Complex PTSD: The Long Term Effects of Trauma

Similar to far too many other mental health issues, there are plenty of misconceptions that fuel the stigma that surrounds complex post-traumatic stress disorder. Individuals who suffer from C-PTSD often hear that they should ‘move on’ or ‘get over it.’ The most common stigma associated with PTSD is that the individual lives in the past.

This stigma exists because we fail to understand as a society how chronic stress, trauma, and fear physically alter our brains and the connections within them. Traumatic events burn marks into our minds, bodies, and souls. These marks do not fade on their own. Individuals that struggle with complex post-traumatic stress disorder often require up to ten years of treatment to overcome the long-term effects of their trauma. 

What Is C-PTSD?

C-PTSD, or complex post-traumatic stress disorder, is a mental health condition that causes trauma symptoms alongside difficulty managing emotions and maintaining relationships. Fear, isolation, depression, and anxiety shape the life of an individual living with complex PTSD. Those of us living with CPTSD would often use the words; broken, different, and distrustful to describe ourselves. Examining the symptoms and behaviors associated with CPTSD below will help you understand why. 


The symptoms of complex PTSD are similar to PTSD in memory emergence and hypervigilance but vary dramatically in emotional regulation and social effects. Symptoms include issues with self-perception and world outlook.

  • Uncontrollable Memories in Nightmares, Flashbacks, and Intrusive Thoughts
  • Hypervigilance Through Fear, Anxiousness, and Irritability
  • Difficulty Connecting with Others
  • Issues with Controlling Emotions
  • Feelings of Shame, Guilt, and Worthlessness


Each of us believes that some darkness or negative quality lives within us. But, those with CPTSD often can not find the light or positive characteristics we portray. CPTSD is most often associated with long-term childhood trauma. Throughout childhood, we develop our personalities, beliefs, and attachment style. We also learn how to interact with others, manage our emotions, and solve problems. A childhood drenched in fear, neglect, and violence has lasting consequences. It hinders our growth and shapes our development. The following behaviors are directly related to our trauma. 

  • Suicidal Thoughts and Behaviors
  • Reexperiencing Trauma Emotions 
  • Feeling Shame and Believing that We Deserve the Trauma
  • Feeling Misunderstood and Believing Themselves Fundamentally Different from Others
  • Pushing Others Away for No Obvious Reason
  • Seeking Out Dangerous People Due to Familiarity
  • Inability to Trust Anyone, Including Themselves
  • Feeling ‘Unreal,’ or Dissociated, Using Sex, Drugs, and Alcohol to Cope with the Discomfort and Pain

The Foundation of C-PTSD

It is interesting to look at individuals that went through similar situations. Why do some develop CPTSD while others do not? How can one sibling vividly remember their childhood while another can not recall several months or years? Several things contribute to the development of CPTSD; age during trauma, the number of experiences, support received during or following the events, and proximity to the ones that hurt you. 

Childhood Abuse and Neglect 

C-PTSD is often a product of childhood trauma. The most common forms of childhood trauma are sexual, emotional, verbal, and physical abuse or neglect. Our relationships with our caregivers form in our primitive years. In early childhood, our brains act as sponges soaking up our environment and interactions. If our surroundings are nurturing and affectionate, and those around us are attentive to our needs and feelings, we form healthy attachments and learn to trust the world. 

When our surroundings are painful and chaotic, and our caregivers are emotionally or physically unavailable, abusive, or inattentive, we fail to form healthy attachments with them and learn to fear and distrust the world. C-PTSD is a product of this upbringing. ACEs or adverse childhood experiences are directly related to complex PTSD. The following events are considered ACEs. 

  • Physical Abuse
  • Sexual Abuse
  • Emotional Abuse
  • Attachment Trauma
  • Neglect
  • Other Traumatic Experiences (house fire, kidnapping, etc.)

Domestic Violence and Explosive Conditions 

There are specific circumstances where C-PTSD may develop due to an event in adulthood. For complex PTSD to form in adulthood, an individual must live in a scary, chaotic, and dangerous environment with little opportunity of leaving. Domestic violence situations and living in war zones are two specific instances where an adult may develop complex PTSD. 

Instances such as assault, rape, and war, typically result in post-traumatic stress disorder. Living in war zones and domestic violence households could result in complex post-traumatic stress disorder because the situations are inescapable. The trauma is chronic and persistent. 

