Understanding Complex Post-Traumatic Stress Disorder (C-PTSD) in Neurodivergent Adults: Symptoms, Causes & Strategies for Healing

Kaitlyn Boudreault
Oct 13
13 min read

Updated: Oct 18

Do you feel as if you are constantly on alert? Maybe you are waiting for something bad to happen, even during the moments that seem calm.

Or perhaps you have a difficult time trusting anyone. You may think that even those closest to you will eventually turn on you.

For many neurodivergent individuals, this persistent state of hypervigilance and lack of trust may be linked to complex post-traumatic stress disorder, which may develop after prolonged exposure to trauma.

If you are experiencing C-PTSD, healing is possible with the right support. Working with a trauma therapist in Ontario, Canada, who understands the unique ways trauma and neurodivergence intersect can help make sense of your emotional patterns, rebuild a sense of safety, and reconnect with trust.

Use this blog as a guide to understand what C-PTSD is, how it develops, and how to begin your healing journey through trauma-informed strategies and support.

What Is C-PTSD?

C-PTSD is a mental health condition and form of neurodivergence that may develop after a person has been repeatedly exposed to an experience involving death or the threat of death. Examples of experiences that could result in C-PTSD include chronic exposure to traumatic events such as bullying, domestic violence, captivity, or abandonment.

It is not yet recognized as a separate diagnosis from PTSD in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Instead, it is diagnosed using the criteria for PTSD and three other symptom clusters [more on this later].

What is important to note is that C-PTSD doesn’t only develop after you personally experience the trauma events. It can also develop if you repeatedly hear about traumatic events, through what is known as vicarious trauma.

Vicarious trauma involves the emotional and psychological response to another person's traumatic experiences, which can happen through direct exposure to their stories or through witnessing traumatic events.

Regardless of how you develop C-PTSD, if you are experiencing it, it can impact every area of your life and affect your ability to regulate emotions, maintain a stable sense of self, and form safe, trusting relationships.

Individuals with C-PTSD may also experience symptoms similar to those of Post Traumatic Stress Disorder (PTSD), such as flashbacks, hypervigilance, and avoidance.

Prevalence of C-PTSD in Canada

Since C-PTSD only became officially recognized by the World Health Organization (WHO) in 2019 through the International Classification of Diseases 11th revision (ICD-11), societal understanding and research on its prevalence are still ongoing.

However, a recent systematic review and meta-analysis of 167 studies using validated ICD-11 assessments found a global prevalence of C-PTSD of about 6.2%.

In Canada, Statistics Canada reported that approximately 8% of Canadians reported moderate to severe symptoms of PTSD. Experts believe that a portion of individuals who meet the criteria for C-PTSD will also meet the criteria for C-PTSD, especially if they have been exposed to repeated traumatic events.

Symptoms of C-PTSD

According to the ICD-11, C-PTSD includes the same core symptoms of PTSD, which involve:

Flashbacks: involuntary, vivid re-experiences of past traumatic events. These flashbacks may be triggered by subtle sensory cues such as sounds, smells, or even emotional tones that the brain associates with past danger.
Avoidance: Avoiding reminders such as people, places, or activities associated with trauma.
Hypervigilance: a state of heightened alertness and scanning for potential threats.

Alongside these core symptoms, C-PTSD also includes three additional clusters of symptoms, which include:

Emotional dysregulation: There may be heightened emotional sensitivity, including intense anger, sadness, or numbness that feels uncontrollable.
Negative self-concept: A distorted self-image may arise from profound shame, guilt, or perceptions of being unworthy or "broken."
Relationship difficulties: challenges trusting others, maintaining closeness, or feeling safe in relationships.

In addition to these symptom clusters, individuals with C-PTSD may also experience some other common symptoms, including:

Sleep disturbances or nightmares
Dissociation or feeling disconnected from reality
Chronic depression
Difficulty concentrating or feeling emotionally “numb

If you relate to these symptoms, your reactions are not a character flaw. They are adaptive survival responses that you developed because they once helped you stay safe in unsafe environments.

How C-PTSD Affects Trust

One of the hallmark clusters of challenges for individuals with C-PTSD is trust issues, which can involve trust in oneself or others.

For those who experience difficulties with trust, you may experience some of these common symptoms, including:

Feeling suspicious or hypervigilant in relationships
Assuming others have hidden motives or will eventually leave
Withdrawing to avoid being hurt
Intense fear of betrayal or abandonment
Difficulty accepting care or kindness without questioning it
Replaying past betrayals in new relationships

These experiences may occur because past experiences in relationships have taught you that closeness could be dangerous. Some of these experiences may include:

Emotional neglect or invalidation during childhood
Repeated betrayal by caregivers or partners
Chronic gaslighting or manipulation
Being punished for expressing needs
Experiencing love as conditional or unpredictable
Attachment trauma in early relationships
Exposure to unstable or unsafe environments

As a result of these experiences, your nervous system continues to interpret emotional intimacy as a threat, even if you feel safe. For example, when boundaries were ignored or violated in the past, mistrust became a form of protection.

