Understanding 17 symptoms of C-PTSD: Frameworks and healing

Complex post-traumatic stress disorder (C-PTSD) emerges from prolonged exposure to trauma, encompassing experiences like chronic abuse, neglect, or enduring distressing events. Pete Walker's articulation of the 17 symptoms of C-PTSD offers a comprehensive framework for understanding the multifaceted challenges that survivors often encounter.


Rather than framing it as a disorder, voices like Pete Walker and Lucy Johnstone advocate for understanding C-PTSD as a natural response to prolonged trauma, removing the pathologising language and highlighting its roots in survival mechanisms.

Walker's 17 symptoms, originating from his book Complex PTSD: From Surviving to Thriving, provide nuanced insights into the manifestations of trauma. In exploring the 17 symptoms of C-PTSD, we emphasise a non-pathologising approach. These symptoms reflect adaptive responses to overwhelming experiences and need compassionate acknowledgement rather than stigmatisation:

  1. Emotional dysregulation: Struggling with intense and fluctuating emotions, making it challenging to manage or stabilise feelings.
  2. Emotional flashbacks: Intense emotional experiences that overwhelm the present, often leading to dissociation and feeling as though one is reliving past traumas.
  3. Negative self-concept: Pervasive feelings of shame, guilt, or worthlessness, often stemming from prolonged abuse or invalidation.
  4. Distorted perception of the perpetrator: Oscillating between idealising and demonising the perpetrator, struggling to form a clear understanding of the abuser's role.
  5. Chronic feelings of emptiness: A persistent sense of inner void or emotional numbness, leading to difficulty in experiencing joy or fulfilment.
  6. Interpersonal difficulties: Challenges in forming and maintaining relationships due to trust issues, fear of intimacy, or difficulty establishing healthy boundaries.
  7. Hypervigilance: Heightened sensitivity to perceived threats, leading to constant alertness or readiness for danger, even in safe environments.
  8. Sleep disturbances: Insomnia, nightmares, or disrupted sleep patterns stemming from recurring traumatic memories.
  9. Difficulty with emotional attachment: Struggles in forming secure and healthy attachments, either being overly clingy or emotionally distant in relationships.
  10. Somatic symptoms: Physical manifestations of distress, such as chronic pain, gastrointestinal issues, or tension, reflecting unresolved trauma stored in the body.
  11. Sense of foreshortened future: Difficulty envisioning or planning for the future due to a pervasive sense of hopelessness or belief that life will be cut short.
  12. Self-destructive behaviour: Engaging in harmful actions, from substance abuse to self-harm, as maladaptive coping mechanisms to manage emotional pain.
  13. Difficulty regulating self-esteem: Fluctuations in self-worth, swinging between feeling excessively competent or inadequate, often in response to external validation or criticism.
  14. Impaired sense of agency: Feeling powerless or lacking control over one's life, stemming from the history of trauma and an environment where choices were limited or disregarded.
  15. Cognitive distortions: Persistent negative beliefs about oneself, others, and the world, leading to skewed perceptions and interpretations of events.
  16. Survival strategies: Adaptive behaviours developed in response to trauma, which might have been crucial for survival but become hindrances in daily life.
  17. Difficulty with emotional expression: Challenges in articulating emotions or needs, possibly due to a history of invalidated feelings or repression.

The root causes of C-PTSD are deeply ingrained in the impact of prolonged trauma on the individual's nervous system, brain functioning, and overall well-being. Trauma disrupts the body's stress response system, leading to alterations in brain structures and neurochemical imbalances underlying C-PTSD symptoms.

It's important to note that as of now, the DSM (Diagnostic and Statistical Manual of Mental Disorders) does not include a specific diagnosis for C-PTSD, although ongoing research continues to explore its distinct features and appropriate classification.

However, in the International Classification of Diseases, 11th Revision (ICD-11), the position on C-PTSD represents a significant stride in acknowledging the enduring impact of prolonged trauma on mental health. The inclusion of C-PTSD as a distinct diagnosis emphasises the complexity of trauma-related conditions, recognising the diverse and pervasive symptoms that individuals experience following prolonged exposure to traumatic events.

This classification aims to provide a more comprehensive framework for understanding and addressing the multifaceted nature of trauma's long-term effects, fostering better identification, assessment, and tailored interventions for those grappling with the aftermath of sustained trauma. The ICD-11's recognition of C-PTSD signifies a critical step forward in enhancing awareness, validating experiences, and guiding more effective approaches to support individuals navigating the complexities of trauma-related challenges.

Lucy Johnstone's Power Threat Meaning Framework (PTM) provides a non-pathologising perspective. The PTM focuses on understanding an individual's responses to distressing events in terms of power dynamics, threats, and personal meanings. The approach takes a lens of 'What happened to you?' rather than 'What's wrong with you?' PTM encourages exploring the broader context of trauma and its impact on identity, relationships, and coping strategies.

Misdiagnosis challenges exist, with individuals experiencing C-PTSD sometimes being misidentified with other conditions like borderline personality disorder (BPD). Overlapping symptoms, such as emotional dysregulation and identity disturbances, contribute to misdiagnosis. Understanding the distinct features of C-PTSD versus other diagnoses is crucial for accurate assessment and treatment planning.

Therapeutic approaches that integrate somatic techniques, mindfulness, and trauma-informed care offer a holistic pathway toward healing. Seeking support from qualified therapists and practitioners aligned with an empowerment-focused narrative can provide individuals navigating C-PTSD a compassionate space for holistic healing, acknowledging their experiences and fostering recovery.

The views expressed in this article are those of the author. All articles published on Counselling Directory are reviewed by our editorial team.

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London, EC2A
Written by Laura Prendiville, MSC, MCCP.
London, EC2A

I'm an accredited Contemporary Psychotherapist. I use creative and dynamic approaches to working with trauma, anxiety and relationship challenges. My areas of speciality are CPTSD, Emotional neglect and ADHD.

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