Complex PTSD (C-PTSD)

Complex PTSD is a diagnostic category formalised in ICD-11 (2018) for trauma presentations arising from sustained or repeated traumatic exposure. Common origins include childhood abuse or neglect, domestic violence over years, captivity, war-zone exposure, or institutional abuse. The condition is distinct from single-incident PTSD.

Diagnostic features include the standard PTSD criteria (re-experiencing, avoidance, hyperarousal) plus three additional clusters: disturbances in self-concept (chronic shame, sense of worthlessness, feeling fundamentally damaged), affect dysregulation (difficulty managing emotions, dissociation, self-harm), and disturbances in relationships (difficulty trusting, attachment patterns, isolation).

Treatment requires a phase-based approach.

• Phase 1 — Stabilisation: autonomic regulation through somatic experiencing, trauma-informed yoga, EFT, or other body-based work. Foundational safety, before processing begins. Often 6 to 12 months.
• Phase 2 — Trauma processing: EMDR or extended somatic work to process the traumatic memory components. Done only after Phase 1 stabilisation. Typically 6 to 18 months.
• Phase 3 — Integration and identity work: consciousness coaching or integrative therapy to address the self-concept and relationship disturbances. Often the longest phase.

Why C-PTSD specifically requires body-based work: pre-verbal trauma (before approximately age 4 to 5) cannot always be reached through narrative therapy because verbal-memory access was not yet developed when the trauma occurred. Sustained childhood trauma also produces autonomic dysregulation that operates below cognitive awareness. The body holds what the conscious mind cannot fully process.

Evidence base: phased treatment combining body-based work with trauma processing consistently outperforms single-modality approaches for C-PTSD. The EMDR-only or CBT-only approaches that work well for single-incident PTSD often produce limited results for C-PTSD without the stabilisation foundation.

Course length is realistic: 12 to 24 months minimum for a substantive course. This is not a flaw in the treatment; it is the appropriate duration for the substrate-level work involved.