If you’ve experienced ongoing trauma—childhood abuse, domestic violence, or years in an environment where you weren’t safe—you may be living with complex PTSD. Complex posttraumatic stress disorder develops differently than PTSD from a single event, and it requires a different approach to treatment.
You might recognize yourself in these experiences: difficulty regulating your emotions, a deep sense of shame or feeling permanently damaged, patterns that keep repeating no matter how hard you try. These aren’t character flaws. They’re adaptations your mind and body made to survive repeated trauma.
At Therapy Group of DC, our therapists specialize in complex trauma and mental health concerns related to prolonged traumatic stress. We understand that healing from C-PTSD takes time, requires a strong therapeutic relationship, and looks different than treatment for single-incident trauma. Our approach prioritizes safety, pacing, and helping you develop skills before processing difficult memories directly.
Is Complex PTSD Treatment Right for You?
You might benefit from complex PTSD treatment if you:
- Experienced trauma that was ongoing—not a single event
- Survived childhood abuse, neglect, or an unstable home environment
- Were in a situation involving domestic violence or ongoing control
- Notice patterns of emotional dysregulation that feel out of your control
- Struggle with shame, self-blame, or feeling fundamentally broken
- Have difficulty trusting others, setting boundaries, or staying connected
- Feel disconnected from yourself, your body, or your emotions
What to know:
- Complex PTSD is recognized by the World Health Organization in the ICD-11
- Treatment focuses on both PTSD symptoms AND how trauma affected your sense of self
- Phase-based treatment builds safety and skills before processing trauma
- Many people affected by complex trauma see significant improvement with specialized treatment
Understanding Complex PTSD
Complex PTSD (C-PTSD) develops after exposure to traumatic events that were prolonged, repeated, or involved situations where escape was difficult or impossible. While post traumatic stress disorder can result from a single event—an accident, assault, or natural disaster—complex PTSD typically emerges from chronic trauma, especially in childhood or within close relationships.
The term complex post traumatic stress disorder was suggested shortly after the introduction of PTSD in the DSM-III to capture the long-term consequences of prolonged, repeated, early life interpersonal trauma. The World Health Organization includes complex PTSD in the ICD-11 as a distinct diagnosis, with post traumatic stress disorder constituting three components: reliving in the here and now, avoidance of trauma material, and a heightened sense of current threat.
What Causes Complex PTSD?
Childhood abuse and neglect — Physical abuse, emotional abuse, childhood sexual abuse, or chronic neglect during developmental years. People who were sexually abused or experienced child abuse during formative years are more likely to develop complex PTSD. Traumatic stress during childhood shapes the developing nervous system.
Domestic violence — Ongoing domestic violence creates a climate of fear and unpredictability. The trauma isn’t just the violent incidents but living under constant threat.
Abandonment and betrayal — Repeated experiences of abandonment, betrayal, or being trapped in abusive situations compound over time.
Institutional trauma — Prolonged exposure to war zones, refugee camps, human trafficking, or institutional settings where abuse occurred. Among forcibly displaced people, over 30% are affected by PTSD, with depression and anxiety occurring at similar rates.
Other chronic trauma — Any situation involving repeated trauma, extreme stress, and lack of safety or escape.
Adverse childhood experiences shape how the nervous system develops, how emotions are regulated, and how we connect with others.
Complex PTSD vs. PTSD: Key Differences
Complex PTSD includes core PTSD symptoms—intrusive memories, avoidance, and hypervigilance—plus additional symptoms related to “disturbances in self-organization.”
Core PTSD Symptoms
Re-experiencing — Flashbacks, nightmares, and intrusive thoughts about traumatic events that feel like they’re happening now.
Avoidance — Steering clear of reminders of the trauma, including places, people, thoughts, or feelings associated with what happened.
Hyperarousal — Feeling constantly on edge, easily startled, difficulty sleeping, irritability, or difficulty concentrating.
Additional CPTSD Symptoms
Complex PTSD is characterized by the loss of emotional, social, cognitive, and psychological skills due to exposure to complex trauma. Symptoms include difficulties with affect and impulse regulation, amnesia or dissociation, a sense of being permanently damaged, and inability to trust.
Affective dysregulation — Difficulty managing emotions, also called affect dysregulation. You might experience intense emotional reactions that feel disproportionate, or swing between emotional flooding and numbness.
Negative self-concept — A pervasive sense of being permanently damaged, worthless, or fundamentally different from others. Stigma, discrimination, and depression can severely impair quality of life for victims of childhood abuse.
Interpersonal difficulties — Trouble trusting others, interpersonal problems in relationships, difficulty with boundaries, or feeling disconnected even from close others.
