Complex Post-Traumatic Stress Disorder (C-PTSD or CPTSD) is a condition that can develop when a person has been exposed to prolonged, repeated, or inescapable trauma, especially when escape from the situation was difficult or impossible. This is different from regular PTSD, which often follows a single traumatic event.
C-PTSD was officially recognised as a separate diagnosis in 2018 when the World Health Organization included it in the ICD-11 (International Classification of Diseases, 11th Revision). It is not yet included as a separate diagnosis in the DSM-5 (the American manual), but it is widely recognised in clinical practice.
What Kinds of Trauma Lead to C-PTSD?
C-PTSD typically develops from experiences that are:
Prolonged — lasting months or years, not a single event
Repeated — happening over and over
Inescapable — where the person could not leave or stop what was happening
Common examples include:
Childhood abuse (emotional, physical, or sexual) or neglect
Long-term domestic violence or controlling relationships
Captivity, slavery, or torture
Repeated bullying over many years
Growing up in a household with chronic conflict, addiction, or emotional invalidation
Long-term experiences of war, displacement, or persecution
The Symptoms — Two Layers
C-PTSD includes all the symptoms of PTSD plus three additional groups of symptoms that come from the lasting effects of prolonged trauma:
Layer 1 — PTSD core symptoms:
Re-experiencing the trauma (flashbacks, nightmares, intrusive memories)
Avoiding reminders of the trauma
A constant sense of being on alert (hypervigilance, easily startled)
Layer 2 — "Disturbances in Self-Organisation" (DSO):
Emotional dysregulation — strong emotions that come on quickly and feel hard to manage; or, the opposite, feeling emotionally numb
Negative self-concept — deep feelings of shame, guilt, worthlessness, or feeling "fundamentally broken"
Relationship difficulties — struggling to feel close to others, to trust, or to maintain connections
This second layer is what makes C-PTSD "complex." It is the deeper, slower wound — the way prolonged trauma reshapes how a person sees herself and others.
The Inner Experience
Many sisters with C-PTSD describe their inner world with these recurring themes:
A constant feeling of being unsafe, even when safe
A harsh inner voice that says she is "broken," "too much," or "unlovable"
Difficulty knowing what she feels or needs
Cycling between intense emotions and emotional numbness
Pulling close to people, then pushing them away
Body symptoms — chronic pain, fatigue, digestive issues — that often go alongside the emotional wounds
How C-PTSD Differs From PTSD
Both share core symptoms. The differences are:
PTSD is often more linked to a single event (an accident, an assault, a disaster)
C-PTSD develops from sustained, repeated experiences — and the damage runs deeper into a person's sense of self
C-PTSD typically requires longer, more relationship-focused treatment
Many sisters carry C-PTSD without ever having heard the term. The pain is real. So is the path to healing, bidhnillah.
A Soft Word
If anything in this reflection feels familiar — the constant alertness, the harsh inner voice, the difficulty feeling close to others — please know: you are not broken. What happened to you was real, and it shaped your nervous system in ways that made sense as survival. The same nervous system can be helped to soften, with care, with time, and with the right support.
You are not alone in this. May Allah grant healing to every sister who carries this quiet weight, aameen.
Sources & Further Reading
World Health Organization. International Classification of Diseases (11th Revision). 2022.
Brewin CR, et al. "A review of current evidence regarding the ICD-11 proposals for diagnosing PTSD and complex PTSD." Clinical Psychology Review, 58:1–15, 2017.
Maercker A, et al. "Complex post-traumatic stress disorder." The Lancet, 400(10345):60–72, 2022.
Cloitre M, et al. "ICD-11 complex post-traumatic stress disorder: simplifying diagnosis in trauma populations." British Journal of Psychiatry, 216(3):129–131, 2020.
van der Kolk B. The Body Keeps the Score. Penguin, 2014.
Karatzias T, et al. "Evidence of distinct profiles of posttraumatic stress disorder (PTSD) and complex posttraumatic stress disorder (CPTSD)." Journal of Affective Disorders, 207:181–187, 2017.
UK Trauma Council. Post-traumatic stress disorder (PTSD) and Complex PTSD.