Understanding Complex-PTSD
If you’ve experienced repeated, prolonged or relational trauma — perhaps developmental wounds, ongoing stress, or early attachment injuries — you may find that the usual trauma symptoms don’t fully describe what’s going on. In those cases, the term Complex post‑traumatic stress disorder (CPTSD) can help you make sense of your experiences.
What is CPTSD?
CPTSD is now formally recognized in the International Classification of Diseases – 11th Revision (ICD-11) as a distinct diagnosis from classic PTSD.
In simple terms, whereas standard Post‑traumatic stress disorder (PTSD) often relates to a single traumatic event (or limited number of events) and is characterized by the three-core symptom clusters (re-experiencing, avoidance, sense of current threat) — CPTSD includes all of those plus persistent disturbances in self-organization (DSO):
Affective dysregulation – problems managing intense emotions or emotional numbing.
Negative self-concept – feeling worthless, defeated, deeply shameful, or fundamentally broken.
Relational difficulties – trouble sustaining connections, feeling distant, detached, or unable to trust or be close.
The ICD-11 states that CPTSD often arises after exposure to repetitive or prolonged traumatic events (especially in contexts where escape is difficult) such as chronic abuse, neglect, domestic violence or developmental trauma.
Importantly: recognizing CPTSD isn’t about pathologizing you or labelling you as broken — it’s about naming what’s happening so you can find the right kind of support.
How it shows up in everyday life: key symptoms & impacts
Here are some of the prominent ways CPTSD may show in someone’s life:
Core trauma symptoms (as in PTSD)
Intrusive memories, flashbacks, nightmares about the trauma.
Avoidance of reminders (people, places, thoughts) of the trauma.
A persistent sense of threat or hypervigilance (even though the trauma is in the past).
Disturbances in Self-Organisation (DSO)
Emotion dysregulation: You might oscillate between being overwhelmed by emotions (anger, fear, sadness) and feeling numb or shut down.
Sense of self as broken, worthless, unlovable — a deep-seated shame or guilt that may not fit with what people tell you.
Relationship patterns: You might find it hard to trust others, to feel close, or to repeatedly feel isolated. You might also stay in unsafe relationships or withdraw altogether.
Behavioural impacts: Risk-taking, self-soothing with substances, self-harm, or addictive behaviours are unfortunately common coping responses when the inner pain is intense.
Wider Life Impacts
Because CPTSD affects identity, regulation, and relationships, it often impacts work, school, parenting, friendships, and day-to-day functioning. You might struggle with:
chronic emptiness or purposelessness
“I know I shouldn’t feel this way … why can’t I just move on?”
repeating patterns each weekend (e.g., substances, party behaviour) that you regret
feeling stuck, behind peers, or disconnected from life.
If any or many of these ring true for you — you are not alone, and what you’re experiencing is valid.
Why healing needs both “top-down” and “bottom-up” approaches
Trauma leaves footprints throughout the nervous system, the body, parts of the self, and relational patterns. Effective therapy for CPTSD tends to integrate both top-down (cognitive, relational, internal-parts work) and bottom-up (somatic, nervous system regulation, experiential) pathways.
Top-down approaches
These involve working with thoughts, beliefs, internal parts, and meaning-making. For example:
The modality Internal Family Systems (IFS) helps you compassionately explore internal “parts” (e.g., an anxious part, a hurt part, a self-critic) and develop the Self-led capacity to care for your system. Research is emerging but has shown IFS to be effective in treating PTSD.
Working relationally: building trust, safety, corrective relational experiences, a grounded sense of self in connection.
Bottom-up approaches
These involve the body, nervous system, implicit memories and somatic regulation — crucial especially for the “non-verbal” or preverbal layers of trauma:
Eye Movement Desensitization and Reprocessing (EMDR) is widely researched for trauma and now increasingly for CPTSD. Meta-analysis shows moderate to strong effects for trauma symptoms. For CPTSD specifically: “treatment results are in line with mounting evidence supporting the notion that EMDR therapy is a safe and potentially effective treatment alternative for individuals with CPTSD.”
Accelerated Experiential Dynamic Psychotherapy (AEDP) emphasises somatic-relational change, the body’s capacity to heal, and the transformation of trauma through embodied emotional experience.
Why both matter
If therapy only talks about thoughts, it may miss the body’s “holding” of trauma, the stuck activations, dissociations, shame-body states.
If therapy only focuses on bottom-up regulation but doesn’t integrate meaning, identity and relational repair, then patterns keep repeating.
Integrating both means: You learn to feel safer in your body and nervous system and build a compassionate, resilient self-relationship that can engage meaningfully in life.
Research and clinical guides recommend a phase-based or integrative model: Phase 1 for stability/regulation, Phase 2 for trauma processing, Phase 3 for consolidation & reconnecting to life. In practice, that means we attend to nervous-system and relational safety, build internal resources, then move into deeper reprocessing, then live the recovery in the world.
How I work with CPTSD: What therapy can look like
In my approach at Wild Rose Counselling (North Vancouver), I blend relational safety, parts work, somatic attunement, and trauma-processing so that healing is both deep and embodied. Here’s a rough outline of what you might expect:
Building safety, stabilisation & resource-development
We co-create a safe therapeutic relationship and begin somatic work (grounding, tracking sensations, regulating activation).
I use parts-work (bringing awareness to the internal parts that feel stuck, wounded, or protective) to establish compassionate internal leadership.
You learn internal & external capacity: noticing triggers, learning to respond rather than react, mapping patterns.
Moving into trauma-processing (when you’re ready)
Using EMDR to gently re-process key traumatic memories (old relational wounds, attachment injuries, developmental trauma) in a way that is paced for you and honours nervous-system regulation.
IFS work continues: helping you witness and transform parts that were stuck in shame, fear, helplessness.
experiential somatic work: to access what words alone cannot reach; to transform stuck emotional-physiological patterns.
Integration & living your emerging self
We support you in reconnecting to life: relationships, purpose, body, identity.
Building flexible capacity: when triggers come up (and they will), you have inner leadership, relational support, somatic regulation.
Ongoing growth: you’re not just symptom-free; you’re more present, more alive, more connected.
Who this is for
If you recognize yourself in some of the following, this blog may be relevant for you:
You’ve experienced repeated/interpersonal trauma (child abuse, neglect, domestic violence, attachment wounds, chronic relational betrayal).
You feel stuck in patterns of shame, worthlessness, self-criticism, and repeated harmful relational cycles.
You “know” you should be better by now, yet still find yourself exhausted, disconnected, impulsive, using substances or avoiding life.
You long for a sense of purpose, connection, and inner peace—but the trauma-body keeps pulling you back.
A gentle reminder
Healing is not linear. CPTSD speaks of a deeper wound, so the journey may feel slower at times. But you can heal. You deserve compassionate, body-wise, respectful therapy. You don’t have to keep living from that wounded place.
Naming what’s happening is the first step toward finding the right support. Healing from CPTSD is possible with the right relational container, the right blend of approaches, and most importantly, your own courageous willingness to meet yourself with compassion.
If you’re ready to explore this, lets connect to see if we’re a good fit for this work.
