Therapy for complex PTSD

What complex PTSD is

Complex PTSD (CPTSD) is a diagnosis in ICD-11, the World Health Organization's international classification of diseases, where it was established as separate from PTSD. It includes the core symptoms of PTSD plus what ICD-11 calls disturbances in self-organization: significant difficulties in three areas.

• Managing emotions, which can feel overwhelming or very hard to settle.
• How you see yourself, such as feeling deeply worthless or defeated.
• Relationships, such as real difficulty staying emotionally close to people.

How it differs from PTSD

Complex PTSD can follow any trauma, but it is more likely after chronic, repeated trauma involving other people, such as long-term abuse. Earlier descriptions tied it to prolonged trauma early in life; ICD-11 doesn't require any particular type of trauma.

The American diagnostic manual, DSM-5, doesn't include complex PTSD as a separate diagnosis; some of its symptoms are covered by the PTSD diagnosis instead. So you may hear different terms from different clinicians. What matters is that your treatment fits what you're living with.

Only a clinician can diagnose complex PTSD. If this page sounds familiar, that's a reason to talk to someone, not a diagnosis.

Can trauma-focused therapy help?

According to the U.S. National Center for PTSD, there is encouraging evidence that people with complex PTSD can benefit from the trauma-focused treatments already used for PTSD.

Some clinicians recommend a period of skills work before trauma memories are addressed, because difficulty managing emotions can make that work harder. So far, studies comparing this phase-based approach with standard PTSD treatment haven't found a clear advantage for it. In evaluations of intensive programs, including one combining prolonged exposure and EMDR over eight days, people with and without complex PTSD had comparable decreases in symptoms.

Researchers are still asking whether complex PTSD needs different approaches. We'll tell you honestly what's known and what isn't.

How we approach complex PTSD

We start with a careful assessment of your history and how you're coping now. Preparation is built into EMDR: before memory work begins, you learn about how trauma affects you and practise ways to steady yourself.

From there, we work on the memories and triggers that drive your symptoms, using EMDR and EMDR 2.0, and gradual exposure when it fits your goals. Some people choose to do this work as an intensive over consecutive days.

You keep control of the pace throughout. Trust can take time when people have hurt you, and it's fine to say so.

Further reading on our blog

These articles on our blog summarize published research. Most link to the original study, so you can read it for yourself.

• Transforming Lives: Discover the Power of Intensive Trauma-Focused Treatment for Complex PTSD: results of an intensive treatment program for people with complex PTSD (Voorendonk et al., 2020).
• Trauma‐focused treatment of a client with Complex PTSD and comorbid pathology using EMDR therapy Research: a case study of EMDR therapy for complex PTSD alongside other conditions (De Jongh et al., 2023).
• Transformative EMDR Therapy for Complex PTSD: Guiding Treatment Strategies: an overview of EMDR treatment strategies for complex PTSD.