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TIRCIA · General public · Understanding

PTSD or complex PTSD? Understanding what repeated trauma leaves behind

What this diagnosis covers, why shame takes up so much room, and how to find help

By Marie-Agnès Thulliez · Author · Publishing Director12-minute read

Perhaps you lived through violence or humiliation for months, sometimes for years, and you still carry the marks. Memories come back without warning. And there is something else too: a shame that never leaves you, emotions that overflow or suddenly switch off, great difficulty trusting anyone. Since 2022 this cluster of difficulties has had official recognition: it is called complex post-traumatic stress disorder, or complex PTSD.

This article explains in plain terms what this diagnosis covers, where it comes from, how it is treated and whom to turn to. It may help you put words to what you are going through and prepare for a conversation with a professional.

Before you read

This article talks about violence and its consequences. Reading it may stir things up. You can take it at your own pace, in several sittings, and stop whenever you wish. If it brings difficult things back, the helpline numbers are just below.

If you are struggling right now

If you are in immediate danger, call your local emergency number (999 in the UK, 911 in North America, 112 in the EU). If you are having suicidal thoughts, or are worried about someone close to you, contact a crisis line: 988 (US/Canada), Samaritans 116 123 (UK and Ireland), or find a local helpline at findahelpline.com. In France: 3114.

If you have experienced violence, whatever your situation, local victim support services can listen and guide you: for example Victim Support in England and Wales (0808 168 9111), or the national domestic abuse and sexual assault helplines in your country, such as the National Domestic Abuse Helpline in the UK (0808 2000 247, 24 hours) or the National Domestic Violence Hotline in the US (1-800-799-7233). If you are under 18, or if a child is in danger, contact your local child protection services; in the UK, the NSPCC helpline is 0808 800 5000, and you can call yourself.

Elsewhere, contact your local emergency services or your doctor. Across Europe, 112 works from any phone.

In brief

  • Complex PTSD combines the symptoms of post-traumatic stress with lasting difficulties in three areas: emotions, self-image and relationships.
  • It most often develops after repeated trauma from which escape was difficult or impossible, such as childhood abuse or domestic violence.
  • These difficulties are understandable consequences of what was lived through, rather than flaws of character.
  • Only a professional can make the diagnosis. A validated questionnaire can help you talk about it.
  • Treatments exist and they help, even if the road often takes time.

1. Post-traumatic stress, in a few words

Post-traumatic stress disorder (PTSD) can develop after an extremely threatening or horrific event: an assault, a serious accident, violence. The International Classification of Diseases, published by the World Health Organization (WHO), whose 11th revision (ICD-11) has been in force since 2022, describes it through three groups of signs (WHO, 2026):

  • Re-experiencing the event in the present: images, sensations or nightmares that make it feel as though it is happening again now, rather than simply being remembered.
  • Avoiding reminders: places, people, conversations, and even one's own thoughts.
  • Feeling constantly under threat: being on guard all the time, startling at the slightest noise.

These signs persist for at least several weeks and interfere with personal, family or working life.

2. What complex PTSD adds

In complex PTSD, these three groups of signs are present. On top of them come deep and lasting difficulties in three areas of life.

Emotions

Emotions can be very intense and hard to soothe: anger that takes you by surprise, bouts of tears, an urge to hurt yourself or take risks to relieve the tension. Or, at the other extreme, they can suddenly switch off: you feel empty, “cut off” from yourself, as if wrapped in cotton wool. If you are harming yourself at the moment, you can talk to a crisis line (see the numbers above), even if you are not having suicidal thoughts.

Self-image

This is often the most painful part. Many people feel fundamentally damaged, worthless, “useless”, and carry overwhelming shame or guilt, often out of all proportion to any real responsibility. “It’s my fault”, “I’m dirty”, “I don’t deserve to be loved”: these thoughts are a trace of what was lived through, rather than a description of reality.

Relationships

It becomes hard to feel close to others and to keep relationships going over time. Many people withdraw or keep their distance to protect themselves, because closeness reawakens the fear of being hurt again. Some feel lonely even when surrounded by people.

Key point

Shame, anger and mistrust are reactions with a history. When you have had to survive for a long time in a dangerous environment, these reactions were often forms of protection. They can carry on long after the danger has ended.

3. Where does complex PTSD come from?

The American psychiatrist Judith Herman proposed the concept in 1992, after observing people who had endured prolonged abuse: childhood abuse, domestic violence, captivity (Herman, 1992). The WHO made it an official diagnosis, in force since 1st January 2022. The diagnosis does not appear in the American manual (DSM), and some health systems still code with the previous version of the classification: a professional may therefore not use the term, even when they are familiar with these difficulties.

