What is CPTSD?

(Complex Post-Traumatic Stress Disorder)

Complex PTSD is a trauma-related mental health condition that results from abuse, which from a subjective point of view was difficult/impossible to escape. CPTSD is related to but different from post-traumatic stress disorder (PTSD).

It is mainly characterized by emotional dysregulation, very negative inner dialogue, diminished sense of safety and distortion of the person’s core identity (or even perceived lack of).

It is not listed in the DSM V (current issue of The Diagnostic and Statistic Manual of Mental Disorders), but it is included in the World Health Organization’s (WHO) International Statistical Classification of Diseases and Related Health Problems (ICD-11) since 2018, which means therapists all over the world can make such a diagnosis.


CPTSD is a more severe form of Post-traumatic stress disorder. It is different from it by five of its most common and troublesome features: emotional flashbacks, toxic shame, self-abandonment, a vicious inner critic and social anxiety.

Emotional flashbacks

are the most noticeable feature of CPTSD. Survivors of traumatizing abandonment are extremely susceptible to painful emotional flashbacks, which unlike ptsd are not visual.
Emotional flashbacks are sudden and often prolonged regressions to the overwhelming feeling-states of being and abused/abandoned child. These feeling states can include overwhelming fear, shame, alienation, rage, grief and depression. They also include unnecessary triggering of our four fight/flight instincts.
Flashbacks can range in intensity from subtle to horrific. They can also vary in duration ranging from moments to weeks on end where they devolve into what many therapists call a regression.

CPTSD as a learned response

First, good news. It is a learned set of responses, and a failure to complete numerous important developmental tasks. This means that is is environmentally, not genetically, caused. In other words, unlike most of the diagnoses it is confused with, it is neither inborn nor characterological. As such, it is learned. It is not inscribed in your DNA. It is a disorder caused by nurture [or rather the lack of it] not nature.
This is especially good news because what is learned can be unlearned and vice versa. What was not provided by your parents can now be provided by yourself and others.

Pete Walker in his own words

about CPTSD

(Author of ‘Complex PTSD: From Surviving To Thriving’)

On this Page you can read about:

  • Symptoms of CPTSD

  • Trauma – definition

  • Types of Traumatizing Abuse and Abandonment

  • How Common are Trauma and CPTSD?

  • Treatment for CPTSD

  • CPTSD Left Untreated

  • Dealing/Coping with CPTSD

  • Brief History of CPTSD

  • Statistics on Trauma and Mental Health

  • Resources

Symptoms of CPTSD

Pete Walker: People with CPTSD may experience personality issues, emotional deadness, or intense emotional outbursts that overwhelm their ability to cope. They may also have severe relationships issues as well as lapses in judgment, concentration, and problem-solving. These issues may cause significant impairment in day-to-day functioning. It’s important to note that symptoms of CPTSD can vary widely between people, and even within one person over time. For example, you might find yourself avoiding social situations for a period of time, only to start seeking potentially dangerous situations months or years later.

Common CPTSD Symptoms according to Pete Walker

Survivors may experience all of these, or varying combinations. Factors affecting this are your 4F type and your childhood abuse/neglect pattern.

  • Emotional Flashbacks
  • Tyrannical Inner &/or Outer Critic
  • Toxic Shame
  • Self-Abandonment
  • Social Anxiety
  • Severe feelings of loneliness and abandonment
  • Fragile Self-Esteem
  • Attachment Disorder
  • Developmental Arrest
  • Relationship Difficulties
  • Radical Mood Swings
  • Dissociation via distracting activities or mental processes (feeling detached from emotions or body)
  • Hair-triggered fight/flight response
  • Suicidal Ideation (depressed thinking or fantasizing about wanting to die)

Other common symptoms of Complex PTSD

  • Emotional dysregulation (lack of emotional regulation, uncontrollable feelings) e.g. explosive anger or ongoing sadness
  • Changes in self-perception, including feeling totally different from other people
  • Distorted perceptions of the perpetrator or abuser, which may include ascribing all the power to this person, becoming obsessed with him or her, or becoming preoccupied with revenge
  • Avoidance of people, places, or things that are reminders of the trauma
  • Self-destructive behavior
  • Nightmares of the trauma
  • An ongoing search for a rescuer or even seeking an abuser
  • Trust issues
  • Hopelessness, helplessness, powerlessness, feeling small and vulnerable, despair
  • Intense, toxic guilt or shame to the point of feeling worthless and unlovable
  • Social isolation
  • Digestive issues
  • Sexual promiscuity
  • Physical or medical issues
  • Abuse amnesia (forgetting that traumatic event ever occurred or minimizing it or its effects)
  • Loss of a system of meanings, such as losing one’s core beliefs, values, religious faith, or hope in the world and other people

7 Domains of Symptoms and Behavioral Characteristics according to Cook

Attachment – problems with relationship boundaries, lack of trust, social isolation, difficulty perceiving and responding to others’ emotional states

Biology – sensory-motor developmental dysfunction, sensory-integration difficulties, somatization, and increased medical problems

Emotional regulation – poor emotional regulation, difficulty identifying and expressing emotions and internal states, and difficulties communicating needs, wants, and wishes

Dissociation – amnesia, depersonalization, detached states of consciousness with unconnected memories, emotions, and functioning, and impaired memory for state-based events

Behavioral control – problems with impulse control, aggression, and sleep

Cognition – difficulty regulating attention, problems with a variety of ‘executive functions’ such as planning, judgment, initiation, use of materials, and self-monitoring, difficulty processing new information, difficulty focusing and completing tasks, poor object constancy, problems with ’cause-effect’ thinking, and language developmental problems such as a gap between receptive and expressive communication abilities

Self-concept – fragmented and disconnected autobiographical narrative, disturbed body image, low self-esteem, excessive shame, and negative internal working models of self

People Pleaser Syndrome

According to Richard Grannon it is characterized by:

  1. Emotofobia – fear of negative emotions (of feeling bad or making others feel bad)
  2. Neurotic levels of naivety – insisting on not seeing reality as it presents itself
  3. Neurotic desire to be liked/accepted/approved of
  4. External locus of control – neurotic levels of reliance on authority figures
  5. Inability to say ‘no’ – originating in the lack of boundaries and self-worth
  6. Excessive conscientiousness – lack of assertiveness, giving other people’s arguments more power than your own, excessive defending, explaining and understanding of other people’s (often abuser’s) behavior
  7. Blurry sense of self or lack of boundaries
  8. Emotional dependence
  9. Low self-confidence, self-esteem, self-worth and value
  10. Over-intellectualizing – excessive drive to rationalize and justify other people’s actions
  11. Addiction to approval
  12. Emotional and Psychological Immaturity – abuse can arrest a person’s healthy development
  13. Excessive amount of compassion, altruism, and responsibility – wanting to help everybody all the time
    Loneliness, self-isolation
  14. Being excessively impressionable – susceptibility to be obsessively impressed by people, ideas, trends, etc

Somatic Symptoms

Here are some body-harming reactions to CPTSD stress:

  • Hypervigilance
  • Shallow and incomplete breathing
  • Constant adrenalization
  • Armoring (chronic muscle tightness)
  • Exhaustion from rushing and armoring
  • Inability to be fully present, relaxed and grounded in our bodies
  • Sleep problems from being over-activated

Key Developmental Arrests in CPTSD

These, according to Pete Walker, are key features of a healthy human being. Abuse Survivors can experience some or all of them to a different degree. They might be diminished or absent entirely. The important factor is also the recovery work that you’ve already done.

  • Self-acceptance
  • Clear sense of identity
  • Self-compassion
  • Self-protection
  • Capacity to draw comfort from relationship
  • Ability to relax
  • Capacity for full self-expression
  • Willpower & Motivation
  • Peace of mind
  • Self-care
  • Belief that life is a gift
  • Self-esteem
  • Self-confidence
  • Emotional intelligence
  • Emotional literacy

Common Behaviors/Characteristics

Victimization and Control

One of the most important characteristics of the experience of someone who has been through long-term trauma is the loss of control that comes with being a victim for an extended period of time. The perpetrator has the power and control over the victim, and as it goes on for so long it can cause serious psychological harm. They may feel trapped, overwhelmed, and unable to escape. They may also begin to identify with and protect the person who hurt them most. This puts victims at high risk of continued abuse and re-traumatization.

Some studies have even found that victims of this kind of trauma experience what is termed a mental death; they have lost their pre-trauma sense of identity. This may help explain the symptoms and behaviors someone with C-PTSD exhibits, such as loss of faith and beliefs, a feeling of being different from other people or damaged, feeling alienated, and being unable to trust other people. Addressing this loss of identity and re-establishing control over one’s life is crucial in treatment for C-PTSD.

In some cases, survivors may believe they are at fault for the trauma they experienced. Consequently, they may feel severe guilt, shame, or believe they are no longer human.

People with Complex PTSD may exhibit certain behaviors in an attempt to manage their symptoms. Examples of such behaviors include:

  • Abusing alcohol or drugs
  • Avoiding unpleasant situations by becoming “people-pleasers”
  • Lashing out at minor criticisms

These behaviors can develop as a way to deal with or forget about trauma and emotional pain. Often, a person develops them during the period of trauma. Once the trauma is no longer ongoing, a person may begin to heal and reduce their reliance on these behaviors. Or, the behaviors may persist and even worsen with the passage of time. Friends and family of people with Complex PTSD should be aware that these types of behaviors may represent coping mechanisms and attempts to gain some control over emotions. To recover from Complex PTSD, a person can seek therapeutic treatment or life coaching and learn to replace these behaviors with ones that are more positive and constructive.

Typical beliefs and concepts of CPTSD sufferers

  • Other people cannot be trusted, are dangerous
  • The world is a dangerous place
  • Distorted perception of abuser – This includes becoming preoccupied with the relationship between you and your abuser. It can also include preoccupation with revenge or giving your abuser complete power over your life.


CPTSD is sometimes misdiagnosed as:

  • PTSD
  • Borderline personality disorder
  • Bipolar Disorder
  • Depression that’s difficult to cure
  • Anxiety disorder that’s difficult to cure

During the beginning of my healing journey I found my symptoms match following conditions:

  • Hypersensitivity
  • Chronic fatigue syndrome
  • Burnout
  • Fibromyalgia
  • Irritable Bowel Syndrome
  • Panic Disorder
  • Depression
  • General Anxiety Disorder
  • Social Anxiety Disorder
  • Narcissistic Personality Disorder
  • Borderline Personality Disorder
  • Attention Deficit Disorder (I scored high enough to be qualified)
  • Attention Deficit Hyperactive Disorder (also qualified)
  • Obsessive-Compulsive Disorder
  • Shopaholizm
  • Agoraphobia

Why is it important to know about CPTSD

If you’ve experienced abuse, particularly a narcissistic abuse, it is very important to self educate yourself (it is one of the recommended steps of treatment) about CPTSD and which exactly symptoms do you have, because this provides you with a structured strategy for your recovery.
Many online resources, especially YouTube channels dedicated to narcissistic abuse are doing a great job educating people on this kind of abuse and traits of people on the spectrum for Narcissistic, Borderline and Antisocial Personality Disorder. It is important for the victims of abuse to know how to recognize the red flags, because they were trained to stay blind to them during their primary abuse.

However, focusing only on this subject, or on some ‘general’ unspecific healing, without addressing your CPTSD components is not going to help you recover from it.

Please stay away from so-called ‘experts’ either on narcissistic abuse or CPTSD, who try to convince people that they don’t need to consult a doctor, therapist or a coach. It is especially harmful, since the survivors of abuse have already damaged ability to trust other people, and usually have been shamed or punished for looking for help. Convincing them to not look for counsel, while they might be in extreme pain is wrong and morally outrageous.

For example – you can learn that one of the symptoms of CPTSD is lack or damaged sense of safety, and you may identify that struggle within you. You can proceed to research this subject and get to know, that strengthening your boundaries, self-esteem, assertiveness and emotional literacy can help you recover your sense of safety. From here it’s a clear path to research which would be the best books or workbooks on this subject, or perhaps online courses, videos or other resources. Now it’s just a one step from acquiring them and starting your work with the subject. From here it won’t be long until you’ll see results in your day-to-day feeling.

