Complex PTSD Symptoms: The Full ICD-11 List, the Codes, and What They Look Like Day to Day
Complex PTSD (ICD-11 code 6B41) has six symptom groups: the three core symptoms of PTSD, which are re-experiencing the trauma in the here and now, avoiding reminders, and a persistent sense of current threat, plus three more: severe problems regulating emotions, a deep belief that you are diminished, defeated or worthless, and persistent difficulty staying close to people. That is the World Health Organization's definition. ICD-10 never had a complex PTSD code, and DSM-5 does not include the diagnosis at all.
This page is the list and the codes. If you want the plain difference between the two diagnoses, read PTSD vs complex PTSD first. I'm not a clinician; everything below is quoted or summarised from the WHO, NICE and published abstracts, listed at the end.
What are the symptoms of complex PTSD? (the full ICD-11 list)
ICD-11 says complex PTSD may follow "an event or series of events of an extremely threatening or horrific nature, most commonly prolonged or repetitive events from which escape is difficult or impossible", such as prolonged domestic violence or repeated childhood sexual or physical abuse. All of the following must be present:
| Symptom group | What ICD-11 requires | What the WHO says it can look like |
|---|---|---|
| 1. Re-experiencing | The event is "not just remembered but is experienced as occurring again in the here and now" | Vivid intrusive memories, flashbacks from mild to a complete loss of awareness of your surroundings, nightmares, strong physical sensations |
| 2. Avoidance | Deliberate avoidance of reminders | Pushing thoughts away, avoiding people, conversations or places; in extreme cases moving house or changing jobs |
| 3. Sense of current threat | Persistent perceptions of heightened current threat | Hypervigilance, not sitting with your back to the door, repeatedly checking the rear-view mirror |
| 4. Affect regulation | Severe and pervasive problems | Big reactions to minor stressors, violent outbursts, reckless or self-destructive behaviour, dissociating under stress, emotional numbing, being unable to feel pleasure |
| 5. Negative self-concept | Persistent beliefs about yourself as diminished, defeated or worthless | Deep and pervasive shame, guilt or failure, for example guilt about not having escaped |
| 6. Relationships | Persistent difficulty sustaining relationships and feeling close to others | Avoiding or deriding relationships, or occasional intense relationships that are hard to keep going |
Groups 4 to 6 are what researchers call "disturbances in self-organisation", or DSO. On top of all six, the symptoms must cause significant impairment at home, work, school or socially, and the WHO adds a line I think matters: "If functioning is maintained, it is only through significant additional effort." Coping on the outside does not rule it out.
One detail people miss: in complex PTSD, ICD-11 says the startle reaction "may in some cases be diminished rather than enhanced".
Is there a complex PTSD symptoms checklist?
The closest official checklist is in NICE guideline NG116. It tells clinicians to be aware that people with PTSD, including complex PTSD, may present with:
- re-experiencing
- avoidance
- hyperarousal, including hypervigilance, anger and irritability
- negative alterations in mood and thinking
- emotional numbing
- dissociation
- emotional dysregulation
- interpersonal difficulties or problems in relationships
- negative self-perception, including feeling diminished, defeated or worthless
Researchers often measure complex PTSD with the International Trauma Questionnaire. A questionnaire can point you towards a conversation with a professional; it cannot diagnose you.
What are the ICD-11, ICD-10 and DSM codes for complex PTSD?
| System | Complex PTSD | Nearest codes |
|---|---|---|
| ICD-11 (WHO) | 6B41 Complex post traumatic stress disorder | 6B40 Post traumatic stress disorder |
| ICD-10 (WHO) | No code | F43.1 Post-traumatic stress disorder; F62.0 Enduring personality change after catastrophic experience |
| ICD-10-CM (US) | No separate code | F43.10 PTSD unspecified, F43.11 acute, F43.12 chronic |
| DSM-5 (US) | Not included | PTSD only |
F62.0 is the interesting one. ICD-10 described it as personality change lasting at least two years after catastrophic stress, with "a hostile or distrustful attitude toward the world, social withdrawal, feelings of emptiness or hopelessness, a chronic feeling of 'being on edge'", and noted that PTSD may come before it. ICD-11 sits complex PTSD in chapter 06, under "Disorders specifically associated with stress", next to PTSD. Which code appears in your records is your clinician's decision.
