What is CPTSD?

Complex PTSD (CPTSD) is a mental health condition that can develop from prolonged or repeated exposure to trauma from which there is little or no chance of escape, such as long-term domestic abuse, child abuse, or torture.

Unlike PTSD, which is often tied to a single traumatic event, CPTSD is characterised by a pervasive and long-lasting impact on a person's life, including difficulties with emotional regulation, sense of self, and relationships. People with CPTSD typically report a persistent re-experiencing of the trauma, avoidance of reminders of the trauma, hypervigilance, feelings of shame, guilt and worthlessness, and difficulties in relationships.

CPTSD, in the general population, is 2-3x more common ⁹ in women and people AFAB. CPTSD is frequently misdiagnosed as BPD. CPTSD often co-occurs with autism and ADHD, particularly in women and AFAB people due to high rates of intergenerational trauma.

CPTSD is a relatively new diagnosis. CPTSD was added to the ICD-11 in 2018. CPTSD is still not a formal diagnosis in the DSM-5 (Maercker, 2021) ¹⁰

CPTSD affects around 1% to 7% of the population. It is significantly more common in women and people assigned female at birth (AFAB), who are 2 to 3 times more likely to develop the condition. This is often due to higher lifetime exposure to interpersonal and domestic trauma.

CPTSD is caused by prolonged exposure to trauma. Common causes include:

• childhood abuse, neglect or abandonment
• ongoing domestic violence or abuse
• repeatedly witnessing violence or abuse
• torture, kidnapping or slavery
• being forced or manipulated into prostitution

You are more likely to develop it if the trauma happened at an early age, lasted for a long time, or was caused by someone close to you.

Yes. It is very common for neurodivergent people to also have CPTSD. Because autistic and ADHD people process the world differently, they often experience higher rates of social rejection, sensory overwhelm and systemic exclusion, which can be traumatic over time.

A sensitive nervous system can make a person more vulnerable to the effects of environmental stressors, meaning neurodivergence and trauma often exist together.

No. Trauma does not cause ADHD or autism. These are innate neurological differences that a person is born with. However, the two are deeply linked. Neurodivergent people are more likely to experience trauma, and CPTSD symptoms can sometimes mimic or worsen the presentation of ADHD and autistic traits.

Unlike a visual flashback where you see a memory, an emotional flashback is an intense feeling of being back in the trauma. You may suddenly feel small, helpless, terrified or ashamed without a clear reason in the present.

Your body is reacting to a trigger as if the original threat were happening now, even if you do not have a specific visual memory of the event.

Hypervigilance is a state of constant alertness where you are always scanning your environment for threats. Hyperarousal is the physiological side of this, where your "fight or flight" system is stuck in the on position.

This can lead to being easily startled, having trouble sleeping, feeling irritable or finding it difficult to concentrate because your body believes it is in danger.

Somatic symptoms are physical sensations or bodily pains that are caused or made worse by emotional distress and trauma. Because the mind and body are connected, the "alarm" from CPTSD often manifests physically.

Common somatic symptoms include chronic muscle tension, headaches, digestive issues, unexplained fatigue, and chest tightness. These are real physical experiences, even though they stem from the nervous system being stuck in a survival state.

Sometimes, as a way to cope with overwhelming experiences, people may experience moments of detachment or feel disconnected from themselves, their memories, or their surroundings. These are known as dissociative experiences.

Dissociation can be caused by trauma, pain or sensory overload. Dissociation is a recognised symptom of CPTSD ¹¹ and BPD ¹². Dissociation, in the general population, is more common in women and AFAB people.

Alexithymia is a trait which involves difficulty identifying, labelling and describing one's own emotions.

While commonly reported by ADHD and autistic people, Alexithymia is not an ADHD symptom or an autistic trait. Alexithymia is theorised to be a trauma response.

Alexithymia is often conflated with both dissociation and Alexisomia ¹³ - which involves difficulties identifying, distinguishing and describing one's own bodily sensations and physical feelings. You may also hear people describe this as "difficulties with interoception."

Alexithymia, in the general population, is more common in men ¹⁴ and people AMAB. Other research shows elevated levels of alexithymia amongst people who identify as trans. ¹⁵ Research shows a link with alexithymia and eating disorders ¹⁶ particularly in ADHD and autistic women and AFAB with anorexia or bulimia.

Masking, or "camouflaging," refers to the active efforts marginalised people make to conceal or modify aspects of their identity, behaviour, or communication to avoid discrimination, exclusion, rejection, bullying, or abuse. This includes both conscious imitation of others' actions or language and unconscious imitation, where people blend in or conform to social expectations without realising it (Pearson et al., 2021). ¹⁷

Masking is increasingly recognised as a trauma response. Research shows that neurodivergent women mask more than men, and minority genders mask at higher rates still. (Hull et al., 2020) ¹⁸. Masking is also commonly reported among people who identify as LGBTQIA+.

Rejection Sensitivity Dysphoria (RSD), also simply described as "rejection sensitivity," is an extreme adverse emotional, physiological, or behavioural reaction to perceived or actual rejection, abandonment, criticism, blame, or exclusion.

While it is often discussed in relation to ADHD, RSD is not recognised as a symptom of ADHD nor included in its diagnostic criteria. Rejection sensitivity is a recognised symptom of Social anxiety, Avoidant personality, PMDD, BPD and CPTSD. These mental health conditions, in the general population, are 2-3x more common in women and people AFAB.

RSD is increasingly understood as a trauma response. Relationally, ADHD and autistic women face significantly higher levels of victimisation, bullying, exclusion, exploitation, and abuse compared to their neurotypical peers. Consequently, they may be more sensitive to rejection as adults.

Borderline personality (BPD), also known as emotionally unstable personality (EUPD), is a mental health condition that causes difficulties in regulating emotions and challenges in how you relate to yourself and others. BPD is characterised by a deep fear of abandonment, rapidly shifting emotions, impulsivity and an unstable sense of self.

BPD, in the general population, is diagnosed 3x more often ¹⁹ in women and people AFAB. This rises to 4:1 if you identify as trans ²⁰. BPD is a common misdiagnosis amongst late‑discovered ADHD and autistic women, non‑binary and AFAB people, particularly those with co-occurring CPTSD.

• One study showed that 50% of people with BPD meet the clinical cut-off for autism (Nanchen et al., 2016)
• A meta-analysis found that up to 60% of people with BPD meet the clinical cut-off for ADHD (Ditrich et al., 2021). ²¹

BPD is increasingly viewed as a trauma response. Around half of people with BPD recover and no longer meet the threshold within 5 years (Phyllis Zelkowitz, 2007). ²²

Bessel Van Der Kolk, a psychiatrist who specialises in trauma, argues that most people diagnosed with BPD would benefit from a corrected diagnosis of CPTSD. The charity Mind offers a page on Why personality diagnosis is controversial .