Benefits of understanding CPTSD

  • It can help you feel not alone in this, and that you’re part of a recovering community
  • It can help you feel more resourceful and hopeful
  • It can help you put your struggles into manageable perspective
  • It can show you that these are specific issues that have very clear solutions
  • Even if you are not ready to reach out for help, it might put you on a concrete path to find resources to address these specific issues by yourself
  • The clarity of being able to practically identify your challenges can bring you sense of hope, reassurance, validation, opportunities and empowerment


It is a deeply distressing or disturbing experience; an emotional upset; a disordered psychic or behavioral state caused by severe metal or emotional stress or physical injury, resulting in overwhelming a person’s ability to cope, causes feelings of helplessness and powerlessness, diminishes their sense of self and their ability to feel the full range of emotions and experiences.

Pete Walker: Trauma occurs when attack or abandonment triggers a fight/flight response so intensely that the person cannot turn it off once the threat is over. He becomes stuck in an adrenalized state. His sympathetic nervous system is locked ‘on’ and he cannot toggle into the relaxation.

One common instance of this occurs when a child is attacked and hurt by a bully after school. He may remain in a hypervigilant, fearful state until someone takes action to insure him that he will not be revictimized, and until someone helps him release the hypervigilation in his nervous system.

If the child has learned through experience that he can come to at least one of his parents when he is hurting, frightened or needing help, he will tell mom or dad about it. With them, he will grieve the temporary death of his sense of safety in the world by verbally venting, crying and angering about it.

Moreover, his parent will report the bully and take steps to assure that it will not happen again, and the child will typically be released from the trauma. He will naturally relax back into the safety.

When the trauma however is repetitive and ongoing and no help is available, the child may become so frozen in trauma that the symptoms of ‘simple’ ptsd begin to set in. This can also occur during prolonged trauma of combat or entrapment in a cult or domestic violence situation.

If however, a person is also afflicted by ongoing family abuse or profound emotional abandonment, the trauma will manifest as a particularly severe emotional flashback because he already has CPTSD. This is particularly true when his parent is also a bully.

Children can suffer chronic trauma such as neglect, maltreatment, family violence, and a disruption in attachment to their primary caregiver. In many cases, it is the child’s caregiver who caused the trauma.

Some examples of trauma that can cause Complex PTSD:

  • experiencing childhood neglect
  • experiencing other types of abuse early in life
  • experiencing domestic abuse
  • experiencing human trafficking
  • being a prisoner of war
  • living in a region affected by war

Types of Traumatizing Abuse and Abandonment

Abuse is a pattern of behavior used by one person over another in order to gain and maintain power and control over that person. It appears usually in a cycle (abuse, then apparent regret, guilt and apologies, then abuse again), which confuses a victim as to the intentions of the abuser, and if the abuse is even real. If a victim stays in such abusive relationship for a longer period of time, it is almost always traumatizing.

If it appears in an intimate relationship, it is not always obvious from the beginning. Another very confusing factor is that it might not be visible to the people on the outside of the relationship, who might not believe the victim when she or he opens up about this.

Child abuse is also very often difficult to recognize for the children themselves, because on one hand, if a child is being raised in such situation from the beginning, it is the ‘normal’ for them. Another difficulty is the fact, that children, in order to survive, need to believe that their parents love them, therefore whatever their parents do to them, they might have a tendency to call it love, however painful. This is not only harmful for the child during the time of abuse, but also after the child grows up and moves out, because this kind of relationship becomes their blueprint for love, and as such, might make them look for partners that would confirm the belief that this cruelty is how love looks like.

Narcissistic Abuse

Any abuse done by a narcissist (a person with Narcissistic Personality Disorder), or a narcissistic person (not having a full-blown personality disorder but having some traits of it).
Some experts consider Borderline Personality Disorder to also be narcissistic as well as people with Antisocial Personality Disorder, and I would agree with them.
The only difference between experiencing any other type of abuse and narcissistic abuse, in my opinion, is the experience of enduring the person who is doing it. It is a specific experience to deal with a person believing they are better and deserve more than everyone else, devoid of empathy, feeling entitled to cruelty, and devoted to totally and completely destroy the sense of self of the other person.


The act of overly criticizing, insulting, or denouncing another person, characterized by underlying anger and hostility. A destructive form of communication intended to harm the self-concept of the other person and create negative emotions.


Any act that may diminish the sense of identity, dignity, and self-worth, including: confinement, isolation, verbal assault, humiliation, intimidation, infantilization, yelling or swearing, name calling, criticizing, insults, mocking, ridiculing, threats (of violence or abandonment, intentionally frightening, making a person fear they will not receive the food or care they need, repeatedly raising the issue of death), ignoring or excluding, lying, denial of the abuse and blaming the victim, violating boundaries (being over-familiar and/or disrespectful), blaming, shaming, scape-goating, mind games like gaslighting, withholding affection as punishment, belittling, punishment or threats of punishment, manipulation, refusing to communicate.

Special mentioning deserves neglect, as it is often not regarded as abuse. However, not only harmful actions can be abusive and traumatizing, but the lack of the good, positive, supportive, nourishing ones, even as simple as empathy, can be just as destructive.

Other examples:

  • intentionally misinterpreting traditional practices
  • telling an individual that they are too much trouble
  • unreasonably ordering an individual around; treating an individual like a servant or child
  • making derogative or slanderous statements about an individual to others
  • withholding important information


Psychological manipulation and harm inflicted on a person by using the teachings of their religion. Abuse administered under the guise of religion, including the abuse of clerical position, harassment or humiliation, misuse of religion for selfish, secular, or ideological reasons.


Any intentional act causing harm, injury or trauma to another person or animal by physical contact.


It’s an unwanted, abusive sexual behavior or sexual act done by one person upon another. It might be done with the use of force, making threats or by taking advantage of another. It is done without consent or when the victim is not able to give consent because of age or mental of physical incapacity. When the force used is immediate, of short duration, or infrequent, it is called sexual assault.