Complex PTSD most often develops after repeated or prolonged trauma from which escape was difficult or impossible: physical or sexual abuse in childhood, domestic violence, coercive control, torture. This is a tendency rather than an absolute rule. Not everyone who has lived through such situations develops complex PTSD, and it sometimes follows a single event. What counts is the whole picture of current difficulties, as well as the history. And not having these difficulties takes nothing away from the seriousness of what you went through.

It is a common condition. According to a review published in the medical journal The Lancet, it may affect 1 to 8% of the population. In mental health services, the figure can reach one person in two (Maercker et al., 2022).

If the violence is still going on

If you are still experiencing violence, in your relationship, your family or elsewhere, your safety comes first. You can talk to a domestic abuse helpline or victim support service in your country, or call the police. A professional will first help you protect yourself; work on the memories will come later.

4. Telling it apart from other difficulties

  • It is something other than “your personality”. Many people have lived with these difficulties for so long that they believe they are “just like that”. Naming complex PTSD often helps them understand that these difficulties have an origin, and that they can change.
  • It is distinct from borderline personality disorder (also called emotionally unstable personality disorder), even though the two are often confused. An intense fear of abandonment, a very unstable sense of identity, passionate and chaotic relationships and impulsivity point more towards borderline disorder (Cloitre et al., 2014). The two can also coexist, and many people with borderline disorder have also experienced trauma. Neither diagnosis is a judgement on the person, and both can be treated. A professional will be able to tell them apart.
  • It goes beyond depression or anxiety, even though these often come with it. If treatment for depression has not been enough, it may be worth exploring with a professional the part played by trauma.
  • Some people also experience marked dissociation: memory gaps, a sense of unreality, the impression of watching themselves from outside. This is important to mention to the professional.

5. How can you tell?

Reading an article can help you recognise yourself, but only a health professional trained in psychotrauma can make a diagnosis, after an in-depth assessment.

There is a short self-report questionnaire designed for this diagnosis: the International Trauma Questionnaire (ITQ) (Cloitre et al., 2018). It has been validated in several languages, including French (Peraud et al., 2022), and in France the Centre national de ressources et de résilience (Cn2r) makes the French version available as a free download. Filling it in can help you prepare for a first appointment and talk about it. If it stirs you up, stop: you can do it later, or with a professional. A score, high or low, says little on its own about what you are going through: the questionnaire opens a conversation, and the conversation is what matters.

For children and adolescents, assessment is a matter for specialist professionals, in child and adolescent mental health services.

6. Can it be treated?

Yes, treatments exist and they help. So-called “trauma-focused” therapies, meaning therapies that work directly on traumatic memories and their effects, reduce post-traumatic stress symptoms. This also holds for people who have the difficulties specific to complex PTSD (Karatzias et al., 2019). Among them:

  • certain forms of cognitive behavioural therapy (CBT), which help change the thoughts and behaviours maintained by the trauma, and exposure therapies;
  • EMDR (Eye Movement Desensitization and Reprocessing), which helps reprocess traumatic memories using eye movements or other forms of alternating stimulation.

These three approaches reduce post-traumatic stress symptoms; for self-image and relationships, the evidence is currently more extensive for cognitive behavioural therapies and exposure, as EMDR has been the subject of fewer trials in this context (Karatzias et al., 2019).

Therapy often addresses several dimensions. They do not always follow a fixed order, and depending on the person, work on the memories can begin fairly early, once a few anchors of safety are in place (Maercker et al., 2022):

  • Understanding what is happening, so that the reactions become less frightening.
  • Feeling safe, in your life and in the relationship with the therapist, and learning to soothe overwhelming emotions.
  • Working on the traumatic memories, at a suitable pace, so that they lose their charge.
  • Rebuilding a fairer image of yourself and calmer relationships.

Some people feel more stirred up for a while at the start of work on the memories. This is common, and it can be discussed with the therapist. Medication can sometimes help with certain symptoms, such as sleep or an associated depression, alongside psychotherapy, which remains the core of treatment. There is no standard length of treatment, and a good relationship with your therapist is part of the care.

7. Whom to turn to?

  • Your GP or family doctor is often a good first port of call. They can refer you to a psychiatrist or psychologist.
  • Public mental health services offer consultations with psychiatrists and psychologists; in France, the centres médico-psychologiques (CMP) provide them free of charge.
  • In France, the Mon soutien psy scheme reimburses sessions with a participating psychologist, under the conditions in force.
  • Specialist psychotrauma centres exist in many countries; in France, regional psychotrauma centres linked to the Cn2r operate in every region, often with satellite sites, although they remain unevenly distributed and waiting times vary. You can find the nearest one on the Cn2r page Localiser les structures de soin [Find care services].
  • A psychologist, psychiatrist or psychotherapist trained in psychotrauma. In France, for cognitive behavioural therapies, the AFTCC (Association française de thérapie comportementale et cognitive) offers a directory. For EMDR, the EMDR France association offers a directory of practitioners; elsewhere, national EMDR associations keep similar directories.
  • Victim support organisations, such as France Victimes in France (116 006), can guide you and support you through the formalities, including legal ones.

