Understanding Complex PTSD Through a Relational Lens

When I was trained as a psychologist, we didn't talk about Complex PTSD.

We certainly talked about trauma. We understood PTSD as something that could happen after war, sexual assault, a serious accident, or another terrifying event. But we had much less language for understanding what happens when trauma isn't one event with a clear before and after. What about growing up for years with a parent who ignored you, humiliated you, or wasn't able to respond to what you needed? What happens when the people you depend upon for love and safety are also the source of fear, rejection, unpredictability, or pain?

At that time, we were more likely to understand some of the difficulties that followed these experiences as problems of personality. Borderline personality disorder, for example, was often part of the conversation when someone struggled with intense emotions, fear of abandonment, unstable relationships, self-harm, or an uncertain sense of self. BPD remains a valid diagnosis, and it is not interchangeable with Complex PTSD. What has changed is that we have become much better at recognizing the role that trauma and attachment can play in shaping how a person experiences themselves, other people, and relationships.

That change in perspective has been important in my own work. Complex traumas like the ones above make the most sense when we understand them relationally. Many of the experiences happen in relationships, often during years when we are especially dependent upon other people.

Not surprisingly, the effects frequently show up later in relationships as well. And relationships, including the therapeutic relationship, can become an important part of healing.

When Trauma Isn't a Single Event

Most people are familiar with PTSD, at least in a general sense. Something terrible happens, and afterward the nervous system continues to respond to reminders of that experience. A person may have nightmares or intrusive memories, avoid situations connected with what happened, feel constantly on guard, startle easily, or experience periods of emotional disconnection.

Complex PTSD, or C-PTSD, includes many of the symptoms associated with PTSD, but the history behind it is different. Rather than one traumatic event, there may have been prolonged or repeated experiences that were difficult or impossible to escape. Childhood abuse or neglect, domestic violence, chronic emotional abuse, trafficking, captivity, and institutional abuse can all contribute to complex trauma. Sometimes the history is less obvious. A child may have grown up with a caregiver who was chronically unpredictable, emotionally absent, highly critical, or unable to provide a consistent sense of safety.

This is where attachment becomes so important. Children are dependent upon their caregivers not only for food and shelter, but for comfort, reassurance, help regulating emotions, and a growing sense of who they are. When the person you turn to for comfort is also someone you fear, or when comfort is simply unavailable, there isn't an easy solution. A child can't decide that this is an unhealthy relationship and leave. They have to find ways to live within the relationships they have.

Over time, children become very good at doing what their environment requires of them. One child may become highly attuned to a parent's moods and learn to notice the smallest signs that trouble is coming. Another may become compliant and undemanding. Someone else may learn not to rely on other people at all. A child may become the caretaker in the family, trying to keep everyone calm, or may discover that disconnecting from feelings makes an overwhelming situation easier to tolerate. These responses aren't calculated strategies. They develop gradually because, in some way, they work.

The difficulty is that we can carry them with us long after the circumstances that created them have changed.

When Old Relationships Shape New Ones

This is one of the places where Complex PTSD can become particularly painful. Someone may genuinely want a close, loving relationship and still find that closeness activates fear. They may trust their partner and yet become intensely distressed when that person seems distant. A minor disagreement may feel much larger than it objectively is. Someone may find themselves apologizing quickly, trying to fix another person's mood, withdrawing before they can be rejected, or needing reassurance that the relationship is still okay.

These responses often make more sense when we understand what relationships have meant in the person's life. If affection was unpredictable, a small sign of distance may carry much more weight. If anger once meant that something bad was about to happen, an irritated tone of voice can produce an immediate physical response. If expressing needs led to criticism or withdrawal, asking for something in an adult relationship may still feel surprisingly risky.

People are often very aware that their reactions don't entirely fit the present situation. I've heard some version of "I know this doesn't make sense, but I can't stop feeling it" many times over the years. Intellectually, the person knows that their partner isn't their parent, that a friend taking several hours to respond isn't necessarily abandoning them, or that a disagreement doesn't mean the relationship is over. Their emotional and physical response, however, may be drawing on a much older set of expectations.

The Shame That Can Develop Around These Patterns

One of the most painful parts of complex trauma is how easily people come to blame themselves for these reactions. They may see themselves as too sensitive, too needy, too angry, too difficult, or simply bad at relationships. If the same patterns occur repeatedly, it can begin to feel like evidence of a fundamental flaw.

Understanding trauma doesn't make every response acceptable, and it doesn't remove our responsibility for how we treat other people. What it can do is provide context. There is a difference between recognizing that a behavior is creating problems and concluding that the behavior proves something terrible about who you are.

It can be valuable to become curious about how a pattern developed. Why does another person's disappointment feel so difficult to tolerate? Why is saying “no” so uncomfortable? Why does asking for help bring up shame? Why does closeness create the urge to pull away? These questions help us understand what we are actually trying to change.

That understanding can also bring some compassion to the process. A person who learned to monitor everyone else's emotions may eventually want to stop doing that, but there was probably a reason they became so good at it. Someone who learned not to depend on anyone may now feel lonely, but self-reliance may once have protected them from repeated disappointment. We can appreciate why a response developed while also recognizing that it no longer works very well.

