Complex trauma is the lasting effect of repeated or prolonged traumatic experiences, often in childhood or in close relationships, and it can shape how a person feels about themselves, manages emotions and trusts others. Complex PTSD (CPTSD) is the diagnosis the World Health Organization added in ICD-11 for people who have the core symptoms of PTSD plus long-lasting difficulties with emotions, self-worth and relationships.
 | Prepared by Trevor Keen Founder and Physiotherapist · Reviewed 11 November 2026 |
This guide is for adults who are wondering whether their experiences fit, and for people supporting them. Reading it doesn't diagnose anything: only a GP or psychologist can do that after talking with you.
At a glance
| ✓ | Complex trauma usually follows repeated or long-lasting events that were hard or impossible to escape, such as childhood abuse or neglect or prolonged family violence. |
| ✓ | Complex PTSD is a diagnosis in ICD-11. The DSM-5, the other main manual, doesn't list it as a separate diagnosis. |
| ✓ | Signs include PTSD symptoms plus ongoing difficulty with emotions, a harsh sense of self and trouble with close relationships. |
| ✓ | Therapy is often phased: safety and stabilising first, then working with traumatic memories, then rebuilding life. Research on treating complex PTSD is still developing. |
| ✓ | If you need to talk to someone now, Blue Knot's helpline is 1300 657 380 (press 1). In danger, call 000. |
In this guide
What is complex trauma?
Blue Knot Foundation describes complex trauma as coming from repeated, prolonged or chronic traumatic experiences, often in the context of close relationships. Examples include childhood abuse or neglect, domestic violence and prolonged medical trauma.
It often happens during the years when children are still learning to manage emotions and to trust other people. That is why its effects can reach beyond a reaction to one event and into a person's sense of self and their relationships. The Australian guidelines say complex PTSD applies to adults, adolescents and children who have experienced prolonged, repeated or multiple forms of traumatic exposure.
Is complex PTSD an official diagnosis?
It depends on which manual a clinician uses. The WHO's ICD-11 lists complex post traumatic stress disorder (code 6B41) as its own diagnosis. It describes exposure to events of an extremely threatening or horrific nature, most commonly prolonged or repetitive ones from which escape is difficult or impossible, followed by all the core symptoms of PTSD plus severe and persistent problems in three areas, covered in the next section.
The DSM-5, the American Psychiatric Association's manual, doesn't list complex PTSD as a separate diagnosis. The US National Center for PTSD says it is listed in ICD-11 but not in DSM-5, and a 2024 review in BJPsych Advances notes that ICD-11 has both PTSD and CPTSD while DSM-5-TR does not make this distinction. Australia's national guidelines for PTSD were expanded to include complex PTSD for the first time.
Researchers still debate how distinct complex PTSD is from PTSD, and its symptoms overlap with depression and borderline personality disorder. The Australian guidelines note this overlap and the risk of over-diagnosis, which is why a careful assessment matters more than a label.
What are the signs of complex trauma and complex PTSD?
Not everyone has all of these, and having some doesn't mean you have complex PTSD. The ICD-11 definition groups them into two sets. The first three are the core PTSD symptoms, and the second three are called disturbances in self-organisation.
Reliving, avoiding and feeling on edge. These are the PTSD core symptoms in the ICD-11 description.
- Memories, images, nightmares or flashbacks where it feels as if the event is happening again now.
- Avoiding thoughts, people, places or situations that remind you of what happened.
- A constant sense of threat: being easily startled, on guard or unable to relax.
Changes in emotions, self-view and relationships. These are the extra features that, in ICD-11, set complex PTSD apart.
- Emotions: feelings that are very intense and hard to settle, or that go numb.
- Sense of self: believing you are worthless, defeated or to blame, often with deep shame or guilt.
- Relationships: finding it hard to stay close to people, to trust, or to feel connected, even with people who care about you.
The Australian guidelines also say a thorough assessment should look at substance use, self-harm, relationship challenges, dissociation, guilt and shame. Blue Knot describes dissociation and fragmented or incomplete memories as common in people with complex trauma histories. Dissociation means feeling cut off from yourself or your surroundings.
To count as a diagnosis, these difficulties must last and significantly affect personal, family, social, work or other important parts of life. They overlap with depression, anxiety and other conditions, so talk them through with a professional.
Thinking about talking to someone?
The first call with our triage team is free, and we usually reply within 1 to 2 business days. You don't have to share your story to make contact. Read more about trauma support with a psychologist in Adelaide. Our psychologists work with adults who have complex trauma and complex PTSD.
Book or referCall 08 8166 4700How is complex trauma treated?
There is no single approach, and honest answers include what research doesn't yet know. The Australian guidelines say that because complex PTSD is a new diagnosis, there is currently no direct evidence about how to treat it, and that treatment may involve more varied interventions or take longer than treatment for PTSD.
