Complex PTSD: Tests, Causes, And Dealing With Emotional Flashbacks

Many of us are familiar with post-traumatic stress disorder (PTSD), an anxiety disorder caused by a traumatic event. However, people can develop different types of PTSD, such as complex PTSD.

Complex PTSD is caused by ongoing trauma and is often linked to more than one type of trauma. Additionally, many people with complex PTSD experience flashbacks, and this symptom can become quite troubling.

Here we discuss the causes of complex PTSD, the tests that can help identify it, and the available treatments that can also help with emotional flashbacks.

Have you considered clinical trials for Post-traumatic stress disorder (PTSD)?

We make it easy for you to participate in a clinical trial for Post-traumatic stress disorder (PTSD), and get access to the latest treatments not yet widely available - and be a part of finding a cure.

What is PTSD?

PTSD¹ can develop after someone has witnessed or experienced a traumatic event. These events are typically shocking, dangerous, or harmful.

Everyone deals with trauma in their own way, and different situations can have different impacts. Sometimes, people can overcome their trauma in a few days or weeks. However, others may experience longer-lasting effects that could persist for several months or years.

If you notice that the effects of the trauma persist for some time, you might have PTSD. If that's the case, seeing a doctor for a proper diagnosis and treatment is essential.

PTSD symptoms

Several symptoms are associated with PTSD. However, it's unlikely that you’ll develop all of them.

Since there are many symptoms, experts have split them into five main categories.

These categories are:

  • re-experiencing (reliving) symptoms

  • avoidance symptoms

  • arousal and reactivating symptoms

  • cognition and mood-related symptoms

  • somatic symptoms (physical manifestations of PTSD)

Re-experiencing symptoms

Re-experiencing symptoms can make it feel like you’re reliving the traumatic event. 

Re-experiencing symptoms include:

  • flashbacks (moments when it feels like the event is happening again)

  • nightmares or dreams of the traumatic event

  • frightening thoughts about the traumatic experience

  • being triggered by certain people, places, or items that remind you of the event

Avoidance symptoms

Avoidance symptoms are linked to circumstances or certain factors you avoid because they remind you of an unpleasant aspect of the trauma.

Avoidance symptoms include:

  • preventing yourself from thinking about the trauma

  • avoiding discussions of the event

  • avoiding certain places that remind you of the trauma

  • avoiding certain people who are related to the trauma or remind you of what happened

Arousal and reactivating symptoms

Arousal and reactivating symptoms refer to how you respond when triggered by something that reminds you of the event. 

Arousal and reactivating symptoms include:

  • feeling on edge

  • feeling tense

  • feeling jittery

  • feeling anxious and stressed

  • being startled easily

  • mood swings and angry outbursts

  • difficulty concentrating or staying focused

  • difficulty falling asleep or staying asleep

  • difficulty eating or a loss of appetite

Cognition and mood-related symptoms

Cognition and mood-related symptoms affect your emotions and thoughts. 

These symptoms are:

  • difficulty recalling memories of the trauma

  • negative thoughts about yourself and the world

  • feeling detached from the world or everyday life

  • blaming yourself or feeling guilty about the trauma

  • finding it challenging to enjoy past activities, interests, or hobbies

  • feeling alienated from family and friends

Somatic symptoms

Somatic symptoms are physical manifestations of the disease that have no other explanation as to what might be causing them.

Somatic symptoms are:

  • muscle tension

  • body aches and pain

  • gastrointestinal complications such as nausea

  • decreased immune function

  • disrupted endocrine function

  • cardiovascular complications such as an elevated heart rate or high blood pressure

PTSD subtypes

Since PTSD can affect everyone differently, three main subtypes have been developed to identify your PTSD more specifically.

These subtypes are:

  • simple PTSD (also called uncomplicated PTSD)

  • complex PTSD

  • comorbid PTSD

Simple PTSD² is related to a one-off traumatic event. In comparison, complex PTSD is associated with a series of traumatic events.

Comorbid PTSD is when a person experiences PTSD alongside another illness. For example, someone may have major depressive disorder, generalized anxiety disorder, or substance abuse disorder. Therefore, when healthcare professionals approach this type of PTSD, they consider how the other conditions may affect PTSD or its treatment.

Complex PTSD

As mentioned before, complex PTSD arises from a series of traumatic events. Hence, the trauma you experienced lasted for a considerable time and was not a one-off occurrence. 

What does complex PTSD look like?

Someone who has complex PTSD experienced several traumatic events. As a result, they might have difficulty maintaining relationships, feel hopeless, or lack emotional regulation. In some cases, the person may undergo a personality change.

Causes of complex PTSD

Like all subtypes of PTSD, complex PTSD is caused by a traumatic event. However, it's usually linked to repeated or multiple types of trauma.

Complex PTSD is commonly related to traumatic events such as:

  • childhood abuse

  • sexual abuse

  • physical abuse

  • emotional abuse

  • spousal abuse

  • war and combat exposure

What symptoms are related to complex PTSD?