Complex PTSD and Attachment

CPTSD forms due to chronic trauma, often during childhood. We develop our attachment styles and learn how to interact with others throughout childhood. Traumatic incidences disrupt this social growth and learning, as our brain focuses on survival instincts.

 From these statements, we can assume that the person grew up in an environment where they could not trust or rely on the individuals responsible for caring for them. These tense relationships between children and their caregivers often result in attachment disorders

Disorganized Attachment 

Children form disorganized attachment styles with caregivers that are erratic and frightening. The primary reason behind this is that children typically rely on their caregivers to provide them with a safe place when they are scared or upset. But, if the caregiver frequently demonstrates frightening behavior, the child’s survival response is to run from them. This dynamic is conflicting. The child’s response is generally to disassociate from the feelings. Disassociation and conflict result in a disorganized attachment style. Adults with this attachment style display the following behaviors. 

  • View the World as a Dangerous and Hostile Place
  • Struggle to Form Relationships with Peers, Partners, and Children
  • Demonstrate Poor Emotional Regulation and Social Skills
  • Difficulty Managing Emotions
  • Distrusting Other People, Overly Self-Reliant
  • Difficulty Self-Soothing and Reaching Out

Fearful-Avoidant Attachment 

The fearful-avoidant attachment style is a disorganized attachment. We characterize this attachment style as an individual’s yearning to have a close relationship but failed to allow others to stay close to them. While people with a fearful attachment style crave love and intimacy, they fear close relationships, trust, and emotional pain. Fearful avoidants have a low model of themselves and others. Common behaviors associated with this attachment style are as follows. 

  • Hypervigilance, Always Searching for Danger
  • Never Feeling Safe, Something is Always Wrong
  • Lack of Personal Boundaries
  • Pushing Others Away, Trying to Force them Closer
  • Seeking Control and Dominance in Relationships
  • Negative Views of Self, Others, and Life
  • Highly Focused on Education/Career Goals 
  • Avoidance of Personal Relationships

Trauma Attachment

 When children are frequently overwhelmed and feel alone in emotionally charged situations, they develop attachment trauma. In many cases, the ‘attachment person,’ or caregiver, is the cause of the overwhelming distress. The dynamic plants the seed that relationships breed mistrust into the child’s mind. 

When attachment trauma is persistent and builds, it often results in a child’s inability to regulate emotional distress. “Horror without resolution” describes the cause of attachment trauma. The individual that is responsible for protecting you from the dangerous situation is the cause of it. Thus, a child’s attachment system seeks comfort and closeness from the individual despite the child’s fear. The central caregiver triggers feelings of fear, anxiety, and panic in the child. T

This dynamic between child and caregiver often results in an alternation between punishing and caring behavior from the child towards the caregiver. To stop the pattern, the child may punish the caregiver for fear, neglect, or abuse. When that fails, the child may change gears and ‘care’ for the caregiver in hopes that they will stop. 

Trauma attachments are associated with disorganized attachment styles in adults. This attachment style increases the risk of retraumatization due to its complex nature and inconsistent behavior. 

Complex PTSD and Memory

Complex PTSD is a result of significant trauma. Trauma affects the temporal lobe, inferior parietal cortex, hippocampus, and amygdala. The effects trauma has on our brain leads to memory issues such as the following. 


Dissociation is the feeling of detachment from your body or the rest of the world. Individuals that feel dissociated often explain that the world does not feel real, or they feel as though they are watching themselves rather than living their lives. Dissociation is a stress and trauma response. Frequent dissociation correlates to a dissociative disorder in adulthood. 

Individuals with PTSD often have fear-related pathways and alterations in sensory integration regions of the brain. Scientists believe that these alterations increase the likelihood of dissociation as a stress response in adulthood. When our amygdala identifies fearful stimuli, it alters our consciousness and awareness. These alterations could result in depersonalization and derealization. Two symptoms of dissociation.

Memory Gaps 

Complex PTSD is often associated with memory gaps. Some individuals suffering from C-PTSD can not remember long periods, while others forget lists, facts, and important dates. One of the most frustrating memory issues associated with PTSD is the inability to recall your trauma story and tell it chronically. In addition to this failed recall, a disconnect in our brains separates feelings and emotions from traumatic events. Due to this, many trauma survivors downplay the trauma and feelings associated with it. 


