What's the Difference Between PTSD and Complex PTSD?

What’s the difference between PTSD and C-PTSD?

• PTSD is a mental health issue that can occur in people who have lived through a specific traumatic event or series of events that have a definitive time limit, or in many cases, only happen once.
• C-PTSD, is the result of prolonged exposure to trauma over long periods of time, often during childhood.

If you or your loved one has struggled with post-traumatic stress disorder (PTSD) or trauma, you may have stumbled across a psychiatric term you may not have heard of before — complex PTSD, also called C-PTSD.

• What is PTSD?

Upon seeing this term, you may have thought to yourself, “What makes this mental illness ‘complex’? Aren’t all mental illnesses complex?” If this sounds familiar, you’re not the only one.

Because there’s a lack of knowledge surrounding PTSD and C-PTSD, we spoke to trauma-informed treatment specialist, Patrick Walden, LICSW, to help us understand the difference. In addition, we also consulted every psychologist’s best friend: the handy-dandy Diagnostic and Statistical Manual of Mental Disorders.

Below, we’ll give you a fuller definition of each condition, let you know what its classic symptoms are and point you in the direction of treatment options and resources.

Here’s what you need to know about PTSD and C-PTSD:

PTSD

Though war veterans are usually the first group of people to come to mind when we think of PTSD, the reality is PTSD can affect many types of people. Specific events (or a series of events) like sexual assault, natural disasters, a serious car accident, or having a child in the neonatal intensive care unit (NICU) are other non-war circumstances that can contribute to an individual developing PTSD.

While we shouldn’t stop thinking of veterans when we think of PTSD, it’s important that we broaden our understanding of who can struggle with it. The cultural association with PTSD and veterans can sometimes even keep people from realizing they need to seek help.

During her mental health recovery journey, Mighty contributor Jill Alexandra learned PTSD wasn’t just something that happened to soldiers. In her piece, “How I’ve Spent 14 Years Avoiding the Reason for My PTSD,” she explains her experience coming to terms with her sexual assault:

“For 14 years I have kept a secret that has only gotten worse with time. Flashbacks and post-traumatic stress disorder (PTSD) stopped being things I associated only with war and soldiers, and became part of my own life…

Fourteen years later, it’s time I learn to say it.

Fourteen years ago – I was raped…

Now if I could only explain the strength it took, and the terror I felt, just to type those five letters — maybe then PTSD would be a little easier to understand. For all of us.”

PTSD can affect people regardless of age, race, gender — or even veteran status. It’s important to know the signs and symptoms so we can direct people to the support they need.

Symptoms of PTSD

According to the DSM, an essential feature of PTSD is developing symptoms directly related to the traumatic experience. Though it’s not necessary for a person with PTSD to exhibit every symptom below, Walden walked us through four of the most common categories of PTSD symptoms.

1. Intrusion Symptoms

A person with PTSD often experiences intrusive symptoms of the traumatic event in a number of ways including:

• Recurring involuntary and distressing memories of the traumatic event
• Recurring dreams/nightmares
• Dissociative reactions like flashbacks

Walden told The Mighty someone affected by these symptoms may experience severe emotional distress or physiological responses to something that reminds them of the trauma. In children, themes of the traumatic event(s) may be expressed in play.

2. Avoidance

Avoidance can be a common symptom in other mental illnesses, including social anxiety, avoidant personality disorder, and obsessive-compulsive disorder (OCD). For people with PTSD, Walden explained, avoidance can be both external and emotional. Here are two common ways avoidance shows up in people with PTSD:

• External avoidance: avoiding certain people, places, activities, and objects that are reminders of the traumatizing event.
• Emotional avoidance: avoiding thinking about, remembering, or discussing the traumatic event with others.

Someone who survived a serious car accident might practice external avoidance by going out of their way to avoid the intersection where the accident occurred, even if that means taking a longer route. An example of emotional avoidance is a veteran who doesn’t disclose to their family the traumatic events of war so they don’t have to think about it.