At a first appointment, you are entitled to ask questions: “Have you been trained in trauma treatment?”, “Which method do you use, and why for me?”, “What do we do if it becomes too hard for me?”, “Roughly how long will it take, how much will it cost, and is it reimbursed?”. A good therapist will welcome these questions and go at your pace. If you do not get on, you are entitled to change therapist.

Check the practitioner’s title (doctor, psychologist, psychotherapist): in many countries these titles are protected and listed in public registers. Be wary of anyone who promises a quick cure, isolates you from your loved ones or asks you to cut ties.

For family and friends

If someone you love lives with these difficulties, their reactions (withdrawal, anger, mistrust) are aimed at their own pain rather than at you. You can still set limits, kindly. Try not to minimise (“that’s in the past”) or to push for steps (confrontation, a police complaint) that the person has not chosen. You can encourage them to seek help without forcing them, listen without demanding an account, and look after yourself too: crisis lines and victim support organisations also answer family and friends.

Frequently asked questions

I recognise myself in this article. Do I have complex PTSD?

Perhaps, perhaps not: other difficulties can look similar. The most useful step is to talk to a professional trained in psychotrauma. You can bring this article, or the completed ITQ questionnaire, to make the conversation easier.

Do I have to tell everything that happened right from the start?

No. A trained therapist will not ask you to tell everything straight away. Work on the memories is prepared together with you, and you stay in charge of the pace. You do not need to be feeling perfectly well to begin.

Will I get better?

Many people improve with appropriate treatment: memories weigh less, emotions become more manageable, the way you see yourself changes. For some, particularly after abuse in childhood, progress is slower. If it takes time, or if a first therapy has not been enough, that is no failure on your part: the approach can be adjusted, or you can change therapist.

Further reading on TIRCIA

In one sentence

Complex PTSD names what repeated trauma often leaves behind (memories that come back, but also persistent shame, overwhelming emotions and damaged relationships), and it can be understood and can get much better with the right help.

If you recognise yourself in these lines, what you are going through has a name and can ease. Talking to a professional trained in psychotrauma is a first step, and if you are struggling right now, crisis lines answer at any hour.

Sources

  1. Cloitre, M., Garvert, D. W., Weiss, B., Carlson, E. B., & Bryant, R. A. (2014). Distinguishing PTSD, complex PTSD, and borderline personality disorder: A latent class analysis. European Journal of Psychotraumatology, 5(1), 25097. https://doi.org/10.3402/ejpt.v5.25097
  2. Cloitre, M., Shevlin, M., Brewin, C. R., Bisson, J. I., Roberts, N. P., Maercker, A., Karatzias, T., & Hyland, P. (2018). The International Trauma Questionnaire: Development of a self-report measure of ICD-11 PTSD and complex PTSD. Acta Psychiatrica Scandinavica, 138(6), 536–546. https://doi.org/10.1111/acps.12956
  3. Herman, J. L. (1992). Complex PTSD: A syndrome in survivors of prolonged and repeated trauma. Journal of Traumatic Stress, 5(3), 377–391. https://doi.org/10.1002/jts.2490050305
  4. Karatzias, T., Murphy, P., Cloitre, M., Bisson, J., Roberts, N., Shevlin, M., Hyland, P., Maercker, A., Ben-Ezra, M., Coventry, P., Mason-Roberts, S., Bradley, A., & Hutton, P. (2019). Psychological interventions for ICD-11 complex PTSD symptoms: Systematic review and meta-analysis. Psychological Medicine, 49(11), 1761–1775. https://doi.org/10.1017/S0033291719000436
  5. Maercker, A., Cloitre, M., Bachem, R., Schlumpf, Y. R., Khoury, B., Hitchcock, C., & Bohus, M. (2022). Complex post-traumatic stress disorder. The Lancet, 400(10345), 60–72. https://doi.org/10.1016/S0140-6736(22)00821-2
  6. World Health Organization. (2026). ICD-11 for Mortality and Morbidity Statistics, 6B41 Complex post-traumatic stress disorder. https://icd.who.int/browse/2026-01/mms/en#585833559
  7. Peraud, W., Hebrard, L., Lavandier, A., Brockbanck-Chasey, S., Brennstuhl, M. J., & Quintard, B. (2022). French cross-cultural adaptation and validation of the International Trauma Questionnaire (ITQ) in a French community sample. European Journal of Psychotraumatology, 13(2), 2152109. https://doi.org/10.1080/20008066.2022.2152109

This article offers general guidance, up to date at the date of publication. It is no substitute for the advice of a doctor, who alone can make a diagnosis, or for support from a psychologist or psychotherapist trained in psychotrauma.

Declaration of interests: the author directs TIRCIA, some of whose online programmes are mentioned in this article.

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