Complex PTSD Treatment and Recovery: What the Science Says About CPTSD — Part 1: Understanding the Condition and Medications Used to Treat It

In my time spent reading experiences of others with CPTSD, I often come across this misguided idea that CPTSD can't be cured. Though I am still very much in the weeds of treating my own CPTSD, I have recovered a great deal so far, and science suggests that recovery from CPTSD is completely possible.

Until recently I also believed that CPTSD has no end, and for the rest of my life I would only be learning how to manage my symptoms and go through box after box of "relationship band-aids". I was not willing to give up on myself, and I kept searching through literature to find if that was actually true. What I have found is that it is not true that there is no cure for CPTSD, but the misconception most certainly has to do with the lack of research until recent years.

In this series of articles, I am going to explore what CPTSD is, evidence on what treatments work, and why there is so little information on it. In this article, I want to start at square one with the difficulty of starting the healing process, and the monster in the room that is using medications to treat CPTSD.

What Is Survival Mode and Why It's the First Obstacle to Recovery and Treatment of CPTSD 

The first step to healing is getting out of "survival mode", which is a colloquial term used to refer to when your nervous system is in the near constant state of arousal, and your life is centered around ensuring survival. The largest hurdle of getting out of survival mode is that it first requires getting out of the bad environment, and somewhere that is safe and stable. This process of getting to safety and stability is no small feat and takes a long time because it is difficult to find stability when survival mode prevents you from making long term plans.

Bessel Van Der Kolk in his book The Body Keeps The Score writes that the challenge of recovery is to reestablish ownership of your body and your mind — of yourself (pg. 205, Van Der Kolk). He identifies four main areas for most people to reestablish this connection:

• Finding ways to become calm and focused.

• Learning to stay calm in the presence of things that typically trigger trauma responses such as images, sounds, thoughts, or other physical sensations.

• Establishing ways to stay present at the moment.

• Not needing to keep secrets from yourself about ways that you survived.

  
  

In short, he is suggesting getting to a safe, stable environment, finding ways for your nervous system to calm down, and getting out of survival mode. Of course, this is easier said than done considering the many ways that abuse victims can remain trapped in their abuse, which I talk about in my article Domestic Violence: Why They Stay.

Why CPTSD Is Not in the DSM — and What That Means for Patients

The process of treatment and recovery of CPTSD is even more complicated by the disagreement in the field of mental health about what CPTSD is, and even if it is its own disorder or just another type of PTSD. In countries that use the ICD-11, CPTSD has been given the "honorific" of being its own disorder. In places that use the DSM-5-TR, including the USA, CPTSD is not included at all.

One reason that CPTSD was not included in the most recent version of the DSM is because it almost never occurs without PTSD also being present. To accommodate the different symptoms of complex post-traumatic stress disorder, they were added to the diagnosis for PTSD in the DSM, and a dissociative subtype was added as well (Larson, 2025).

Why There Is a Lack of CPTSD Research in the United States 

The definition of CPTSD is not the only issue with CPTSD not being a recognized disorder in the DSM, but it also means that there is not much research on CPTSD in countries that use the DSM, because research is funded by disorder, and if it is not in the DSM then it is not a disorder and there is no funding. Since there is so little research in the USA on CPTSD, most of the studies that I will be focusing on will be from countries that use the ICD-11.

At the core of this discrepancy is the debate on whether CPTSD is a disorder, or if it is just a variant of PTSD. For those who suffer from CPTSD in countries where it is not accepted as a disorder, the refusal to include it in the DSM-5 has caused a lot of confusion amongst patients and doctors, misdiagnosis, and ineffective treatment plans.

Anyone living in a country that uses the DSM is not diagnosed with CPTSD — they are diagnosed with PTSD. From what research we have, we know that many of the treatments for PTSD do not work for CPTSD as effectively, and the prognosis is different. For many who have PTSD, they are attempting to restore "normal" functioning and there is a clear "before the trauma." However, for those with CPTSD, there is no "before" because most of the time the trauma is prolonged throughout childhood while they were developing.

What Is CPTSD? Symptoms and Diagnosis Explained 

CPTSD is a condition characterized by all of the potential symptoms that we recognize as PTSD, with the addition of more.

Classic PTSD has three categories of symptoms, and for a person to be diagnosed with CPTSD they have to meet the criteria required in each category designated by the DSM or ICD:

• Intrusive symptoms - Flashbacks, intrusive thoughts, nightmares.

• Avoidance - Avoiding people, places, and things that remind you of the trauma.

• Hyperarousal - Feeling constantly on edge, or jumpy.

  
  

The diagnosis of CPTSD in the ICD-11 includes all of the criteria for PTSD, with additional symptoms such as difficulty with emotional regulation, altered perception of self, amnesia or dissociation, physical symptoms related to emotional trauma or stress (somatization), despair, and distorted sense of meaning (Larson, 2025).

How Is CPTSD Treated? Medications, Therapy, and What the Evidence Shows 

Lastly, there is the question of what treatments work for CPTSD, and how those really differ from those used to treat PTSD. Treatment for PTSD is also not entirely successful, as using psychotropic drugs only seems to improve symptoms a little more than half of the time (Hoskins, 2021). The only FDA- and EMA (European Medicines Agency)-approved treatments for PTSD are sertraline (Zoloft) and paroxetine (Paxil). Notably, the VA does not recommend medication as a first-line treatment for PTSD, prioritizing trauma-focused therapy instead. Despite this, a study of over 1,000 psychiatric inpatients across German-speaking countries found that the vast majority of PTSD patients were being prescribed medication off-label — meaning not approved for that medical use — most commonly a combination of an antidepressant and an antipsychotic (AMSP, 2020).