How C-PTSD Affects Emotional Regulation

One of the other core features of C-PTSD is difficulty regulating your emotions. You may find that your emotional responses feel unpredictable or that they are disproportionate to what the situation warrants. C-PTSD may also cause you to shift rapidly between feeling emotionally numb and feeling overwhelmed.

Some of the common symptoms and experiences of emotional dysregulation include:

Feeling flooded by emotions such as anger, sadness, or shame
Emotional numbness or detachment as a way to cope
Sudden mood swings that seem “out of nowhere”
Difficulty calming down after becoming upset
Physical symptoms like trembling, nausea, or fatigue following emotional distress
Feeling unsafe expressing emotions or fearing they’ll be “too much” for others

These symptoms and challenges often arise because your nervous system has been taught from a young age to stay on alert.

Because you were exposed to ongoing unsafe environments, your body has become conditioned to react strongly to threats. Emotional regulation is difficult in these situations because your brain is prioritizing survival instead of reflection.

For instance, if you were repeatedly punished if you showed your emotions, you may have learned to suppress them. Alternatively, if you lived in a state of constant fear, even minor stressors might now trigger intense emotional responses.

Healing from C-PTSD involves rebuilding a sense of emotional safety, which could involve noticing, naming, and soothing your feelings without judgment.

Trauma-informed approaches, including mindfulness, Brainspotting, and Eye Movement Desensitization and Reprocessing (EMDR), can help you reconnect with your body’s cues and regulate your emotions from a place of compassion rather than fear.

How C-PTSD Affects Self-Concept

C-PTSD may also shape how you see yourself. If you have been repeatedly exposed to trauma, it can distort your sense of identity, self-worth, and belonging. You might recognize some of the following experiences:

Persistent feelings of shame, guilt, or worthlessness
Struggling to know who you are outside of survival roles (caretaker, achiever, peacekeeper, etc.)
Negative self-talk or an inner critic that mirrors past abusers
Difficulty celebrating achievements or accepting compliments
Feeling “broken,” unlovable, or fundamentally different from others
Dissociation or feeling detached from your sense of self

These patterns of negative self-concept often develop because your experiences of trauma interrupted your brain's process of identity formation. Since you grew up in an environment that invalidated and didn’t meet your needs, emotions, or boundaries, your self-concept was built around others’ expectations instead of your own values and truth.

As a result, you may have internalized the belief that you have to please others or be perfect to be deserving of love or safety, which can lead to chronic self-doubt and difficulty with trusting your instincts.

Recovery from C-PTSD would involve rebuilding your sense of self that is grounded in authenticity and compassion.

Causes of C-PTSD

C-PTSD develops from repeated, long-term exposure to trauma-related events, particularly when a person feels like their life is in danger, they cannot escape, or they feel powerless.

But not everyone who experiences repeated, long-term exposure to traumatic events will go on to develop C-PTSD. Research is still ongoing to understand exactly why this may be the case.

But we do know that chronic trauma can alter the brain structure and function in specific areas, such as the amygdala, hippocampus, or prefrontal cortex. These regions are responsible for emotional regulation, memory, and decision-making, respectively.

It is believed that over time, these changes can lead to persistent fear, shame, and difficulty trusting others. And in some individuals, these changes can be so severe that they lead to a diagnosis of C-PTSD.

Certain populations are at an increased risk of developing C-PTSD, which include:

Survivors of long-term domestic or childhood abuse
Refugees and survivors of war or displacement
Victims of trafficking or exploitation
First responders and healthcare workers who are exposed to ongoing trauma

The Connection Between C-PTSD and Neurodivergence

C-PTSD also frequently overlaps with other neurodivergent identities. In particular, PTSD, BPD, ADHD, and autism are quite common in those with C-PTSD and can intensify the challenges due to concurrent challenges with emotional regulation, executive functioning, and social connection.

C-PTSD vs. PTSD: What’s the Difference?

While both C-PTSD and PTSD involve exposure to trauma and have core symptoms that include flashbacks, avoidance, and hypervigilance, there are some differences. The duration and type of trauma are one key distinguishing factor.

Feature	PTSD	CPTSD
Type of Trauma	Usually, a single traumatic event (e.g., accident, natural disaster)	Repeated or long-term trauma (e.g., ongoing abuse, captivity)
Duration of Exposure	Short-term	Chronic, prolonged
Core Symptoms	Flashbacks, nightmares, hypervigilance, avoidance	All PTSD symptoms plus difficulties with emotional regulation, identity, and relationships
Sense of Self	May remain largely intact.	Often marked by deep shame, guilt, or a distorted self-image.

