In this post, we delve into the ongoing effects of difficult early life relationships, and how particular experiences we have as children and adolescents can play a role in the distress or challenges we might experience as adults. This kind of distress can be conceptualised in various interrelated ways, such as Complex Post-Traumatic Stress Disorder (C-PTSD), emotional neglect, and attachment trauma. In this blog, we will talk about all of these terms, as well as give a broad overview of how you can address the symptoms in therapy or counselling.

Defining C-PTSD

Complex Post-Traumatic Stress Disorder (C-PTSD) is a term used to describe a psychological condition that develops in response to chronic or prolonged trauma or neglect. Unlike traditional PTSD, which typically stems from a single traumatic event, C-PTSD is often associated with ongoing trauma, such as emotional neglect, physical or sexual abuse, ongoing fear of harm or abandonment, or exposure to caregivers who have difficulties with emotional regulation, empathy and attunement, provision of basic childhood needs, and/or being present. C-PTSD is characterised by a range of symptoms that extend beyond those of traditional PTSD.

Violence and Abuse

Physical and sexual abuse in childhood can play a significant role in the development of C-PTSD. Enduring or repeated abuse can lead to a range of traumatic experiences that deeply impact a child’s sense of safety, trust, and self-worth. This includes chronic exposure to violence as both a witness and a target of the violence. Children who have witnessed ongoing violence or abuse towards other family members, for example, are likely to experience similar difficulties to those who experience it firsthand.

Emotional Neglect in Childhood

As opposed to instances of abuse, neglect can be harder to identify when recalling our childhood. Neglect can refer to a failure of our caregivers to provide basic physical needs such as shelter, food, clothing, medical intervention when required, and so on. But emotional neglect also has profound effects on the development of a child. Emotional neglect refers to the failure of caregivers to meet a child’s emotional needs consistently. It involves dismissing, ignoring, or trivialising the child’s feelings, thoughts, and experiences. Emotional neglect can manifest in various ways, such as a lack of interest and emotional support, minimal affection or validation, and neglecting to address the child’s emotional and psychological well-being.

Attachment Trauma

Attachment trauma occurs when a child experiences disruptions or negative experiences in the formation of secure attachments with primary caregivers. It can result from inconsistent or neglectful caregiving, separations, loss, or abusive relationships. Attachment trauma can have long-lasting effects on a child’s emotional development and their ability to form healthy relationships later in life.

The Impact of Violence, Emotional Neglect and Attachment Trauma

Both emotional neglect and attachment trauma can significantly impact an individual’s psychological well-being, contributing to the development of C-PTSD. Here are some ways in which they can influence the development of C-PTSD in adulthood:

  • Disrupted Sense of Self: These childhood experiences can disrupt the development of a stable and coherent sense of self. Individuals may struggle with identity formation, have difficulties understanding their emotions and needs, and experience a persistent sense of emptiness and/or loneliness, even when they have other people around.
  • Dysfunctional Coping Mechanisms: Without the necessary emotional support, individuals who have experienced these painful childhood experiences may develop coping strategies that create other problems. These can include self-isolation, substance abuse, self-harm, or engaging in destructive relationships as a way to regulate their emotions or numb the pain. These behaviours can be an attempt to manage uncomfortable feelings that the person has not had the opportunity to confront or process in a supportive manner.
  • Impaired Emotional Regulation: Childhood trauma can interfere with the development of healthy emotional regulation skills. Individuals may have difficulty identifying and managing their emotions, leading to intense mood swings, emotional dysregulation, and difficulties in interpersonal relationships. They may also report “feeling too much” or being overwhelmed by certain feelings, and may have developed a fear about experiencing certain feelings.
  • Challenges in Forming Trusting Relationships: Childhood trauma can erode an individual’s ability to trust others and form secure attachments. They may struggle with intimacy, fear abandonment, or exhibit avoidant or anxious attachment patterns in their relationships. These patterns often interfere with, or are at odds with, the person’s values and goals – such as wanting close friendships, a partner, or a particular career path.

Symptoms of C-PTSD

So far we have established that chronic violence or abuse, emotional neglect, and attachment trauma can lead to a set of difficulties in adulthood that many psychologists call C-PTSD. But what are the symptoms of C-PTSD in adulthood?