When employee/s of an institution or a system abuse or use inappropriately power and control over you, don’t take enough care and don’t protect you when you ask for help, or are dependent on them for care. This could happen in a hospital or a care home, but also when you receive care in your own home. The abuse can take many forms, including neglect, and poor care and professional practices as a result of the structure, policies, processes and practices in an organization.

  • Lack of personal clothing or possessions
  • Lack of choice – in food, in decoration, in lighting and heating, and in other environmental aspects.
  • Lack of privacy, dignity, and respect for people as individuals
  • Withdrawing people from community or family contacts
  • No choice offered with food, drink, dress or activities
  • No respect or provisions for religion, belief, or cultural backgrounds
  • Treating adults like children, including arbitrary decision-making. An unsafe, unhygienic or overcrowded environment
  • A strict or inflexible routine


When your financial resources are being controlled and withheld from you or you have a limited and/or conditional access to them, in an effort to create financial dependence as a means of control, which diminishes the victim’s capacity to support themselves and forces them to depend on the perpetrator financially. A common tactic used by abusers to gain power and control over the victim, happens in 99% of cases of domestic violence. While less commonly understood, it is one of the most powerful methods of keeping a victim trapped in an abusive relationship, deeply diminishing the victim’s ability to stay safe after leaving an abusive partner. It can be overt or more subtle, including:

  • tactics to conceal information, limit the victim’s access to assets, or reduce accessibility to the family finances
  • employment-related abuse (sabotaging employment, demanding the victim to quit her job, interfering with the work performance)
  • preventing the victim from accessing existing funds or deciding when they can do it
  • coerced debt, and more

Pete Walker: When abuse or neglect is severe enough, any one category of it can cause the child to develop CPTSD. This is true even in the case of emotional neglect if both parents collude in it. When abuse and neglect is multidimensional, the severity of the CPTSD worsens accordingly.

Denying and Minimizing Abuse

The fact that verbal and emotional abuse can be traumatic can be lost on many childhood trauma victims. Many survivors of verbal and emotional abuse never learn to validate its soul-damaging effects. Attempts to acknowledge it are typically blindsided with thoughts that it was nothing compared to kids who were repeatedly beaten – who ‘had it so much worse’.

Denial about the traumatizing effects of childhood abandonment can seriously hamper your ability to recover. In childhood, ongoing emotional neglect typically creates overwhelming feelings of fear, shame and emptiness.

As a child I minimized the abuse I was experiencing

thinking that everybody has it this way (I heard through the walls in my building a lot of parents screaming at their children and heard from classmates they are also being hit).

I started rebelling against it after my sister was born (I couldn’t take a thought of her being hit like me, let alone witness it, so I stood up at some point so ferociously and suddenly, that my father never hit any of us again).

It was later so much easier to acknowledge the physical abuse by being hit by my father than to acknowledge my mother’s soul-eviscerating rage attacks (when she asked my father to hit me, otherwise she’d ‘tear me apart’).

It was only during my therapy that I realized the weight of it, when I bitterly but casually mentioned it during the session to my therapist, and I heard a response that opened up my eyes. That’s how my journey of healing emotional abuse and neglect begun.

How common are Trauma and CPTSD?

Pete Walker (Psychotherapist):

I believe that we have an epidemic of traumatizing families.

Specialists say that CPTSD might be the underlying issue of 95% of mental health issues.

Bessel van der Kolk (Psychiatrist): Trauma is the West’s most urgent public health issue.

[P.W. Continued]: I once heard renowned traumatologist, John Briere, quip that if CPTSD were ever given its due, the DSM [The Diagnostic and Statistic Manual of Mental Disorders] used by all mental health professionals would shrink from its dictionary like size to the size of a thin pamphlet. In other words, the role of traumatized childhood in most adult psychological disorders is enormous.

The number of American citizens killed by family members is bigger than the number of soldiers US lost in both wars.

Women are 2 times more likely to experience domestic violence and the health problems because of it, than to experience breast cancer.

[B. vd K. Continued]: “If your parents’ faces never lit up when they looked at you, it’s hard to know what it feels like to be loved and cherished”. Neglect creates mental maps used by children, and their adult selves, to survive. These maps distort their view of themselves and the world.

Family disturbance or generalized neglect can cause children to be so stressed, that they are almost constantly in a fight or flight mode. Or they may be so “numbed out” by keeping demons at bay they can’t engage with life’s pleasures or protect themselves from future trauma. Even parents who are not connected with their children can do untold damage, according to van der Kolk.

Trauma has effects on:

  • mental and physical health
  • employment
  • education
  • crime
  • relationships
  • domestic or family abuse
  • alcoholism
  • drug addiction

Treatment for CPTSD

Many experts believe that Complex PTSD care has to focus on helping victims re-establish control, power, and self-identity. This can be done through therapy, life coaching, empowering activities, and healthy, supportive and safe relationships.

Individual or group therapy may help treat Complex PTSD.
Psychotherapy may take place on a one-to-one basis or in a group setting.

Initially, therapy will focus on stabilizing the person so that they can:

  • address their feelings, including distrust and negative worldviews
  • improve their connections with others
  • deal adaptively with flashbacks and anxiety

Reparenting Yourself

Pete Walker: Recovery from CPTSD typically has important self-help and relational components. The relational piece can come from authors, friends, partners, teachers, therapists, therapeutic groups or any combination of those. I like to call this reparenting by committee.

Certain types of trauma-focused psychotherapy, that proved to be effective include:

  • Cognitive behavioral therapy (CBT) – focuses on replacing negative thought patterns with more positive ones
  • Prolonged exposure therapy (PE)
  • Cognitive restructuring therapy
  • Dialectical behavior therapy (DBT) – helps people to deal with stress, self-harm urges, and suicidal thoughts and behaviors
  • Eye Movement Desensitization and Reprocessing (EMDR) – after preparation and practice, the therapist will ask the person to recall the traumatic memory. The therapist will then engage both hemispheres of the brain interchangeably to help the mind process the memory. To do that he or she will either move a finger from side to side, tap your legs from left and right, or give you a sound track with a click heard interchangeably in the left and right ear. The method originated from a therapist performing a therapy with a client during the walks in the forest, realizing it was the interchangeable movement of legs during walking that helped activate both hemispheres of the brain and increase communication between them, that helped the client easier process the experiences to the point that they stopped being bothering. When effective, this process helps to desensitize the person to the trauma so that they can eventually recall the memory without having a strong adverse reaction to it.