Alongside the above differences, C-PTSD may also involve a more complex interplay of emotions and emotional dysregulation, including chronic feelings of worthlessness or being “damaged” or persistent feelings of anger or emptiness.

C-PTSD vs. Borderline Personality Disorder (BPD)

Sometimes individuals with C-PTSD are misdiagnosed with having BPD and vice versa. This is because both conditions share overlapping features such as emotional dysregulation and relationship instability.

But there are key differences between the two:

Feature	BPD	C-PTSD
Cause	Often linked to a combination of biological vulnerability, invalidating environments, and sometimes trauma. Trauma may be present, but it is not required.	Requires a history of chronic trauma. The core issue is chronic traumatic stress and learned survival patterns.
Onset	Typically develops in adolescents or early adulthood.	Develops at any age
Identity	Rapidly shifting self-concepts and intense abandonment are often linked to interpersonal stress.	Often experience a persistent negative self-view rooted in trauma.
Emotions	The emotional changes are often unrelated to specific trauma reminders.	Emotional responses are often triggered by reminders of trauma.
Core Emotions	Anger, emptiness, fear of abandonment, and emotional pain are predominant.	Shame, guilt, fear, sadness, and grief are central.
Dissociation and Flashbacks	Dissociation may occur under stress but is typically brief and situational, often related to rejection or conflict rather than trauma memories.	Flashbacks (emotional or sensory reliving of trauma) are common. Dissociation is often a protective response to overwhelming memories.

There are some researchers who suggest that C-PTSD and BPD may exist on a spectrum of trauma-related conditions, but they are treated using different therapeutic approaches. More research needs to be done to determine the legitimacy of these claims.

C-PTSD and ADHD

There is some research to suggest that adults with ADHD are six to seven times more likely to experience trauma-related conditions than those without ADHD (Antshel et al., 2013).

The ongoing stress of managing executive dysfunction, rejection sensitivity, or emotional dysregulation in a world that doesn’t understand your brain and often looks down upon your challenges is what may make ADHDers more vulnerable to trauma. This trauma can, in turn, amplify ADHD symptoms.

C-PTSD and Autism

C-PTSD is common among autistic individuals because autistic people are more likely to experience chronic exposure to social rejection, bullying, and misunderstanding of the way they navigate the world.

Some research shows that over 40% of autistic adults have experienced a probable trauma-related condition within the last month, and over 60% have experienced it at some point in their lives (Rumball et al., 2020).

For autistic individuals, navigating environments that constantly invalidate or pathologize their way of being can be deeply traumatic, which can lead to heightened stress responses and burnout.

Neurodiversity-Affirming Strategies for Healing from C-PTSD

Healing from a trauma-related condition such as C-PTSD is not something that happens overnight. It will take time and often begins with the foundation of safety, self-compassion, and trust.

Although everyone with C-PTSD will cope differently and use their own unique coping mechanisms, here are some trauma-informed, neurodiversity-affirming strategies that have helped other individuals with C-PTSD rebuild a sense of trust and safety.

1. Validate the Mistrust

You’re not “broken” for struggling with trust. Your brain adapted to keep you safe. Trust issues are protective strategies that made sense in unsafe environments. Validating that mistrust is a trauma response, not a flaw, can be the first step in healing. You don’t have to force trust. You can honour your hesitancy and move at your own pace.

2. Build Micro-Trust

Trust doesn't need to start with huge leaps. Try building micro-trust moments, like letting someone help you carry something or sharing a small truth. Trust can grow slowly, through consistency and low-stakes interactions. Notice who shows up, listens without judgment, and respects your “no.” Let those small signals matter.

3. Rebuild Self-Trust

Often, the deepest wound in C-PTSD is not just mistrusting others but mistrusting yourself. Trauma can make it difficult to distinguish intuition from fear. Start small by rebuilding your self-trust: notice what feels good and what feels off, and let your body’s cues guide you. Reconnecting with your inner voice is the foundation for rebuilding confidence and safety.

4. Name Your Trust Triggers

Naming what triggers mistrust can help reduce its intensity. Ask yourself: Is it silence? Inconsistency? Being interrupted? Naming those patterns can help you distinguish between past and present. Once you can name these patterns, you can also communicate your needs more clearly. For example:

"I feel safer when people follow through."
"I need more time before I open up."
"This isn't a weakness. It’s self-awareness born from survival."

5. Practice Grounding Techniques

One useful grounding technique is the 5-4-3-2-1 method, which encourages you to focus on your senses to bring you back to the present moment. By engaging your senses, you anchor yourself in the here and now, reduce intrusive thoughts related to trauma, and foster a sense of safety and calm.

