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Childhood trauma – forms: These are the most important cPTSD symptoms

Childhood trauma – cPTSD Symptoms

Childhood trauma (cPTSD) as a result of abuse and neglect leads to manifold disorders in a wide variety of areas, especially in the control of emotions, self-perception, sexuality or the shaping of relationships. In addition, there are changes in self-perception and personal values and beliefs within the framework of a so-called trauma identity.

List of the most common cPTSD symptoms

Survivors of childhood trauma do not have to experience all the symptoms listed below. The symptoms that develop depend on the 4F type and the patterns of abuse and neglect experienced in childhood. Typical in any case are:

  • Emotional flashbacks, trigger states
  • A tyrannical inner and / or outer critic,
  • Toxic shame,
  • Fragile self-esteem,
  • Self-denial,
  • Social anxieties,
  • Terrible feelings of loneliness and abandonment,
  • Attachment disorders, relationship difficulties,
  • Developmental disorders of personality,
  • Radical mood swings
  • Dissociation,
  • Hypersensitivity in stressful situations

Typical symptoms are thus summarized under the term complex stress disorder (cPTSD). Survivors of trauma either feel too much or too little. Trauma consequences can be divided into a plus variant (intrusive symptoms) and a minus variant (constrictive symptoms).


Plus-symptoms impose themselves on those affected and are often accompanied by intense anxiety and overload. Thoughts or perceptions to which little attention is paid can be responsible as triggers for the plus symptoms. Emotional triggers can lead to panic reactions that are difficult to control or to barely controllable anger – in both cases, traumatic experiences are remembered as vividly as if they were being relived.

Typical of the plus-symptoms is their haunting, vivid character (here and now) and the intense physical stress reactions, so it becomes difficult for sufferers to distinguish the stressful memories from the present, safe life situation. Memories and plus symptoms can be so pronounced that they result in a feeling of loss of control and being at the mercy of others. For outsiders, the intense plus symptoms are very impressively perceptible.

These include flashbacks in the form of scenic and visual reliving, as well as sounds, smells or body memories. In this way, the traumatic experience forces its way into everyday consciousness. Emotional flashbacks – slipping into trauma-related states – also belong here. (see below)

Recurring nightmares of the same content are also plus-symptoms.

Features of the plus-symptoms:

  • Thinking: imposing memories, obsessive thoughts of experiences.
  • Emotions: Fear, lack of sense of security, powerlessness, helplessness.
  • Body experience: Body memories, pain symptoms.
  • Expressive behaviour: Uncontrollable stress reactions, rage attacks.


Minus-symptoms include the loss of functions and perceptual content, or an altered perception and reaction. They are hardly noticeable at first glance. They can appear, for example, as concentration disorders or memory blocks. Minus symptoms can make the experience so unreal that those affected feel paralysed or emotionally numb. Body perception, in particular, can be defined either by pressing body symptoms or by an experience of alienation or sensations of weakness, as if all strength were draining from the body, up to and including loss of bodily functions and signs of paralysis—for example, those affected experience extreme tiredness or lack of strength. Therefore, minus symptoms run the risk of going unnoticed. Or they are misinterpreted as a refusal to communicate.

Features of the minus symptoms:

  • Thinking: memory lapses, concentration problems.
  • Emotions: Emotionlessness, listlessness, lack of future perspective.
  • Body experience: Experience of alienation, the feeling of unreality, loss of function, muteness.
  • Expressive behaviour: Paralysis, powerlessness, extreme fatigue.

The plus-minus polarity of the trauma consequences occurs in different areas of experience and action. Plus- and minus-symptoms can also occur simultaneously, or sufferers switch rapidly between both poles of expression. Especially when plus and minus symptoms and states occur alternately, which is not uncommon, the environment and therapists often react with irritation. Why does the person affected behave so extremely differently?

Primary and secondary cPTSD symptoms

Primary cPTSD symptoms

According to the temporal relationship to childhood trauma, the symptoms of PTSD can be divided into two basic categories. First, there are the so-called primary trauma consequences. These are all complaints that can be understood as direct effects of traumatic experiences. They are, therefore, directly related to the trauma experience. The complaints mentioned are often plus-symptoms clearly related to traumatic stress in terms of content. They can be provoked by confrontation with the traumatic memory or corresponding triggers.

  • Flashbacks,
  • Nightmares,
  • Fears directly associated with the trauma experiences,
  • Avoidance behaviour,
  • Trigger states with stress reactions connected to certain memories and others belong here.

Suppose fears and avoidance are indirectly related to the content of traumatic experiences. In that case, they are also primary trauma consequences, as are palpitations, sweating, and restlessness with excessive irritability and jumpiness. Typical examples are the fear of objects or sounds that can remind one of the traumas, or the avoidance of corresponding places.

Secondary cPTBS symptoms

Secondary consequences arise in an attempt to cope with the primary symptoms resulting from traumatic experiences. These include:

  • Fear of people,
  • Self-isolation,
  • Distrust in relationships,
  • Changes in self-image,
  • Addictive behaviour and others.

Secondary trauma consequences were helpful and valuable in coping and adapting to the traumatic stress in the acute state. Later, however, negative long-term consequences arise from the patterns of perception, interpretation and behaviour. This includes withdrawal behaviour and fear of people or certain situations (for example, leaving the house after dark). Avoidance plays a unique role here: for one thing, it blocks the possibility of corrective experiences and favours the expansion and generalization of fears, which become increasingly difficult to bear. This is especially true of mistrust and the increasing fear of all people.