What might be holding you back from coaching/therapy

Some survivors of CPTSD-engendering families were so thoroughly betrayed by their parents, that it may be a long time, if ever, before they can trust another human being enough to engage in relational healing work. When this is the case, pets, books and online therapeutic websites can provide significant relational healing.

Finding the right therapist

If you believe you might be affected by CPTSD and you would like to look for a therapist, keep in mind that you may need to see a few doctors before you find someone you feel comfortable with. This is very normal, especially for people dealing with post-traumatic stress. Try to carefully select one that you can trust and work with.

Some therapist might want to focus entirely on you, and treat the abuse you went through with a sense of your experience being relative, which would not be very helpful, in fact a therapist that followed learning program where there was no mention of cluster-b personality disorders might minimize or even deny the abuse and the role of the abuser, which would lead to retraumatization of a survivor (even if the therapist acts with best intentions in mind).

If Survivors have been gaslighted by their abuser, and therefore feel confused, bewildered, guilty and not sure if what they went through was a real abuse, or was it just in their mind, or was it even their fault, then they need a therapist they can trust, who will empathize with them and help them see what really happened. You would highly benefit from a therapist that specializes in work with trauma recovery, abuse, anxiety recovery, has very good knowledge of personality disorders of cluster B (Narcissistic, Borderline and Antisocial Personality Disorders). Such a therapist can validate your experience and help you draw a clear line between illusion and reality. Look also for a therapist who is healing oriented and present and future oriented. You don’t need to spend years in therapy talking about your past, you can make your recovery faster if your therapist can help you overcome your trauma and develop healthy self-image and coping skills.

Finding the right Life Coach

You might also find a Life Coach with an intimate knowledge of cluster-b personality disorders and even CPTSD. They can offer help in providing knowledge about CPTSD to further educate you, and help you develop or recover healthy coping skills that will not only help you self-heal, but will equip you in managing your feelings, thoughts to navigate the world with a proper sense of safety, identity, worth, self-love, self-compassion and boundaries. Life Coaches as a rule are healing, and present and future oriented, which means that their main job is to make sure you can go on living in the now the life you choose. Through interesting, fun exercises and modeling they can help you overcome your struggles in an empowering and light-hearted way.

CPTSD Left Untreated

Untreated CPTSD always leads to retraumatization. It can also lead to suicide.

How severe/serious is CPTSD?

CPTSD can lead to suicidal ideation, meaning thinking and fantasizing about death or committing suicide, and when it does it often leads to suicidal attempts, a lot of which are successful.

It also often leads to fatigue, obsessive thoughts, procrastination, low self-esteem, low self-worth, feeling unsafe, isolation, intense rage, insomnia, eating disorders, depression, generalized anxiety, social anxiety, paranoia, psychosis, OCD, codependency, addiction, chronic pain and chronic psychosomatic illnesses. In other words, the prolonged sustained stress and emotional suffering, when left unchecked will eventually manifest in the body as serious chronic illness.

How long can CPTSD last?/Is CPTSD lifelong?

Untreated CPTSD can last entire lifetime. However, recovering from CPTSD can last from a couple of months to a couple of years. The duration depends on the individual, the severity of the trauma and in the biggest part – the person’s determination and effort put into the healing process. CPTSD is a learned survival strategy and stress response, it can be unlearned, the more you are comitted to the process and the more work you put into it, the faster your recovery. The prognosis is very good and the recovery can potentially be complete.

Moreover, after the recovery work you will most likely develop better coping skills than that of an average person’s.

How CPTSD affects the brain?

CPTSD, as a result of prolonged stress, causes the amygdala to grow (responsible for stress and flight or fight, freeze or fawn response), the hippocampus to shrink in size (responsible for short term memory, learning and planning), and during a flashback cuts off the prefrontal cortex (responsible for short term and long term memory and rational thinking).

Emotional flashbacks can last from a couple of minutes even to weeks and months on end.

Dealing with CPTSD

Although it can be difficult to cope with the symptoms of CPTSD, there are several steps you can take to manage the condition. Here are some recommended things you can do:

  • Seek professional care of a therapist and/or a life coach

    Trauma therapy with a Therapist can help you get desentisized about bothering memories, understand what happened to you and make sense out of your life.

    Coaching with a Life Coach can help you develop new, constructive and supportive coping skills and strategies, providing you with tools and resources you were supposed to be given by your parents, in order to love yourself and be successful in life.

    This will allow you to experience the relational healing, empathy and validation, and teach you how to care for and protect yourself. Remember, that CPTSD/CPTSR is a learned response, you can reverse it by unlearning and relearning how to approprietaly relate to yourself and others.

  • Learn as much as you can about CPTSD

    Remember, that knowledge is power. In this case knowledge gives you the power of clarity.

    There’s absolutely nothing wrong with you, you are a normal, good person, to whom difficult, bad things happened. It wasn’t your fault, you’re not a bad person, and what you’re going through is a normal process of adaptation in order to survive terrible circumstances. Learning more about it will help you get out of the darkness and demistify what’s happening within you, giving you more sense of control, clarity and ease in handling it. It Can Be Done!

  • Monitor your symptoms and learn about your triggers

    This will help you better understand yourself and will give you even more sense of control. You will slowly develop an idea of a map of your triggers, which will help you to get out of them and even avoid them all together.

  • Learn and use relaxation techniques

    Prolonged stress is damaging our brain, by changing its structure to work against us – the brain center responsible for stress grows bigger and the part responsible for processing, planning, learning and short term memory grows smaller. So the more you stress, the more you stress and obsess. However, we can change it by practicing deep relaxation techniques, like mindfulness, meditation, yoga, progressive muscle relaxation, etc. These techniques are scientifically proved to reverse the damage completely.