Trauma damages our hippocampus. The hippocampus of trauma survivors is 8% smaller than the average brain. A smaller hippocampus signifies a reduction in emotion regulation, long-term memory storage, and the organization of memories. Damage to the hippocampus increases anxiety, disorganized perception, and flashbacks. 

Flashbacks force PTSD survivors to relive some or all of the traumatic event as though it is still happening. Flashbacks include images, sounds, smells, tastes, physical sensations, and emotions. People, places, or situations can trigger flashbacks that last a few seconds to several hours. 


Sleep disturbances are closely related to CPTSD. Individuals with complex PTSD may have difficulty falling asleep, staying asleep, or having frequent nightmares. Because trauma affects the regions of the brain related to fear response and memory recall, scientists believe that nightmares are our brain’s way of experiencing the traumatic event in our sleep. PTSD nightmares may not mirror the traumatic events but carry the undertones or pieces of the traumatic experiences. 

Differences Between C-PTSD and PTSD

The primary difference between complex PTSD and PTSD is the root cause of the trauma. A single traumatic incident is usually the cause of PTSD. Complex PTSD is an outcome of repetitive and prolonged trauma, often occurring in our formative years. Trauma is more complex in CPTSD because of its significance in daily life and drastic effects on development. 

Living in Fear 

Both forms of PTSD are associated with hypervigilance or feeling unsafe. For many PTSD survivors, certain sounds, people, or events can trigger the fear. Complex PTSD survivors experience chronic fear, danger, and anxiousness. CPTSD survivors often claim that things do not feel ‘right’ or that they ‘know’ something is wrong with themselves, others, or the world. 

Struggling with Self-Image

While PTSD survivors struggle with the stigma and judgment, complex PTSD survivors have a warped self-image. They often feel that they are different from everyone else and that no one can understand what happened to them. Individuals with CPTSD have difficulty finding meaning in life and often feel damaged or broken. 

Related Mental Health Issues

A single mental health issue increases the risk of developing another. Symptoms often apply to multiple mental health issues. Complex PTSD is difficult to assign without understanding an individual’s life story. Psychologists study ACEs and use the presence of these experiences to diagnose complex PTSD. The following mental health issues are closely related to complex PTSD and often coexist. 

  • Bipolar Disorder
  • Borderline Personality Disorder
  • Dissociative Disorders
  • Attachment Disorders
  • Anxiety
  • Depression

Suicidal Thoughts and Tendencies

Most trauma survivors experience suicidal thoughts and tendencies at some point in life. Those living with complex PTSD may struggle with these thoughts often. If you or a loved one is experiencing suicidal thoughts, remember that things get better. Please reach out to a trusted professional for help and advice. 

Call, or text, the Suicide and Crisis Lifeline at 988


(2020). What is Posttraumatic Stress Disorder (PTSD)? American Psychiatric Association.

(2021). Complex Post-Traumatic Stress Disorder (Complex PTSD). Mind.

(2022). Complex PTSD- Post-Traumatic Stress Disorder. NHS.

(n.d.). What Is C-PTSD? Beauty After Bruises.

Brickel, R. E., M.A. (2021). Injured, Not Broken: Why It’s So hard to Know You Have CPTSD. Psych Alive.

Firestone, L., PhD (2016). Disorganized Attachment: How Disorganized Attachments Form & How They Can Be Healed. Psych Alive.

Franco, F., PhD (2018). Attachment and C-PTSD: How Complex Trauma Gets in the Way. Good Therapy.

Guy-Evans, O. (2020). Fearful Avoidant Attachment: How It Develops & How to Cope. Simply Psychology.,trusting%20others%20and%20getting%20hurt.

Lahousen, T., Unterrainer, F. H., & Kapfhammer, P. H. (2019). Psychobiology of Attachment and Trauma-Some General Remarks From a Clinical Perspective. Frontiers in Psychiatry.

Lyons, A., MA, LPC (2019). PTSD Memory Loss: 10 Ways It’s Affecting You. April Lyons Psychotherapy Group.

Schiavone, F. L., Frewen, P., PhD, McKinnon, M., PhD, & Lanius, R. A., MD, PhD (2018). The Dissociative Subtype of PTSD: An Update of the Literature. PTSD Research Quarterly.

Published by alswartz

I am an aspiring novelist working on my first book. I have an interest in mental health and each of my works is related to mental health in some way.

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