3. Negative changes in thinking and mood

For people with PTSD, thinking and mood changes can affect the ability to form and maintain close friendships. Walden said people with PTSD may also struggle with emotional numbness and feel hopeless about the future. Some other changes may include:

• Persistent negative beliefs about oneself or one’s situation (“I am bad” or “I can’t trust anyone” are some common examples)
• Memory or cognition issues
• Lacking interest in once-enjoyable activities
• Feeling detached from others
• Ongoing inability to experience positive emotions like happiness or loving feelings

4. Changes in Arousal and Reactivity

Folks with PTSD often experience symptoms like heightened alertness (hypervigilance), being easily startled or frightened, irritability, and anger outbursts. Walden said many people with PTSD have difficulty trusting others, struggle with negative self-esteem and feelings of overwhelming guilt and shame.

• Heightened irritability and anger outbursts
• Reckless or self-destructive behavior
• Hypervigilant behavior
• Being easily startled or frightened
• Concentration difficulties
• Insomnia

Treatment

If you live with PTSD, there is hope. There are many types of evidence-based therapy approaches that have been proven to help people healing from trauma. Therapy types of particular interest to trauma survivors may be eye movement desensitization and reprocessing (EMDR) and schema therapy.

Complex PTSD (C-PTSD)

Though it’s not officially classified in the DSM, trauma researchers say C-PTSD is the result of prolonged exposure to trauma over long periods of time, often during the formative years of childhood. Because of this, it’s often referred to as developmental trauma since healthy development is interrupted.

“PTSD is generally related to a single event or specific events, whereas complex PTSD is related to a series of events or one prolonged event,” Walden told The Mighty. “This can mean the difference between a traumatic car accident one had in childhood and childhood itself.”

By “childhood itself,” Walden means childhoods that are characterized by severe abuse — emotional, physical, and/or sexual.

Prolonged childhood trauma literally rewires your brain. In a study on how trauma affects the brains of those with a history of childhood abuse, researchers studied brain matter from people who had died by suicide (both with a history of childhood trauma and without) and compared it to brain samples from deceased psychiatrically healthy people. They found trauma had significantly altered the brain matter of people with a history of childhood trauma, making them more vulnerable to suicide and mental illnesses like depression, anxiety, and substance abuse during their lives.

Research like this underscores the reality that complex trauma can play a much larger role in mental illness than we realize or give it credit for. It’s research like this that may have prompted trauma specialist John Briere, Ph.D. to (jokingly) say, “If complex PTSD were ever given its due… the DSM would shrink to the size of a thin pamphlet.”

Mighty contributor Vicki Peterson also believes complex trauma needs to be addressed and taken seriously in mental health treatment. In her piece, “We Can’t Keep Treating Anxiety From Complex Trauma the Same Way We Treat Generalized Anxiety,” she wrote:

“For those who have experienced trauma, anxiety comes from an automatic physiological response to what has actually, already happened. The brain and body have already lived through ‘worst case scenario’ situations, know what it feels like and are hell-bent on never going back there again. The fight/flight/ freeze response goes into overdrive. It’s like living with a fire alarm that goes off at random intervals 24 hours a day. It is extremely difficult for the rational brain to be convinced “that won’t happen,” because it already knows that it has happened, and it was horrific.

Those living with generalized anxiety often live in fear of the future. Those with complex trauma fear the future because of the past.”

Symptoms of C-PTSD:

According to Walden, people with C-PTSD may experience symptoms that are similar to typical PTSD, though treatment may not be as straightforward.

“Compared to PTSD, this deep wound to the psyche makes the symptoms of complex PTSD even more difficult to address,” Walden said.

Some common symptoms of C-PTSD include:

• Nightmares
• Memory issues (often blocking out reminders of the traumatic event)
• Heightened irritability
• Decreased interest in once-enjoyable activities
• Dissociation
• Flashbacks (oftentimes emotional flashbacks)
• Severe feelings of guilt and shame
• Difficulty maintaining close and trusting relationships with others

One of the most difficult symptoms Walden said many people with C-PTSD face is the belief that they are responsible for the trauma that happened to them.

“These no-win thought cycles quite often lead to the [person] pushing people away, to loneliness, to self-destructive thought patterns and behaviors and to profound interpersonal difficulties,” Walden added.

Treatment

If you live with or think you may be struggling with C-PTSD, there is hope and help available to you. Common treatments for PTSD like eye movement desensitization and reprocessing (EMDR), cognitive behavioral therapy (CBT), and schema therapy may be helpful for people with C-PTSD. Learn more about these types of treatments.