  • Practice State Management

    Take care of your sleeping quality and hygene, give yorself enough rest, excercise regularily, monitor your physiology (your body posture and movement – do you carry yourself like a person feeling down or scared? Your mind affects your body posture and facial expression, but it works the other way around too!), stay hydrated, eat enough nutritious food, avoid drugs, alcohol, cigarettes, don’t drink too much coffee. People with CPTSD are more sensitive to tiredness, psychoactive substances, sleep deprivation and being undernourished and underexercised. In these states we are more prone to emotional flashbacks, so take good care of yourself if you want to avoid them as much as possible.

  • Write about how you feel

    Journaling is an excellent practice helping us slow down the thinking process and give us an opportunity to express our thoughts and look at them from the outside.

    It can also help you track your progress, which can be very challenging in the beginning. In such situations there is nothing like going back a little bit to see that there is a difference between how we used to think and how we do now.

    Additionaly journaling about our feelings helps us develop emotional awareness and literacy, and aids us in the process of learning to acknowledge and validate our feelings, something we’ve been denied by our abusers, but now have an opportunity to provide ourselves with it.

  • Eliminate the Unsupportivenes and Negativity from Your Life

    Try to stay away or avoid all together people and activities that dumpen your mood and spirit. The Recovery Journey and life itself can be challenging enough, there’s absolutely no reason you need to tolerate relationships that make your life more complicated. The general wisdom says we should make our lives easier and siplify it as much as we possibly can.

  • Surround Yourself with Supportive Messages

    Consume positive, supportive and constructive media content, read good quality Self-Help Books, it will create an environment in which it would be easier for you to recover.

  • Engage in spiritual activities

    Doesn’t have to be religion, if you’re not religious. Anything that helps you see life in a bigger perspective and take it lightly, gives you consolation, comforting and trust in the future. It can be even philosophy or practicing deeper connection with your Higher Self.

  • Join a support group

    If you choose to join online support group, make sure that the one you join is constructive, focused on healing and recovery, and has knowledge of the matter of abuse, personality disorders, and most importantly CPTSD/CPTSR

  • Take part in activities you enjoy

    It’s good for us to remember that life is not only about the heavy stuff.

Does trauma have to be life-threatening to qualify you for CPTSD?

Some Internet sources claim that the trauma needs to be life-threatening to develop CPTSD. I consider it very confusing and unhelpful. Please, do yourself a favor and stay away from such sources, because they might have disvalidating and therefore retraumatizing effect on you. It might be a result of the writer not having done a proper research and assuming too much similarities with PTSD. For the person on the outside the trauma can seem to not be life-threatening, but for the one experiencing it, subjectively it might be the end of the world and the end of life, and is experienced as such.

Most of the survivors of abuse in adulthood have been primed for the abuse in their childhood by abusive or neglectful parents. For the child, an issue of their parents loving them and caring for them is a matter of survival, therefore any perceived threat of not being loved is experienced as life-threatening. Later on in life, when we experience more abuse, we flashback to the exact feeling of being about to die, or being in a lot of danger.

Therefore the trauma doesn’t have to be physical or actually life endangering, it can be emotional, verbal, sexual, economic, institutional and spiritual for the victim to develop CPTSD.

Entrapment as a qualifying CPTSD factor: Is it still CPTSD if other people say I could run away, but I believed I was trapped?

‘Other people’ who haven’t experienced mental or emotional abuse often find it easy to say that you can or could have just move out. And they find it hard to understand why anyone would stay in a situation of abuse. It is unfortunate but common. Experiencing abuse in a relationship (romantic, family, work, school) is a graduate and an on-and-off process, causing big confusion in a victim. It is accompanied often by gaslighting and scapegoating, where the victim is being convinced that she/he is the one who’s to blame and crazy. The abuse also often involves blackmail (material, economical, mental or emotional) and is especially difficult to escape if it involves shared custody over children. However what is usually the primary reason for the victim to stay in the abusive relationship despite the abuse, is having been primed for abuse during childhood by adverse childhood experiences, toxic domestic situation, disfuctional family inflicting abuse, neglect or both. Having been taught in childhood that it is not permissible to protect oneself, the adult is prone to engage in similarly abusive scenarios until he or she becomes self-aware of the pattern and starts work on their recovery.

Brief history of CPTSD

  • Fist described by Judith L. Herman in her book ‘Trauma & Recovery’, 1992, as psychological symptoms after extended trauma exposure:

    • Alterations in regulation of affect and impulses
    • Alterations in attention or consciousness
    • Alterations in self-perception
    • Alterations in relationships with others
    • Somatization
    • Alterations in systems of meaning

    Labeled DESNOS (Disorder of extreme stress, not otherwise specified)

  • Pete Walker’s book ‘Complex PTSD: From Surviving to Thriving’, 2013

    Still to this day the best book on CPTSD, written by a psychotherapist, who diagnosed himself with CPTSD

  • 2018 - CPTSD is officially included in the World Health Organization’s (WHO) International Statistical Classification of Diseases and Related Health Problems (ICD-11)

    From then on therapists all over the world can make such a diagnosis


on Trauma and Mental Health

Consequences of Experiencing Trauma

Young children exposed to five or more significant adverse experiences in the first three years of childhood face a 76% likelihood of having one or more delays in their language, emotional or brain development.

