The C-PTSD Symptom Wheel

feature art

C-PTSD Symptoms

in visual form

A therapist-designed resource designed to bring the ICD-defined symptoms into conversation.

Recently, I discovered an academic journal article exploring the symptoms of Complex Post Traumatic Stress Disorder, and I was inspired to create this illustration.

In this illustration of the diagnostic criteria for C-PTSD, I show how the diagnosis is defined by symptom clusters, and how those clusters break down into specific symptoms.

Too often, the work of mental health researchers gets stuck in academia- never making it to clinicians or clients. This is what led me to create this C-PTSD symptom wheel, a new research-backed resource for therapists and trauma survivors.

In this article, I’ll provide an overview of complex post-traumatic stress disorder, highlight why it’s important to translate academic speak, share my intent behind creating this resource, and explain my new C-PTSD wheel.

C-PTSD Explained

Complex post-traumatic stress disorder (more often called simply C-PTSD) is a type of PTSD that can develop when a person has been exposed to multiple traumatic events.

Regular PTSD is a diagnosis that most often fits the symptoms of people with single-event trauma. Many people who have experienced prolonged exposure to traumatic stress (such as abuse, incarceration, being a refugee, etc) often have a cluster of symptoms that fit less neatly into the standard list of PTSD symptoms.

Historically, mental health providers haven’t done a great job of understanding and categorizing the experiences of these trauma survivors. They were once commonly misdiagnosed with “hysteria” before “borderline personality” became the most common diagnosis. However, these diagnoses typically label rather than empower people with complex trauma.

In an attempt to remedy this, in 2000, the international version of the DSM-5, called the ICD, was updated to include complex post-traumatic stress disorder. With a robust body of research funded by this international update, we can expect that complex PTSD will be added to the United States version of the diagnostic manual, the DSM-V.

In the meantime, accessing care for this disorder can be difficult.

blank c-ptsd symptom wheel

Limited Care: Limited Training

One reason diagnoses can be valuable is that they pave the way for providers to learn about effective treatments.

Because the DSM-5 doesn’t list C-PTSD as a disorder, providers often have to diagnose with less accurate, less helpful diagnoses in order to get insurance to reimburse for treatment for complex PTSD.

Additionally, since the disorder is not listed in the US diagnostic manual, most clinicians (still! In 2023) don’t receive training during their graduate education or internships on effective treatments for C-PTSD.

Because there are fewer trained providers, individuals who recognize this symptom cluster in themselves should seek out the care of a trauma therapist who has additional credentials, training, experience, and supervision in treating complex trauma.

Defining C-PTSD

The World Health Organization developed a diagnostic criteria for C-PTSD in 2000.1 Researchers divided the symptoms that characterize this disorder into eight categories.

When I found the World Health Organization’s list of C-PTSD symptoms visually represented in an Australian medical journal, I knew it – like so many journal articles – had incredibly valuable resources buried in academic speak.

The categories that researchers identified were:

  • avoidance,
  • hypervigilance,
  • reexperiencing,
  • altered attention and consciousness in memory,
  • emotional dysregulation,
  • interpersonal instability,
  • belief systems affected,
  • and somatic symptoms.

So what do those mean in everyday language? Well, that’s why I created this version of the C-PTSD symptom wheel. Understanding our diagnoses and being empowered to self-advocate requires a grasp of how those categories of symptoms show up in our lives.

Translating Academic Speak

One of the problems I recognized as a graduate student is that so much important research published by academics never quite made it beyond academic circles.

I started doodling journal articles to help bridge this gap – today, patrons make it possible for me to create engaging easy-to-understand visuals that help connect the valuable work of academics to the wider world.

Now more than ever, it’s important to consume information from reliable sources. However, when reliable sources are unnecessarily complex or overly clinical, it can create a barrier to accessing the information needed to advocate for ourselves and others. My resources are desgined to be a bridge.

Download the C-PTSD Wheel PDF

Download for personal or professional use

This 3-page PDF download includes a full-color wheel, a black-and-white wheel, and a wheel with a blank outer ring.

The first two resources are designed as educational tools, while the third can be used as a fill-in-the-blank worksheet for therapists to use as they help individuals recognize how symptoms might show up in their lives.

How the C-PTSD Symptom Wheel is Set Up

The second ring in the octagon wheel is broken down into specific examples of how these symptom categories show up in someone’s life.

For example, no one sits down in a therapist’s office and reports that they have “frequent relational instability.” Instead, people slowly become aware of just how isolated they feel, how often their relationships end in conflict, or how frightening it is when they are close to someone.

c-ptsd symptom wheel

The key idea is that when we can see examples and understand what each symptom cluster means, it’s easier to see ourselves in our own behavior in relation to the wheel.

