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What Is Complex PTSD & How Does PTSD Affect Relationships?

how does ptsd affect relationships

Do you or a loved one suffer with PTSD or CPTSD? You’ve likely heard the term post-traumatic stress disorder, or PTSD. But what is Complex PTSD? And how does it affect relationships? Profoundly…let me explain.

CPTSD is a relatively new diagnosis. It was first included in the 11th version of the International Classification of Diseases (ICD-11) of the World Health Organization (WHO) in June of 2018. It was a subset of criteria for post-traumatic stress disorder.

Many behavioral scientists see the CPTSD diagnosis as a significant step forward in recognizing the traumatic causes of problems. Problems that often look like personality disorders or relationship dysfunction. Or may explain why some people struggle with addictions.

The difference between PTSD and CPTSD has to do with how the trauma developed as well as its symptoms..

This article will help you understand who CPTSD affects, how it’s diagnosed, and the effect it has on relationships.

What is CPTSD and who does it affect?

CPTSD affects people of all ages. And most of the time it is due to childhood sexual abuse. See: However the cause can be repeated trauma in adolescence or adult life.

Younger traumatized children can begin to show signs of developing CPTSD. And it’s common for them to have problems with bed wetting and loss of speech. They may re-enact trauma during their playtime. They are often clingy. And it may be difficult for their parents to soothe them.

People who are unemployed, unmarried, living alone and taking psychotropic medication are more likely to have CPTSD. (Karatzias et al., 2017).

Females appear to be twice as likely than males to have CPTSD. (Hyland et al., 2017) However females are not any more likely than males to have PTSD. This is most likely due to higher rates of childhood sexual abuse for females.

How Many People Struggle with PTSD and CPTSD?

About 7.3% of Americans will get PTSD sometime in their lives. And about 4% of those who get PTSD will also meet criteria for a diagnosis of CPTSD.

About twice as many women suffer from CPTSD than men do. Another study found that 21% of children who were abused in institutional settings have CPTSD.

It’s interesting to note that about 25 to 50% of veterans who have PTSD also have CPTSD.

Any kind of life threatening event is a shock to a person’s neurological system. It puts the brain’s amygdala on high alert for danger. So this can throw your nervous system into an ongoing state of fear.

Symptoms may result from changes in some regions of the brain that deal with emotion, memory, and reasoning. Affected areas may include the amygdala, the hippocampus, and the prefrontal cortex.

How we diagnose CPTSD

The concept of Complex Post-traumatic Stress Disorder was developed in 1992 by Judith Herman. She said, “The syndrome that follows upon prolonged, repeated trauma needs its own name. I propose to call it complex post-traumatic stress disorder.” CPTSD requires a diagnosis of PTSD + CPTSD.

What is PTSD?

Post-traumatic stress disorder (PTSD) is a disorder that may develop following exposure to an extremely threatening or horrific event or series of events.

The following symptoms must persist for at least several weeks and cause significant impairment in personal, family, social, educational, occupational or other important areas of functioning.

Re-experiencing symptoms:

  • Flashbacks—reliving the trauma over and over. This can include physical symptoms like a racing heart or sweating
  • Nightmares
  • Strong overwhelming emotions of fear or horror with strong physical sensations

Re-experiencing symptoms are often triggered by reminders of the trauma. These reminders can be in the person’s thoughts, or can be people, places or things that trigger a trauma memory. Once triggered the person can feel like he or she is re-living the event.

Avoidance symptoms:

Avoidance of places, events, or objects that are reminders of the experience

Avoiding thoughts or feelings related to the traumatic event. These avoidance symptoms can cause a person to not go to places where they might see someone who is a trigger. Or to simply stay away from geographic locations where a traumatic event has occurred. This can mean avoiding entire cities.

Arousal and reactivity symptoms:

  • Hyper-vigilance, which is an enhanced startle response to noises or things that appear dangerous
  • Feeling tense or “on edge”
  • Having difficulty sleeping, and/or having angry outbursts

PTSD is categorized as an anxiety disorder. That said, being easily startled, “on edge”, having difficulty sleeping and having angry outbursts are a result of being in a constant state of anxiety.

What is Complex PTSD and how does it affect relationships?

Complex post-traumatic stress disorder (CPTSD) develops when people are exposed to an event or series of prolonged traumatic threatening events from which escape is difficult or impossible.

These events include:

  • Torture, slavery, genocide campaigns
  • Prolonged domestic violence
  • Repeated childhood sexual or physical abuse

A CPTSD diagnosis requires that all diagnostic requirements for PTSD are met. In addition, Complex PTSD is characterized by “severe and persistent” symptoms.

The symptoms for CPTSD include:

  • Problems in affect regulation
  • 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. These symptoms cause significant impairment in personal, family, social, educational, occupational or other important areas of functioning.

How does Complex PTSD affect relationships?

The years of exposure to severe trauma makes it very difficult to form safe intimate attached relationships. Because the traumatic emotional memory is so embedded it affects a person’s view of self and others. And it affects how they regulate their own emotions and perceptions.

