Complex post-traumatic stress disorder (c.PTSD) is a formal clinical diagnosis, classed in the World Health Organisation’s diagnostic manual, the ICD-11, as a ‘disorder specifically associated with stress’.  It has earned its place in our glossary as c.PTSD is a common co-occurring condition for us neurodivergents.

I’d recommend reading the glossary entry on PTSD before reading any further here. Firstly, for some important background information and also because the criteria for diagnosing PTSD include three components, as described under the items numbered 1 to 3 on that page. Click here to go to the PTSD page.

One of the key differences between PTSD and c.PTSD is that the latter is the result of a series of traumas often, but not always, beginning in childhood and building up over time. For some people, c.PTSD will be unrelated to childhood and can have arisen as the result of ongoing/repeated trauma throughout adulthood – this is particularly relevant to us as vulnerable adults.

Neurodivergents and complex PTSD: Neurodivergents, as we know, experience daily struggles to navigate, and be understood, in a world designed by and for neurotypical people. We are all too often the victims of abuse, of all kinds, from people who seek to take advantage of our vulnerabilities, our trust and our need for support. This, sadly, means that our exposure to trauma is greatly increased compared to the majority, and this increased vulnerability doesn’t diminish as we grow older – we are ongoingly disabled by the environment in which we live, and all that goes with that.

An additional hurdle is one we may face at the diagnostic stage. Many autistics struggle to recognise and express our own emotions (co-occurring alexithymia). So diagnosing any condition is that much harder when we struggle to relate what we’re feeling and thinking. So c.PTSD, autism, ADHD, depression and so many other conditions that overlap in symptoms can remain hidden for a very long time, maybe even permanently.

Back to c.PTSD. So, we’ve established the three key points (numbered on the PTSD page) that must be met to consider a diagnosis. In addition to those, a clinician will consider complex PTSD if the following conditions are met (apologies again for the clinical writing style):

  • As with PTSD, it is being exposed to an event or multiple events/situations ‘of an extremely threatening or horrific nature’, including victimization.
  • Additionally, these are ‘most commonly prolonged or repetitive events from which escape is difficult or impossible’.
  • The three core features that are essential for the complex part of PTSD, in addition to the three core elements of PTSD, are:
    • Ongoing serious problems with ‘affect regulation’. This describes such things as extreme emotional reactions to minor incidents, anger, violence, self-harm, addictive behaviours, impulsive and reckless acts. It also includes the feeling of being numb to any emotion – good or bad, feelings of being dissociated from oneself.
    • Very poor self-esteem, shame, guilt, not having got out of the situation that caused the trauma, not having saved others from it, feeling that we are unworthy and that we are without value.
    • Relationship difficulties of all kinds. Both sustaining existing ones and forming and maintaining new ones. We can find ourselves shying away from relationships, ending them on purpose, in order to avoid closeness. We may experience occasional very intense relationships but these tend to burn themselves out.
    • As with PTSD, these elements affect all areas of everyday life and make continuing to participate in the world very difficult.
  • These aspects may also be present but are not essential:
    • Suicidal ideation or suicide attempts.
    • Addictions in the form of drugs and alcohol.
    • Depression
    • Psychosis – hallucinations, confused thinking and delusional thoughts and behaviours.
    • Physical ailments such as headaches and stomach problems.
  • As with the PTSD diagnostic criteria, many people experience prolonged trauma and don’t experience all of these negative symptoms – each person is different.
  • c.PTSD symptoms are thought to be more extreme and more prolonged than PTSD and are more likely to have begun in childhood
  • As with PTSD, greater numbers of females are diagnosed with c.PTSD and the symptoms are known to have a greater impact on our ability to function.

For the full detail on this diagnosis, here is the link to the ICD-11 diagnostic information for c.PTSD.

If you are in need of urgent and/or ongoing support you will find links on the PTSD glossary page, by clicking here and scrolling to the end → PTSD (post-traumatic stress disorder)

The UK charity, Mind has lots of useful information about c.PTSD → click here.