Many new people come into my office asking the same question: Why am I not getting better?
For many people, the missing piece is complex PTSD.
My practice has a way of becoming a landing place for people who feel stuck—people who’ve already tried therapy. I don’t know if it’s decades of experience, a deep respect for human complexity, or simply the fact that there are a lot of people walking around carrying unresolved layers beneath the surface. It’s probably all of that.
These are clients who have done trauma work like EMDR. They understand their history. They’ve learned coping skills. They can explain why they react the way they do. And still-something doesn’t shift. Symptoms soften but don’t fully resolve. Relationships remain painful or exhausting. Emotions feel either overwhelming or strangely out of reach.
I often describe this as trauma residue. A kind of emotional and physiological imprint that lingers even after insight arrives. It lives in the body. It’s sticky. Emotions catch on it. No matter how much someone understands their story, shame, emptiness, or self-blame keeps resurfacing, as if the nervous system didn’t get the memo that it’s safe now.
Complex PTSD—often called C-PTSD—is not “worse PTSD.” It’s not a failure to heal. It’s a different pattern entirely. And when it’s finally named and understood, the relief can be immediate—not because everything is fixed, but because things finally make sense.
Complex PTSD develops in response to chronic, repeated exposure to trauma over time, especially when that trauma occurs within relationships or during formative years-when there is no reliable path to safety, relief, or repair. Instead of the nervous system stretching and returning to baseline, it learns to stay pulled back. The internal rubber band never fully rebounds forward; it remains under tension, shaping how the body, emotions, and sense of self move through the world long after the original threat has passed.
This can include:
While PTSD is often linked to a specific event, complex PTSD is linked to events that are repeated over periods of time.
It’s not just about what happened, it’s about what your nervous system had to do over and over again to survive.
Traditional PTSD is often organized around a past event that feels intrusive in the present. Symptoms may include flashbacks, nightmares, avoidance, and hypervigilance tied to a specific memory or trigger.
Complex PTSD includes those elements, but goes further.
This is why people with complex PTSD often feel confused when therapy helps but does not resolve issues completely. The trauma isn’t just remembered, it’s embedded. It has created an internal environment that feels “right” to your system, that same temperature I talked about earlier, so starting to feel better actually feels wrong at first, and it takes time for your system to adjust.
Complex PTSD shapes the nervous system from the inside out.
When stress or threat is chronic, the nervous system doesn’t get to return to baseline. It adapts by staying prepared, through hypervigilance, emotional numbing, people-pleasing, shutdown, or collapse. Clients often say why does the healthy thing feel wrong. Getting your automatic defense system offline takes time. And the right kind of therapy for you.
Anxiety, depression, dissociation, chronic shame, emotional overwhelm, emptiness, and exhaustion are not separate problems, they are expressions of the same survival system.
This is why complex PTSD can look like many diagnoses at once, and why people often feel misdiagnosed, misunderstood, or told that everything is “just trauma” without real relief.
If you’ve ever asked yourself this, it doesn’t mean you’re failing therapy.
It may mean your system is responding exactly as it was shaped to.
In these cases, healing is not about revisiting memories alone. It’s about helping the nervous system learn something it never learned before: sustained regulation.
That takes time. And it takes the right framework.
Trauma research has long shown that trauma changes how the brain and body function. Psychiatrist Bessel van der Kolk famously described how trauma is stored not just as memory, but as bodily experience.
This is not a failure of coping. It’s a nervous system that never learned how to stand down.
Understanding this shifts the question from “What’s wrong with me?” to “What did my system have to learn in order to survive?”
These defense responses did their job to help you survive some horrible things but now it's time to bounce back to lower that water temperature.
When everything is framed as a trauma response, though, another problem can emerge: over-reduction.
Not everything is trauma.
And effective treatment depends on knowing the difference.
One of the most important shifts in trauma-informed care is recognizing that complex PTSD often co-occurs with other neurologically based conditions-and that treatment must address all of them.
ADHD and complex PTSD frequently overlap. Research shows high rates of co-occurrence, and the relationship is bidirectional:
Symptoms such as distractibility, emotional reactivity, restlessness, shutdown, and overwhelm can belong to either, or both.
If ADHD is missed, treatment may focus only on trauma processing while core executive functioning needs go unsupported. If trauma is missed, ADHD treatment alone may not address emotional and relational patterns.
With complex PTSD, it is often both, not either/or.
Autistic individuals are also at increased risk for complex trauma, particularly when sensory needs, communication differences, and social vulnerability go unrecognized.
Sensory overwhelm, shutdown, and social exhaustion are sometimes interpreted solely as trauma responses when they may also reflect underlying neurodevelopmental differences.
When autism is not identified, treatment may unintentionally push tolerance, exposure, or emotional processing that overwhelms rather than heals.
Understanding your neurotype is essential, not to replace trauma work, but to make it effective.
OCD deserves special mention.
Intrusive thoughts, compulsions, and mental rituals are neurologically driven. While trauma can influence OCD content or severity, OCD cannot be resolved through trauma processing alone.
With complex PTSD, OCD can coexist alongside trauma, and both must be treated directly, using the right approaches for each.
Again: both/and, not either/or.
Effective treatment is not about labeling, it’s about precision.
Reducing everything to trauma can feel validating at first—but over time, it limits healing.
True trauma-informed care asks a better question:
If you suspect complex PTSD, it doesn’t mean you’re harder to treat.
It means your system adapted deeply-and wisely-to conditions that required it.
Healing complex PTSD is not about erasing the past.
It’s about expanding capacity, restoring regulation, and building a sense of self that is no longer organized around survival.
And when co-occurring conditions are identified and treated alongside trauma, progress often feels less confusing, and far more sustainable.
If you’ve been wondering why things haven’t clicked yet, complex PTSD may be the missing context, not the end of the story.
It’s often the beginning of one that finally makes sense.