C-PTSD vs PTSD: Understanding the Differences

Characteristics of C-PTSD

Complex PTSD (C-PTSD) is a group of symptoms that are caused by repeated emotional trauma. In addition to the typical symptoms of PTSD, C-PTSD is often marked by difficulty regulating emotions, low self-esteem, and a pattern of unhealthy relationships. These symptoms are consequences of the emotional pain experienced by traumatized individuals.

Symptoms of C-PTSD include the following:

• Persistent negative beliefs about yourself
• Avoidance of relationships or difficulty trusting others
• Remaining involved in unhealthy relationships
• Difficulty managing emotions, resulting in angry outbursts or intense sadness
• Engaging in high-risk behaviors
• Self-harming behaviors
• Feelings of hopelessness or emptiness
• Extreme startle responses
• Disturbed sleep patterns and nightmares
• Flashbacks
• Intrusive, frightening thoughts
• Hypervigilance, or always feeling “on edge”
• Irritability
• Difficulty concentrating
• Loss of interest in previously enjoyed activities
• Loss of memory for parts of the traumatic events
• Persistent feelings of fear, guilt, or shame
• Persistent beliefs that other people are “bad” or that the world is generally unsafe

C-PTSD is caused by ongoing trauma which continues for months or years. When trauma occurs during childhood in the form of ongoing abuse, neglect, or abandonment, C-PTSD may result. Adults who live with ongoing domestic violence may also develop C-PTSD. Other kinds of trauma that might cause this disorder include being kidnapped or tortured, or living in a war zone.

Characteristics of PTSD

PTSD is a disorder which can result from being exposed to one or more events in which you feel that your life or safety is threatened. This can be a direct threat to yourself or witnessing someone else’s trauma. Symptoms of PTSD last for more than four weeks, are not due to a medical condition, and cause problems with daily functioning.¹

Symptoms of PTSD include the following:

• Recurrent disturbing memories of the traumatic event
• Dreams or nightmares related to the trauma
• Dissociation from the present moment
• Having flashbacks to the event, with visual, auditory, emotional or physical sensations
• Active avoidance of people, places, or objects which are reminders of the trauma
• Inability to remember part or all of the trauma
• Disturbing negative beliefs about yourself, others and/or the world, such as “people can’t be trusted” or ‘the world is a terrible place”
• Persistent negative mood, such as feeling anger, fear, guilt, despair, or isolation
• Feeling numb to positive emotions, such as joy, hope, or enthusiasm
• Loss of interest in activities previously enjoyed
• Often feeling irritable or angry, or having angry outbursts
• Taking part in self-destructive or high-risk behaviors
• Unable to relax due to always watching out for threats
• Being easily startled
• Having difficulty concentrating
• Disturbances in sleep patterns

PTSD may result from trauma which occurred only once, or on several occasions. It is not unusual to experience PTSD after a car accident. Other single events which can result in PTSD include a sexual assault, the sudden death of a loved one, or receiving a diagnosis of a life-threatening illness. Living through a natural disaster or a terrorist event might also cause PTSD.

What Are the Differences Between PTSD and C-PTSD?

These two disorders differ in the range of symptoms which can be involved as well as the types of trauma which usually cause each of them. A person suffering from C-PTSD might have any or all of the symptoms of PTSD, plus additional symptoms. The longer duration of the trauma which is associated with C-PTSD results in more complex symptoms.²

Type of Trauma

While PTSD can be caused by a specific event, C-PTSD is caused by ongoing trauma. Living in any environment in which one’s safety is threatened for an extended time might result in C-PTSD symptoms. When a person is held captive for a long time, unable to get free from the perpetrator and avoid danger, they become vulnerable to C-PTSD.

Such circumstances include living in a violent community, a refugee camp, or a war-zone.³ A person trapped in a domestic violence situation, whether as a child or an adult, is at risk for C-PTSD.  Abuse which occurs in the home, whether towards a child or an adult, rarely occurs as a single incident.

PTSD is more likely to result when trauma occurs as a single incident or within a brief period of time. In addition to the various single incidents noted earlier, a common circumstance that leads to PTSD is working in a high-risk occupation. For example, PTSD is common among members of the military and among emergency medics.⁴

Type & Duration of Symptoms

The type of symptoms experienced with both of these disorders can be grouped into four categories:⁵

1. Intrusive memories, including nightmares and flashbacks
2. Avoidance of reminders of the trauma
3. Changes in thought patterns and mood
4. Arousal symptoms such as being easily startled, always on guard, and having trouble concentrating or sleeping.

While these symptoms may be present with both disorders, C-PTSD involves additional symptoms, including:^{3, 6}

• Difficulty regulating emotions
• Poor self-image
• Ongoing relationship problems

These additional symptoms often involve more complex and persistent problems and therefore a longer period of treatment.

How Does Treatment Differ?

Treatments for PTSD and C-PTSD are generally similar and both may involve psychotherapy, medication, or a combination of both approaches. Two of the evidence-based therapies for these disorders are cognitive processing therapy and prolonged exposure therapy.^{3, 4} Medication may be helpful in reducing the intensity of symptoms, while the person works toward gradually recovering from the past trauma.⁶

Evidence suggests that individuals with C-PTSD may benefit most from a flexible therapeutic approach.⁷ This approach would start with Skills Training in Affective and Interpersonal Regulation (STAIR) rather than starting with specific trauma-focused treatment. Initial goals of treatment for C-PTSD are to create a safe environment in the context of a trusting relationship with the therapist.

Trauma-focused treatments include trauma-focused CBT. CBT has been effective for treating PTSD. Another commonly used treatment for PTSD is Eye Movement Desensitization and Reprocessing (EMDR). This method uses bilateral stimulation to help the individual process the traumatic experience.

Can PTSD Turn Into C-PTSD?

Trauma can compound itself over time. C-PTSD is basically a result of layers of trauma occurring one after another. What initially appears to be PTSD based upon a single incident or brief period of trauma may later be seen more clearly as a related to a series of traumatic events over time. The result of such layers over time is that the symptoms are more complex and intense, so they are better understood as C-PTSD.⁸

Symptoms of trauma might disappear for a while and re-emerge months or years later, possibly due to a trigger in the environment or a change in life circumstances.⁹ When symptoms re-emerge, they might cause new problems in relationships, educational goals, or maintaining employment. This can become a repeated cycle of hardship and even further trauma.¹⁰

How to Find a PTSD Therapist

It is important to seek help for PTSD or C-PTSD as soon as you recognize your symptoms. There are many mental health professionals who are trained in the care of individuals who have been through trauma. These therapists follow specific guidelines involved in trauma-informed care.⁹

These include the assurance of a safe, welcoming office space while providing choices about type of treatment. The therapist’s focus is on collaborating with you and being worthy of your trust. Another guideline is to empower you to gradually build skills for coping and for managing triggers.

One way of finding a qualified therapist is by using an online therapist directory. You may also want to check with your physician in order to rule out any physical cause for your symptoms.

Final Thoughts

Knowing the differences between trauma disorders can help you get the help you need. You might be able to recognize the symptoms you have as related to one or more past traumatic experiences. Whether you are aware of being exposed to ongoing trauma or to an isolated event, you can get the help of a therapist who has experience in trauma-care. You can make the choice to get professional help for coping with the consequences of the trauma in hopes of enjoying a better quality of life.