However, medications used to treat PTSD are directed to only be used as supplemental treatment alongside other treatments. These medications are not meant to be used long-term, and the studies on their safety are not conducted for as long as real-world patients are generally prescribed them. Currently, the recommendation is to avoid benzodiazepines and other sedative medications in the treatment of PTSD because they have been found to make intrusive and dissociative symptoms worse (Schrader, 2021).

There are other medications being tested that show promise in the treatment of PTSD, but they are not yet approved anywhere, so I am not going to discuss them in this article. However, I would like to note that a new presidential order has fast-tracked researching psychedelic drugs for treatment of PTSD which you can read about in this CBS News article.

In treatment for CPTSD, many of the same medications that have been tried for PTSD have been tried for it as well. A study published in 2021 showed that both PTSD and CPTSD benefited from treatment plans made up of a few different types of treatment, potentially including medication, with a trauma focus more than just one treatment modality. For those with CPTSD, it was found they responded to more varied treatments and took longer to recover than those with PTSD (Cloitre, 2021).

Bessel Van Der Kolk notes in The Body Keeps The Score that while SSRIs can help reduce the emotional overwhelm that traumatized people experience, they are best understood as a supportive tool within a broader treatment plan rather than a treatment in themselves (pg. 36, Van Der Kolk). In conclusion, evidence suggests that while medication for PTSD and CPTSD can be an important tool for some in managing disruptive symptoms — enabling them to calm down enough for other healing to work — they are not a cure for these disorders and have a low efficacy rate (meaning that the chance of a patient getting the desired effect from using this treatment is statistically low). In fact, according to the 2021 study A Review of PTSD and Current Treatment Strategies, Cognitive Processing Therapy (CPT), Prolonged Exposure Therapy (PE), and Eye Movement Desensitization and Reprocessing (EMDR) are considered the "gold standard" by the VA for PTSD treatment. However, CPTSD does have different treatment recommendations, so while some treatments do overlap, I will be focusing on the ones for CPTSD in future articles.

The Bottom Line: Can Medication Help With CPTSD? 

Medications may not be the "cure" for CPTSD or PTSD, but for some they do show some promise in reducing symptoms while other forms of non-medication therapy that have a high rate of efficacy can be administered. As Bessel Van Der Kolk pointed out, it is hard to treat people who cannot talk about their trauma. For many, medications let them function in everyday life and talk about their trauma to begin the healing process. However, for deciding to go on and continue to take them, there is always a risk/benefit analysis we, as patients, should consider for ourselves. These psychiatric medications all have their own potential side effects, and it is up to the individual to advocate for themselves and research any medication before they are put on it.

Have you tried medication for CPTSD or PTSD? What treatment has worked for you? Let me know in the comments or find me on social media!

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References:

Alorfi, N. M. (2025). Pharmacological management of post‑traumatic stress disorder: A qualitative analysis of ClinicalTrials.gov. Drug Design, Development and Therapy, 19, 9697–9708.

Andersson, J., Bråhn, C., Zhai, H., Mattelin, E., Münger, A. C., & Korhonen, L. (2026). Prevalence and discriminant validity of PTSD and CPTSD in a community sample of adolescents with refugee backgrounds residing in Sweden. European child & adolescent psychiatry, 35(2), 575–586. https://doi.org/10.1007/s00787-025-02858-8

Cloitre M. (2021). Complex PTSD: assessment and treatment. European Journal of Psychotraumatology, 12(Suppl ), 1866423. https://doi.org/10.1080/20008198.2020.1866423

Hoskins, M. D., Bridges, J., Sinnerton, R., Nakamura, A., Underwood, J. F. G., Slater, A., Lee, M. R. D., Clarke, L., Lewis, C., Roberts, N. P., & Bisson, J. I. (2021). Pharmacological therapy for post-traumatic stress disorder: a systematic review and meta-analysis of monotherapy, augmentation and head-to-head approaches. European journal of psychotraumatology, 12(1), 1802920. https://doi.org/10.1080/20008198.2020.1802920

Pai, A., Suris, A. M., & North, C. S. (2017). Posttraumatic stress disorder in the DSM‑5: Controversy, change, and conceptual considerations. Behavioral Sciences, 7(1), 7.

Reinhard, M. A., Seifert, J., Greiner, T., Toto, S., Bleich, S., & Grohmann, R. (2021). Pharmacotherapy of 1,044 inpatients with posttraumatic stress disorder: current status and trends in German-speaking countries. European archives of psychiatry and clinical neuroscience, 271(6), 1065–1076.

Schrader, C., & Ross, A. (2021). A Review of PTSD and Current Treatment Strategies. Missouri medicine, 118(6), 546–551.

U.S. Department of Veterans Affairs, National Center for PTSD. (2025). Complex PTSD: History and definitions. https://www.ptsd.va.gov/professional/treat/essentials/complex_ptsd.asp

Van der Kolk, B. A. (2014). The body keeps the score: Brain, mind, and body in the healing of trauma. Penguin Books.

World Health Organization. (2026). Complex post traumatic stress disorder (6B41). In ICD‑11 for mortality and morbidity statistics (MMS 2026‑01). Retrieved April 22, 2026, from https://icd.who.int/browse/2026-01/mms/en#585833559

The Diary of a Flopping Fish and any posts or articles published on Diaryofafloppingfish.com are not reviewed by a therapist or medical or mental health professional. Resources are cited, and opinion is opinion. No advice or opinions in any articles replace professional advice from a doctor, therapist, or any other kind of health professional. The author is not a licensed professional of any kind.