In addition, there may be apparently pre-existing disorders. In particular, developmental deficits in ego functions, such as in self- and emotion regulation, identity problems and relationship disorders, are indistinguishable from childhood trauma’s consequences, as they are usually the result of neglect in early childhood. On the other hand, symptoms can also occur, under stress, as a temporary weakening of existing healthy ego functions, without any fundamental disturbances of the ego structure.

Childhood trauma – cPTBS symptoms: key areas

In addition to the symptoms and trauma consequences, many areas are essential for successfully overcoming childhood trauma, including concurrent psychosomatic and psychiatric medical conditions. Under certain circumstances, such disorders must be treated as a matter of priority. Due to their frequency, the following disorders are critical:

  • Anxiety disorders,
  • Depressive disorders,
  • Addiction disorders, and
  • Psychosomatic disorders, mainly in the form of persistent pain disorders.

Problem areas that are particularly significant for personal growth after childhood trauma also include self-harm and other self-harming or self-endangering behaviours, including suicidal thoughts. It may seem contradictory, but they help – at least in the short term – with self-regulation and relief.

Equally important are stressful feelings such as grief, shame, and guilt, but also anger and rage. To deal with them, it is crucial to have sufficient methods of self-control at hand. (The same applies to maintaining a therapeutic relationship even when irritations or other difficulties arise). Therefore, techniques for dealing with difficult emotions are prerequisites for personal growth in cPTSD.

The area of personal resources is similarly vital for individual resilience. Understanding, interpreting and naming problems is particularly important for successful self-help.

Areas of cPTBS symptoms

  • Post-traumatic stress disorder / Complex post-traumatic stress disorder,
  • Dissociative disorders,
  • Accompanying conditions:
    • Anxiety disorders,
    • Depressive disorders,
    • Psychosomatic disorders,
    • Addictions,
  • Andere wichtige Problembereiche:
    • Suicidal thoughts,
    • Self-harming behaviour,
    • Disturbances in emotional and self-regulation,
    • Ability to deal with stressful affects, control of anger and rage,
  • Individual resources
    • Social contacts,
    • Interests, hobbies, and
    • Positive experiences in everyday life.

And these are the most important distinguishing features of the cPTBS

Complex PTSD is a more severe form of post-traumatic stress disorder. It is distinguished from other forms of stress disorder by five of its most common and distressing distressing features:

  1. Emotional flashbacks,
  2. Toxic shame,
  3. Self-abandonment,
  4. A vicious inner critic, and
  5. Social anxieties.

Emotional Flashbacks

Emotional flashbacks are perhaps the most striking and characteristic feature of cPTBS. Survivors of abuse and neglect are highly prone to painful emotional flashbacks, which typically have no visual component. They are sudden and often prolonged relapses into the overwhelming emotional states of an abused, unwanted or abandoned child. These trigger states include overwhelming fear, shame, alienation, anger, sadness, depression and our 4 Fs.

When children are yelled at hatefully, it may feel to them like a raging hot wind that grabs them and tears them away or as if the inside is being blown out, like the flame of a candle. In the emotional flashback, this sensation appears in the adult in trigger situations. The condition is not only unbearable but also confusing until it becomes clear that it is an intense emotional flashback, a return to the countless moments in which the sufferer as a child was plunged into fear, shame, dissociation and helplessness by the parents’ anger. Because of this, the emotional flashback arouses intense reactions of attack, flight, numbness or submission, along with a stress response from the sympathetic nervous system, the part of the nervous system that controls autonomic arousal and activation. Affected people feel incredibly anxious and panicky. Or there is a feeling of profound numbness, paralysis and a desperate desire to hide. Feelings of being small, unworthy, fragile, powerless and helpless – humiliating and crushing toxic shame – override all these sensations.

Childhood trauma – cPTBS symptoms: What you may have been diagnosed with

A traumatized childhood plays an enormous role in most mental disorders in adulthood. Thus, cPTBS mistakenly appears as anxiety disorders or even depressive disorders.

Furthermore, many affected people are wrongly and unfairly diagnosed with bipolar, narcissistic, dependent or borderline personality disorder. (This is not to imply that cPTBS cannot co-occur with these disorders).

Considerable confusion also arises in the case of ADHD (attention deficit hyperactivity disorder) as well as OCD, which can actually be more accurately described as fixed escape reactions to trauma (4F).

ADD (attention deficit disorder), autism spectrum disorder, and some depressive and dissociative disorders can similarly be fixed solidification reactions to trauma.

In addition, minus-symptoms are often attributed to depression or classified as Dissociative Disorder.

Similarly, I believe that many forms of addiction, substance-related or not, must also be seen as maladaptations to parental abuse and neglect. They are behaviours that attempt to alleviate or distract from the mental, emotional and physical pain of cPTBS experienced early on.

Consequences of childhood trauma are always normal reactions to a profoundly abnormal situation – maladaptations to extreme stress that survivors had to learn as traumatized children. But even if similarities or co-occurrences are common, uncovering the traumatic cause is vital for dealing with what sufferers are actually struggling with. A “panic disorder” needs different therapeutic tools than panic in the context of an emotional flashback. The result of such misperceptions is unsuccessful treatment attempts that fail to recognize the underlying problem and leave it untreated. Those affected feel abandoned and react with mistrust or rejection of treatment offers. Or they despair at the idea that they are so disturbed that no one can help them.

At the same time, it is clear that these adaptive reactions, because they have been learned, can and should just as well be “unlearned”, often erased or considerably reduced and replaced by healthy patterns of perception and behaviour under stress.


Sack, M. (2010). Schonende Traumatherapie: Ressourcenorientierte Behandlung von Traumafolgestörungen. Schattauer.

Walker, P. (2013). Complex PTSD: From Surviving to Thriving: A Guide and Map for Recovering from Childhood Trauma. CreateSpace.

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