Understanding complex PTSD
A plain-language handout on what complex PTSD is, what can lead to it, why the reactions make sense and what therapy can involve. It does not diagnose. Based on ICD-11 6B41 (WHO, 2025) and NICE NG116 (2018): a plain-language summary that leaves out the diagnostic rules and session numbers, and adds two optional questions.
Written by Tarun Vermani, Trainee Clinical Psychologist Last reviewed
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Understanding complex PTSD
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About this handout
This handout explains complex post-traumatic stress disorder (complex PTSD) in plain words. You can read it on your own or with your therapist. Reading it does not mean you have complex PTSD: only a qualified professional can assess that, with you.
You do not need to write about anything that happened to you. The questions at the end are about how you are now, and you can leave them blank.
This can bring up strong feelings. You can stop at any point, use a grounding skill, and come back to it later or bring it to your next session.
If going over this brings back urges to hurt yourself, stop and use your safety plan if you have one, and tell your therapist. If you might act on the urges, call 999 or go to A&E. To talk to someone now, call Samaritans free on 116 123.
The three main parts of PTSD
Complex PTSD includes the three main parts of post-traumatic stress disorder (PTSD).
Reliving: the trauma comes back as if it is happening now, in vivid memories, flashbacks or nightmares, often with strong fear and feelings in the body.
Avoiding: keeping away from thoughts, feelings, places, people or activities that remind you of it.
Feeling under threat: being on guard, jumpy or easily startled, as if danger is still close.
Your therapist can share other handouts that go into these parts, such as ones on trauma and the brain and on flashbacks.
What makes it complex
In complex PTSD there are also long-lasting difficulties in three more areas.
Feelings: emotions can be too strong and hard to calm, even about small things, or you may feel numb, cut off or far away when stressed, and find it hard to enjoy things.
How you see yourself: you may feel worthless, defeated or damaged, with deep shame, guilt or a sense of failure.
Relationships: it can be hard to feel close to people or to keep relationships going. You may keep away from others, or have a few intense relationships that are hard to keep steady.
These difficulties get in the way of daily life, such as work, family, friendships or looking after yourself.
What can lead to it
Complex PTSD most often follows trauma that was severe and went on for a long time, or happened again and again, where getting away was very hard or not possible. Examples include long-term abuse or violence at home, repeated abuse in childhood, torture or slavery. Not everyone who goes through these things develops complex PTSD.
Why these reactions make sense
Many of these reactions began as ways of getting through danger: staying alert, shutting feelings down, or keeping away from people. They can carry on after the danger has passed, when they cost more than they protect. These reactions are not a sign of weakness. If you blame yourself for what happened, that is common, and something to talk through with your therapist.
What therapy can involve
Therapies used for PTSD can also be used for complex PTSD. With complex PTSD, your therapist may suggest some changes.
Your therapist may suggest taking more time to build trust before working on memories.
Your therapist may suggest making sure your life is as safe and settled as it can be.
Your therapist may suggest learning ways to manage strong feelings and the other things that make therapy hard.
Your therapist may suggest planning what support you will have after therapy ends.
You and your therapist agree the pace together, and you can say at any point if it is too much.
My thoughts after reading
If you want to, note your thoughts here and bring them to your next session. Write about how things are for you now, not about what happened.
Try it here — nothing you type is saved. Sign up to assign it and let clients complete it on any device.
When to use ‘Understanding complex PTSD’
‘Understanding complex PTSD’ is a psychoeducation handout based on cognitive behavioural therapy (CBT), most often used in CBT for trauma and PTSD.
It is designed to be read within therapy rather than as a standalone self-help tool: a therapist introduces it and discusses it with the client. You can preview the full handout above, then assign it for clients to read between sessions on any device or download it as a print-ready PDF. Where a short reflection is included, it offers space to respond to the reading.
How it works
Most people work through it in around 8 minutes. It moves through six short sections to read:
- About this handout: This handout explains complex post-traumatic stress disorder (complex PTSD) in plain words. You can read it on your own or with your…
- The three main parts of PTSD: Complex PTSD includes the three main parts of post-traumatic stress disorder (PTSD). Reliving: the trauma comes back as if it is happening…
- What makes it complex: In complex PTSD there are also long-lasting difficulties in three more areas. Feelings: emotions can be too strong and hard to calm, even…
- What can lead to it: Complex PTSD most often follows trauma that was severe and went on for a long time, or happened again and again, where getting away was…
- Why these reactions make sense: Many of these reactions began as ways of getting through danger: staying alert, shutting feelings down, or keeping away from people. They…
- What therapy can involve: Therapies used for PTSD can also be used for complex PTSD. With complex PTSD, your therapist may suggest some changes. Your therapist may…
The handout can be read on a phone, tablet or computer, or downloaded as a print-ready PDF. If it includes a reflection, answers entered on the Formulate platform are saved automatically and shared back with the therapist for review before the next session.
The CBT approach behind it
‘Understanding complex PTSD’ introduces a CBT approach that involves noticing the links between situations, thoughts, feelings, physical sensations and behaviour and finding practical ways to change unhelpful patterns. The aim is not positive thinking but a clearer, shared understanding of what keeps a difficulty going and practical, testable ways to change it.
Because it is a CBT tool it stays focused on the here-and-now links between thoughts, feelings, the body and behaviour, and it works best as one part of a wider course of therapy rather than as advice or a diagnosis.
Evidence & sources
This handout is grounded in established cognitive behavioural therapy theory and practice. Key sources include:
- World Health Organization (2025). International classification of diseases for mortality and morbidity statistics (11th revision), version 01/2025: 6B41 Complex post traumatic stress disorder. World Health Organization. https://icd.who.int/browse/2025-01/mms/en#585833559.
- National Institute for Health and Care Excellence (2018). Post-traumatic stress disorder (NICE guideline NG116). NICE. Published 5 December 2018. https://www.nice.org.uk/guidance/ng116.
For use alongside professional support
Formulate provides educational CBT resources for use with a qualified therapist. They are not a substitute for professional assessment, diagnosis, or crisis care.
If you need urgent help now:
- Emergency services: 999 — if you or someone else is in immediate danger
- NHS 111 (NHS 24 in Scotland): 111 — choose the mental health option for urgent help, in England, Scotland and Wales (in Wales, press 2)
- Lifeline: 0808 808 8000 — for urgent help in Northern Ireland, free, day or night
- Samaritans: 116 123 — free, day or night, 365 days a year
- Shout: 85258 — text SHOUT, free, day or night
- SANEline: 0300 304 7000 — 4pm–10pm, every day
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