Is complex PTSD in the DSM-5?
No. NICE puts it plainly: "DSM-5 does not include a diagnosis of complex PTSD." It covers the complexity through a wider range of core PTSD symptoms instead. I couldn't find a primary source on future DSM plans, so I won't guess.
What does complex PTSD look like day to day?
The ICD-11 text describes a kind of re-experiencing that many people call an emotional flashback: "being overwhelmed or immersed in the same intense emotions that were experienced during the traumatic event, without a prominent cognitive aspect". No picture, just the feeling, arriving out of nowhere. I wrote about emotional flashbacks and how to come back from them.
In daily life that can mean scanning every room, losing a whole evening to shame over one small mistake, going numb when you should feel joy, or keeping people at arm's length. A 2026 study that tracked 553 intrusive memories in 51 people with PTSD or complex PTSD found that anger just before an intrusion predicted more distress and a stronger sense of losing control.
Can complex PTSD cause memory loss or memory problems?
It can be linked with memory problems, though "memory loss" overstates what the evidence shows.
- ICD-11 says dissociative symptoms after trauma can include "memory disturbances", especially during re-experiencing.
- It says children and teenagers with complex PTSD are more likely to have "cognitive difficulties (e.g., problems with attention, planning, organizing)".
- A 2025 study of 64 patients found both PTSD and complex PTSD groups scored below the test norms, and the complex PTSD group scored lower on visual memory and selective attention. It is small.
- In 428 UK veterans, every complex PTSD symptom cluster was linked with worse self-reported executive function, including working memory. That was cross-sectional, so it shows association, not cause.
Does complex PTSD cause brain damage?
I can't find evidence that supports calling it brain damage. ICD-11 classifies it as a mental disorder, not a brain injury. A 2022 review describes "an imbalance in limbic-frontal brain networks" across complex PTSD, PTSD and BPD, but also notes that no fMRI studies directly compare the three. Different brain activity is not the same thing as damage.
Complex PTSD and dissociation
ICD-11 lists "dissociative symptoms when under stress" as an example of the emotion-regulation problems. If dissociation happens only during flashbacks, a separate dissociative disorder should not be diagnosed; if it happens outside them and meets full criteria, it may be.
In 106 UK clinical patients, those with complex PTSD had much higher dissociation than those with PTSD. But in 165 people meeting complex PTSD criteria in a treatment trial, only 42.3% had clinically significant dissociation, and the authors concluded the data does not support complex PTSD being a dissociative disorder.
Can complex PTSD cause psychosis or hallucinations?
ICD-11 lists "psychotic symptoms" among features that may be present. It also says severe flashbacks can have a hallucinatory quality, and that auditory pseudo-hallucinations, recognised as your own thoughts, "should not be considered evidence of a psychotic disorder".
- Among 213 people seeking trauma treatment, 27.9% of those with probable complex PTSD reported hearing voices, against 15.4% of those with probable PTSD.
- In 153 people with both trauma symptoms and psychosis, emotion, self-concept and relationship symptoms in the previous 90 minutes predicted paranoia, voices and visions at the next check-in, even after allowing for core PTSD symptoms.
These are specific samples. If you hear or see things others don't, tell your GP.
What are the physical symptoms of complex PTSD?
ICD-11 says "somatic complaints may be present", and re-experiencing typically comes with "strong physical sensations". For PTSD it lists somatic symptoms that can be prominent in some cultures, including headaches, dizziness, shortness of breath, gastrointestinal distress and trembling.
In surveys of 1,020 Irish and 1,051 UK adults, PTSD and DSO symptoms fully mediated the link between childhood trauma and somatic problems in adulthood. That is self-report and cross-sectional. A small London interview study described the relationship both ways, with pain triggering flashbacks.