Seeing specific examples might help us understand that “oh, this actually isn’t what I experience” or have that “aha” moment of being like “oh my gosh, this fits me to a T.” No matter what your experience is with this C-PTSD symptom wheel, I hope that you will use it with kindness and for the purpose of care, accessibility, and advocacy.

This Wheel is Available as a Throw Pillow for Home or Office:

C-PTSD Symptoms

I’ve put together a quick rundown of the contents of the C-PTSD symptom wheel, which is itself based on the World Health Organization’s diagnostic criteria for C-PTSD.1


Hypervigilance symptoms are broken down into startle response, watchful, and careful.

People who experience hypervigilance with C-PTSD are often easy to surprise. They may carefully monitor their surroundings for danger, and may be slow to let down their guard. The World Health Organization, however, specifies that the startle response may be decreased in some individuals with complex PTSD.

Intrusive Memories and Reexperiencing:

Like PTSD, C-PTSD involves nightmares, flashbacks, and somatic intrusions. The World Health Organization is careful to specify that these can occur on a spectrum. For some people, flashbacks take the form of emotional flashbacks, which are often less visual or sensory than the type of flashbacks we typically think of.

Traumatic re-enactment- in which some part of the original trauma is re-enacted in the present (in a subconscious attempt to master or alter the experience), is common.

In some cases, these symptoms can be confused with panic attacks. “Survivors may struggle to identify triggers, and so may misinterpret re-experiencing as panic attacks or hallucinations.”2

Memory and Attention Problems:

A unique characteristic of C-PTSD is issues with memory, thinking, and cognition. People who have experienced complex trauma may have trouble focusing, experience distractibility, and be forgetful.

Some of these symptoms can mirror the symptoms of ADHD, according to the World Health Organization ICE diagnostic criteria.1 Fragmented memories, like those explained by the BASK model of trauma memory, are common.3

Emotion Regulation Struggles:

Emotion regulation difficulties related to complex post-traumatic stress are one of the hallmarks of this disorder and one of the most difficult to recognize without the support of an emotionally regulated person. I’ve chosen to include “overwhelming emotions,” “self-harm,” and “crisis” as the three specific symptoms of this cluster, since these capture the intensity of the emotions associated with C-PTSD.

Relational instability:

Relational instability is another category of symptoms in the C-PTSD symptom wheel. I chose to break down this category into three common relational symptoms of complex trauma: often expereincing unsafe relationships, having relationships with high conflict, and experiencing problems with intimacy.

Like the fearful-avoidant attachment style often associated with C-PTSD, trauma survivors often “can’t get close and can’t get far enough away.” In an overlap with symptoms in the re-experiencing category, survivors may experience traumatic reenactment in relationships, which can lead to painful conflict with the people we care about.

Belief Systems Impacted:

One of the unique symptoms of C-PTSD, relative to other mental health disorders, is that it is often connected to a loss of meaning, deconstruction of belief systems, or a loss of belief in a religion that was previously important.

Having a belief system impacted by this C-PTSD symptom cluster doesn’t have to be about organized belief structures; it can also be internal, personal, familial, communal, etc. For many people, this is experienced as meaninglessness, guilt, and shame about their traumatic experiences and the loss of belief in beliefs that were previously important.

Somatic Symptoms:

While none of these symptom clusters are more important or bigger than the others, somatic symptoms are often what cause the most suffering and force us to make connections between what we are experiencing in the present and what we have experienced in the past. In this somatic symptoms section of the C-PTSD resource, I’ve listed physical symptoms, tightness, and chronic pain, as these were the most appropriate specific symptoms based on my own reading on C-PTSD.


The final symptom cluster contained within this C-PTSD symptom wheel is avoidance. A predictable symptom for anyone surviving trauma is to avoid situations that might be scary because of what they’ve been through. For PTSD and individuals with C-PTSD, the whole world can become frightening after a series of traumas that create the symptom constellation of C-PTSD.

In the outer wheel of this resource, I’ve chosen a few specific examples, including isolation, dissociation and compulsive behavior. Many people with C-PTSD avoid circumstances and situations that might remind them of their trauma, dissociate during extreme stress, or avoid feeling anything by compulsively engaging in negative behaviors (like substance abuse) or positive behaviors (like exercise, work, or maladaptive perfectionism).

“A person might seek to avoid unpleasant experiences by rerouting their sense of chaos to something they feel they can control, this can give rise to unhelpful behaviors” 2

While young children are most likely to dissociate traumatic memories, “dissociation can still occur even if the event occurs after adolescence, especially the more significant the intrusiveness of the event, and if there is a pronounced experience of helplessness” 2 Research also suggests that “symptoms may be more predominant at important life events such as marriage, pregnancy, and childbirth.”4

Advocacy is Key

The resources I’m most proud of are those that are empowering. For example, my emotion sensation wheel is a positive resource that helps people make connections that can help them heal.