Complex Trauma Lives in the Body Too

Complex trauma isn't only about what someone remembers. It can also show up in physical and emotional reactions that happen before the person has had time to think about them. A particular tone of voice may cause the chest to tighten. Someone walking away during an argument may bring on panic. Conflict can lead to shaking, anger, numbness, or a sudden inability to think clearly.

Sexual intimacy may evoke fear or disconnection even when the person consciously wants closeness.

Sometimes there is a clear connection to the past, and sometimes there isn't. A person may simply know that something about the situation feels threatening. This can be confusing when they also know that they are objectively safe. The body is reacting to something the conscious mind may understand very differently.

Part of trauma work involves becoming more familiar with these reactions rather than judging them immediately. What happened just before the shift? What did you notice in your body? What did you suddenly expect from the other person? Did you want to leave, become angry, apologize, take care of them, or shut down? Over time, these responses can provide useful information about what the nervous system has learned to expect in relationships.

Healing Through New Relational Experiences

If complex trauma often develops within relationships, it makes sense that relationships can also be important in recovery. This doesn't mean that a good therapeutic relationship by itself is enough to heal trauma. It does mean that therapy offers opportunities to experience some things differently.

For someone whose needs were routinely ignored, having another person take those needs seriously can matter. Someone who learned that disagreement led to punishment or withdrawal can experience a difference with a therapist and find that the relationship remains intact. A person who has spent years taking care of everyone else may gradually become more comfortable allowing attention to remain on them. Someone who expects boundaries to be ignored can experience having a boundary respected.

There is also the experience of repair. No therapist gets everything right, and therapy doesn't need to be a relationship without misunderstandings. In fact, being able to talk about something that didn't feel right, have it taken seriously, and remain connected afterward can itself be meaningful. Healthy relationships aren't relationships in which nothing ever goes wrong. They are relationships in which there is enough safety to address what happened.

EMDR, somatic approaches, parts work, attachment-focused therapy, and other trauma therapies can help people process experiences that continue to affect them emotionally and physically. But I don't see these methods as occurring separately from the relationship between therapist and client. Feeling respected, having choices, being able to slow down, saying no, expressing anger, asking for what is needed, and knowing that the other person isn't going to disappear because something difficult happened are all part of the work.

Try This: Practice a Small Repair

Choose a relationship that feels basically safe and think of a small moment of disconnection such as something that bothered you, a misunderstanding you never cleared up, or something you agreed to when you really wanted to say no. Don't choose the most difficult relationship or the biggest rupture in your life. This is an experiment with repair, not a test of how much discomfort you can tolerate.

Now try completing these three sentences:

What happened:Something felt off between us when...

What I usually do when this happens:My instinct is to...

What I might try instead:This time, I could...

Then, if the relationship feels safe enough, consider doing that last thing. It might mean returning to a conversation you've been avoiding, telling someone that a comment stayed with you, acknowledging that you pulled away, apologizing for your part in something, etc,

You don't need a perfectly worded conversation. Something as simple as "I've been thinking about what happened the other day, and I'd like to come back to it" may be enough.

Afterward, notice what happened. Were you able to stay connected to yourself while talking with the other person? What happened when they had their own feelings or perspective? Did the relationship tolerate some discomfort? Were you able to remain connected even if you didn't completely agree?

The important part of the exercise isn't getting the response you hoped for. It's having the experience of approaching a small rupture differently and seeing what happens next. For someone who learned that conflict meant withdrawal, punishment, or loss of connection, discovering that a relationship can be successfully repaired can be healing.

A Different Understanding of Complex PTSD

Our understanding of trauma has changed considerably since I began my career. I think one of the most valuable changes has been recognizing that people adapt to the environments and relationships in which they live. Those adaptations may later become painful. They may interfere with intimacy, make conflict difficult, contribute to dissociation, or leave someone continually preparing for rejection or danger. But they didn't come from nowhere.

Complex PTSD gives us a framework for understanding some of this, but I don't want the diagnosis to become another way of defining a person. I'm much more interested in what it allows us to become curious about: What did you learn about relationships? What happened when you needed comfort? What did you have to do to feel safe or stay connected? What did you learn about expressing anger, having needs, trusting another person, or relying on someone?

And then there are the questions that become possible as healing progresses. Which of those lessons are still true? Which responses are still protecting you, and which are making your life smaller? What would it be like to remain connected to yourself while also being close to another person?

For people who have lived with complex trauma, healing is rarely about simply putting the past behind them. It is more often a gradual process of discovering that the past doesn't have to determine every relationship that comes next.

About Dr. Heidi Dalzell

Heidi J. Dalzell, PsyD, is a licensed clinical psychologist with more than 30 years of experience working with trauma, eating disorders, body image, and the ways early experiences can affect our relationships with ourselves and others. She is EMDR Certified and an EMDRIA Consultant and incorporates EMDR, attachment-focused, somatic, and integrative approaches into her trauma work. Dr. Dalzell provides psychotherapy and EMDR intensives through Sedona Integrative Therapy, with in-person services in Arizona and telehealth services in Pennsylvania and New Jersey.