A negative self-view

CPTSD can cause people to struggle with deep feelings of self-hatred and shame. And they often feel damaged and not worthy of the love of others. So it can be frightening to get close in relationships. There is often a fear of rejection once people discover who they really are. This creates a self-fulfilling prophecy. By pushing others away, they feel alone and unacceptable. So on and on it goes, with the reinforcement of their negative self-view.

Changes in beliefs and worldview

It’s difficult for people to maintain a positive worldview when years of chaotic prolonged abuse have plagued them. They lose faith that their lives can improve. And their belief that God loves them unconditionally.

CPTSD can cause people to be constantly changing beliefs. Perhaps in search for love and security, and this can create relationship difficulties. The partner of the CPTSD person may be frustrated adjusting to the fluctuating worldviews, which may result in lifestyle changes, new spiritual practices, or political agendas.

Emotional regulation difficulties

Healthy human beings will self-regulate and co-regulate emotions. They know how to manage their own emotions using meditation or exercise. Or by slowing down, reading a great book or enjoying nature. And they know how to soothe themselves with positive self-talk.

People with CPTSD don’t learn these skills. And they most likely never saw family members manage their own emotions in a healthy way. They grew up in families that use anger, abuse and addiction to deal with overwhelming emotions.

This causes them to be difficult to live with. As a result their partners may try to keep them at a safe distance in order to stay out of their emotional whirlwind.

Humans turn to the people they love for emotional support. It’s in their wiring. Relationships have to be safe in order to do this well. But the chaotic internal world of CPTSD makes it difficult for him or her to send out consistent emotional signals that the partner can read and respond to. Emotional co-regulation becomes difficult or impossible.

People can lose control of their emotions when they have problems with emotional self and co-regulation. As a result they may experience intense anger or sadness. They may have thoughts of suicide.

Difficulty Trusting Others

People with CPTSD have trouble trusting the people they love the most. Trust in relationships is built on emotional predictability and comfort. So when there are emotional self and co-regulation problems in a love relationship, a couple will have problems building trust. The longer the trust problem lasts the greater the trust problem becomes.

Over time the couple will struggle with negative cycle arguments. We call them attack-attack arguments. Each likely feels that they are on trial by an attorney.

The same is often true when it comes to trusting children and other family members. The person with CPTSD does not generally have a felt sense of trust their relationships. Because they cannot extend trust, trust isn’t returned. So the feeling of being defective persists. And the reality of isolation persists, often causing chronic feelings of abandonment.

Detachment from the trauma

The brain tries to protect us from harm. It knows how to detach from trauma emotion. And people who are repeatedly traumatized can actually go to a different safe place in their minds. They dissociate or disconnect from their bodies. Their emotions. And their pain. And they can even disconnect from the terrible reality of what is happening to them.

When stress or fear levels are high, dissociation can become a go-to way of coping. And it’s often involuntary. People usually begin to do it unconsciously. It’s their way of getting relief from whatever seems overwhelming in the present moment.

This can make it difficult to work through conflict in relationships. When the tension in the conversation rises, the person with CPTSD can leave the room. Mentally and emotionally. And this can cause the other person to feel angry and abandoned.

Preoccupation with an abuser

If you are married to a person with CPTSD there is often a third person in the relationship.Tthe abuser.

Those who’ve been traumatized for months or years never want this to happen to them again. Because they are on the lookout to protect themselves from the dangerous “bad guy.”

The partner who betrays a person with CPTSD becomes the bad guy. So forgiveness and moving the relationship forward will become quite difficult. Relationships eventually fall apart when there is no trust.

Why the CPTSD diagnosis is important for relationships

The addition of CPTSD as a sub category of PTSD is important because it distinguishes those people who have more severe trauma symptoms from those who suffer from PTSD alone. CPTSD symptoms can make it especially difficult to build a secure relationship. Therefore, understanding what Complex PTSD is and how it affects relationships is critical.

Researchers have found that there is a great deal of overlap between the CPTSD diagnosis and the Borderline Personality (BPD) diagnosis.

This diagnosis fits the Emotionally Focused Couples Therapy approach with couples who approach major relationship conflict from a trauma perspective, rather than a personality disorder.

We give meaning to a couples distress when we understand their fear from a trauma perspective. It is then that both parties can make sense out of the negative fearful cycle of conflict.

It’s difficult for couples to realize that they long for deep attachment security when emotional trauma memory is front and center in a relationship. So therapists and couples must not only understand Complex PTSD but also how PTSD affects relationships.

The CPTSD diagnosis has the potential to help all relationship therapists to develop more targeted interventions that will decrease fear and dissociation and increase secure emotional co-regulation and trust.

I’m Michael W. Regier, Ph.D. I’m a highly trained and experienced clinical psychologist and Certified Emotionally Focused Couples Therapist.  I help couples throughout California via teletherapy or in my office in San Luis Obispo, CA.  I help couples and therapists understand the challenges of PTSD and how it affects relationships. With my wife Paula, I co-authored Emotional Connection: The Story & Science of Preventing Conflict & Creating Lifetime Love.

This article was originally published on and is reprinted here with permission.






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