Understanding Complex PTSD: What You Need to Know

By Joy Plote, Coda Counselor | The Space Between

Trauma leaves deep imprints, but for some, the effects are more layered and enduring than what is typically described in post-traumatic stress disorder (PTSD). That’s where Complex Posttraumatic Stress Disorder (CPTSD) comes in—a newer diagnosis that helps us better understand the impact of prolonged or repeated trauma.

What is CPTSD?

CPTSD was officially included in the International Classification of Diseases (ICD-11) in 2018. Unlike PTSD, which is often tied to a single traumatic event, CPTSD typically develops after long-term exposure to trauma that is difficult—or impossible—to escape. Examples include childhood abuse or neglect, domestic violence, or experiences of captivity and war.

At its core, CPTSD includes all the hallmark symptoms of PTSD—such as flashbacks, nightmares, avoidance, and hypervigilance—but it also goes further. The ICD-11 identifies an additional set of symptoms known as disturbances in self-organization (DSO):

• Affect dysregulation: Intense emotions that feel difficult to manage, or emotional numbness.

• Negative self-concept: A persistent sense of worthlessness, guilt, or shame.

• Relationship difficulties: Struggles with closeness, trust, and maintaining stable relationships.

CPTSD vs. PTSD and Borderline Personality

One key difference is that the DSM-5 (used widely in the U.S.) doesn’t currently recognize CPTSD as a separate diagnosis—it only defines PTSD. The ICD-11, however, distinguishes between the two, acknowledging the unique effects of complex trauma.

Another frequent point of confusion is the overlap with Borderline Personality Pattern (BPP). Both involve challenges in emotional regulation, identity, and relationships. But while BPP is marked by instability, impulsivity, and intense fear of abandonment, CPTSD reflects more stable patterns of chronic shame, avoidance, and emotional detachment.

How Common is CPTSD?

Research shows that rates of CPTSD vary widely depending on the population studied:

• Around 3% of the general population may meet criteria.

• In high-risk groups—such as refugees, survivors of intimate partner violence, or those in prison settings—rates can soar to 30–40% or higher.

• For survivors of chronic childhood trauma, CPTSD is especially prevalent.

• Unfortunately, we do not yet have reliable data on the prevalence of CPTSD in the Deaf or CODA communities. This is a significant gap — especially considering the high rates of language deprivation, discrimination, and intergenerational trauma these communities face. Many of us are actively working to change this by raising awareness, gathering data, and advocating for research that includes Deaf people and Codas in meaningful ways.

• A call to researchers: We urge trauma researchers, clinicians, and institutions to include Deaf and Codayes

• populations in their studies. Without this data, these communities remain invisible in both policy and practice. By filling this gap, we can ensure more equitable mental health services and culturally responsive treatment for those most affected by complex trauma.

How is CPTSD Assessed?

Several tools are used to identify CPTSD:

• PCL-5 (PTSD Checklist for DSM-5): A widely used 20-item self-report tool that screens for PTSD severity. While not designed for CPTSD, it’s a standard measure often used in both research and clinical practice.

• International Trauma Questionnaire (ITQ): A brief self-report tool.

• International Trauma Interview (ITI): A structured clinical interview administered by professionals.

• Complex Trauma Inventory (CTI): A longer self-report measure that explores the range of CPTSD symptoms.

Using these assessments helps clinicians avoid misdiagnosis and ensures Deaf and Coda clients get the right kind of support.

Treatment Approaches

Because CPTSD is a relatively new diagnosis, research into specific treatments is ongoing. Still, promising approaches include:

• Trauma-focused therapies like EMDR (Eye Movement Desensitization and Reprocessing), CBT (Cognitive Behavioral Therapy), and exposure therapy—effective in reducing PTSD symptoms, but sometimes less effective for the deeper relational and self-identity wounds of CPTSD.

• Phase-based therapies such as STAIR-MPE (Skills Training in Affective and Interpersonal Regulation + Modified Prolonged Exposure), which focus first on building emotional and relational skills before processing traumatic memories.

• Integrative therapies designed for specific populations, like refugees, which combine trauma recovery with rebuilding life skills.

• Medication: While there’s no specific pharmacological treatment for CPTSD, medications commonly prescribed for PTSD (such as SSRIs) can help manage some symptoms.

CPTSD in Children and Adolescents

Children are especially vulnerable to CPTSD, and its effects can show up in unique ways:

• Attention and learning difficulties

• Emotional dysregulation and aggression

• Risk-taking behaviors or dissociation

• Challenges in forming healthy attachments

Because trauma during childhood shapes brain development, early recognition and support are vital.

Why This Matters

CPTSD is not “just more PTSD.” It acknowledges the layered wounds that come from living through repeated trauma—wounds that touch not just memory and fear, but also identity, relationships, and self-worth. For Deaf people and Codas, this often includes language deprivation, systemic audism, and the unique pressures of navigating two worlds.

Unfortunately, because there is a lack of research on CPTSD in the Deaf and Coda communities, these experiences often remain invisible in the data. This lack of evidence has real consequences: funding is harder to secure, services are slower to develop, and too many individuals remain unsupported. Naming CPTSD in these communities is one way of pushing back against that invisibility.

By raising awareness and advocating for research, we take an important step toward change. We invite researchers, providers, and policymakers to recognize the urgent need to include Deaf and Coda voices in studies and service design. Healing is possible, but it requires culturally affirming, trauma-informed care that is accessible in sign language — and backed by evidence that reflects the reality of our communities.

You Are Not Alone

If you need support, there is help and you are not alone. If you are Deaf, a parent of a Deaf child, a Coda, or a parent of a Coda, we can help you. We are also happy to provide consultation to your current provider to support and empower you to take charge of your mental health and wellbeing. We have providers who are well versed — and who bring lived experience — to walk with you on your healing journey.

Learn more or connect with us at space-between.online