Complex PTSD includes the same symptoms as PTSD. However, some additional symptoms are related to complex PTSD.

These symptoms include:

  • lack of emotional regulation

  • difficulty maintaining relationships

  • dissociation (feeling disconnected)

  • feeling that previous belief systems have been challenged

  • feelings of hopelessness

  • changes in your personality

  • self-harm

  • emotional flashbacks

  • feelings of worthlessness, shame, and guilt

Difficulty maintaining relationships

Trusting people can be difficult for those who have experienced long-term trauma, especially if the trauma was linked to a family member or spouse. Because of this, it might be challenging to form new relationships or maintain pre-existing ones.


Dissociation is when you feel disconnected. For example, you may feel disconnected from your thoughts, memories, identity, surroundings, or other aspects of your everyday life. 

Additionally, experiencing repeated trauma can change your perspective of the world and how you think about yourself. Therefore, another aspect of dissociation is feeling hopeless or noticing changes in your personality.

Challenged belief systems

It's also common for people to feel like their past beliefs have been challenged. For example, the trauma could alter your religious or spiritual beliefs as you try to come to terms with what happened. Or, it could change previous beliefs you had about the world.


Self-harm is complex, and several reasons can explain why someone may resort to this action. For example, someone may feel guilty or ashamed of what happened.

If you or a loved one is self-harming or feels the urge to, seek medical help immediately. Self-harm only prolongs the recovery from complex PTSD and could create more trauma.

Emotional flashbacks

Emotional flashbacks³ is a type of dissociation classified as a re-experiencing symptom. Hence, flashbacks can make it feel like you’re reliving the traumatic experience.

Flashbacks can feel vivid, as though the trauma is reoccurring in the present moment. However, they can also manifest in different ways.

Examples of how you may experience a flashback include:

  • seeling full or partial images of the trauma in your mind

  • being triggered by specific images, sounds smells or tastes that remind you of the trauma

  • experiencing physical sensations such as pressure or pain

  • re-experiencing emotions that you felt when the trauma was happening

Flashbacks can be triggered by thoughts or certain people or places that remind you of the trauma. Sometimes, a flashback can occur spontaneously when you least expect it. 

Unfortunately, flashbacks have no time limit. While some may only last for a few seconds or minutes, others could keep happening over several hours or days. 

Therefore, it's essential to see a doctor immediately if you’re struggling to overcome a flashback or if it happens frequently.

Tests for complex PTSD

Complex PTSD is a relatively new condition, and some doctors may not be aware of it. Therefore, you might be diagnosed with PTSD instead of complex PTSD. 

However, no biological or physical tests are available to determine whether complex PTSD is present. So instead, your doctor will ask you questions based on criteria from the Diagnostic and Statistical Manual of Mental Disorders. Depending on the edition, this manual is commonly called the DSM-IV or DSM-5. 

To be diagnosed with PTSD, someone must fit the following criteria for at least one month: 

  • have one or more re-experiencing symptom

  • have one or more avoidance symptom

  • have two or more arousal and reactivity symptoms

  • have two or more cognition and mood symptoms

Treatment for complex PTSD and emotional flashbacks

The treatment for complex PTSD is generally the same type of treatment required for PTSD. 

Treatment options include:

  • medications such as antidepressants

  • exposure therapy

  • cognitive restructuring

  • eye movement desensitization and reprocessing (EMDR) 

These treatments may also help by reducing the frequency of emotional flashbacks. 


Antidepressants are a class of medications typically used to treat PTSD. 

Examples of antidepressants include:

  • sertraline (Zoloft)

  • paroxetine (Paxil)

  • fluoxetine (Prozac)

  • venlafaxine (Effexor)

  • mirtazapine⁴

If you have trouble with PTSD nightmares, your doctor might prescribe:

  • prazosin

  • clonidine

When taking antidepressants,⁵ you shouldn’t discontinue this medication unless you’ve been advised to do so, and you should stop taking the medication gradually. When you suddenly discontinue antidepressants, this can lead to withdrawal symptoms.

Exposure therapy

Exposure therapy is a type of talk therapy. It typically involves writing about the event or visiting the place where it happened. This therapy aims to prevent avoidant symptoms associated with PTSD by enabling someone to confront their fears actively.

Cognitive restructuring

Cognitive restructuring is another type of talk therapy. It involves discussing your trauma with a trained professional. Doing so may help you gain a new perspective and resolve bad feelings such as guilt or shame.

Eye movement desensitization and reprocessing

With EMDR, you recall the details of your trauma while moving your eyes rapidly from side to side. This movement is known as bilateral stimulation. As you do this movement while recalling your memories, it can make these memories less vivid.

When to see a doctor

If you have any concerns about your PTSD or the symptoms you’re experiencing, it's always best to see a doctor. If you delay getting help, your symptoms could worsen. Therefore, early treatment or help is the best option. 

The lowdown

Complex PTSD is a PTSD subtype linked to trauma that persisted for some time. If you suspect that you have complex PTSD, it's best to mention this to your doctor so that they can provide treatment or help if needed.

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