Complex PTSD: When Nothing Makes Sense (and the Kitchen Sink)

In this episode, Dr. Faisal Rafiq explores the complexity of Complex PTSD (cPTSD)—a condition shaped by chronic, repeated trauma that often masquerades as mood, personality, or anxiety disorders. Through a trauma-informed lens, this episode walks clinicians through recognizing cPTSD’s emotional and somatic layers, differentiating it from BPD or TRD, and understanding why traditional diagnostic frameworks often fall short. Dr. Rafiq breaks down symptom clusters, guides clinicians on medication strategies, and introduces emerging treatments like Rexulti and Auvelity, while also revisiting underutilized options like Elavil for trauma-linked insomnia and pain. A critical theme is the importance of sequencing care properly—using medication to stabilize before engaging in deep trauma therapy such as EMDR or IFS. With supervision reflections woven throughout, the episode reinforces the message: Complex PTSD isn’t a broken brain—it’s an adapted one.
Treatment begins with safety, structure, and steady presence.