“Let your fears see the light of day by talking to other people about what it is that you struggle with… You can’t heal behind closed doors, so take risks to be honest and vulnerable with the people in your life about what it is you struggle with and are working on,” Walden explained. “In turn, you can learn to develop ongoing trust with others and a hopeful, positive outlook on yourself and the world around you.”

If you are a survivor of childhood abuse and neglect, go easy on yourself, Walden advised. Healing takes time and often includes “reparenting yourself,” which often means treating yourself with the kindness you needed growing up and engaging in safe relationships with others to help you fill developmental gaps or unmet needs from childhood.

For those who don’t know where to start with “reparenting,” it may be helpful to seek out a therapist who can engage in a type of schema therapy called “limited reparenting therapy.” According to the International Society of Schema Therapy, limited reparenting is when a therapist takes on a trustworthy parent-like role (within the bounds of a professional relationship) in treatment so the client can learn what a safe and trusting relationship looks like.

Learn How to Self-Soothe

Walden also recommends incorporating self-soothing techniques into your life if you live with C-PTSD. Below are some techniques that help his clients.

1. Meditation

Walden recommends using meditation apps and audiobooks to quiet the mind and focus on someone else’s voice.

“It’s really nice to have another person’s soothing voice guide you through as you’re learning to flex your emotional muscles around building skills like thought-stopping and rerouting negative self-talk,” he explained.

2. Develop Mantras

Rehearsing mantras to yourself can be an important way to fight against negative thoughts about yourself and the world around you.

“A common automatic thought from someone who [lives with] C-PTSD is, ‘I shouldn’t trust others,’ Walden said. “When you practice mantras like, ‘I am safe,’ ‘I’ll be OK’ and ‘I got this,’ it’s possible to have a profound effect on your thinking and the way you engage with the world around you.”

3. Feel Your Feelings

For many folks who have lived through traumatic childhoods, repressing feelings is common. Learning to feel and identify your feelings can be challenging, but is so important.

“It’s my opinion that you’re either riding the wave or you’re under the wave, and if you allow yourself to feel your feelings, even the hard ones, as they come up, you’re more likely to stay on top of the wave,” Walden explained.

If you struggle to feel your feelings, you’re not alone. Seek support from trusted friends and a mental health professional if you need help with this.

4. Track Your Healing

Tracking your mental health journey is a great way to celebrate recovery milestones. If you struggle with follow-through on tracking, ask your therapist to provide support and accountability.

“Because it’s common for folks with C-PTSD to think the worst and discredit the positive, it’s helpful to go back and read your own words and track your progress,” Walden said.

5. Move Your Body

Research shows trauma affects the body physically. For this reason, Walden recommends engaging with your body physically to self-soothe in tough moments. He explained:

“Identify which feelings are coming up and address them via exercise. For example, if you are experiencing anger, go for an intense run. If you’re feeling restless anxiety, consider renting a kayak for the afternoon. Eventually, you’ll begin to feel the benefits of mindful exercise and even crave it as a way to keep your mind and spirit right.”

6. Psychoeducate Yourself

An important key to recovery is learning about C-PTSD and how it manifests.

“Knowledge is power. Learn about C-PTSD and its effects, for the benefit of your own understanding and to be able to share with those who love and care for you,” Walden said.

Walden also recommends reading Pete Walker’s book, “Complex PTSD: From Surviving to Thriving” and the writings and teachings of Bessel Van Der Kolk.

If you are in the process of healing from C-PTSD or childhood trauma, we’re proud of you for committing to recovery — even when it’s hard. Recovery can be a long road, but healing is worth it. For anyone struggling with the impact of childhood trauma, Walden has these words of encouragement for you:

“Think about what you would do if you encountered a younger version of yourself in need, and treat yourself accordingly. Ultimately, give yourself what you deserve and are worthy of, which is heaps of self-compassion and empathy. In that vein, meet yourself where you’re at, and celebrate the heck out of small victories.”

Here at The Mighty, we believe in celebrating small victories and asking people to come alongside you in your health journey. To celebrate with people who understand the magnitude of “small wins,” post on The Mighty with the hashtag #CheerMeOn. We’re on your team and you’re never alone.