Skip to main content

Warning notification:Warning

Unfortunately, you are using an outdated browser. Please, upgrade your browser to improve your experience with HSE. The list of supported browsers:

  1. Chrome
  2. Edge
  3. FireFox
  4. Opera
  5. Safari

Complex PTSD - Post-traumatic stress disorder (PTSD)

Complex PTSD may be diagnosed in adults or children who have repeatedly experienced traumatic events. These could be violence, neglect or abuse.

Complex PTSD can be more severe if:

  • the traumatic events happened early in life
  • the trauma was caused by a parent or carer
  • the person experienced the trauma for a long time
  • the person was alone during the trauma
  • there is still contact with the person responsible for the trauma

It may take years for the symptoms of complex PTSD to be recognised. Because of this, a child's development can be affected as they get older.

Adults with complex PTSD may lose their trust in people and feel separated from others.

Symptoms of complex PTSD

The symptoms of complex PTSD are similar to symptoms of PTSD.

They may include:

  • feelings of shame or guilt
  • difficulty controlling your emotions
  • re-experiencing - reliving the traumatic event through flashbacks, nightmares and distressing images or physical sensations
  • periods of losing attention and concentration - this is known as dissociation
  • physical symptoms - such as headaches, dizziness, chest pains and stomach aches
  • cutting yourself off from friends and family
  • relationship difficulties
  • destructive or risky behaviour - such as self-harm, alcohol misuse or drug misuse
  • suicidal thoughts

Your GP can refer you to mental health specialists if they feel you will benefit from treatment.

Treating complex PTSD

One of the key symptoms of complex PTSD is losing trust in people.

If possible, people with complex PTSD are recommended to slowly start doing regular activities, such as:

It's important to try and develop some feelings of trust. It may take some time, but a trusting relationship with a therapist will help treat complex PTSD.

How to get a therapist

Getting free counselling

What therapy for PTSD involves

Treatment from a therapist may be given in the 3 following stages.

1. Stabilisation

One of the first steps in treating complex PTSD may involve talking with a therapist. They will help you to control feelings of distrust and lose the feeling of being 'disconnected' from friends and family.

'Grounding' techniques may help you separate an abusive or traumatic past from the present. The aim is to make the past seem less frightening and reduce the amount of flashbacks you experience.

With time, you can reduce feelings of anxiety and learn to cope with daily life.

2. Trauma-focused therapy

Trauma-focused therapy may include:

  • psychotherapy
  • cognitive behavioural therapy (CBT)
  • eye movement desensitisation and reprocessing (EMDR)

These treatments may help you to control any distressing thoughts. Your therapist will discuss with you the most suitable treatment for you and check how well it is working.

Types of talking therapies and what to expect

3. Reintegration

The final stage of treatment for PTSD is to use new skills and techniques you have learned to develop better relationships.

If psychotherapy is not possible or you feel unsafe, your therapist may recommend medicine such as antidepressants.


Content supplied by the NHS and adapted for Ireland by the HSE

Page last reviewed: 15 April 2025
Next review due: 15 April 2028