What Is Complex Trauma (C-PTSD) Explained by a Somatic Therapist
Complex Post-Traumatic Stress Disorder (C-PTSD)
Complex post-traumatic stress disorder, often shortened to C-PTSD, describes the lasting impact of prolonged, repeated trauma, particularly trauma that happens within relationships and begins in childhood. In this post I explore how complex PTSD came to be recognised, how it differs from PTSD and why somatic therapy can be such a supportive approach to recovery.
"intergenerational trauma is the transfer of trauma from one generation of survivors to the next. Genocide, colonisation, historical oppression, gender oppression, cultural suppression... structures of pain and violence can and do affect communities, families, parenting techniques, abusive patterns and coping mechanisms. They affect our relationship, with our bodies and ourselves" Tutu Mora (@Tutu_Mora)
How did PTSD come to be recognised?
After many years of debate, post-traumatic stress disorder was included in the third edition of the American Diagnostic and Statistical Manual of Mental Disorders, known as the DSM-III, in 1980. This was a significant shift. Until then, the manual had largely described and categorised symptoms without pointing to their causes, whereas PTSD named a clear origin, a traumatic event that drives the psychological symptoms that follow.
What is complex PTSD?
In the early 1990s, as the trauma field was growing, the psychiatrist Judith Herman argued in her book Trauma and Recovery that the PTSD diagnosis did not go far enough. She observed that people who had lived through prolonged, repeated trauma, especially ongoing abuse in childhood, often experienced a much more complex set of difficulties, including lasting changes in how they related to others and how they saw themselves. Concluding that this pattern of suffering "needs its own name", she proposed calling it complex post-traumatic stress disorder.
Around the same time, the psychiatrist Lenore Terr described two broad types of childhood trauma. Type I trauma refers to a single, sudden event, sometimes called shock trauma, while Type II trauma refers to experiences that are prolonged or repeated, which is much closer to what we now call complex trauma.
Despite the strength of these arguments, recognising complex trauma met resistance within traditional and academic psychology for many years. This mattered a great deal, because whether a condition is formally recognised shapes clinical treatment, research, funding and public policy.
In June 2018, the World Health Organization released the eleventh edition of its International Classification of Diseases, the ICD-11, which included complex PTSD as a distinct diagnosis for the first time. It came into effect worldwide on 1 January 2022. Complex PTSD is still not included as a separate diagnosis in the American DSM, although it is recognised in the ICD-11, which is the system used by the NHS and in many countries around the world.
How is complex PTSD different from PTSD?
In the ICD-11, PTSD is described through three core features, which are re-experiencing the trauma, avoiding reminders of it and a persistent sense of current threat. Complex PTSD includes all three of these, along with three further areas that the WHO describes as disturbances in self-organisation.
The first of these additional areas is affect dysregulation, which describes ongoing difficulty regulating emotions. It can include a wider sense of being out of control of your body and reactions, and in more intense forms, disconnecting or dissociating from your physical, emotional and mental experience.
The second is negative self-concept, which describes persistent difficulties with identity, such as deeply held beliefs that you are shameful, bad, worthless or somehow contaminated. In more intense forms, this can feel like having a fragmented sense of self, or very little sense of self at all.
The third is difficulties in relationships, which describes ongoing struggles to feel close to others and to sustain connection, whether in friendships, intimate relationships or parenting. Some people find themselves feeling persistently disconnected, and others may avoid relationships altogether.
What causes complex PTSD?
Complex trauma tends to develop through long-term exposure to relational and emotional harm in situations where a person has little or no control and little or no hope of escape. When this happens in childhood, in response to failures of care and attachment, it is often called developmental trauma. A key feature is that the child depends on the very adults who are causing harm or failing to provide safety.
Complex trauma can also affect adults, for example through domestic abuse, long-term captivity, torture or trafficking. It can arise from wider systemic, cultural and intergenerational harm as well, and it often sits alongside experiences of shock trauma, which is one reason it can be difficult to recognise.
The landmark Adverse Childhood Experiences study, published by Vincent Felitti and colleagues in 1998, found strong links between childhood experiences such as abuse, neglect, witnessing domestic violence and living with a parent who misused substances, and a wide range of later difficulties in adult health and wellbeing. Many of these experiences are ongoing and familiar rather than dramatic or obviously life-threatening, which is part of what makes developmental trauma so easy to overlook.
Why is the complex PTSD diagnosis so important?
The complex PTSD diagnosis offers a framework for understanding suffering that has often been misunderstood. Many children who have experienced relational trauma are given labels that describe their behaviour without recognising the trauma beneath it, and the same is true for many adolescents and adults, who may receive diagnoses such as anxiety, depression, sleep or eating difficulties, dissociative conditions or personality disorders. These diagnoses can be helpful in their own right, although on their own they may miss the pervasive impact that early trauma can have on development.
For people who have spent years feeling helpless and unable to make sense of their suffering, the complex PTSD diagnosis can bring real relief and hope. It shifts the question from "what is wrong with me?" towards "what happened to me, and how did I adapt?", which opens the door to more compassionate and effective support. Recognising complex trauma may also help us understand some of the wider challenges it is associated with, including substance misuse, self-harm, chronic illness and repeating cycles of harm within families and communities.
How does complex trauma affect the nervous system?
One way to understand the difference between shock trauma and complex trauma is to look at what each one threatens.
