You Deserve Support and Understanding
If any of this feels familiar, you might be wondering what you can do to start feeling better. Here are a few gentle steps you might consider:
Practice self-compassion: Notice how you speak to yourself. Can you offer yourself the same kindness you would show a friend?
Journaling: Writing down your feelings and experiences can help you make sense of your emotions and see patterns over time.
Reach out for support: Whether it’s a trusted friend, a support group, or a mental health professional, you deserve to be heard and supported.
Remember, you’re not alone; many have walked this path. Healing is possible, even if it feels slow. Taking any small step toward understanding or caring for yourself is something to be proud of. You deserve support, hope, and the chance to rediscover your strengths.
References
Brewerton, T. D. (2022). Neurobiology and treatment of eating disorders and PTSD. European Eating Disorders Review, 30(2), 107–121.
Cloitre, M., Garvert, D. W., Brewin, C. R., Bryant, R. A., & Maercker, A. (2020). Evidence for proposed ICD-11 PTSD and complex PTSD: A latent profile analysis. European Journal of Psychotraumatology, 11(1), 1733258.
Ford, J. D., Grasso, D. J., Greene, C. A., Levine, J., Spinazzola, J., & van der Kolk, B. A. (2021). Clinical significance of a proposed developmental trauma disorder diagnosis: Results of an international survey of clinicians. Journal of Clinical Psychiatry, 82(3), 20m13724.
Ford, J. D., & Courtois, C. A. (2021). Complex PTSD, affect dysregulation, and borderline personality disorder. Borderline Personality Disorder and Emotion Dysregulation, 8(1), 24.
Giourou, E., Skokou, M., Andrew, S. P., Alexopoulou, K., Gourzis, P., & Jelastopulu, E. (2018). Complex post-traumatic stress disorder: The need to consolidate a distinct clinical syndrome or to reevaluate features of psychiatric disorders following interpersonal trauma? World Journal of Psychiatry, 8(1), 12–19.
Herman, J. L. (2022). A new diagnosis for women with complex trauma histories: Complex PTSD. Clinical Psychology: Science and Practice, 29(2), 208–218.
Krause, A. J., Bikson, M., & Rahman, A. (2022). ASD and trauma: Overlapping symptoms and diagnostic challenges. Current Psychiatry Reports, 24(4), 171–180.
Moor, S., & Anderson, T. (2019). Gender, trauma, and diagnosis: Implications for misdiagnosis in women. Australian & New Zealand Journal of Psychiatry, 53(5), 457–465.
Sáez-Francàs, N., Monteagudo-Gimeno, E., & Arrufat, F. X. (2023). ADHD and trauma: Diagnostic and treatment considerations. ADHD Attention Deficit and Hyperactivity Disorders, 15(2), 93–104.
Trottier, K., & MacDonald, D. E. (2017). Update on psychological trauma, other severe adverse experiences and eating disorders: State of the research and future research directions. Journal of Eating Disorders, 5(1), 26.
Disclaimer:
This blog post is provided for general information and psychoeducation purposes only. It is not intended as a substitute for professional advice, diagnosis, or treatment. If you are seeking mental health support or assessment, please consult a qualified health professional.