What they do say is that trauma-focused therapies such as cognitive behavioural therapy (CBT), exposure therapy and EMDR (eye movement desensitisation and reprocessing) appear to be effective for several of the complex PTSD symptom clusters, though they may not be well tolerated by everyone.
Many clinicians use a phased approach. Blue Knot's clinical guidelines recommend a three-phase model:
| 1 | Safety and stabilisation Building a safe, consistent relationship with your psychologist, learning to manage emotions and building your window of tolerance, meaning the range in which you can feel and think without being overwhelmed. |
| 2 | Processing Working with traumatic memories at a pace you can manage, once there is enough stability. |
| 3 | Integration Rebuilding identity, relationships and daily life. |
The phases aren't a straight line, and you can return to earlier steps. Experts disagree about how long to spend on the first phase. The Australian guidelines record that some researchers argue stabilisation first may delay helpful trauma-focused work, while others find that dropout and symptoms worsening are reduced when skills come first, and a peer-reviewed review describes the same debate. Good therapy is guided by you, and you shouldn't be pushed to talk about anything before you're ready.
The guidelines say medications are unlikely to be curative and would ideally be used alongside psychotherapy. Your GP or psychiatrist can talk through whether they might help.
How do you get started with a psychologist?
A good first step is a visit to your GP, who can talk through what's been happening. If your GP agrees you are eligible, Medicare's Better Access program pays a rebate for up to 10 individual sessions a calendar year with a mental health treatment plan and referral. Read more in our guide to mental health care plans in SA. You can also book privately without a referral.
Our psychologists support adults and children with trauma, including adults with complex trauma and complex PTSD. Ask us about current availability on the free first call, or read more on our trauma psychologist page.
Good to know
Support you can use right now
The Blue Knot Helpline offers trauma-specialist support to adults affected by childhood trauma, and to the people supporting them: 1300 657 380, press 1, 9am to 5pm AEST/AEDT, 7 days a week. It isn't a crisis service. Details are on Blue Knot's helpline page. If you're in crisis, call Lifeline on 13 11 14 at any time. If your life is in danger, call 000.
Common questions
What is the difference between PTSD and complex PTSD?
Complex PTSD includes all the core symptoms of PTSD plus ongoing problems with emotions, self-worth and relationships. In ICD-11 it is usually linked to repeated or prolonged events, though the criteria don't require a particular kind of trauma. The Australian guidelines note this.
Do I have to talk about what happened?
Not straight away. Blue Knot's guidelines say safety and stabilisation come before trauma processing, and that therapy shouldn't push you beyond what you can manage. You and your psychologist agree the pace.
Can people recover from complex trauma?
Many people find that therapy helps them feel safer and manage symptoms, and trauma-focused therapies appear to help several symptom clusters. Research on complex PTSD specifically is still developing, so no one can promise a timeframe or outcome.
Book a psychologist in Adelaide
Our psychologists support adults, young people and children at our Salisbury and Seacliff clinics. Send a referral or call 08 8166 4700.
Book or referSee our feesRelated reading
- Mental health care plans in SA: how they work
- Trauma-focused CBT for children and teens
- Acceptance and commitment therapy at CHSA
Prepared by
 | Trevor Keen Founder, Conscious Healthcare SA · Physiotherapist (AHPRA PHY0002063374) · Master of Physiotherapy and Bachelor of Psychological Studies, Flinders University |
Trevor is a physiotherapist whose lived experience of disability led him to found CHSA, bringing psychology, assessments, occupational therapy, behaviour support and dietetics under one roof in Adelaide. He has completed a Bachelor of Psychological Studies at Flinders University, is now studying psychology at honours level, and helps write our guides alongside the clinicians who deliver each service.
Sources
- WHO ICD-11: 6B41 Complex post traumatic stress disorder (primary; opened and read 11 Nov 2026)
- Phoenix Australia: Australian Guidelines for ASD, PTSD and Complex PTSD, Chapter 7 CPTSD (national guideline; read 11 Nov 2026)
- Phoenix Australia: Australian Guidelines for PTSD (national guideline; read 11 Nov 2026)
- Blue Knot Foundation: Complex trauma counselling, key differences in supporting clients (peak body; read 11 Nov 2026)
- Blue Knot Foundation: Blue Knot Helpline (peak body; read 11 Nov 2026)
- US National Center for PTSD: Complex PTSD, history and definitions (government, updated September 2026; read 11 Nov 2026)
- Siddaway et al. (2024), BJPsych Advances: DSM-5-TR PTSD, ICD-11 PTSD and ICD-11 complex PTSD (peer-reviewed; read 11 Nov 2026)
- Brewin (2019), BJPsych Advances: Complex post-traumatic stress disorder, a new diagnosis in ICD-11 (peer-reviewed; abstract read 11 Nov 2026)
- Department of Health, Disability and Ageing: Better Access initiative (primary; read 11 Nov 2026)
If you are in crisis or thinking about harming yourself, call 000 or Lifeline on 13 11 14.
This guide is general information, not advice about your situation. Speak with your GP or one of our team about what's right for you.
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