Imagine walking beneath a tree when a large branch suddenly cracks and falls towards you. Before you have time to think, your body moves you out of the way. This is a survival response, often described as fight, flight or freeze, and it happens largely in the older, faster parts of the brain that are designed to protect us from immediate physical danger. Shock trauma is centred on this kind of threat to life.
Relational trauma is different. When the danger comes from the very people a child depends on for connection, comfort and love, the child is caught in an impossible bind, because the source of safety is also the source of threat. The threat here is less about physical survival and more about the security of the child's developing sense of self. For a young child who is completely dependent on their caregivers, a lack of connection and love can feel like a threat to their very existence.
For this reason, complex trauma tends to shape much more than the immediate survival response. It can affect how a person learns to regulate emotions, how they see themselves and how they relate to others, which are exactly the areas the ICD-11 describes. While fear is certainly part of relational trauma, many therapists and researchers see shame as playing an especially central role, since it is so closely tied to our sense of who we are and whether we belong.
Why is somatic therapy helpful for complex PTSD?
From a somatic point of view, one of the most important features of complex PTSD is affect dysregulation, the difficulty in regulating emotional and bodily states. Because relational trauma shapes the nervous system, many people living with it experience difficulties with sleep, eating, impulse control or intimacy, as well as anxiety, depression, panic, numbness or pain. These can then ripple out into relationships, parenting and work.
Somatic therapy works directly with this. Rather than focusing only on thoughts and memories, it helps you gradually build the capacity to notice and tolerate what is happening in your body, to regulate your nervous system and to experience safety in relationship. Because so much of complex trauma happened in relationship, the therapeutic relationship itself becomes an important part of healing, offering a steady, attuned presence that the nervous system can slowly learn to trust. In my own work, this can also include attuned, consent-led touch through NeuroAffective Touch®, which you can read more about in my post NeuroAffective Touch® Therapy in the UK: What to Expect in a Session
Can people grow after complex trauma?
Recovery from complex trauma is usually gradual, and it rarely follows a straight line. Alongside the pain, many people also come to experience what the psychologists Richard Tedeschi and Lawrence Calhoun called post-traumatic growth, which can include a deeper appreciation of life, closer relationships and a stronger sense of personal meaning. This growth does not erase what happened, and it is never something anyone should feel pressured to find, although it can gently emerge over time.
Healing also tends to have a ripple effect. As one person begins to regulate, feel and relate differently, the change often reaches their relationships, their children and their community, gently interrupting patterns that may have been passed down for generations.
If you are finding things very hard and have thoughts of harming yourself, please reach out for support straight away, whether to your GP, NHS 111 or to Samaritans, who you can call free at any time on 116 123.
Taking a next step
If something in this post feels familiar and you would like support, you are warmly welcome to book a free connection call. It is a relaxed conversation about what you are experiencing and whether working together feels right for you, with no pressure either way. I offer one to one somatic therapy online and in person in Beverley, East Yorkshire.
If you would rather explore at your own pace, the Sunday Pause is a gentle weekly email with a moment of reflection and a short practice to help your nervous system soften and reconnect. You are warmly welcome to sign up using this form below.
About the author
Laura Starky is an integrative somatic therapist based in Beverley, East Yorkshire, offering sessions in person and online. Her path into this work began in pre-hospital emergency care and continued through 25 years in social work across child protection, substance misuse and mental health. Her somatic training began with ISOHH and has since deepened through NeuroAffective Touch® training with Dr Aline LaPierre. She holds ACCPH Senior Member accreditation and works under regular professional supervision.
Laura is also a qualified yoga and meditation teacher and a committed practitioner of contemplative practice, rooted mainly in the non-dual tradition of Shaiva Tantra.
Resources and references
Research
Cloitre, M., Garvert, D. W., Brewin, C. R., Bryant, R. A. and Maercker, A. (2013) Evidence for proposed ICD-11 PTSD and complex PTSD: a latent profile analysis. European Journal of Psychotraumatology, 4, 20706. Available at: https://doi.org/10.3402/ejpt.v4i0.20706
Felitti, V. J., Anda, R. F., Nordenberg, D., Williamson, D. F., Spitz, A. M., Edwards, V., Koss, M. P. and
Marks, J. S. (1998) Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults: the Adverse Childhood Experiences (ACE) study. American Journal of Preventive Medicine, 14(4), pp. 245–258.
Tedeschi, R. G. and Calhoun, L. G. (2004) Posttraumatic growth: conceptual foundations and empirical evidence. Psychological Inquiry, 15(1), pp. 1–18.
Terr, L. C. (1991) Childhood traumas: an outline and overview. American Journal of Psychiatry, 148(1), pp. 10–20.
World Health Organization (2019) International Classification of Diseases, 11th Revision (ICD-11). Available at: icd.who.int
Books
Heller, L. and Kammer, B. J. (2022) The Practical Guide for Healing Developmental Trauma: Using the NeuroAffective Relational Model to Address Adverse Childhood Experiences and Resolve Complex Trauma. Berkeley: North Atlantic Books.
Herman, J. L. (1992) Trauma and Recovery. New York: Basic Books.
LaPierre, A. (2012) Healing Touch: Honoring the Somatic Dimension of Psyche [ebook]. Available at: www.neuroaffectivetouch.com
Walker, P. (2013) Complex PTSD: From Surviving to Thriving. Lafayette, CA: Azure Coyote.
Further reading
You may also find my post The Inner Critic and Complex Trauma: Why Your Inner Voice Is So Harsh helpful.
Last updated: September 2026
