Understanding the difference between PTSD and Complex PTSD can be challenging as they are related and share some commonalities. People often use these terms together but they are different conditions resulting from different types and lengths of traumas. Read on to learn more about their similarities and differences
What Is Complex PTSD (C-PTSD)?
C-PTSD is a type of trauma caused by long or repeated, sustained exposure to traumatic events, particularly during childhood or early adulthood. While CPTSD is often associated with chronic trauma in childhood, adults who experience chronic trauma can also develop the condition. For CPTSD, the events are usually prolonged or repetitive and escape from the situation is impossible or dangerous.
These events often involve:
- Neglect
- Abandonment
- Incarceration
- Interpersonal violence, such as physical or sexual abuse
- Sustained community violence
CPTSD may affect, among others:
- Victims of bullying
- Emergency service workers
- Victims of chronic sexual, psychological and physical abuse
- Victims of chronic intimate partner violence
- Victims of kidnapping and hostage
- Victims of slavery and human trafficking
- Prisoners of war or solitary confinement
The effects of complex trauma can be severe and long-lasting. There is a chronically heightened state of arousal and stress after a series of traumatic events. The impact of complex trauma is far-reaching, affecting:
- Emotional regulation
- Consciousness
- Self-perception
- Perceptions of perpetrators
- Relations with others
- One’s system of meaning
Individuals with complex trauma may experience severe psychological challenges including
- Difficulties in controlling emotions
- Profound feelings of shame or guilt
- Challenges with forming healthy relationships.
They are also at a higher risk of developing mental health disorders such as depression and anxiety disorders.
A diagnosis of CPTSD, can be made when someone has all the symptoms of PTSD listed below, as well as three further sets of “disturbances in self-organisation” or “DSO”:
- Difficulty regulating emotions
- Negative self concept (such as feelings of guilt, shame and loneliness)
- Interpersonal problems which impact on building and maintaining relationships
To be diagnosed with PTSD, an adult must have all of the following for at least 1 month:
- At least one re-experiencing symptom (flashbacks, nightmares)
- At least one avoidance symptom (avoiding reminders of trauma)
- At least two arousal and reactivity symptoms
- At least two cognition and mood symptoms
Is Complex PTSD a Separate Condition or Just a Sub-type?
It’s a bit confusing as there are two different sets of criteria that are in use. Yes it is separate when using the ICD-11 criteria. No, when using the DSM-5 criteria. Neither is superior to the others, just different. Both have symptoms of re-experiencing, avoidance and hyperarousal. However the ICD-11 classification requires three additional sets of symptoms, the DSO.
Diagnosing Complex PTSD vs PTSD
Experts disagree on the classification of these two conditions.
PTSD is classified according to the Diagnostic and Statistical Manual (DSM-5) produced and revised by the American Psychiatric Association (APA), used in North America and many other countries. Symptoms of PTSD usually begin within 3 months of the traumatic event, but sometimes emerge later. You must have the symptoms for longer than 1 month and they must be severe enough to interfere with aspects of daily life such as relationships or work. The symptoms must be unrelated to medication, substance use or other illness.
The DSM-5 does list a sub-type of PTSD called dissociative PTSD that appears to encompass CPTSD symptoms.
CPTSD is not found in the DSM-5. It is classified according to The International Classification of Diseases – 11th Revision (ICD-11) produced and revised by the World Health Organisation (WHO). It is used in Europe and other countries.
The criteria are similar but not identical as there are narrower/fewer diagnostic ICD-11 criteria for PTSD compared with the DSM-5 criteria for PTSD. PTSD symptoms can be present differently in traumatised infants, children and young people.
As CPTSD is still a relatively “new” condition and term (even with the update to the ICD-11), some doctors may not be aware of its existence yet which can make it hard to get an official diagnosis.
Some children who develop CPTSD have experienced complex traumatic events. However not everyone who experiences complex traumatic events will then develop CPTSD as recovery from Trauma is common
Some experts believe that CPTSD, PTSD and borderline personality disorder may exist on a spectrum of trauma-related mental health conditions that vary in the severity of their symptoms.
The following table summarizes each condition’s diagnostic requirements.
| PTSD (DSM-5) [1] [3] | Complex PTSD (ICD-11) [2] [3] |
| Must have all of the following for at least 1 month: | A diagnosis of CPTSD is made when the criteria for PTSD are met plus 3 further sets of symptoms which are called disturbances in self-organisation’ or ‘DSO’. |
| At least one re-experiencing symptomRe-experiencing the trauma through intrusive memories, flashbacks and nightmares | |
| At least one avoidance symptomAvoiding people, places, or thoughts that remind you of the trauma | |
| At least two arousal and reactivity symptomsChanges in mood or thinking, including feeling distant from other people and having overwhelming negative emotions | |
| At least two cognition and mood symptomsFeeling on edge, alert and reactive and becoming irritable, easily frightened, or having difficulty concentrating or sleeping | |
| Disturbances in self-organisation’ or ‘DSO’ | |
| Difficulty regulating emotions | |
| Impairment in relationships and daily functioningNegative self concept (such as feeling of guilt, shame and loneliness) | |
| Interpersonal problems which impact on building and maintaining relationships | |
| People with PTSD may also have the “DSO” symptoms in the right column | |
What Could Cause C-PTSD?
Simply put, PTSD results from a single traumatic event such as a natural disaster, car accident, war or mass shooting.
Complex PTSD in children, according to the National Childhood Traumatic Stress Network, describes both children’s exposure to multiple traumatic events—often of an invasive, personal nature—and the wide-ranging, long-term effects of such exposure. These events are severe and pervasive, such as abuse or profound neglect.
They usually occur early in life and can disrupt many aspects of the child’s development and the formation of a sense of self. Since these events often occur with a caregiver, they interfere with the child’s ability to form a secure attachment [4]. In adults, Complex PTSD results from repeated traumatic events.
Complex PTSD Treatment in Utah
Treatment is available in Utah. Are you or a loved one looking for a compassionate space to heal from PTSD or CPTSD, other mental health issues or addictions? Our licensed trauma-informed professional therapists and counselors at Corner Canyon Health Centers can provide compassionate help using a range of therapeutic and holistic techniques.
Reach out to our Admissions team now at Corner Canyon. We’re in a peaceful setting bordered by the beautiful Wasatch Mountains.
Sources
[1] National Institute of Mental Health. Post-Traumatic Stress Disorder.
[2} National Health System Wales. Diagnosis, Classification, PTSD and CPTSD.
[3] PTSD and C-PTSD: The similarities and the differences. ptsduk.org
[C] National Child Traumatic Stress Network. Complex Trauma.
