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Complex Posttraumatic Stress Disorder

The Symptoms, Causes and Treatment of Complex PTSD


Updated August 02, 2011

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Complex post-traumatic stress disorder (PTSD) is also sometimes called "disorder of extreme stress not otherwise specified" (DESNOS). This is a condition characterized by three categories of symptoms: emotion dysregulation, dissociation and problems in physical health.

Complex PTSD or DESNOS is thought to result from severe and chronic childhood maltreatment. Complex PTSD is not listed as a separate diagnosis in the DSM-IV; the features of complex PTSD are instead listed as "associated features" of PTSD.

One of the reasons that complex PTSD was left out of the fourth edition of the DSM was that experts in the field felt that this syndrome was so similar to borderline personality (BP) that it did not warrant a separate diagnostic category. Indeed, many of the features of complex PTSD are also core symptoms of BP. A critical difference, however, is that the cause of BP is not always known, whereas complex PTSD can always be traced back to traumatic events.

Emotion Dysregulation

Severe emotion dysregulation is a symptom typical of both complex PTSD and BP. In both conditions, people experience very intense emotions that shift unpredictably and are difficult to soothe.


Both complex PTSD and BP are also associated with dissociation. Dissociation is a state of altered perception that leaves people feeling "unreal," "zoned out," or "numb." In complex PTSD and BP, dissociation is frequent and chronic – it tends to happen often and can continue for long period of time.

Physical Health

Complex PTSD is also associated with problems in physical health, such as chronic pain, a proneness to frequent illnesses and frequent and complex medical problems that do not respond to medical treatment. While physical health problems are not in the diagnostic criteria for BP, research suggests that many of these same medical problems are associated with BP.

Complex PTSD Treatment

Experts on complex PTSD, such as Julian Ford, Ph.D., have recommended that treatment should be approached in phases. The first phase of treatment involves engagement (i.e., forming a trusting relationship with a therapist), stabilization (i.e., reducing dangerous behaviors) and psychoeducation (i.e., learning about the causes and symptoms of complex PTSD). There are several therapy models that can be drawn from to address these issues, including cognitive behavioral therapies for PTSD, and dialectical behavior therapy (DBT).

The second phase of treatment involves addressing the traumatic memories in order to reduce their impact on the person’s psychological functioning. This can be done through a variety of methods, including imaginal exposure, writing and processing the memories within therapy sessions, with the therapist guiding the process and helping the person to cope with the emotions and sensations that are associated with the memories.

The final phase of treatment involves improving the person’s quality of life, by increasing engagement in relationships, work, school, spirituality or other sources of meaning and fulfillment. This is similar to the process of "creating a life worth living" that is part of DBT.


Ford JD. “Complex Posttraumatic Stress Disorder.” In G Reyes, JD Elhai, JD Ford (Eds.) Encyclopedia of Psychological Trauma, 152-154, 2008, New York: Wiley.

Ford JD, Courtois CA, Steele K, van der Hart O, Nijenhuis ERS. “Treatment of Complex Posttraumatic Self-Dysregulation.” Journal of Traumatic Stress, 18(5):437-447, 2005.

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