You may have come across the term complex PTSD, sometimes written CPTSD, online, in a book or from a therapist. It is an official diagnosis in one classification system and not in another, which causes confusion.
This article explains where the term comes from, what it adds to PTSD, how common it appears to be, and what is and is not known about treatment. It describes a diagnosis. It cannot tell you whether that diagnosis applies to you. Only a clinician can assess that.
What is complex PTSD?
It is a diagnosis in ICD-11, the international classification published by the World Health Organization (WHO). ICD-11 describes it as "a disorder that may develop following exposure to an event or series of events of an extremely threatening or horrific nature, most commonly prolonged or repetitive events from which escape is difficult or impossible."
Under ICD-11, all the diagnostic requirements for PTSD must be met. In addition, there are three kinds of severe and persistent difficulty:
- "problems in affect regulation," which in plain words means trouble managing emotions;
- "beliefs about oneself as diminished, defeated or worthless, accompanied by feelings of shame, guilt or failure related to the traumatic event";
- "difficulties in sustaining relationships and in feeling close to others."
ICD-11 adds that these symptoms cause significant impairment in important areas of life, such as family, work or education. The PTSD requirements themselves are described in PTSD symptoms.
Why is it not a separate diagnosis in the American manual?
Because the two systems disagree. The VA's National Center for PTSD says: "There is not agreement among these classification systems as to whether complex PTSD is its own unique disorder." In the DSM, the manual used in the U.S., the PTSD diagnosis already covers a broad range of symptoms, including changes in the way people see themselves and difficulty feeling connected to other people. In the VA's words: "There is not a separate complex PTSD diagnosis, because it is captured by the diagnosis of PTSD."
ICD-11 has two separate diagnoses, and a person can have only one or the other. The VA notes that the complex PTSD diagnosis was added in the 11th edition, published in 2022.
In practice, the VA says, complex PTSD "is not often given as an official diagnosis" in the U.S., and "Some providers may use the terms in place of each other." If a clinician here uses the term, you can ask what they mean by it.
What kinds of experiences is it linked to?
The VA says the idea refers to traumas that were long-lasting, happened during childhood and involved harm from another person, especially a person who was trusted. People who went through them, it says, "may find changes in their personality, their ability to have meaningful relationships, and their ability to manage strong emotions."
The type of event does not settle the diagnosis, though. The VA says "any type of trauma can be related to PTSD or complex PTSD," and that repeated, personal, childhood traumas are more likely to lead to complex PTSD but "this is not always the case." Childhood trauma in adults looks at early experiences more closely.
How common is complex PTSD?
One U.S. study gives an estimate. Cloitre and colleagues (2019) assessed a population-based sample of U.S. adults using ICD-11 criteria. They reported that 7.2% met criteria for one of the two diagnoses: 3.4% for PTSD and 3.8% for complex PTSD. Women were more likely than men to meet criteria for both. Cumulative childhood trauma was more strongly associated with complex PTSD than with PTSD.
Read the figures with care. This was one survey, it relied on a self-report measure of current symptoms, and the published summary does not give the sample size.
What is known about treating complex PTSD?
Less than for PTSD, and the sources say so. The VA says "there has been less research" and that "There is a lot of misinformation about treatments for complex PTSD." Its position is: "Trauma-focused treatments, which are the most effective for PTSD, also treat complex PTSD. This is a good place to start." It adds that once PTSD has been treated, some other concerns, such as depression or relationship health, may still need to be addressed.
The International Society for Traumatic Stress Studies (ISTSS) said in a 2018 position paper that treatment of complex PTSD "may involve greater diversity of treatment interventions and/or longer duration," but that "there are no clinical studies to date addressing the need for or potential benefits of applying different treatments to each disorder."
A 2019 meta-analysis by Karatzias and colleagues pooled 51 randomized trials of psychological treatments for PTSD in samples likely to have significant levels of complex PTSD symptoms. Cognitive behavioral therapy, exposure alone and EMDR did better than usual care for PTSD symptoms. The benefits were smaller when the comparison was a non-specific intervention, and one analysis suggested that childhood-onset trauma was associated with a poorer outcome. The main limit: the trials predate the ICD-11 diagnosis, so the participants had not been diagnosed with complex PTSD.
Do you need a stabilization phase before trauma-focused work?
This is debated, and the evidence is mixed. Earlier expert guidelines said therapy for adults with complex PTSD should start with a "stabilization phase." A 2016 review describes that phase as teaching self-regulation strategies so that a person is better able to tolerate trauma-focused treatment. Three pieces of research frame the argument.