  • 15 times more likely to attempt suicide
  • 4 times more likely to become an alcoholic
  • 4 times more likely to develop a sexually transmitted disease
  • 4 times more likely to inject drugs
  • 3 times more likely to use antidepressant medication
  • 3 times more likely to be absent from work
  • 3 times more likely to experience depression
  • 3 times more likely to have serious job problems
  • 2.5 times more likely to smoke
  • 2 times more likely to develop chronic obstructive pulmonary disease
  • 2 times more likely to have a serious financial problem

Statistics on Childhood Trauma

  • 60% of adults report experiencing abuse or other difficult family circumstances during childhood
  • 26% of children in the United States will witness or experience a traumatic event before they turn four
  • Four of every 10 children in America say they experienced a physical assault during the past year, with one in 10 receiving an assault-related injury
  • Nearly 14% of children repeatedly experienced maltreatment by a caregiver, including nearly 4% who experienced physical abuse
  • More than 13% of children reported being physically bullied, while more than 1 in 3 said they had been emotionally bullied
  • 1 in 5 children witnessed violence in their family or the neighborhood during the previous year
  • In one year, 39% of children between the ages of 12 and 17 reported witnessing violence, 17%reported being a victim of physical assault and 8% reported being the victim of sexual assault
  • About 10% of children suffered from child maltreatment, were injured in an assault, or witnessed a family member assault another family member
  • Nearly half of children and adolescents were assaulted at least once in the past year

Statistics on Mental Health

  • Approximately 1 in 5 adults in the U.S. (46.6 million) experiences mental illness in a given year
  • Approximately 1 in 25 adults in the U.S. (11.2 million) experiences a serious mental illness in a given year that substantially interferes with or limits one or more major life activities
  • Approximately 1 in 5 youth aged 13–18 (21.4%) experiences a severe mental disorder at some point during their life. For children aged 8–15, the estimate is 13%
  • 6.9% of adults in the U.S.—16 million—had at least one major depressive episode in the past year
  • 18.1% of adults in the U.S. experienced an anxiety disorder such as posttraumatic stress disorder, obsessive-compulsive disorder and specific phobias
  • Among the 20.2 million adults in the U.S. who experienced a substance use disorder, 50.5%—10.2 million adults—had a co-occurring mental illness
  • Only 41% of adults in the U.S. with a mental health condition received mental health services in the past year. Among adults with a serious mental illness, 62.9% received mental health services in the past year
  • Just over half (50.6%) of children with a mental health condition aged 8-15 received mental health services in the previous year

Consequences Of Lack Of Treatment

  • Hospitalization
  • Increased risk of having chronic medical condition
  • School dropping out
  • Suicide is the 10th leading cause of death in the U.S., and the 2nd leading cause of death for people aged 10–34
  • More than 90% of people who die by suicide show symptoms of a mental health condition
  • Each day an estimated 18-22 veterans die by suicide

Other names You might have heard:

  • Narcissistic Abuse Syndrome
  • Narcissistic Victim Syndrome
  • Echoism

These are some popular ways to describe the effects of abuse done by an abusive personality type person.

The Narcissistic Abuse is a term coined by Sam Vaknin (writer diagnosed with NPD, who declares himself he is a psychopathic narcissist, author of ‘Malignant Self-Love: Narcissism Revisited’), can be done by a person with Narcissistic Personality Disorder (NPD), Antisocial Personality Disorder (ASPD or APD), Borderline Personality Disorder (BPD), or a person displaying traits of them.
The abuse creates trauma.

If a person lives in a relationship with an abuser, either in their family or relationship, or even at school or work – this creates a situation of sustained, repeated trauma, that has very devastating effects.

You could have also heard it be called

  • Complex Trauma
  • Childhood PTSD

These terms might be sometimes helpful and functional, however, the clinical term is CPTSD – Complex Post-Traumatic Stress Disorder.

Which name is better?

I, personally, don’t favor the terms involving words ‘narcissists’ or ‘abuse’, because they focus on the perpetrator and the act of harm, instead of on the person who experienced it and is now suffering the consequences.

Often the person sustaining the abuse gets out of the relationship and looks for the ways to heal. I don’t consider it to be very reassuring and supportive to remind the survivor about the abuser and the abuse, every time we address their symptoms.

Instead I prefer to focus on the set of symptoms displayed right now and recovering from them, focusing on the present and the future, because this is where their lives are going. It is less retraumatizing and painful, and more supportive, encouraging and empowering.


13 Steps for Managing Flashbacks

By Pete Walker

1. Say to yourself: “I am having a flashback”. Flashbacks take us into a timeless part of the psyche that feels as helpless, hopeless and surrounded by danger as we were in childhood. The feelings and sensations you are experiencing are past memories that cannot hurt you now.

2. Remind yourself: “I feel afraid but I am not in danger! I am safe now, here in the present.” Remember you are now in the safety of the present, far from the danger of the past.

3. Own your right/need to have boundaries. Remind yourself that you do not have to allow anyone to mistreat you; you are free to leave dangerous situations and protest unfair behavior.

4. Speak reassuringly to the Inner Child. The child needs to know that you love her unconditionally- that she can come to you for comfort and protection when she feels lost and scared.

5. Deconstruct eternity thinking: in childhood, fear and abandonment felt endless – a safer future was unimaginable. Remember the flashback will pass as it has many times before.

6. Remind yourself that you are in an adult body with allies, skills and resources to protect you that you never had as a child. [Feeling small and little is a sure sign of a flashback]

7. Ease back into your body. Fear launches us into ‘heady’ worrying, or numbing and spacing out.

7a. Gently ask your body to Relax: feel each of your major muscle groups and softly encourage them to relax. (Tightened musculature sends unnecessary danger signals to the brain)

7b. Breathe deeply and slowly. (Holding the breath also signals danger).

7c. Slow down: rushing presses the psyche’s panic button.

7d. Find a safe place to unwind and soothe yourself: wrap yourself in a blanket, hold a stuffed animal, lie down in a closet or a bath, take a nap.

7e. Feel the fear in your body without reacting to it. Fear is just an energy in your body that cannot hurt you if you do not run from it or react self-destructively to it.

8. Resist the Inner Critic’s Drasticizing and Catastrophizing: [a] Use thought-stopping to halt its endless exaggeration of danger and constant planning to control the uncontrollable. Refuse to shame, hate or abandon yourself. Channel the anger of self-attack into saying NO to unfair self-criticism. [b] Use thought-substitution to replace negative thinking with a memorized list of your qualities and accomplishments

9. Allow yourself to grieve. Flashbacks are opportunities to release old, unexpressed feelings of fear, hurt, and abandonment, and to validate – and then soothe – the child’s past experience of helplessness and hopelessness. Healthy grieving can turn our tears into self-compassion and our anger into self-protection.

