The trauma you don’t remember: What is complex PTSD and why is it so frequently missed?
You may be under the impression that you’ve never suffered a truly traumatising event, or that your history simply isn’t ‘bad enough’ to warrant a diagnosis of PTSD or complex PTSD (C-PTSD).
It may surprise you to learn that PTSD can be caused in ways that don’t necessarily register as dramatic to us, often through a cumulation of certain patterns and dynamics over time.
If you’re reading this, your journey has likely involved receiving several diagnoses over time, none of which quite made sense when applied to your lived experience as a whole. If any of the signs and symptoms to come resonate, alongside pangs of “my previous diagnosis just doesn’t feel right”, then C-PTSD could be worth exploring further.
“The concept of trauma has become so generalised that the individual meaning can be lost. This is the inherent limit of attempting to categorise objectively what is uniquely subjective, that is the pattern of suffering emerging from one’s own story.” – Dr Ben Janaway, The London Psychiatry Centre
As such, it doesn’t follow from familiarity with a word that we’re able to identify the condition it describes when it comes to ourselves. This is especially true where personal experience varies vastly, and symptoms aren’t clear-cut.
Fortunately, there are extremely effective treatment options available for PTSD, and many people struggling with PTSD live normal lives when provided with the right support.
It’s our hope that this article sheds some light on the reality of C-PTSD by exploring what C-PTSD looks like in practice, why it’s so often missed, and what impactful treatment actually involves.
What is complex PTSD?
C-PTSD is a distinct condition, formalised in the ICD-11 in 2019. It shares the core symptoms of PTSD: re-experiencing trauma through flashbacks and bodily sensation, avoidance, and hypervigilance.
But with C-PTSD there is an added layer of difficulty, taking form in disturbances in self-organisation (DSO). You may have noticed difficulties with emotional regulation and persistent problems in forming and sustaining relationships.
“People diagnosed with C-PTSD often report a persistent feeling of low-self worth, shame and lack of trust. This is an understandable response as a form of protection against a world that seems to have betrayed them. If one’s personality is dependent on experience, our relationship with the world becomes disorganised by tragedy. We live in constant worry of the past.” – Dr Ben Janaway
Perhaps it feels as if the same dynamics follow you wherever you go even if you recognise them as unhealthy, and no matter how hard you try to shed them.
A startling 6.6 million people in the UK are expected to develop PTSD or C-PTSD at some point in their lives, and on some estimates, C-PTSD is judged to be more prevalent than PTSD. Yet, it remains under-identified, under-diagnosed and as a result, under-treated.
How is complex PTSD different from PTSD?
The difference between PTSD and C-PTSD matters for both patients and doctors. Standard PTSD tends to follow more cleanly from identifiable traumatic events. By contrast, C-PTSD typically develops from prolonged, repeated, and interpersonal trauma. This includes but isn’t limited to:
- Childhood neglect or abuse
- Domestic violence
- Coercive control
- Rejection, dismissal or betrayal
- Institutional trauma.
C-PTSD often finds its roots during childhood when your brain is still developing, and your sense of self remains highly vulnerable to outside influence. Whilst treatment approaches can vary between PTSD and C-PTSD, trauma-focussed CBT and EMDR remain first-line recommendations.
“Although there is a clinical distinction between PTSD and C-PTSD, and the exact treatment approach differs, EMDR (Eye Movement Desensitisation and Reprocessing) is built into treatment pathways for both. Our unique approach to EMDR at The London Psychiatry Centre means that we are able to achieve remission within an average of 1-3 sessions as opposed to the standard 8-13 sessions, as reported in our 2019 CQC report.” – Dr Andy Zamar, Consultant Psychiatrist and Founder
What is EMDR and how does it work?
EMDR is an effective, structured psychotherapy. It helps people process and integrate distressing memories that have become “stuck” in the brain’s trauma response system, which prevents them from being stored as ordinary, harmless past experiences when we access them.
EMDR works by having the patient recall a traumatic memory while simultaneously following a bilateral stimulus – typically a clinician’s moving finger, or sounds that alternate between the ears – which appears to mimic the natural processing that occurs during deep sleep.
This allows your brain to reprocess the memory so it loses its emotional charge, and can be filed away without triggering the same distress signals.
If you have C-PTSD, you may have never considered that your personal difficulties could stem from trauma. It may feel virtually impossible for you to look to the past and pinpoint any particularly damaging events, as often there is a backlog of experiences that feel benign in isolation, or that you justified to yourself as normal.
What does complex PTSD actually look like day to day?
C-PTSD doesn’t reliably look like what most people picture when they think of PTSD. There may be no flashbacks, and no single memory that surfaces. Instead, you may encounter a pervasive and exhausting pattern of experiences and behaviours that colours your self-image, your relationships and your general emotional processing.
Research has found that people with C-PTSD experience elevated rates of chronic physical health conditions alongside psychiatric symptoms, including gastrointestinal disorders, chronic pain, and functional neurological symptoms.
“Unresolved traumatic experience is never forgotten completely, just blocked from conscious awareness where possible by defense mechanisms and the process of ‘somatisation’: the body’s reaction to an internal and constant fear. A simpler animal experiences fear to escape death, whereas humans mount the same response against our own memories. As we cannot escape them, the body lives them again.” – Dr Ben Janaway
The body can hold what the mind has not been able to process, and one manifestation is often a dysfunctional nervous system.