Complex PTSD symptoms can overlap with borderline personality disorder, leading to potential misdiagnosis. An accurate assessment by a mental health professional experienced with complex trauma is essential. The International Trauma Questionnaire (ITQ) is the most-studied assessment tool for complex PTSD.
Why Complex PTSD Requires Specialized Treatment
Standard trauma protocols were developed primarily for single-incident PTSD. While approaches like prolonged exposure therapy and cognitive processing therapy have strong evidence for PTSD, people affected by complex trauma often need a modified approach.
Why is C-PTSD so hard to treat?
The trauma shaped development. When traumatic events occur during childhood, they affect brain development, emotion regulation, and how we understand connection.
Multiple traumatic events compound. Rather than processing one memory, complex PTSD treatment involves working through layers of experiences that built on each other.
Trust and safety are core issues. People with complex PTSD often experienced trauma at the hands of caregivers. The therapeutic alliance is both more important and more challenging.
Emotion regulation must come first. Before processing trauma directly, people with complex PTSD need skills for managing intense emotions.
Comorbidities are common. People with complex PTSD frequently experience co-occurring mental health conditions including depression, anxiety disorders, substance use disorders, and sometimes personality disorders. Mental health professionals need to address the full picture.
Our Approach to Complex PTSD Treatment
At Therapy Group of DC, we use a phase-based approach to treat PTSD presentations that stem from chronic trauma—building safety and skills before trauma processing.
Phase 1: Safety, Stabilization, and Skills
The first phase focuses on creating safety in your external life and internal experience. Skills Training in Affective and Interpersonal Regulation (STAIR) is one commonly studied phase-based treatment that builds these foundational capacities.
Building the therapeutic relationship. A strong working connection is crucial. We take time to build trust and establish safety in the therapy space itself.
Developing emotion regulation skills. Dialectical Behavior Therapy (DBT) skills help with emotional regulation, distress tolerance, and interpersonal effectiveness—particularly useful for complex PTSD.
Establishing safety in daily life. Self-care practices such as regular exercise and spending time with trusted individuals help provide stability for intensive trauma work.
Psychoeducation. Understanding complex PTSD—how it developed, why you respond the way you do—helps you make sense of your experiences.
Phase 2: Processing Trauma
Once you have a foundation of stability and skills, trauma treatment can begin. This phase involves working through traumatic memories so they become integrated into your history rather than intruding into your present. International guidance recommends trauma-focused therapies for people with PTSD and comorbidities.
Trauma-focused psychodynamic therapy explores how traumatic experiences shaped your patterns of thinking, feeling, and relating. This approach helps you understand the deeper roots of your responses and how past trauma shows up in your present life.
EMDR therapy uses bilateral stimulation to help your brain reprocess trauma. Eye movement desensitization and reprocessing can be effective for complex PTSD when integrated into a phase-based approach. Research shows high remission rates, with some populations exceeding 70%. Learn more about EMDR therapy at our practice →
Internal Family Systems (IFS) Therapy views the self as composed of different “parts” and helps integrate the fragmented parts that developed due to trauma. Schema Therapy and IFS aim to reduce maladaptive patterns by addressing deep-seated schemas.
Narrative Exposure Therapy (NET) helps you create a coherent life story that includes traumatic events without being defined by them. CBT and NET are effective for reducing core PTSD symptoms in individuals with complex trauma histories.
Somatic approaches address how trauma is held in the body. Complementary practices like mindfulness and yoga may be integrated to support nervous system regulation.
Phase 3: Integration and Reconnection
As symptoms decrease, treatment shifts toward rebuilding your life and relationships:
- Developing healthier patterns of connection
- Building a more stable sense of identity
- Reconnecting with life goals and meaning
- Maintaining gains and preventing relapse
What about medications? APA guidelines recommend psychotherapy as primary treatment for post traumatic stress disorder. Selective serotonin reuptake inhibitors (SSRIs) or serotonin norepinephrine reuptake inhibitors may help manage associated depression or anxiety, but medication alone is not sufficient for treating complex PTSD.
What to Expect in Complex PTSD Treatment
Timeline
Complex PTSD treatment typically takes longer than treatment for single-incident PTSD—sometimes a year or more. This isn’t because treatment isn’t working. It’s because complex PTSD involves rewiring patterns that developed over years and rebuilding trust.
Pacing and Safety
You control the pace. We never push you to discuss traumatic material before you’re ready. Trauma-informed care recognizes that most people with behavioral health concerns have some experience of trauma—it means respecting your autonomy and ensuring you feel safe throughout.
Working with Difficult Symptoms
Treatment often involves working with challenging symptoms like dissociation, intense shame, or difficulty trusting your therapist. These aren’t signs that treatment is failing—they’re often signs that important material is emerging. The evidence base for trauma-focused therapies in complex trauma populations continues to grow.