  1. Emotional Dysregulation: Adults with C-PTSD often struggle with emotional dysregulation, experiencing intense and fluctuating emotions. They may find it challenging to regulate their emotions in response to triggers or stressors, leading to emotional outbursts, mood swings, or a sense of emotional numbness and detachment.
  2. Flashbacks and Intrusive Memories: Similar to traditional PTSD, individuals with C-PTSD may experience intrusive memories or flashbacks related to the traumatic events they have endured. These intrusive experiences can be distressing, vivid, and cause a sense of reliving the trauma. Flashbacks can be triggered by specific cues or reminders, making it difficult for individuals to feel present and safe in the current moment. Such flashbacks may be emotional in nature, rather than come with any narrative memory, and the person may notice an intense emotional experience that does not seem in proportion to the current situation.
  3. Dissociation: Dissociation refers to a disconnection or detachment from one’s thoughts, feelings, sensations, or even the sense of self. Adults with C-PTSD may experience dissociative episodes as a way to cope with overwhelming emotions or traumatic memories. Dissociation can manifest as feeling detached from one’s body, experiencing memory lapses, or having a sense of being disconnected from reality.
  4. Distorted Self-Perception: C-PTSD can significantly impact an individual’s self-perception. Adults may struggle with a distorted sense of self, feeling inadequate, unworthy, or plagued by guilt and shame. They may also have difficulty establishing and maintaining a consistent and coherent sense of identity.
  5. Relationship Difficulties: C-PTSD often affects an individual’s ability to form and maintain healthy relationships. Adults with C-PTSD may struggle with trust, fear of abandonment, and have difficulty establishing secure attachments. They may exhibit patterns of interpersonal conflicts, emotional distance, or difficulties with intimacy and vulnerability. They may also place a lot of emphasis on the other person in the relationship, trying to match what they imagine the other person wants them to be, or behave in a way that ensures the other person will not become upset with them. This can be at the cost of their own sense of self, and at the cost of expressing their own preferences or opinions.
  6. Hypervigilance and Hyperarousal: Individuals with C-PTSD may exhibit hypervigilance, a state of heightened alertness and constant scanning of the environment for potential threats. This hyperarousal can lead to difficulties sleeping, irritability, a sense of being constantly on edge, and an exaggerated startle response.
  7. Negative Self-Beliefs: C-PTSD can result in deeply ingrained negative beliefs about oneself and the world. Adults may struggle with feelings of worthlessness, self-blame, and a persistent sense of being fundamentally flawed or damaged. These negative self-beliefs can contribute to low self-esteem and self-destructive behaviours.
  8. Somatic Symptoms: C-PTSD can also manifest in physical or body-based symptoms. Adults may experience chronic pain, headaches, gastrointestinal problems, or other unexplained physical ailments. These somatic symptoms are often a reflection of the psychological distress experienced as a result of C-PTSD, and may be ways that the person has learned to automatically manage high levels of anxiety and emotional pain when there were no other safe options available to them.


It’s important to note that not all individuals with C-PTSD will experience the same symptoms, and the severity and combination of symptoms can vary. If you or someone you know is experiencing these symptoms, seeking professional help from a mental health provider experienced in trauma and the effects of chronic childhood maltreatment is recommended.

Treatment and healing

While C-PTSD can be a complex and challenging condition to overcome, it is essential to emphasise that healing is possible. Seeking professional help, such as therapy or counselling, is especially important for this set of symptoms.

Therapeutic approaches like trauma-focused therapy, attachment-based therapy, and EMDR (Eye Movement Desensitization and Reprocessing) can help individuals address the underlying trauma, develop healthy coping strategies, and foster secure attachments. There are many treatment approaches that can be helpful. Here are some details of a few of those approaches, bearing in mind that this is not an exhaustive list:

  1. Schema therapy: This approach addresses maladaptive schemas—deeply ingrained patterns of thoughts, beliefs, and behaviours that develop as a result of traumatic experiences. Schema Therapy aims to help individuals with C-PTSD develop healthier coping strategies, heal from relational wounds, and foster a stronger sense of self.
  2. Psychodynamic Therapy: Psychodynamic therapy explores the unconscious processes (or the automatic reactions we have without full awareness) and unresolved conflicts that contribute to C-PTSD symptoms. It focuses on uncovering and understanding the root causes of emotional distress. Intensive Short-term Dynamic Psychotherapy (ISTDP) is a particular type of psychodynamic therapy that focuses on uncovering and processing unconscious emotions and defenses, helping individuals with C-PTSD develop a deeper understanding of their trauma, enhance emotional regulation, and build healthier relationships by working through unresolved relational issues. By examining the impact of past relationships and exploring unconscious patterns, psychodynamic therapy aims to facilitate healing and personal growth.
  3. Attachment-Based Therapy: Attachment-based therapy acknowledges the impact of attachment trauma in C-PTSD. It emphasises creating a secure and trusting therapeutic relationship, similar to the parent-child bond, where the individual can experience safety, support, and healing. Therapists provide a secure base from which the individual can explore their trauma, develop healthy attachment patterns, and process relational difficulties.
  4. Eye Movement Desensitization and Reprocessing (EMDR): EMDR is a therapy approach specifically designed to address trauma. It integrates elements of cognitive-behavioural therapy with bilateral stimulation techniques, such as eye movements or taps. EMDR helps individuals reprocess traumatic memories, reduce distressing symptoms, and develop more adaptive beliefs about themselves and the world.
  5. Relational Therapy: Relational therapy focuses on the therapeutic relationship as a vital factor in healing from C-PTSD. The therapist provides a safe and empathetic space where the individual can explore their emotions, develop a sense of trust, and learn healthier ways of relating. The therapeutic relationship becomes an activating and healing experience, offering opportunities for corrective emotional experiences and fostering secure attachments.
  6. Integrative Approaches: Many therapists adopt an integrative approach, combining various therapeutic techniques listed above, based on the individual’s unique needs and preferences. These approaches may draw from elements of psychodynamic therapy, cognitive-behavioural therapy, mindfulness practices, attachment-based therapy, and somatic experiencing to address the multifaceted aspects of C-PTSD.


Emotional neglect, abuse, and attachment trauma during childhood can have profound and long-lasting effects on an individual’s psychological well-being, often contributing to the development of C-PTSD. Recognizing the impact of these experiences is vital for understanding and addressing the complexities of the disorder.

Treatment for C-PTSD requires a comprehensive and individualised approach that considers the complexities of the individual. Therapeutic interventions such as trauma-focused therapy, psychodynamic therapy, attachment-based therapy, EMDR, relational therapy, and integrative approaches can facilitate healing and recovery. The therapeutic relationship plays a significant role in providing a safe and supportive space for individuals to explore their trauma, develop healthier coping strategies, and foster secure attachments, leading to transformative healing experiences.

If you or someone you know is struggling with C-PTSD, reaching out to a mental health professional can provide the support and guidance needed to embark on the path of healing. Reach out to us at Sydney City Psychology today if you would like support to address anxiety, depression, or trauma-related challenges in your life. We would love to hear from you and talk through how we may be helpful to you.