Fortunately, the brain is a remarkable organ – it’s neuroplastic, extremely adaptable and ever-changing. Neural plasticity means that your brain retains the ability to change, form new pathways, and process what it couldn’t process so easily before, regardless of how long trauma has been carried.
Signs of C-PTSD:
- Emotional reactions that arrive suddenly and feel overwhelming, such as anger, despair or shame – often triggered by things that seem small from the outside
- A constant state of alertness, which can involve sleep disturbance
- Difficulty trusting others, including clinicians – often because the trust you gave has been broken or used against you in the past
- A fragmented or negative sense of self
- Avoidance of relationships, environment or situations that bring uncomfortable feelings closer or make you feel out of control
- Physical exhaustion that doesn’t resolve with rest
It’s worth noting that many individuals with C-PTSD function at a high level professionally, while quietly struggling in every other area of life. High performance and internal distress aren’t mutually exclusive. In fact, for some, professional achievement can be an avoidant coping mechanism.
Why is complex PTSD so frequently missed and misdiagnosed?
C-PTSD doesn’t tend to announce itself clearly and symptoms often overlap with those of other conditions, which means it can quietly slip through the cracks.
A correct diagnosis is often the turning point where internal narrative shifts, and feelings of discomfort, confusion and shame start to dissolve. One of the most common misdiagnoses of C-PTSD is emotionally unstable personality disorder (EUPD/BPD).
The EUPD label is applied, particularly to women, when the relational and emotional dysregulation emblematic of C-PTSD is interpreted as a personality trait rather than a trauma response.
‘Misdiagnosis in traumatic experience comes from a few places. One is misinterpreting the pattern of someone’s defenses in relation to the past and the present. Where the emotional dysregulation in BPD speaks of a persistent push and pull between trust and devastation, that of C-PTSD lives in the constant shadow of anticipating loss.” – Dr Ben Janaway, The London Psychiatry Centre
A 2025 study found that among 292 participants with suspected personality disorder, 97% reported significant trauma exposure and over half met the criteria for C-PTSD. Getting the distinction right matters significantly, as C-PTSD and EUPD/BPD require different treatment approaches, although overlap is possible, and misdiagnosis means delayed access to appropriate intervention.
C-PTSD is frequently misidentified as:
- Treatment-resistant depression
- Generalised anxiety disorder
- Bipolar disorder – particularly where emotional dysregulation produces mood instability
- ADHD – particularly in women, where emotional dysregulation and concentration difficulties overlap
There’s a broader cultural barrier worth re-iterating at this point. The trauma that causes C-PTSD is often invisible to us and importantly, to others – unlike the trauma contained in entrenched stereotypes of PTSD: war, sexual abuse, natural disasters.
You may have lived through years of emotional neglect, chronic invalidation, or coercive dynamics that have been subconsciously minimised.
When you are treated by others in a certain way repeatedly, it becomes a baseline. And when the harm began in childhood, there may be no clear memory of ‘before’.
So how can you tell that it’s not normal?
You can’t be expected to know, if this is how you grew up. This question is especially salient given the fact that becoming accustomed to certain relationship dynamics can cause you to actively seek them out.
This idea sheds some light on why some people hop from one abusive relationship to the next, for example, despite knowing and having been told by loved ones that these relationships only cause harm.
To a mind affected by interpersonal trauma in this way, chaos becomes calm, and calm is a foreign concept altogether.
What are the most effective treatments for complex PTSD?
C-PTSD is treatable, and many people recover meaningfully from PTSD to live fulfilling, happy lives – even if the trauma had a profound impact on your wellbeing for many years. Treatment that correctly identifies the condition produces significantly better outcomes than generic approaches to depression or anxiety, so PTSD often involves specialised therapeutic approaches. The evidence base has developed substantially in recent years.
NICE and the International Society for Traumatic Stress Studies (ISTSS) both recommend trauma-focused psychological treatment as the primary approach. Specifically, we’re talking about trauma-focused CBT (TF-CBT) and EMDR.
A recent review in the British Journal of Psychology confirmed that EMDR was the most cost-effective intervention of ten assessed, including TF-CBT, and produced outcomes comparable to or better than all other approaches for PTSD and C-PTSD.
For C-PTSD specifically, treatment often works best in three phases:
- Stabilisation: developing the internal and external resources needed to approach trauma material safely
- Trauma processing: using EMDR, TF-CBT, or somatic approaches to process traumatic memories and their emotional residue
- Integration: rebuilding a coherent self-narrative and sense of identity post-treatment
Dialectical Behaviour Therapy (DBT), a form of talking therapy, also has a strong evidence base for the emotional regulation difficulties that characterise C-PTSD. DBT is particularly relevant where self-harm, suicidal ideation, or intense emotional dysregulation are present, and it’s also the gold-standard treatment for EUPD/BDP.
A clear-eyed, compassionate look into your history, including into your personal relationship history, is as important an inquiry as any when it comes to looking at trauma. At The London Psychiatry Centre, we offer comprehensive assessment for complex trauma presentations and specialist EMDR, TF-CBT and rTMS – including for people who have multiple prior diagnoses, have cycled through various medications and present as treatment resistant.
Getting the right diagnosis is the essential first step to easing your confusion, and finding the path to meaningful recovery.
Contact us on 020 7580 4224 or info@psychiatrycentre.co.uk to book a consultation.
