How Complex PTSD (C-PTSD) Differs from PTSD

When underlying trauma is repeated and ongoing, some mental health professionals make a distinction between post-traumatic stress disorder (PTSD) and its more intense sibling, complex post-traumatic stress disorder—also known as complex PTSD.

Complex PTSD (or C-PTSD) is an anxiety condition that involves many of the same symptoms of PTSD along with other symptoms. First recognized as a condition that affects war veterans, PTSD can be caused by any number of traumatic events, such as a car accident, natural disaster, near-death experience, or other isolated acts of violence or abuse. 

People with C-PTSD and PTSD have an absence of the sense of safety, the past feels like the present.

— YOLANDA RENTERIA, LPC

C-PTSD has gained attention in the years since it was first described in the late 1980s. However, it is important to note that it is not recognized as a distinct condition in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5-TR), the tool that mental health professionals use to diagnose mental health conditions.

What's the Difference Between C-PTSD and PTSD?

Both PTSD and C-PTSD result from the experience of something deeply traumatic and can cause flashbacks, nightmares, and insomnia. Both conditions can also make you feel intensely afraid and unsafe even though the danger has passed. However, despite these similarities, some characteristics differentiate C-PTSD from PTSD according to some experts.

The main difference between the two disorders is the frequency of the trauma. While PTSD is caused by a single traumatic event, C-PTSD is caused by long-lasting trauma that continues or repeats for months, even years (commonly referred to as "complex trauma").

When it comes to C-PTSD, the harmful effects of oppression and racism can add layers to complex trauma experienced by individuals. This is further compounded if the justice system is involved.

The psychological and developmental impacts of complex trauma early in life are often more severe than a single traumatic experience—so different that many experts believe that the PTSD diagnostic criteria don't adequately describe the wide-ranging, long-lasting consequences of C-PTSD.

What Does C-PTSD Look Like in Adults?

In addition to all of the core symptoms of PTSD—re-experiencing, avoidance, and hyperarousal—C-PTSD symptoms generally also include:

• Difficulty controlling emotions. It's common for someone suffering from C-PTSD to lose control over their emotions, which can manifest as explosive anger, persistent sadness, depression, and suicidal thoughts.
• Negative self-view. C-PTSD can cause a person to view themselves in a negative light. They may feel helpless, guilty, or ashamed. They often have a sense of being completely different from other people.
• Difficulty with relationships. Relationships may suffer due to difficulty trusting others and a negative self-view. A person with C-PTSD may avoid relationships or develop unhealthy relationships because that is what they knew in the past.
• Detachment from the trauma. A person may disconnect from themselves (depersonalization) and the world around them (derealization). Some people might even forget their trauma.
• Loss of a system of meanings. This can include losing one's core beliefs, values, religious faith, or hope in the world and other people.

All of these symptoms can be life-altering and cause significant impairment in personal, family, social, educational, occupational, or other important areas of life.

Diagnosis of C-PTSD

Although the concept of C-PTSD is longstanding, it is not in the fifth edition text revision of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR), and therefore isn't officially recognized by the American Psychiatric Association (APA).

Although C-PTSD comes with its own set of symptoms, some believe the condition is too similar to PTSD (and other trauma-related conditions) to warrant a separate diagnosis. As a result, the DSM-5-TR lumps symptoms of C-PTSD together with PTSD.

Many mental health professionals do recognize C-PTSD as a separate condition, because the traditional symptoms of PTSD do not fully capture some of the unique characteristics shown in people who experienced repeat trauma.

Because the condition is relatively new and not recognized in the DSM-5-TR, doctors may make a diagnosis of PTSD instead of complex PTSD. Since there is no specific test to determine the difference between PTSD and C-PTSD, you should keep track of the symptoms you have experienced so that you can describe them to your doctor. 

Treatment for the two conditions is similar, but you may want to discuss some of your additional symptoms of complex trauma that your doctor or therapist may also need to address.

C-PTSD also can share signs and symptoms of borderline personality disorder (BPD). Although BPD doesn't always have its roots in trauma, this is often the case. In fact, some researchers and psychologists advocate for putting BPD under the umbrella of C-PTSD in future editions of the DSM to acknowledge the link to trauma, foster a better understanding of BPD, and help people with BPD face less stigma.

What Causes or Triggers C-PTSD?

C-PTSD is believed to be caused by severe, repetitive abuse over a long period of time. The abuse often occurs at vulnerable times in a person's life—such as early childhood or adolescence—and can create lifelong challenges.

Traumatic stress can have a number of effects on the brain. Research suggests that trauma is associated with lasting changes in key areas of the brain including the amygdala, hippocampus, and prefrontal cortex.

The types of long-term traumatic events that can cause C-PTSD include:

• Child abuse, neglect, or abandonment
• Domestic violence
• Genocide
• Childhood soldiering
• Torture
• Slavery

In these types of events, a victim is under the control of another person and does not have the ability to easily escape.

C-PTSD Treatment

Because the DSM-5-TR does not currently provide specific diagnostic criteria for C-PTSD, it’s possible to be diagnosed with PTSD when C-PTSD may be a more accurate assessment of your symptoms. Despite the complexity and severity of the disorder, C-PTSD can be treated with many of the same strategies as PTSD, including:

Medications

Medications may help reduce symptoms of C-PTSD, such as anxiety or depression. They are especially helpful when used in combination with psychotherapy. Antidepressants are often used to treat complex PTSD, including Prozac (fluoxetine), Paxil (paroxetine), and Zoloft (sertraline).

Psychotherapy

Psychotherapy for C-PTSD focuses on identifying traumatic memories and negative thought patterns, replacing them with more realistic and positive ones, and learning to cope more adaptively to the impact of your trauma. "Psychotherapy for C-PTSD and PTSD focuses on somatic modalities to help people process traumatic experiences and teach people tools to manage symptoms," explains Renteria.

One type of psychotherapy that may be used to treat both PTSD and complex PTSD is known as eye movement desensitization and reprocessing (EMDR). This approach uses eye movements guided by the therapist to process and reframe traumatic memories. Over time, this process is supposed to reduce the negative feelings associated with the traumatic memory.

How Do I Cope With C-PTSD?

Treatments for complex PTSD can take time, so it is important to find ways to manage and cope with the symptoms of the condition. Some strategies that may help you manage your recovery:

• Find support: Like PTSD, complex PTSD often leads people to withdraw from friends and family. However, having a strong social support network is important for mental well-being. When you are feeling overwhelmed, angry, anxious, or fearful, reach out to a trusted friend or family member. 
• Practice mindfulness: Complex PTSD can lead to feelings of stress, anxiety, and depression. Mindfulness is a strategy that can help you become more aware of what you are feeling in the moment and combat feelings of distress. This practice involves learning ways to focus on the present moment. "Grounding exercises can be really helpful for people during flashbacks, episodes of intense emotions, or when they wake up from a nightmare," notes Renteria.
• Write down your thoughts: Research has found that writing in a journal can be helpful in managing PTSD symptoms and decreases symptoms of flashbacks, intrusive thoughts, and nightmares. In terms of treatment, a journal can also be a great way to track symptoms that you can later discuss with your therapist.

Support groups and self-help books can also be helpful when dealing with complex PTSD. Helpful book titles include "The Body Keeps Score" by Bessel van der Kolk, MD, and "Complex PTSD: From Surviving to Thriving" by Pete Walker.

Keep in Mind

If you or someone you care about has been exposed to repeated trauma and are struggling to cope, it's important to seek help from a therapist who is familiar with PTSD. In addition to asking your primary care physician for a referral, there are many online resources that can help you find mental health providers in your area who treat PTSD.