Against requiring it. A 2016 critical review by De Jongh and colleagues, 21 authors in all, concluded that the research supporting the need for phase-based treatment "is methodologically limited." They found no rigorous research showing that a phase-based approach is necessary, that front-line trauma-focused treatments carry unacceptable risks for adults with complex PTSD, or that people profit significantly more when a stabilization phase comes first. They warned that guidelines may be too conservative, so that people are denied or delayed in receiving evidence-based treatment. It is an argument paper, not a trial.
For it. A 2010 randomized trial by Cloitre and colleagues assigned 104 women with PTSD related to childhood abuse to one of three sequences. Sustained and full remission of PTSD was reached by 27% with skills training followed by exposure, 13% with skills training followed by supportive counseling, and 0% with supportive counseling followed by exposure. The skills-then-exposure group also had fewer cases of PTSD worsening than either of the others. Limits: one trial, women only, and modest remission rates in every group.
A later direct test. A 2021 Dutch trial by Oprel and colleagues randomly assigned 149 adults with PTSD related to childhood abuse to prolonged exposure, an intensified form of it, or eight skills sessions followed by eight exposure sessions. All three produced large improvements in PTSD symptoms at one-year follow-up, "with no significant differences among treatments," and dropout rates did not differ significantly. Limits: a single trial, and every group received exposure.
The VA sums up phase-based treatments this way: "we don't yet know if they work better than trauma-focused treatment alone." NICE, the United Kingdom's guideline body, advises building in extra time to develop trust with people who have complex PTSD, by increasing the duration or the number of therapy sessions according to the person's needs.
What does this mean if you are looking for help?
Whichever term a clinician uses, you can ask what they mean by it and what treatment they would suggest. For PTSD, U.S. guidelines most strongly recommend specific trauma-focused psychotherapies. The 2023 VA/DoD guideline names cognitive processing therapy, EMDR and prolonged exposure. The American Psychological Association's 2025 guideline names cognitive processing therapy, prolonged exposure and trauma-focused cognitive behavioral therapy, and gives EMDR a conditional recommendation. Both found insufficient evidence to recommend for or against psychodynamic therapy, which has been studied much less for PTSD. Types of trauma therapy sets this out.
Dr. Rabin's trauma therapy page speaks of PTSD, complex trauma and developmental trauma, and of trouble trusting, shame and a harsh inner critic. (Developmental trauma is a descriptive term, not a formal diagnosis.) Her approach is psychodynamic, attachment-based, trauma-informed and mindfulness-based. The work moves at the client's pace and builds trust and stability before approaching painful material, and the client decides what is discussed and when.
You can request a free consultation of about 15 minutes through the contact page and ask whether she offers a specific trauma-focused treatment or would refer you. If you are thinking about harming yourself, call or text 988, or call 911 in an emergency.
Keep reading
Sources
- World Health Organization, ICD-11 for Mortality and Morbidity Statistics, 6B41 Complex post traumatic stress disorder (2025-01 release)
- VA National Center for PTSD, Complex PTSD (last updated September 29, 2026)
- Cloitre M, Hyland P, Bisson JI et al., ICD-11 Posttraumatic Stress Disorder and Complex Posttraumatic Stress Disorder in the United States: A Population-Based Study. J Trauma Stress (2019)
- International Society for Traumatic Stress Studies, ISTSS Guidelines Position Paper on Complex PTSD in Adults (2018)
- Karatzias T, Murphy P, Cloitre M et al., Psychological interventions for ICD-11 complex PTSD symptoms: systematic review and meta-analysis. Psychol Med (2019)
- De Jongh A, Resick PA, Zoellner LA et al., Critical analysis of the current treatment guidelines for complex PTSD in adults. Depress Anxiety (2016)
- Cloitre M, Stovall-McClough KC, Nooner K et al., Treatment for PTSD related to childhood abuse: a randomized controlled trial. Am J Psychiatry (2010)
- Oprel DAC, Hoeboer CM, Schoorl M et al., Effect of Prolonged Exposure, intensified Prolonged Exposure and STAIR+Prolonged Exposure in patients with PTSD related to childhood abuse: a randomized controlled trial. Eur J Psychotraumatol (2021)
- NICE (UK), Post-traumatic stress disorder, NG116, Recommendations (2018)
- U.S. Department of Veterans Affairs and Department of Defense, VA/DoD Clinical Practice Guideline for Management of Posttraumatic Stress Disorder and Acute Stress Disorder (June 2023)
- American Psychological Association, Clinical Practice Guideline for the Treatment of Posttraumatic Stress Disorder (PTSD) in Adults (2025)
- Bremness A, Polzin W, Commentary: Developmental Trauma Disorder: A Missed Opportunity in DSM V. Journal of the Canadian Academy of Child and Adolescent Psychiatry (2014)
Last reviewed October 2026. This guide is general information, not medical advice or a diagnosis. If you are in crisis or thinking about harming yourself, call or text 988, or call 911 in an emergency.
