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Dr Liam Parsonage

Page medically reviewed by Dr Liam Parsonage (BA, MBBS, MRCPsych, PGCert) Consultant Psychiatrist at Priory Hospital North London

Children who experience early childhood trauma, abuse or neglect are at risk of not developing properly, which can have lasting effects on many areas of their health in the future - as the American Academy of Paediatrics details. One such area is their mental health, where children are at risk of developing profound and long-lasting mental health problems into adulthood, such as complex PTSD (CPTSD).

What is CPTSD?

CPTSD is very similar to PTSD in that it's a type of anxiety disorder that's related to a traumatic event that has occurred in your past. This event is the trigger of a variety of PTSD symptoms such as reliving the trauma in nightmares and severe levels of anger, anxiety and guilt. 

The risk of developing CPTSD is greater if the trauma or abuse is repetitive and prolonged, involves harm or abandonment by caregivers and if it occurs at a developmentally vulnerable age such as early childhood or adolescence, which are critical periods of brain development.


CPTSD differs from PTSD in one significant way, which is that the latter is more typically associated with a single traumatic incident or set of traumatic events.

How CPTSD works

PTSD in childhood affects the development of your brain at a crucial time in your life. The amygdala, part of the limbic system, is the brain’s ‘smoke detector’ and emotional memory centre. The amygdala is triggered if it senses any kind of threat or danger and causes the brain stem to react instinctively and activate the fight, flight or freeze response. This causes an increase in heart rate, breathing rate and muscle tension.

The ‘thinking part of the brain’ (the neocortex), becomes less active and shuts down. At times of danger, we become overwhelmed by feelings and impulses and we don’t think about or contextualise our experiences – we simply react to the danger rather than thinking about it. This evolutionary response to danger takes the fast route via the amygdala, rather than the longer thinking route via the cortex, which has aided our survival. After the danger has passed, the normal response is for the thinking brain to then react, regulate responses, plan, problem solve, and allow arousal levels to return to baseline.

The amygdala is over-sensitive and the capacity of the thinking brain is reduced in people who've been exposed to trauma in childhood and develop CPTSD. Memories have not been processed and fully integrated into autobiographical memory and they remain stuck in implicit (feeling) memory. Flashbacks and re-living of the trauma occur because the amygdala has kicked in and the hippocampus has gone ‘offline’ and is unable to contextualise the memory in the moment. Traumatic memories are therefore ‘re-experienced’ rather than ‘remembered’

The neurological systems that process emotions are significantly compromised in people who've experienced chronic childhood trauma:

  • Chronic stress reduces the size and functioning in the area of the brain that processes memory
  • The amygdala is overstimulated and is in constant overdrive
  • High levels of cortisol make it harder to learn and block memories forming
  • The brains of people with CPTSD show an enhanced sensitivity to threat and are usually in a chronic state of ‘red alert’

What does childhood trauma look like in adults? The symptoms of CPTSD

Trauma survivors can present with a wide range of problems and symptoms, ranging from physical, psychological and maladaptive coping strategies and may report any of the following:

  • Re-experiencing or re-living unwanted memories as flashbacks or nightmares
  • Hyper-arousal: problems with sleep, irritability, anger, anxiety, hyper-alertness, exaggerated startle response
  • Hypo-arousal: feeling numb or cut off, feeling detached from others, dissociating, feeling flat or empty
  • Emotional dysregulation
  • Negative self-concept
  • Relationship difficulties
  • Avoiding thinking or talking about trauma related topics
  • Abuse of alcohol or abuse of substances to avoid and numb their feelings
  • Engaging in self-harm or having suicidal thoughts

Diagnosis of CPTSD

People who have CPTSD often present with co-morbid psychiatric conditions and patients will often not disclose that they've experienced a trauma in their childhood and therefore present with another mental health or physical health problem, relationship or behavioural problems. Other conditions that patients with CPTSD might present with include eating disorders, psychosis, dissociative disorder, emotionally unstable personality disorder (EUPD) and chronic pain.

