What’s the Difference Between PTSD and CPTSD?

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Understanding Post Traumatic Stress Disorder (PTSD) and Complex Trauma Stress Disorder (C-PTSD).

Our understanding of the impact of trauma has shifted over the years as more research and time spent with trauma survivors has shown differences between the impact a one-time traumatic event has on a person versus experiencing prolonged, repeated trauma. This distinction was first highlighted by Dr. Judith Herman in her influential book Trauma and Recovery, where she argued that the traditional PTSD diagnosis does not fully capture the complexities of trauma (Herman, 1992)

What is PTSD?

The clinical diagnosis refers to a person’s difficulty in experiencing safety, due to a threat, leading them to experience a criterion of symptoms which are associated with physiological dysregulation. Within one-time event (shock trauma), a person is impacted by an acute devastating incident that leaves them frozen in fear and internally they become overwhelmed in their capacity to cope with the threat. The sense of threat and overwhelm create a psychobiological process of unresolved fear which disrupts regulatory functioning. This can lead to symptoms like flashbacks, nightmares, intense anxiety, distorted thoughts, irritability, hypervigilance, challenges with concentration and sleep disturbance (American Psychiatric Association, 2013; Hellar & Kammer, 2022).

What is C-PTSD?

Complex Post-Traumatic Stress Disorder (C-PTSD) develops from long-term exposure to relational and emotional trauma in which a person has little to no control (agency) and from which there is little to no hope or escape. Internally, the felt experience is one of helplessness. In adults, this can be experienced in cases such as domestic violence, long-term exposure to torture, trafficking, exploitation and other forms of crisis situations in which there is repeated relational and emotional trauma.

Developmental Trauma

Developmental trauma occurs when a child experiences prolonged abuse, neglect, parental mis-attunement and/or living in a consistently unsafe environment. Children who experience developmental trauma may later experience symptoms which meet criteria for C-PTSD. Developmental trauma is a consequence of what happened to a child (abuse) and/or what did not happen (emotional, physical neglect) which was needed for healthy development.

How are PTSD and CPTSD different?

Unlike PTSD, which often stems from a single incident, C-PTSD develops from repeated experiences where a person feels helpless and has little control over their situation. Due to the chronic mis-attunement and unmet needs the child faces in developmental trauma, they feel that something is wrong with them, which creates deep experiences of insecurity and shame. Children who grow up in these environments may learn to disconnect from their feelings to cope, leading to difficulties in relationships and a negative self-image.

Although both PTSD and C-PTSD are categorized by the following symptoms:

• Experiencing a sense of threat

• Avoidance

• Re-experiencing

C-PTSD has additional symptom layers:

• Affect dysregulation (challenges with managing emotions)

• Negative self-image and difficulties with relationships (Hellar & Kammer, 2022; Hellar & LaPierre, 2012; World Health Organization, 2022).

The Impact of PTSD and C-PTSD on the Body and Mind

When trauma disrupts healthy development, it can lead to physical and emotional symptoms, including anxiety, depression, trouble regulating emotions, dissociation, avoidance, challenges with identity and sense of self, challenges with forming and maintaining relationships and various diseases. People with C-PTSD might find it hard to understand who they are or feel comfortable in their own skin. This can lead to feelings of more shame and self-hatred, which can further complicate their relationships and overall well-being (Hellar & Kammer, 2022).

Different Approaches to Healing

The treatment for PTSD often focuses on addressing the fear response to the traumatic event. Therapeutic models/approaches like Somatic Experiencing, EMDR (Eye Movement Desensitization and Reprocessing), and other mindfulness and somatic-based practices can help people manage their symptoms and reconnect with their bodies. In contrast, treating C-PTSD requires a more nuanced approach which addresses underlying experiences of shame and internal disorganization. Effective treatment includes therapeutic modalities and approaches which can support the relationship of neurobiological systems and can offer both cognitive (top-down) and physiological (bottom-up) support (Hellar & Kammer, 2022).

In Summary

Both PTSD and C-PTSD can have profound effects on a person’s life, but they arise from different types of trauma and can benefit from various healing approaches. Understanding these differences is important in finding the right support and beginning the journey toward healing. If you or someone you know is struggling, consider reaching out for help. You deserve to experience connection, safety and support on your path to recovery.

Sources:

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.).

Heller, L., & Kammer, B. J. (2022). The Practical Guide for Healing Developmental Trauma: Using the neuroaffective relational model to address adverse childhood experiences and resolve complex trauma. North Atlantic Books.

Heller, L., & LaPierre, A. (2012). Healing developmental trauma: How early trauma affects self-regulation, self-image, and the capacity for relationship. North Atlantic Books. 

Herman, J. (1992). Trauma and recovery: The aftermath of violence - from domestic abuse to political power. Basic Books.

World Health Organization. (2022). ICD-11: International classification of diseases (11th revision).