What is Complex Trauma? Signs and Symptoms of Complex PTSD

To understand complex trauma, we must look at the difference between the impacts of a traumatic event versus the effects of a sustained, lived experience of multiple traumatic experiences over time.   


An example of a traumatic life event could be experiencing a natural disaster, witnessing a loved one die, or being in a car crash.  The typical responses to this traumatic life event could be classified as PTSD (posttraumatic stress disorder.) Common signifiers of PTSD can include, but not limited to, difficulty sleeping, “reliving” the event, having intrusive thoughts about the event, or having nightmares.  


Complex trauma occurs when multiple traumatic experiences are sustained over time, and it is difficult to differentiate the effects from one trauma to another.  For example, someone who is born into a low-income family lives in a violent neighborhood, and experiences physical abuse and loss during critical stages of life may develop complex trauma, especially if there are minimal supports available to cope with these challenges. Another example of complex trauma would be the experience of sustained abuse or neglect growing up.  


At this time, the DSM-V (The Diagnostic and Statistical Manual of Mental Disorders) does not differentiate between PTSD and Complex PTSD.  I believe it can be a helpful distinction not only for people impacted by trauma but also clinicians, like myself, working with these folks.  Listed below are some symptoms people may experience when suffering from PTSD.  This list does not encompass the full spectrum of signs/symptoms people may be experiencing.  To get the full list, please consult the DSM-5 which is available online in PDF form.  



Symptoms of Both PTSD and Complex PTSD: 

  • Having flashbacks or nightmares relating to the trauma

  • Recurrent distressing memories of the event

  • Avoiding situations that remind them of the trauma

  • Somatic symptoms (nausea/dizziness) when remembering the trauma

  • Experiencing dissociative amnesia- not remembering the trauma

  • Hyper-arousal/hypo-arousal

  • Persistent negative emotional state ( fear, horror, anger, guilt)

  • Feeling detached from others or things that once interested you.

  • Persistent inability to experience positive emotions (joy, happiness, pleasure)

  • A loss of trust in the self or others

  • Difficulty sleeping or concentrating

  • Being startled by loud noises


Symptoms of Complex PTSD:

  • A negative self-view. Complex PTSD can cause a person to view themselves negatively and feel helpless, guilty, or ashamed. They often consider themselves to be different from other people.


  • Changes in beliefs and worldview. People with either condition may hold a negative view of the world and the people in it or lose faith in previously held beliefs.


  • Emotional regulation difficulties. These conditions can cause people to lose control over their emotions. They may experience intense anger, sadness, self-harm, or have thoughts of suicide.


  • Relationship issues. Relationships may suffer due to difficulties trusting and interacting, and because of a negative self-view. A person with either condition may develop unhealthy relationships because they are what the person has known in the past.


  • Detachment from the trauma. A person may dissociate, which means feeling detached from emotions or physical sensations. Some people completely forget the trauma.


  • Preoccupation with an abuser. It is not uncommon to fixate on the abuser, the relationship with the abuser, or getting revenge for the abuse.


In working with families and individuals who are impacted by substance abuse and addiction, it is imperative to take a more-in-depth look into the familial history and generational patterns involving trauma and complex trauma to gain more understanding into the healing process.  

What is Complex Trauma?



Loretta Miller