Often, I avoid creating resources that might make people feel sicker or resources that enable self-diagnosis.

However, C-PTSD is an exception.

As a trauma survivor myself, I am critically aware of how few therapists are equipped to recognize, diagnose, and treat complex post-traumatic stress disorder.

Because this disorder is not yet included in the US diagnostic manual, most therapists received little to no training on complex trauma. In fact, therapists who graduated from graduate school prior to about 2015 may have never even heard complex posttraumatic stress mentioned during their training.

Because of this, I think it is especially important with C-PTSD to make resources available – even diagnostic resources. While it’s never advisable to self-diagnose, especially a serious mental illness such as C-PTSD, knowledge is power. Knowledge can inform advocacy, which informs empowerment and access to treatment.


This C-PTSD Symptom Wheel is based on the work of Dr. Wei-May Su and Dr. Louise Stone and their article Adult Survivors of Childhood Trauma: Complex Trauma, Complex Needs.2 The authors used the World Health Organization’s diagnostic criteria5 to create a technical version of the internal octagon shown in my resource. You can view this original version via this open access journal article. Their version was developed and languaged for medical doctors, but my C-PTSD symptom wheel is both simplified and expanded to help average readers understand the concepts and recognize real-life examples of how these symptom clusters show up in everyday life.

My adaptation of this resource includes revisions to the language of the internal octagon. My language choice, in contrast to that of researchers, is to choose accurate but easy-to-understand language. After all, accessing and understanding information is the first step to advocacy for ourselves or each other.


In conclusion, the C-PTSD Symptom Wheel is a resource I’ve created to bridge the gap between academic research and practical mental health advocacy. Complex post-traumatic stress disorder is a condition that often goes unrecognized and underdiagnosed due to its absence from diagnostic manuals and the complexity of its symptom clusters. This printable PDF resource provides an accessible breakdown of C-PTSD symptoms, using plain language and tangible examples to help individuals and therapists better understand and identify these symptoms in everyday life.

Image Description

The image is of the “C-PTSD Symptom Wheel,” which is shaped like an octagon. The wheel is split into an inner circle that has 8 symptom categories with a correlating outer circle that shows the symptoms that could be experienced in each of those categories. The first category, which is shaded in yellow, is “hypervigilance.” The symptoms that could be experienced here are “startle response, watchful, or careful.” Clockwise, the second category, which is shaded in orange, is “intrusive memories and re-experiencing.” The symptoms that could be experienced here are “nightmares, flashbacks, or traumatic re-enactment.” The third category, which is shaded in red, is “memory and attention problems.” The symptoms that could be experienced here are “trouble focusing, fragmented memories, or forgetful.” The fourth category, which is shaded in a light red, is “emotional regulation struggles.” The symptoms that could be experienced here are “overwhelming emotions, self-harm, or crisis.” The fifth category, which is shaded in a light pink, is “relational instability.” The symptoms that could be experienced here are “unsafe relationships, high conflict, problems with intimacy.” The sixth category, which is shaded in purple, is “belief systems affected.” The symptoms that could be experienced here are “meaninglessness, shame and guilt, or loss of belief.” The seventh category, which is shaded in blue, is “somatic symptoms.” The symptoms that could be experienced here are “physical symptoms, tightness, or chronic pain.” The eighth and last category, which is shaded in green, is “avoidance.” The symptoms that could be experienced here are “often isolated, dissociation, or compulsive behavior.” The wheel was illustrated by Lindsay Braman.

  1. World Health Organization’s International Classification of Diseases, 11th Revision. [] [] []
  2. Su WM, Stone L. Adult survivors of childhood trauma: Complex trauma, complex needs. Aust J Gen Pract. 2020 Jul;49(7):423-430. doi: 10.31128/AJGP-08-19-5039. PMID: 32599999. Page 426. [] [] [] []
  3. Braun, B. G. (1988). The BASK model of dissociationDissociation: Progress in the Dissociative Disorders, 1(1), 4–23. []
  4. Su WM, Stone L. Adult survivors of childhood trauma: Complex trauma, complex needs. Aust J Gen Pract. 2020 Jul;49(7):423-430. doi: 10.31128/AJGP-08-19-5039. PMID: 32599999. Page 424 []
  5. World Health Organization’s International Classification of Diseases, 11th Revision. []


  1. Hi Lindsay! A patient of mine came in and showed me this, and I just wanted to say thank you. What a great site! I am always looking for resources for my patients, and its great you found my writing helpful. Thank you for all you do


  2. Thank you so much for making wonderful, engaging resources for us and our clients. I have the huge feelings/sensations wheel on my office wall. Best Wishes!!!

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