Complex PTSD symptoms in women and men
ICD-11 says "Females are at greater risk for developing Complex Post-Traumatic Stress Disorder than males" and are more likely to show greater distress and impairment. In a US population study, 3.8% of adults met criteria for complex PTSD and 3.4% for PTSD, with women more likely than men to meet criteria for both. Cumulative childhood trauma was more strongly tied to complex PTSD. In an Irish sample, women were more likely to report sexual and emotional abuse; men reported more physical violence, accidents and disasters.
The symptom list is the same for everyone.
Complex PTSD symptoms in teens and children
ICD-11 says teenagers may show it through "substance use, risk-taking behaviours (e.g., unsafe sex, unsafe driving, non-suicidal self-harm), and aggressive behaviours". In children it can show as regression, reckless or aggressive behaviour, and difficulty relating to peers. When a caregiver was the source of trauma, children can alternate "between neediness, rejection, and aggression".
If this list sounds like you
Take it to your GP and use the words on this page. Here is how to get complex PTSD treatment on the NHS, and UK support by what happened to you. ICD-11 notes that many people with complex PTSD may also meet criteria for a personality disorder, so if you're unsure, complex PTSD or BPD explains the dividing line. For work and benefits, see is complex PTSD a disability?
If you're parenting with it, I wrote Grounded: Parenting with Complex PTSD for you.
Sources
- World Health Organization. ICD-11 for Mortality and Morbidity Statistics (2025-01): 6B41 Complex post traumatic stress disorder, and 6B40 Post traumatic stress disorder, including Diagnostic Requirements. icd.who.int
- World Health Organization. ICD-10 (2019): F43.1 Post-traumatic stress disorder; F62.0 Enduring personality change after catastrophic experience. icd.who.int/browse10
- US National Library of Medicine, Clinical Tables ICD-10-CM search: F43.10, F43.11, F43.12.
- NICE. Post-traumatic stress disorder (NG116), 2018: recommendation 1.1.1 and terms used.
- Cloitre M et al. ICD-11 PTSD and complex PTSD in the United States: a population-based study. J Trauma Stress 2019;32(6):833-842. PMID 31800131
- Dietiker L et al. Intrusive memory sequences in PTSD and complex PTSD. Eur J Psychotraumatol 2026;17(1). PMID 42227348
- Schöndorf ZS et al. Cognitive functioning in complex PTSD compared to non-complex PTSD. Front Psychiatry 2025;15:1433614. PMID 39882167
- Biscoe N et al. Complex PTSD symptom clusters and executive function in UK Armed Forces veterans. BMC Psychol 2024;12:209. PMID 38622745
- Stopyra MA et al. Pathophysiological aspects of complex PTSD. Rev Neurosci 2022. PMID 35938987
- Hyland P et al. ICD-11 PTSD, complex PTSD and dissociative experiences. J Trauma Dissociation 2020;21(1):62-72. PMID 31583967
- Fung HW et al. Dissociative symptoms in people with complex PTSD. Psychiatry Res 2024;339:116076. PMID 38996630
- Cheung CTY et al. Auditory verbal hallucinations among intervention seekers with and without complex PTSD. J Psychiatr Res 2025;184:405-410. PMID 40107031
- Panayi P et al. Complex PTSD symptoms predict positive symptoms of psychosis in daily life. Psychol Med 2024;54(12):3489-3500. PMID 39363544
- Ho GWK et al. Traumatic life events as risk factors for psychosis and ICD-11 complex PTSD. Eur J Psychotraumatol 2021;12(1):2009271. PMID 34900125
- Ho GWK et al. Complex PTSD symptoms mediate the association between childhood trauma and physical health problems. J Psychosom Res 2021;142:110358. PMID 33508705
- Blackett L et al. Complex PTSD and chronic physical health conditions: a qualitative study. Br J Clin Psychol 2025;64(4):1020-1042. PMID 40432224
Read from the published abstracts and guidance on 5 October 2026. If something here is out of date or wrong, tell me.
Nothing here is medical advice, it's lived experience, meant to sit alongside real support, not replace it. If you're struggling, please see the support resources. If you're in crisis in the UK, call Samaritans free on 116 123, or dial 999 in an emergency.