Our Complex PTSD Therapists
Our therapists bring specialized training in complex trauma. They understand that complex PTSD requires patience, attunement, and a strong working alliance.
Dr. Jennifer Melo, Psy.D.
Dr. Melo integrates psychoanalytic, psychodynamic, and trauma-focused approaches. She works with the full range of trauma presentations, including clients with co-occurring eating disorders and substance use concerns. View Dr. Melo’s full profile →
Dr. Michael Burrows, Ph.D.
Dr. Burrows draws on psychoanalytic, psychodynamic, and relational therapy approaches. His focus on identity, self-esteem, and relationships makes him well-suited to complex PTSD’s core challenges—particularly negative self-concept and interpersonal difficulties. View Dr. Burrows’s full profile →
Dr. Rose Medcalf, Psy.D.
Dr. Medcalf integrates client-centered, feminist, and psychodynamic approaches. She specializes in trauma, grief, and loss, with attention to how cultural and identity factors shape healing. View Dr. Medcalf’s full profile →
Dr. Tyler Miles, Psy.D.
Dr. Miles specializes in trauma, with expertise in borderline personality presentations—important given the diagnostic overlap with complex PTSD. Her approach integrates ACT, client-centered therapy, and CBT. View Dr. Miles’s full profile →
Xihlovo Mabunda, MS, LPC
Xihlovo is trained in EMDR therapy—one of the evidence-based approaches for processing trauma. She integrates EMDR with psychodynamic therapy to help clients work through traumatic experiences. View Xihlovo’s full profile →
Dr. Justin Hillman, Ph.D.
Dr. Hillman’s approach integrates attachment-based, psychodynamic, and relational therapy—orientations well-suited to complex PTSD, where early attachment disruptions play a central role. View Dr. Hillman’s full profile →
Dr. Kevin Isserman, Psy.D
Dr. Isserman draws on client-centered and psychodynamic approaches. His focus on identity, self-esteem, and building trust addresses the core challenges of complex PTSD. View Dr. Isserman’s full profile →
Dr. Regan Mayo, Ph.D.
Dr. Mayo uses a psychodynamic approach to help clients explore how their history contributes to current experience. Her focus includes trauma, life transitions, and grief. View Dr. Mayo’s full profile →
Begin Complex PTSD Treatment in Washington DC
Living with complex PTSD is exhausting. The hypervigilance, the struggles with connection, the sense of being permanently damaged—you’ve been carrying this for too long.
Treatment at Therapy Group of DC offers a path forward. Our therapists understand complex trauma and provide the patient, attuned care that healing requires.
You’re not broken. You adapted to survive. And with the right support, you can build a life no longer defined by what happened to you.
Frequently Asked Questions
Is complex PTSD brain damage?
Complex PTSD is not brain damage in the traditional sense. However, chronic traumatic stress—especially in childhood—can affect brain development. Prolonged exposure to traumatic stress impacts areas involved in emotion regulation, memory, and stress response. The good news: the brain remains capable of change. Effective mental health treatment can help rewire neural pathways and reduce functional impairment.
Can C-PTSD be cured completely?
Many people experience significant improvement with appropriate treatment. “Cure” may not be the right framework—trauma happened, and you can’t un-experience it. But you can reach a place where symptoms no longer control your life and relationships feel safer. Systematic reviews show trauma-focused therapies—including exposure therapy approaches—effectively reduce PTSD symptoms even in people with complex trauma.
What not to do to someone with complex PTSD?
Avoid minimizing their experiences, pushing them to “get over it,” or forcing them to talk about trauma before they’re ready. Don’t take their difficulty with trust personally—it’s a trauma response. Be patient, consistent, and respect their boundaries.
Why is complex PTSD not in the DSM?
The DSM-5 does not include complex PTSD as a separate diagnosis. Some symptoms are captured under the “dissociative subtype” specifier. The ICD-11 does recognize complex PTSD as distinct. Many clinicians use the complex PTSD framework because it better captures the experience of trauma survivors.
How is complex PTSD different from borderline personality disorder?
Both PTSD and CPTSD share emotional dysregulation and interpersonal difficulties, which can lead to misdiagnosis. Key differences: complex PTSD symptoms are clearly connected to traumatic events, while BPD involves a broader pattern of instability in relationships. People with complex PTSD typically have a more stable sense of identity (even if negative), while identity disturbance is central to BPD.
Victims of child abuse are three times more likely to experience PTSD over their lifetime.
Therapy Group of DCEvidence-Based Care
We use trauma-focused approaches including psychodynamic therapy, EMDR, and somatic therapies tailored to complex trauma.