Grounding techniques can help regulate intense emotions and anxiety related to C-PTSD. One useful grounding technique is the 5-4-3-2-1 method. Try naming:

5 things you can see
4 things you can touch
3 things you can hear
2 things you can smell
1 thing you can taste

If the above strategy doesn’t work for you, there are a variety of different grounding strategies that may be helpful.

One example is repeating the letter R three to four times before you feel calm. You could also try some dialectical behavioural therapy techniques for grounding.

6. Use Creative Expression

Creative activities can serve as an outlet for emotions tied to CPTSD. They offer a valuable means of expression for those who may struggle with verbal communication. These creative outlets allow individuals to process their feelings in a non-verbal way and reduce the pressure that often accompanies discussing traumatic experiences directly. They can also provide a tangible way to explore complex emotions and thoughts.

7. Establish a Routine

Routine provides structure and reduces anxiety levels. Include time for hobbies or physical movement to allow for creative expression. This approach can help manage stress by creating a greater sense of control. You could also share your routine with a loved one for encouragement to stick to the plan.

8. Use Spoon Theory to Pace Yourself

Spoon Theory is a way of conceptualizing energy as a limited resource. It can help you pace activities, set boundaries, and honour your limits. When living with C-PTSD, using “spoons” to plan your day can reduce overwhelm and prevent burnout. Recognize that some days will require more rest than others, and that honouring your limits is a form of self-care.

9. Incorporate Trauma-Informed Exercise and Movement

Gentle, mindful movement can support regulation of the nervous system and body awareness. Examples include yoga, walking in nature, tai chi, weight training, or gentle stretching. The key is to listen to your body, move safely, and focus on what feels grounding rather than pushing for performance. These practices help release tension stored from trauma and support emotional stability.

10. Seek Support

Healing from C-PTSD often requires professional guidance. Therapists trained in trauma-informed, somatic, or internal family systems approaches can help you process trauma safely. Consider working with a neurodiversity-affirming therapist who understands how trauma intersects with ADHD, autism, and sensory needs.

Treatment for C-PTSD

C-PTSD is a condition that can make you feel isolated or as if you are “too much.” But your responses and reactions are often rooted in survival, not brokenness.

Healing involves learning that recovery is possible and that you can now choose safety, connection, and compassion on your own terms. The treatment often requires a longer, more gradual process than PTSD because of the depth and duration of the trauma.

Therapy is a vital aspect of treatment, as it involves evidence-based approaches, including:

Trauma-Focused Cognitive Behavioural Therapy (TF-CBT): helps individuals identify and reframe unhelpful thoughts while learning coping skills.
Eye Movement Desensitization and Reprocessing (EMDR): helps the brain reprocess traumatic memories in a less distressing way, reducing emotional intensity and allowing new, adaptive associations to form.
Brainspotting Therapy: uses focused eye positions to access and process unhealed trauma stored in the brain and body, often uncovering experiences that words alone can’t reach.
Sensorimotor Psychotherapy: integrates body awareness and movement into talk therapy, helping individuals regulate their emotions and reconnect with their bodies safely.
Internal Family Systems (IFS): works with the different “parts” of yourself that hold trauma, helping you access your core “Self” and foster internal harmony. IFS supports healing by allowing each part to be heard, understood, and integrated, reducing internal conflict and self-judgment.
Body-based mindfulness and breathwork: emphasize grounding, presence, and self-regulation, allowing the body to signal safety before engaging in deeper cognitive work.
Cognitive Processing Therapy (CPT): focuses on understanding how trauma has shaped beliefs and emotions, supporting individuals in developing a more balanced and compassionate perspective about themselves and the world.
Dialectical Behaviour Therapy (DBT): integrates mindfulness, emotion regulation, distress tolerance, and interpersonal effectiveness skills. DBT is especially effective for trauma survivors who experience intense emotions, self-criticism, or difficulty maintaining relationships, helping them cultivate stability and self-compassion.

Medication Management for C-PTSD

While therapy is the cornerstone of C-PTSD treatment, medication alongside therapy can be an important component of C-PTSD treatment. This is particularly true if you also experience anxiety, depression, or sleep disturbances that are significantly affecting your daily life at work, school, and in relationships.

Some common medication approaches may be of benefit for those with C-PTSD, including:

Antidepressants (SSRIs or SNRIs) can help reduce symptoms of depression, anxiety, and hyperarousal.
Mood stabilizers: sometimes prescribed to manage emotional dysregulation or intense mood swings.
Sleep aids or anxiolytics (short-term use): can support rest and reduce physiological hyperarousal.

It’s important to note that medication alone may not be sufficient to treat C-PTSD. But combining pharmacological support with trauma-informed therapy may lead to the best outcomes.

If you are considering medications, always consult with a qualified healthcare provider who understands trauma so that they can prescribe and monitor treatment efficacy, and you can work together to see what works best for you.