The complex trauma – living with the impossible

When a person is confronted with death, serious injury, or sexual violence and feels helpless and alone in the process, trauma can result. If this maximum psychological stress persists over a longer period of time or if traumatizing events occur again and again, a complex trauma can arise.

You can read here what exactly a complex post-traumatic stress disorder (cPTSD) is, what symptoms it shows up and what you can do if you or someone around you suffers from a complex trauma.

How does a complex trauma arise?

Traumas are strong psychological shocks caused by short or long lasting, overwhelming events that pose a threat to the life or physical integrity of the person concerned. The threat does not have to affect you yourself. The trauma can also be triggered by direct experience of such events or their occurrence with close friends or family.

If several traumatic individual results come together and the further traumatic event cannot be predicted, a complex trauma occurs in 8-15% of all traumatized people. In most cases, such trauma arises from first-hand experience of war as a civilian, rape, or sexual abuse.

Although such experiences would cause deep despair in almost everyone, studies show that only 1-4% of people in Germany who have such traumatic experiences develop post-traumatic stress disorder or CPTBS. The rest of those affected develop resilience or psychological resilience through coping strategies.

However, even those who do not develop post-traumatic disorder often suffer from other mental disorders for which traumatic experiences are risk factors. The more often a trauma is repeated, the more likely it is that a complex trauma (building block effect) will occur.

The difference to post-traumatic stress disorder

Better known and researched to date than complex trauma is post-traumatic stress disorder (PTSD). It was examined primarily in connection with war returnees. PTSD has many of the same symptoms as the complex trauma, including an unwanted attachment to the trauma that haunts the traumatized with images, sounds, and memories.

Furthermore, PTSD manifests itself in the avoidance of anything that could trigger the trauma and often associated with social withdrawal. In addition, the arousal threshold of the autonomic nervous system falls due to the traumatic experiences, which leads to a general increase in arousal. All stimuli from the body are intensified and those affected suffer from frequent overstimulation and can sleep poorly even at night.

In complex trauma, these symptoms are also accompanied by pronounced affect regulation disorders, which can be expressed through persistent irritability, negative self-perception and relationship disorders.

Symptoms of complex trauma

  • Reliving the trauma in the here and now
  • Avoidance of triggering / numbing
  • social withdrawal and relationship disorders
  • Increase in arousal and the associated overstimulation, sleep disorders, etc.
  • Affect regulation disorders
  • negative self-awareness

What can I do?

If you are suffering from a complex trauma yourself, you can seek support from a psychotherapist for treatment. The symptoms of a complex trauma can be alleviated by methods of trauma-specific psychotherapy. Studies of PTSD have also shown that social support plays a big role in coping with trauma. Not only the family atmosphere, but also recognition, compassion and understanding in the social environment help those affected to live with their trauma.

Increasingly evidence-based health care, in which patient-oriented decisions are made on the basis of the symptoms present, ensures that the clinical picture of the complex trauma is now becoming increasingly well known. This gives those affected the social acceptance and support they need.

To defend yourself against perpetrators of violence (also with regard to emotional or financial violence), please refer to the page “Find support” in the menu.


PTSD and Complex PTSD: ICD-11 updates on the concepts of measurement in the UK, USA, Germany, and Lithuania . (2017). DOI: 10.1080 / 20008198.2017.1418103

Hecker & Maercker: Komplexe Posttraumatische Belastungsstörung nach ICD-11. (2015).