Living with complex PTSD can strain even the most solid of relationships, but there is a path to healing.

You’re likely familiar with post-traumatic stress disorder (PTSD), an anxiety disorder that occurs after a brief traumatic event. But there’s another kind of trauma, as well.

Chronic or long-term trauma can produce symptoms similar to those of traditional PTSD, along with additional symptoms that overlap with borderline personality disorder (BPD), particularly in the area of interpersonal relationships.

This is known as complex PTSD. Although it’s not yet an official diagnosis in the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5), it is included in the International Classification of Diseases (ICD-11).

Complex PTSD (CPTSD) may occur when you endure trauma for months or even years.

In a 2019 research study, CPTSD was prevalent in 3.8% of the U.S. population. Also, women are more likely than men to be diagnosed with CPTSD.

There are many types of traumatic events that can affect your brain. These include:

  • captivity
  • childhood neglect
  • living in a war zone
  • long-term combat situations
  • repeated physical, emotional, or sexual abuse

Aside from prolonged trauma, there are other risk factors for developing CPTSD, like a family history of mental illness or a previous mental health condition.

Your temperament, lifestyle factors, and the brain’s ability to regulate stress can also impact whether or not you develop CPTSD.

CPTSD can result in significant behavioral, emotional, cognitive, and interpersonal changes. As difficult as these may feel, know that there are effective treatments that can help you work on the thinking patterns and behaviors that might be contributing to your distress.

Research shows that complex PTSD can impact your life in many ways. CPTSD may lead to:

  • a negative self-image or self-perception
  • a loss of foundational belief systems
  • emotional dysregulation, like anger, panic, or depression
  • impulsive behavior
  • lowered stress tolerance
  • memory issues
  • personality changes
  • substance use
  • the inability to trust or interpret the actions of others

As you can imagine, all of these factors can play out in relationships with family and friends. They may also prevent you from wanting to form new bonds, leading you to self-isolate in order to stay safe.

For some time, research has shown that those who live with trauma may also choose relationship partners and connections with people who reenact childhood experiences, often subconsciously. In some cases, this can lead to toxic or abusive relationship dynamics (but not always).

Since relational trauma plays an important role in the development of CPTSD, many of the symptoms may be triggered in relationships.

In fact, research shows that many symptoms of CPTSD overlap with those of borderline personality disorder (BPD), which is marked by challenges in interpersonal relationships.

You may experience difficulties with:

  • emotional regulation in front of others
  • intimacy (physical and emotional)
  • closeness to others
  • trusting other people

For example, some people may find it easy to brush off a hurtful comment and move on with their day. However, if you live with CPTSD, it may not be so simple for you.

These events may trigger a strong emotional response and possibly an outburst, leaving your romantic partner shocked and confused. This kind of emotional dysregulation can be stressful and hurtful for others to experience.

As another example, if one of your beliefs from trauma is that people are untrustworthy, you may find intimacy to be difficult. This could lead you to disengage or withdraw from your partner.

You may even feel skeptical about your partner’s words and actions, or perhaps look for signs of dishonesty where there aren’t any. A fear of abandonment may conflict and fracture the foundation of a relationship.

While many of these symptoms may present challenges, remember, healing is possible. Don’t give up hope.

If you live with complex PTSD, a nurturing and healthy relationship is possible. Like all relationships, it takes hard work and dedication from both you and your partner.

Recognize the past

While it may be difficult not to compare what happened in the past with your present circumstances, try to separate the two, if possible.

Communicate

You may find it helpful to openly communicate with your partner about your feelings and experiences to create trust and a sense of security. Use “I” statements, like, “When you say that, I feel hurt and confused.”

Practice self-care

Self-care techniques may help reduce stress and emotional reactivity. These include:

  • sleeping adequately
  • eating a balanced diet
  • practicing creative hobbies
  • exercising
  • meditating

Know your worth

Try to recognize that you’re worthy of happiness and a loving relationship. With some work, it’s possible to accept the difficult things that have occurred in the past with your partner and move forward toward a better future.

If your partner has CPTSD, recognize that you cannot change or fix their past, as much as you’d like to. If possible, try to focus on moving forward.

Be consistent

You may find it useful to be deliberate and consistent in your actions and communication. Being predictable may make it easier for your partner to trust you and build a secure attachment.

Hold space for their emotions

Acknowledge their emotions so that they feel supported and heard. You can try mirroring language and asking questions. For example, “I hear you saying you want to be left alone. Do I have that right?”

Learn coping techniques

It may make you feel empowered to find helpful ways to support your partner when they’re having a triggered moment or a flashback, such as deep breathing exercises or going for a walk together.

If your partner is in active treatment, you can also support them as they learn coping strategies and new techniques, and practice new behaviors with you.

Depersonalize conflict

Try to remember not to take things personally. If your partner has an angry outburst or withdraws after a triggering event, know that it’s not about you. They’ve been through a lot, and they are doing the best they can.

Practice self-care

Loving someone with any mental health condition can be, at times, overwhelming. Be sure to establish your own boundaries and practice regular self-care. Recognize that not every day will go perfectly or be without difficulties.

If you or someone you love has symptoms of CPTSD, you are not alone and treatment is available. Healing often takes a long time, but there is hope.

You can manage the symptoms of CPTSD with a combination of psychotherapy, medication, and support groups.

Psychotherapy

Psychotherapy, including cognitive behavioral therapy (CBT), involves talking with a therapist to identify and replace negative patterns of thinking with healthy coping mechanisms.

Research shows some effective treatments for PTSD have been recommended for CPTSD. These include:

  • prolonged exposure (PE) therapy
  • cognitive reprocesssing therapy (CPT)
  • dialectical behavioral therapy (DBT)

According to the National Center for PTSD, those with co-occurring conditions like substance use disorder, dissociation, BPD, and sleep disturbances can benefit from these treatment options.

Dialectical behavioral therapy (DBT) can be especially helpful because it gives you the tools to manage stress and build productive interpersonal skills.

Eye movement desensitization and reprocessing (EMDR) has been suggested for use in CPTSD treatment because it helps people safely reprocess traumatic memories in a different way. However, this is controversial in the evidence-based treatment community and more research is needed.

Medication

Medication may be used to treat and reduce the symptoms of CPTSD. A mental health professional may prescribe you antidepressants like Zoloft, Paxil, and Prozac, in conjunction with therapy.

Support groups

Support groups may help you and your loved ones. The CPTSD Foundation offers virtual communities that provide validation and support in an effort to promote healing.

The National Alliance on Mental Illness (NAMI) can also help you and your loved ones find support groups.