Complex PTSD vs. PTSD: Discovering the Difference
Knowing how to navigate your mental health needs can be a challenge, especially if you’ve experienced trauma. Complex PTSD (CPTSD) and Post-Traumatic Stress Disorder (PTSD) are two conditions that can occur in trauma survivors—but what differentiates the two?
When comparing Complex PTSD vs. PTSD, it’s important to note that CPTSD is more than just a more complicated or severe version of PTSD. Instead, the two conditions stem from different root causes, and thus each require unique treatment.
Keep reading to learn more about the similarities and differences between PTSD and CPTSD.
What Is PTSD?
Initially observed in military veterans, PTSD is a trauma-related condition that can develop after a traumatic experience, such as exposure to actual or threatened death, severe injury, or sexual violence.
Symptoms of PTSD may include:
Flashbacks or nightmares in which someone re-experiences the traumatic event
Patterns of avoidance surrounding reminders of the traumatic event
Negative mood or thinking, which may present as irritability, shame, guilt, or emotional numbing
Difficulty concentrating or sleeping
Hypervigilance or an exaggerated startle response that may come across as “jumpy”
Additionally, PTSD can cause physical symptoms such as headache, GI distress, sweating, and increased heart rate.
What Is Complex PTSD?
In many ways, Complex PTSD can present quite similarly to PTSD. Most symptoms of PTSD are also present in CPTSD—however, CPTSD has a slightly different root cause.
According to Alesin Sinclair, LCSW, while PTSD typically stems from a single traumatic event, CPTSD develops from prolonged, repeated traumatic experiences, particularly relational ruptures, or wounds resulting from harm delivered by the people who are supposed to be the safest.
“CPTSD is the nervous system’s response to ongoing, repeated relational trauma,” says Sinclair, such as through neglect, emotional, physical or psychological abuse, domestic violence, trafficking, prolonged medical trauma, refugee experiences, and Indigenous experiences. I often work with clients who share about their struggle to name their trauma and as they grapple with that, they often report the belief operating within them is, ‘It isn’t as bad as what others have gone through. It’s not a plane crash or war or anything like that.’ What is important to know is that exposure to ongoing, repeated relational trauma places us in survival mode neurologically, and over time, our nervous system gets stuck.”
Sinclair further explains that neurologically, a person can feel as though they are going to die without registering that feeling cognitively. When a person is harmed repeatedly, their nervous system learns to stay in survival mode—and if the person causing the hurt is also a person you depend on for survival, that is a life-threatening situation that can result in CPTSD.
Because CPTSD is related to ongoing relational trauma, additional side effects may include:
Difficulty regulating emotions
Negative self-image or low self-esteem
Feeling detached or dissociated from oneself
Difficulties maintaining relationships or trusting others
Distorted perception of the abuser
Complex PTSD vs. PTSD: What’s the Difference?
Oftentimes, PTSD and CPTSD are lumped together or referred to interchangeably by those unfamiliar with the distinctions. However, CPTSD is not simply more severe PTSD. The two conditions are very different clinically, and each requires a unique understanding.
“I have heard CPTSD conceptualized in the field as trauma without borders,” says Sinclair. “There is often no before or after, like there is with PTSD.”
While PTSD is often clearly related to a specific event—trauma with borders—such as combat or a car accident, complex trauma often occurs at a time when a person is developing their identity and just learning how to manage and regulate emotions. When trauma occurs as the self is developing, it can lead to trauma being a part of the fabric of the person’s identity, relationship maps, and body’s baseline state of being.
“CPTSD occurs with chronic and relational trauma, such as from primary caregivers or someone you love who is trusted and it often begins in childhood,” says Sinclair. “This is where the developmental component comes in—when we experience repeated relational harm during the time when our nervous system, attachment style and identity are forming, we are especially vulnerable to developing CPTSD as a result. Our primary caregivers are where we develop our own attachment style and learn how to connect and attach with others. Harm from our primary caregivers, especially repeated, can do a tremendous amount of damage to our ability to securely attach to others.”
How Are PTSD and CPTSD Diagnosed?
PTSD criteria for a diagnosis are spelled out in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5 criteria), which requires:
A qualifying traumatic event
Intrusive distressing memories, dreams, flashbacks, or feelings
Avoidance of thoughts or reminders of the event
Negative shifts in cognition and mood
Shifts in arousal and reactivity
If these criteria persist for more than one month and cause functional impairment, a patient may be diagnosed with PTSD.
However, Complex PTSD is not an official diagnosis in the DSM-5 and thus does not have the same clearly laid out criteria, which can lead to misdiagnosis, which Sinclair says she has seen often in her practice.
“Clients come into my office with a prior diagnosis of Borderline Personality Disorder, Bipolar Disorder, Generalized Anxiety Disorder, or Major Depressive Disorder who have complex trauma in their history that they report has been overlooked. Often, I find that CPTSD better explains what we are seeing diagnostically in many of these cases. The trauma is often the why.”
CPTSD is a recognized diagnosis by the World Health Organization in the International Classification of Diseases (ICD-11), which lists a set of criteria including core PTSD symptoms in addition to affect dysregulation, negative self-concept, and relational disturbances.
Thorough assessment of trauma history from a licensed provider is also essential in the diagnosis of CPTSD.
Treatment for PTSD vs. Complex PTSD
When working with trauma-related conditions, the goal of treatment is often to regain functioning and process the traumatic event(s). The therapeutic relationship provides a safe, structured space for healing to occur. However, because PTSD and Complex PTSD are very different clinically, they each require unique treatment approaches.
