Complex post-traumatic stress disorder
A stress-related disorder from prolonged trauma, with added symptom clusters.
Complex post-traumatic stress disorder (C-PTSD, CPTSD, or cPTSD) is a mental condition tied to stress that typically develops after complex traumas—most often, long or repeated exposure to traumatic events where escape seems impossible. Under the ICD-11 system, C-PTSD falls under post-traumatic stress disorder but includes three extra symptom clusters: trouble regulating emotions, negative beliefs about oneself (like shame, guilt, or feeling a failure for no good reason), and problems with relationships, collectively called disruptions in self-organisation. Symptoms can involve lasting feelings of terror, worthlessness, or helplessness, a warped sense of identity or self, and hypervigilance. Early definitions tied C-PTSD to a specific type of trauma (prolonged and repetitive), but the ICD-11 does not require a particular trauma type.
The World Health Organization’s International Classification of Diseases has recognized C-PTSD since its 2018 revision, which took effect in 2022 (ICD-11). The earlier ICD-10 included a related diagnosis called Enduring Personality Change after Catastrophic Event, which served as a forerunner to C-PTSD. Healthdirect Australia and the British National Health Service also acknowledge C-PTSD as a mental disorder. The American Psychiatric Association, however, has not added C-PTSD to its Diagnostic and Statistical Manual of Mental Disorders. A related condition, Disorders of Extreme Stress – Not Otherwise Specified, was considered for the DSM-IV but ultimately left out; instead, PTSD’s symptom list was broadened in the DSM-IV and later DSM-5 to cover a wider range of responses to all trauma types.
For children, the original PTSD diagnosis was designed for adults who had experienced trauma like war or rape. But children often face chronic trauma—maltreatment, family violence, school bullying, family dysfunction, or disrupted attachment to a primary caregiver—and sometimes the caregiver is the source of the trauma. PTSD does not account for how developmental stages shape children’s symptoms or how trauma affects their growth. The term developmental trauma disorder has been suggested as the childhood counterpart to C-PTSD. This developmental form of trauma raises the risk of other psychiatric and medical conditions. Bessel van der Kolk describes DTD as repeated interpersonal trauma—physical assault, sexual assault, violence, or death
- field
- Mental health / Psychiatry
- known_for
- Stress-related mental disorder with additional symptom clusters beyond PTSD
- classification
- Included in ICD-11 (2018, effective 2022); not included in DSM-5
- related_disorder
- Disorders of Extreme Stress – not otherwise specified (DESNOS)
- childhood_equivalent
- Developmental trauma disorder (DTD)
Lore & Background
Complex post-traumatic stress disorder was first described in relation to prolonged and repetitive traumas, such as childhood maltreatment, family violence, or captivity. The World Health Organization's International Statistical Classification of Diseases included C-PTSD in its eleventh revision, published in 2018 and effective in 2022. The previous edition, ICD-10, proposed a diagnosis of Enduring Personality Change after Catastrophic Event, which was an ancestor of C-PTSD. Healthdirect Australia and the British National Health Service have acknowledged C-PTSD as a mental disorder, while the American Psychiatric Association has not included it in the Diagnostic and Statistical Manual of Mental Disorders.
Reader's Guide
C-PTSD is significant because it expands the understanding of trauma-related disorders beyond the core symptoms of PTSD. In the ICD-11, a person must meet the diagnostic criteria for PTSD—re-experiencing, avoidance, and heightened threat perception—and also exhibit three additional clusters: severe emotional dysregulation, negative self-beliefs such as shame or worthlessness, and difficulties in maintaining close relationships. These symptoms must cause significant impairment. The disorder has been studied in both adults and children, with developmental trauma disorder proposed as its childhood equivalent. A 2025 systematic review and meta-analysis reported pooled prevalences of 2% for PTSD and 4% for C-PTSD among adults in non-war-exposed, economically developed regions, rising to 16% and 15% respectively in war-exposed, less economically developed regions. The International Trauma Questionnaire is a validated self-report measure for assessing ICD-11 C-PTSD.
Did You Know?
- C-PTSD was considered for inclusion in the DSM-IV but was excluded from the 1994 publication.
- The ICD-11 includes C-PTSD as a paired diagnosis with PTSD, requiring all PTSD criteria plus three additional symptom clusters.
- A 2025 systematic review found C-PTSD prevalence of 4% in non-war-exposed developed countries and 15% in war-exposed less developed countries.
- The term developmental trauma disorder has been proposed as the childhood equivalent of C-PTSD.
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