What is CPTSD?

General overview

Complex Post-Traumatic Stress Disorder (CPTSD) describes the long-term psychological effects of chronic, relational, or developmental trauma, often beginning in childhood and occurring in situations where escape was not possible. Many people living with CPTSD do not identify with the classic image of trauma, yet struggle with emotional numbness, anxiety, shame, unstable relationships, or a persistent sense that something is fundamentally wrong.

In my work providing CPTSD therapy in Chiang Mai, I focus on approaches that address not only symptoms, but the underlying nervous system patterns and meaning structures shaped by prolonged trauma.

CPTSD refers to trauma that develops over time rather than from a single overwhelming event. Common sources include childhood emotional neglect, chronic abuse, unstable relationships through childhood, long-term instability, or repeated exposure to fear without protection.

Rather than isolated flashbacks, CPTSD tends to affect a person’s sense of self, their emotional regulation, and their capacity for safety in relationships. People often describe feeling disconnected from their emotions, overly vigilant, or chronically exhausted by social and internal demands.

Although CPTSD is widely recognized by clinicians and included in the ICD-11, it is not formally recognized as a diagnosis in the DSM-5. This does not mean it is controversial in practice. It reflects differences in classification systems rather than disagreement about the clinical reality.

CPTSD vs PTSD: What’s the Difference?
PTSD is typically associated with single-incident trauma, such as accidents, assaults, or combat exposure. Symptoms often center on intrusive memories, avoidance, and heightened arousal. CPTSD includes these features but extends further. It involves persistent difficulties with emotional regulation, deep-seated shame or guilt, disturbances in identity, and long-standing relational patterns rooted in early experiences. Where PTSD is often fear-based, CPTSD is frequently attachment-based. The nervous system adapts not just to danger, but to the absence of safety, attunement, or protection over time.

Why CPTSD Is Often Missed or Misdiagnosed
Many people with CPTSD are diagnosed instead with anxiety, depression, personality disorders, or treatment-resistant mood issues. This happens because the original trauma may not be consciously remembered or recognized as trauma at all.

When trauma occurs in childhood, the nervous system organizes around survival rather than narrative memory. The result is often emotional numbness, dissociation, or chronic self-criticism, rather than clear trauma recollections. Effective CPTSD therapy must work with these adaptations directly, rather than focusing only on symptom reduction.

How CPTSD Affects the Nervous System
Complex trauma shapes the autonomic nervous system over years. Instead of returning easily to a baseline of safety, the system becomes organized around threat, shutdown, or hyper-control. Some people live in chronic anxiety and hypervigilance. Others experience collapse, emotional flatness, or dissociation. Many alternate between these states.

Because CPTSD is stored not only as memory but as physiological expectation, insight alone is rarely sufficient. The body must learn, gradually and repeatedly, that safety and regulation are possible in the present.

My Approach to CPTSD Therapy in Chiang Mai

I work with CPTSD using an integrative, trauma-informed framework that prioritizes pacing, nervous system regulation, and meaning-making over quick symptom fixes.

Narrative Therapy
Complex trauma often leaves people with internal stories shaped by shame, self-blame, or responsibility for harm that was never theirs. Narrative therapy helps externalize these stories and examine how they developed within real relational contexts.

Rather than asking “what’s wrong with me,” the work shifts toward understanding what happened, how the nervous system adapted, and how identity was shaped in response.
This approach is particularly helpful for people who feel stuck in rigid self-concepts or chronic self-criticism.

Body-Based and Nervous System-Oriented Work
CPTSD is fundamentally a disorder of regulation. I incorporate body-based approaches that help clients track physiological states, recognize early signs of activation or shutdown, and build tolerance for emotional experience without overwhelm.

This is not about forcing emotional release. It is about gradual regulation, learning how safety feels in the body, and expanding the window of tolerance over time.

For many clients, this work is essential in addressing emotional numbness, dissociation, and chronic anxiety.

Parts-Based Therapy (IFS-Informed)
People with CPTSD often experience intense internal conflict. One part may push for achievement or control, while another holds fear, grief, or collapse.

Using parts-based therapy informed by Internal Family Systems (IFS), we work with these internal dynamics respectfully rather than trying to eliminate them. Each part is understood as a survival strategy that developed for a reason.

This approach helps reduce internal warfare and builds a more coherent sense of self.

Selective CBT Interventions
Cognitive-behavioral techniques can be useful when applied carefully within a trauma-informed framework. I use CBT interventions selectively to address rigid beliefs, catastrophic thinking, or avoidance patterns—without treating trauma responses as irrational or pathological.

In CPTSD therapy, cognition is worked with after regulation, not instead of it.

How to Heal From CPTSD?
CPTSD therapy is not about reliving trauma repeatedly or pushing emotional exposure beyond capacity. It is not about “fixing” parts of you or forcing positive thinking.

Healing from complex trauma is typically non-linear. Progress often comes in subtle shifts: greater emotional range, improved relational stability, reduced self-attack, or a growing sense of internal safety.

CPTSD Therapy for Expats in Chiang Mai
Many expats living in Chiang Mai seek therapy while navigating cultural displacement, isolation, or unresolved trauma surfacing in a new environment. For individuals with CPTSD, relocation can intensify nervous system stress while also creating space for deeper work.

I offer English-speaking CPTSD therapy in Chiang Mai for expats seeking depth-oriented, trauma-informed treatment that respects both psychological and physiological dimensions of trauma.

How Long Does CPTSD Therapy Take?
There is no fixed timeline for CPTSD treatment. Because the trauma occurred over years, therapy often focuses first on stabilization and regulation before deeper processing.

Some clients work weekly for extended periods; others engage in phases. The emphasis is always on pacing the work in a way that supports integration rather than retraumatization.

Is CPTSD Therapy Effective?
Research and clinical experience consistently show that trauma-informed, body-based, and relational approaches can significantly improve functioning and quality of life for people with CPTSD.

While CPTSD may not be formally recognized in all diagnostic manuals, it is widely treated in clinical practice, and effective therapeutic frameworks are well established.

How to start CPTSD Therapy in Chiang Mai?
If you resonate with descriptions of complex trauma, emotional numbness, chronic anxiety, or long-standing relational patterns, CPTSD therapy may offer a path toward greater regulation, clarity, and self-understanding.

My work in Chiang Mai is grounded in trauma-informed, nervous-system-aware therapy that honors the intelligence of your adaptations while supporting meaningful change.