Practical techniques for emotional stability

  • Psychoeducation: much like physical education in school, psychoeducation involves learning about and understanding mental health and wellbeing
  • Grounding techniques: mental thought processes can help redirect your thoughts away from the distress you're feeling about a past event and bring you back to the present
  • Breathing strategies: calming your body's reaction to stress and anxiety can help you to deal with symptoms in the moment when they occur 
  • Relaxation: mindfulness and meditation to foster a calmer self in your daily life
  • Trigger awareness: techniques that help you to identify and cope with potential triggers for your symptom's
  • Sleep hygiene: sleep disturbance is a big issue for CPTSD sufferers. Sleep hygiene allows you to be in the best possible place to sleep each night
  • Understanding anger: lay the groundwork for understanding the anger you feel towards your traumatic event. This is something therapy is especially effective at delving into

Surrounding yourself with people who know how to help someone with PTSD can also be beneficial as they can offer their support when you need them. 

Education on the neurobiology of trauma

It can be helpful to explain the neurobiology of trauma to patients to help them understand why they have such intense reactions to everyday experiences which don’t affect others in the same way. Tell them about the three complex sections of the brain (the brainstem, the limbic system and the neocortex), and how they combine to result in adult PTSD.

Discussion of or referral for specialist treatment

Most people who have CPTSD will need specialist intervention to confirm the diagnosis, manage risk, formulate an appropriate treatment plan and gain access to talking therapies.

Treatment for CPTSD

Trauma-focused cognitive behavioural therapy (CBT)

Trauma-focused CBT is an evidenced-based, National Institute for Health and Care Excellence (NICE)-recommended talking therapy which has been developed from CBT to specifically help people who have experienced trauma. The recommendation is 8 to 12 individual weekly sessions for an hour with the same therapist each week.

Eye movement desensitisation and reprocessing (EMDR)

EMDR is another NICE-recommended treatment for people who have experienced trauma and often re-live the events as nightmares and flashbacks.

EMDR involves recalling the traumatic event whilst making rhythmic eye movements similar to the eye movements we make whilst we sleep and are processing memories. This helps the brain to process the traumatic experiences and reduce the emotional content so that rather than re-living the experience, the experience becomes a memory, and the distressing symptoms associated with the traumatic event are reduced. 

5-day trauma programme

The 5-day trauma programme is offered at Priory locations in the UK and is based on Pia Mellody’s post induction therapy (PIT) – a method that's widely used in the USA. The PIT approach utilises an eclectic mix of therapy and treatment models, bringing together elements of psychoanalysis, gestalt therapy (gestalt helps people to focus on their immediate thoughts, feelings and behaviours and to better understand the way they relate to others), family systems therapy, transactional analysis therapy and rational emotive therapy.

By using educational and experiential processes, the programme helps patients to identify and address their childhood trauma and family-of-origin issues. Once these issues are identified, patients are able to explore ways to deal with the emotions that accompany their past traumatic events, and how to resolve the resulting grief and distress.


Medications are not the key to treatment of CPTSD but should be used to target specific symptoms, for example antidepressants for low mood, or mood stabilisers for mood instability.

CPTSD Treatment at Priory

Priory is a leading provider of mental health treatment in the UK. With world class teams of psychiatrists, therapists and other mental health professionals at purpose-built facilities across the country, we can help diagnose and treat the symptoms of CPTSD that have been holding you back for so long. 

Get in touch with the team at Priory using the information below for a compassionate discussion about the problems you've been facing with CPTSD and how our treatment can help you regain control of your life.

It’s important to understand that you don’t have to struggle with the traumas of your past. Effective treatment can help you to overcome your symptoms, develop an understanding of why you feel the way you do, and support you every step of the way towards recovery.

Get in touch today

For details of how Priory can provide you with assistance regarding mental health and wellbeing, please call 0330 056 6020 or click here to submit an enquiry form. For professionals looking to make a referral, please click here

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