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What are the differences between Complex PTSD vs. PTSD?

woman with bruises and injuries on her face
Prolonged abusive situations such as Interpersonal Violence, aka Domestic Violence, can lead to C-PTSD.Photo by Sinitta Leunen

You may have heard of the term, Complex PTSD for people who have prolonged trauma from childhood. Complex Post-Traumatic Stress Disorder (C-PTSD) and Post-Traumatic Stress Disorder (PTSD) are related but distinct psychological conditions that can develop in response to traumatic experiences. If you're wondering about the differences between Complex PTSD vs PTSD, this post describes the symptoms and how I can help you recover from them.

Why isn't C-PTSD recognized as a "real disorder?"

It’s important to note that C-PTSD is not an official diagnosis in the DSM-5-TR, the diagnostic manual for mental health disorders. Nonetheless, it seems to apply for a lot of people. The omission of C-PTSD from the DSM-5 has been a topic of discussion and debate within the mental health field. Some argue that C-PTSD represents a distinct clinical entity with unique symptom patterns that deserve separate recognition. Others contend that it is a variant or subtype of traditional PTSD. Until fairly recently, trauma that came from non-combat traumatic incidents was not even recognized as capable of producing PTSD.

It's worth noting that diagnostic criteria and classifications in the field of mental health can evolve over time in response to research and clinical developments. The omission of C-PTSD from the DSM-5 does not mean that it is not recognized or studied by mental health professionals. Many therapists are aware of the concept of C-PTSD and use it to inform their understanding and treatment of individuals who have experienced complex and chronic trauma.

Furthermore, the World Health Organization's International Classification of Diseases (ICD-11) includes a diagnosis called "Complex Post-Traumatic Stress Disorder" as a separate diagnostic category. This reflects a growing recognition of the importance of acknowledging the unique features of C-PTSD.

In honor of October being Domestic Violence Awareness month, I thought it would be important to cover these different types of post traumatic stress. Here are the main differences between them.

The Nature of the trauma differs for Complex PTSD vs. PTSD

The types of traumata that arise in PTSD are somewhat different for C-PTSD vs. PTSD. PTSD typically arises from a single, discrete traumatic event or a series of events with a clear beginning and end. Examples include combat experiences, accidents, natural disasters, or sexual assault. Being involved in such events is difficult and scary, but you are not constantly in these dangerous situations so you can re-stabilize better than with C-PTSD.

Complex PTSD, on the other hand, results from prolonged and repeated exposure to traumatic stressors. This often happens in the context of interpersonal relationships. It's commonly associated with ongoing, pervasive abuse or neglect, such as childhood abuse, domestic violence, or captivity situations. If there’s no escape from your abusers or from the traumatic situation, you might not learn that the situation is abnormal or problematic. So you might think that the problem is you, not the situation.

flames of a fire
Emotional regulation, especially unexpressed anger, can be a part of C-PTSD.

The core symptoms of PTSD are different from C-PTSD

If you have PTSD you are likely to re-experience the traumatic incident through flashbacks or nightmares, and you may avoid reminders of the trauma. Your mood may change for the worse, and your thoughts become negative as well. You may be hypervigilant, or on edge, looking out for the next bad thing to happen. Your nervous system is on high alert and you may have a heightened startle reaction, be more irritable, or have difficulty with sleep or feeling at ease.

The core symptoms of C-PTSD are addition to the core symptoms of PTSD. If you’re suffering from this disorder, you’re likely to feel worthless or shameful and have trouble with relationships with others. You might have intense anger or mood swings, and trouble trusting others and forming healthy relationships.

Additionally, C-PTSD is strongly associated with disruptions in attachment and often involves complex relational issues. It might be hard for you to make and keep healthy boundaries, or have chronic feelings of emptiness. You might also have a sense of betrayal by caregivers or other trusted people in your life. In this way, C-PTSD can resemble disorders like Borderline Personality Disorder, although there’s no evidence that the two are the same.

The length of illness and complexity differ as well for Complex PTSD vs. PTSD

The symptoms of PTSD can last for a long time but are usually more focused on the immediate aftermath of the trauma. The “aftermath” symptoms can include flashbacks, nightmares, hypervigilance, and avoidance of things that remind you of the traumatic incident.

C-PTSD is characterized by a more complex and enduring set of symptoms that may persist for years or even decades. If you have this, your symptoms can include those seen in PTSD but also distorted self-identity, poor emotional regulation, and interpersonal difficulties.

Here’s an example. Say you were raised with neglectful or drug-dependent caregivers and you learned to fend for yourself. In addition, while you were young your caregivers didn’t protect you from unsavory people coming into the home. You may develop flashbacks or avoidance of sexual situations, but also think of yourself as shameful or dirty because of what happened to you. It might be hard for you to trust people, even if they seem trustworthy to others, and you might get flooded with fear or anger when people try to get too close to you.

Treatment Options for Complex PTSD vs PTSD

The treatment of PTSD often focuses on evidence-based therapies like Cognitive-Behavioral Therapy (CBT) and Eye Movement Desensitization and Reprocessing (EMDR) to address specific trauma-related symptoms.

EMDR therapy can also be helpful for C-PTSD, but you might need a little more skill-building and learn how to access your resources more than for PTSD. C-PTSD may require a more comprehensive and long-term therapeutic approach that addresses not only trauma symptoms but also the broader interpersonal and emotional difficulties.

Therapies such as dialectical-behavior therapy (DBT), schema therapy, and psychodynamic therapy can be helpful for C-PTSD, but you have more options than just those. Ericksonian hypnosis can help you access your resources, as well as lower your anxiety. Solution Focused therapy can be useful for helping you see where you’ve been successful before and using those abilities in other contexts. The Flash Technique can also help you resolve early childhood memories without a lot of pain and re-living of the memories.

Both PTSD and C-PTSD can be severe and debilitating, but the differences in their origins and symptom profiles highlight the need for tailored treatment approaches. I can help you sort out what your experience with trauma is like for a proper diagnosis and treatment plan based on your specific experiences and needs. If you’d like to make an appointment to learn more, please call 661-233-6771.

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