10. Cultivate safe relationships and seek support. Take time alone when you need it, but don’t let shame isolate you. Feeling shame doesn’t mean you are shameful. Educate your intimates about flashbacks and ask them to help you talk and feel your way through them.

11. Learn to identify the types of triggers that lead to flashbacks. Avoid unsafe people, places, activities and triggering mental processes. Practice preventive maintenance with these steps when triggering situations are unavoidable.

12. Figure out what you are flashing back to. Flashbacks are opportunities to discover, validate and heal our wounds from past abuse and abandonment. They also point to our still unmet developmental needs and can provide motivation to get them met.

13. Be patient with a slow recovery process: it takes time in the present to become un-adrenalized, and considerable time in the future to gradually decrease the intensity, duration and frequency of flashbacks. Real recovery is a gradually progressive process [often two steps forward, one step back], not an attained salvation fantasy. Don’t beat yourself up for having a flashback.

(from Pete Walker’s website: http://pete-walker.com/13StepsManageFlashbacks.htm)

Recommended Reading


Pete Walker: it describes the very real process of being positively and therapeutically influenced by what one reads. Bibliotherapy can play an enormous role in enhancing recovery from Complex PTSD. I usually find that my clients who make the most progress are those who augment their therapy sessions with reading homework [recommended by me or self-prescribed]. This is especially true of those who further augment their reading with journaling about their cognitive and emotional responses to it. These processes help build the new physiological and neuronal brain circuitry that accompanies the growth of self-compassion and self-championing.


  • “Complex PTSD: From Surviving to Thriving” by Pete Walker is a great resource for breaking down complex psychological concepts related to trauma. Plus, the author is a licensed psychotherapist who happens to have CPTSD
  • “The Tao of Fully Feeling” by Pete Walker
  • “The Body Keeps Score” by Bessel van der Kolk is considered a must-read for anyone recovering from trauma
  • “The Complex PTSD Workbook” contains exercises and examples designed to empower you to take control of your physical and mental health

Pete Walker Recommends:

  • Alice Miller, The Drama of The Gifted Child (Codependence)
  • John Bradshaw, Healing The Shame That Binds
  • Judith Herman, Trauma and Recovery
  • Gravitz&Bowden, Guide to Recovery (Great short, powerful overview)
  • Susan Anderson, The Journey from Abandonment to Healing
  • Jane Middleton-Moz, Children of Trauma
  • Susan Forward, Betrayal of Innocence
  • Robin Norwood, Women Who Love Too Much (Codependence)
  • Pat Love, The Emotional Incest Syndrome (Codependence)
  • Laura Davis and Ellen Bass, The Courage to Heal (Sexual Abuse)
  • Theodore Rubin, Compassion and Self-hate
  • Susan Vaughan, The Talking Cure (How Therapy Works)
  • Jack Kornfield, A Path with Heart (Meditation as a tool of self-compassion)
  • Gay Hendricks, Learning to Love Yourself
  • Byron Brown, Soul Without Shame (Inner critic work)
  • Lewis & Amini, A General Theory Of Love (The Neuroscience of trauma recovery)
  • Lucia Capacchione, Recovery of your Inner Child (Journal therapy)
  • Cheri Huber, There is Nothing Wrong with You
  • Manuel Smith, When I Say No, I Feel Guilty (A Classic on Assertiveness Training)

(from Pete Walker’s website: http://pete-walker.com)

CPTSD Support Helpline

People with complex post-traumatic stress disorder may have thoughts of committing suicide or getting revenge. If you believe you may commit suicide or harm other people, please call any of the following numbers immediately:

International Emergency Lines

  • 911 or your local emergency services number for United States, Argentina, Armenia, The Bahamas, Barbados, Bolivia, Canada, Liberia, Mexico, Philippines
  • 112 for European Union, Armenia, Azerbaijan, India, Indonesia, Mauritius, Russia, United Kingdom
  • 000 in Australia
  • 999 Bangladesh, Ghana, Guyana, Hong Kong, Malaysia, Singapore, United Kingdom
  • 188 Brazil
  • 110 China, Iran
  • 104 ambulance, 105 fire, 106 police on Cuba
  • 122 police, 123 health services in Egypt, 126 foreign emergency
  • 917 Fiji
  • 1018 Greece
  • 100 Israel
  • 110 and 119 Japan
  • 113 Latvia
  • 111 New Zealand
  • 192 police, 193 medical services in Serbia
  • 10111, 10177 South Africa

List Of International Suicide Hotlines

  • Argentina: +5402234930430
  • Australia: 131114
  • Austria: 142; for children and young people, 147
  • Belgium: 106
  • Bosnia & Herzegovina: 080 05 03 05
  • Botswana: 3911270
  • Brazil: 188 for the CVV National Association
  • Canada: 5147234000 (Montreal); 18662773553 (outside Montreal)
  • Croatia: 014833888
  • Denmark: +4570201201
  • Egypt: 7621602
  • Estonia: 3726558088; in Russian 3726555688
  • Finland: 010 195 202
  • France: 0145394000
  • Germany: 08001810771
  • Hong Kong: +852 2382 0000
  • Hungary: 116123
  • India: 8888817666
  • Ireland: +4408457909090
  • Italy: 800860022
  • Japan: +810352869090
  • Mexico: 5255102550
  • Netherlands: 09000767
  • New Zealand: 0800543354
  • Norway: +4781533300
  • Philippines: 028969191
  • Poland: 5270000
  • Portugal: 21 854 07 40/8 . 96 898 21 50
  • Russia: 0078202577577
  • Spain: 914590050
  • South Africa: 0514445691
  • Sweden: 46317112400
  • Switzerland: 143
  • United Kingdom: 08457909090
  • USA: 18002738255
  • Veterans’ Crisis Line: 1 800 273 8255/ text 838255

Other resources I used to write this section

Pete Walker, Complex PTSD: From Surviving to Thriving, An Azure Coyote Book, 2013

15 Traits of People Pleaser Syndrome