PTSD Treatment
Treatment for PTSD may include:
The goal of PTSD treatment is to integrate traumatic memories so they are no longer experienced as a present threat.
CPTSD Treatment
Because much of CPTSD is rooted in relational trauma, the therapeutic relationship offers a healing experience where a patient is seen, heard, and celebrated, and thus develops a sense of felt safety. This is crucial because it might be the first time the patient has experienced a relationship in which the other party is consistent, boundaried, and attuned to them, creating the opportunity for neural repair to occur.
The treatment of Complex PTSD involves a structured three-step approach:
Building trust and security
Processing through the trauma
Integration of traumatic memories
Here’s why each step matters:
Building Trust and Security
As CPTSD patients have often spent years living in a state of fight or flight, it’s important to first prioritize the building of safety. Without this baseline of trust, it’s impossible to move forward through the next steps of treatment.
Aspects of this first step of treatment may include:
Safety planning
Learning emotional regulation skills and strategies
Expanding the window of tolerance for distress
Reducing the baseline of activation
It’s also important during this time for the patient to understand why treatment is so important and how the strategies being used are valuable, as this understanding significantly reduces barriers to access. When a person knows why something works, they’re more likely to use it.
Trauma Processing
Next, the patient must begin processing through the trauma. Common modalities to do this include EMDR, Cognitive and Somatic Processing Therapy, Sensorimotor Therapy, and Narrative Therapy Approaches. Sinclair notes that this part of treatment should be broken up into digestible chunks, easing in slowly rather than jumping into the deep end. Maintaining dual awareness—keeping one foot in the trauma and one foot in the present—is key.
Trauma processing is not a linear journey, and requires periodic regulation to reach a point of repair. “It is the regulation that allows alternate neural pathways to develop and helps the survival pathways to break down over time,” shares Sinclair. “The stronger a neural pathway is, the more we use it. I often explain it to my clients this way: When we become activated in the world, our bodies respond by pumping us full of adrenaline and cortisol to go and fight the tiger or flee from the bear, but in the modern world we are not fighting or fleeing most of the time when we become activated and we are not dealing with lions or tigers or bears. Instead, we are storing that adrenaline and cortisol in our cells. This both primes us for activation next time and damages our bodies at a cellular level as it sits stored.”
Physically processing trauma is critical to healing both PTSD and CPTSD. When a patient is able to learn how to complete the stress response in a reparative way, they’re able to begin to heal. Trauma is not stored if it is physically processed.
Integration
Ultimately, the goal of trauma processing is integration. “As we process complex trauma, we piece together the parts of ourselves that have become fragmented or cut off from one another,” says Sinclair. “We begin to really rewrite the script for who we are, and we understand how our trauma has impacted us. We recognize and build on our strengths, and can acknowledge that our strength comes in part, from what we have been through, opening the door for embracing our whole selves.”
When these scripts are able to be rewritten, a patient is able to start focusing on the present and truly build a new life with a new understanding of who they are.
What Is the Risk of Untreated PTSD or CPTSD?
Untreated trauma, which lies at the root of untreated PTSD and CPTSD, can carry significant consequences in every aspect of life. It makes intimacy, trust, and consistent connection difficult to sustain, which affects friendships, partnerships, parenting, and professional relationships.
If you’re familiar with the phrase “the body keeps the score,” you may know that untreated trauma can also affect your physical health. Chronic trauma and stress dysregulates the nervous system, elevating cortisol and accelerating inflammation.
Those with complex trauma often show increased rates of:
Autoimmune conditions
Chronic pain
Fibromyalgia
Cardiovascular disease
Gastrointestinal conditions
Untreated PTSD and CPTSD are also associated with elevated rates of depression, substance abuse, dissociative disorders, self-harm, eating disorders, and suicidality.
Can I Heal From PTSD or CPTSD?
Absolutely. Healing from trauma does not mean the trauma has been eradicated: the events are real, the losses are real, and Sinclair is quick to point out that trauma processing does not mean forgetting.
What it does mean, however, is that there have been changes in the nervous system’s relationship to the trauma. “Neurobiologically, this looks like structural changes in the brain that show increased activity in areas of the brain like the prefrontal cortex as well as reduced (return to normal) activity in the amygdala (the emotion center),” says Sinclair. “This is because the isolated neural net of wounds within the brain where the trauma had been stored has now been processed and has become integrated with the rest of the brain and the self. This allows for those traumatic memories to be banked in long term memory and time stamped. Our bodies finally know that the trauma occurred in the past and is now over. It is safe to move beyond survival mode.”
Through treatment, a patient can learn how to increase the window of tolerance and overall ability to regulate in the face of stressors and triggers, increasing resilience. Patients are able to internalize the feeling of safety, shifting their nervous system’s predictions about what a relationship can mean by changing the narrative from what their early attachment experiences may have taught them. Integration also looks like processing grief related to the losses experienced amidst the trauma.
“Healing from CPTSD looks like reclaiming your body and your full authentic self, practicing greater self compassion and compassion for others, reconnecting with yourself and others, increasing your flexibility, adaptability and resilience, regaining control over your life and finding greater curiosity, empathy and meaning in life and relationships,” says Sinclair. “Healing is absolutely possible.”
Start Your Healing Journey With Aspire Psychology
If you’ve experienced trauma and wonder if you are now dealing with PTSD or CPTSD symptoms, you deserve the opportunity to process, heal, and learn how to move forward. At Aspire Psychology, our expert therapists would love to walk alongside you and help you discover a new baseline—not of fear or fight or flight, but of safety and security.
Ready to learn more about PTSD or CPTSD treatment? Take the first step today.
