Complex post-traumatic stress disorder (CPTSD) is a symptom presentation that people develop when they undergo multiple traumas or live in an unsafe environment for an extended time. It’s not recognized in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR), which is the main diagnostic reference used in the United States. It does acknowledge that symptoms from prolonged or repeated trauma can look a bit different than typical PTSD. It includes specifiers to cover some of these differences. In the World Health Organization’s ICD-11, it’s a separate diagnosis.

Emotional neglect or repeated abuse are common pathways to developing CPTSD-like symptoms. Most often, it’s a result of emotional neglect in childhood. Some children develop it after enduring abuse. Having parents who were emotionally immature can be enough to leave lasting psychological wounds. 

Pain from feelings of abandonment or rejection will often affect a person’s relationships long into adulthood. With treatment, people who have complex PTSD can start to heal and understand their unique needs. They can develop the skills they need to build supportive and secure relationships.

In this blog post, we’ll discuss seven ways complex PTSD manifests in relationships and how to navigate these challenges.

7 ways complex PTSD manifests in relationships

Do you ever feel like you’re repeating the same cycles over and over again in each new relationship? This is a common experience for people who have complex PTSD. The details can be different from person to person. Maybe you attract people who are narcissistic and don’t consider your feelings. Or maybe you people-please until you realize that you’re not really happy with this person. 

[Quote]Complex PTSD doesn’t define your capacity for love and connection. It’s a set of survival instincts that helped you get through hard times. With support, you can create new patterns.

The circumstances that cause complex PTSD can give you a distorted sense of what’s “normal” or safe in relationships with others. It can be hard to trust people and let your guard down with those who do treat you with respect. At the same time, you may not have a good sense of where your boundaries are or how to enforce them. You’re not alone in these struggles. There is hope that you can connect with people who understand and get the support you need. 

The following are seven ways complex PTSD might manifest in your relationships:

• Difficulty with trust and vulnerability — Do you feel like your relationships never go beyond surface level? After being disappointed or betrayed by someone who was supposed to protect you, it’s common to put up a wall so you won’t have to risk being hurt again. Unfortunately, it also means you won’t have the safe and supportive relationships you want.
• People-pleasing behaviors — If your emotional needs went unmet in childhood, you probably relied on a caregiver’s approval or rewards for good behavior. Authoritarian parenting styles, high expectations and harsh punishments often lead to people-pleasing behaviors that are hard to quit. You might find yourself bending over backward to make a partner happy, even though the relationship isn’t fulfilling for you.
• Emotional regulation challenges during conflict — Emotional flashbacks are a key feature of CPTSD. This is when you feel as if you’re reliving a traumatic event in the present. It’s more about the emotional experience than the details. If you fought with your caregivers or they were aggressive toward you, conflict with other people might bring up the same feelings — even if you’re not being attacked or threatened.
• Self-protective distancing and withdrawal — If it was never safe for you to be your authentic self or let yourself be truly seen by your loved ones, any type of intimacy can feel dangerous. Your instincts might tell you to push people away or cut your losses and run. However, you’re also depriving yourself of support in moments when you need it most.
• Boundary issues — Most people who have CPTSD were never allowed to have personal boundaries. Often, this means you don’t have a sense of privacy or bodily autonomy. It may be hard to say no, especially to people you love. This may allow others to take advantage of you in different ways. Even if it’s not intentional or predatory, you might find yourself doing things that make you uncomfortable. 
• Heightened sensitivity to criticism — This ties back to the need for approval and people-pleasing. If your caregivers were critical, any type of negative feedback can bring up feelings of being unsafe, hurt or abandoned. This is especially true for romantic partners.
• Difficulty receiving care and support — If your experience of love in childhood was conditional, it can be hard to accept care and support when it’s given freely. Your brain might send up alarm signals because, in your experience, there’s always a catch. It’s also understandable that you might feel grief and sadness for the care you didn’t receive as a child.

Moving forward: Healing within relationships

Recognizing the effects of complex PTSD in your life and relationships is the first step toward healing. Many of the trauma responses and behaviors that cause dysfunction for people in adulthood started out as survival skills. Healing from complex PTSD is often about unlearning old patterns that were once useful — but are no longer serving you.

For most people, the best treatment approach for complex PTSD is a combination of medication and psychotherapy. Treatment can be a great place to meet people who get you. You’ll also learn more about how CPTSD affects people and work on your relationship skills. You’ll learn to recognize your patterns of dysfunction and triggers. Self-awareness, communication and boundary-setting skills will help you build connections that are safe and fulfilling. 

Start healing and building healthy relationships at Lightfully

Complex PTSD doesn’t define your capacity for love and connection. It’s a set of survival instincts that helped you get through hard times. With support, you can create new patterns. It is possible to build healthy relationships after childhood trauma. 

At Lightfully, we provide trauma-informed, whole-person-centered mental health treatment. Our Precision Care Model (PCM) combines evidence-based techniques to help people with four core life processes: thoughts, feelings, behaviors and relationships. Complex PTSD touches every part of your life. Our licensed clinicians can help you address the pain and fear at the root of your complex trauma. You’ll also work on new skills in our supportive treatment environment so you can start changing these patterns.

When you’re ready to begin that journey, reach out to our Admissions Concierge Team. We’ll help you build the foundation for healthier connections.