The Difference Between PTSD and C-PTSD (and Why It Matters)

I was sitting on the couch of the therapist I was seeing over 10 years ago. She had her Diagnostic and Statistical Manual (DSM) in her lap, and with my input, she was going over the symptoms of post-traumatic stress disorder (PTSD). I was convinced I had it, she was not. Turns out neither of us was wrong and neither of us was right.

• What is PTSD?

As you’ve already guessed from the title, complex PTSD (C-PTSD) is what I’m talking about today. If you haven’t heard of it, you are in good company because in most parts of North America, it isn’t an official diagnosis just yet. You will find it in the World Health Organization’s (WHO) classifications manual, so that’s very good news.

C-PTSD is similar in some regards compared to PTSD, but there are also some pretty big distinctions. These differences matter a lot for a variety of reasons, and I’d like to spend some time with you walking through why these differences matter. If I had known this information 10 years ago, my treatment path would likely have been altered and ultimately more helpful. It’s my hope this information can do the same for you.

How is it different and why does it matter?

1. “Complex”

The C sitting in front of C-PTSD is a clear difference, but what does it mean exactly? The trauma associated with PTSD generally refers to a single traumatic event, or possibly similar events in a short time frame. Complex refers to the traumas the individual experienced, as being long-standing. Often these occur in childhood, but can also occur during other points in life. Examples could include childhood abuse, living through a time of war, sexual exploitation, domestic violence, neglect, bullying and so forth.

This is an important distinction. For some folks who grew up in a traumatic environment or survived a long time in one, it can feel like in fact it wasn’t “trauma,” rather it was just “life.” Being given the tools to recognize that this continual distress was not “ordinary,” and that it may have had significant impacts on your mind and body, is often an important first step in treating C-PTSD.

2. Symptoms

Here’s a quick overview of PTSD and C-PTSD (and please note this is merely a summary):

Folks who develop PTSD generally have experienced or witnessed a trauma, and have developed disruptive symptoms involving:

• Reliving aspects of what happened.
• Alertness or feeling on edge.
• Avoiding feelings or memories.
• Challenging beliefs or feelings.
• Physical complaints, anxiety, depression, changes in ability to function, and thoughts or actions of self-harm.

Folks with C-PTSD will have experienced longstanding trauma, and will likely have many of the above symptoms and these additional symptoms:

• Difficulties with controlling emotions.
• Feeling distrustful toward the world, or a major worldview change.
• Constant feelings of emptiness or hopelessness.
• Feeling damaged or totally different from other people.
• Feeling no one can understand you or what happened.
• Avoiding relationships, or finding trust difficult.
• Often experience dissociative symptoms.
• More frequent physical symptoms and regular suicidal feelings.
• Another distinction is one made by therapist and author Pete Walker who talks about C-PTSD involving “emotional flashbacks” rather than what would be considered traditional flashbacks. He has a great guide about that available here.

When I look at this list of additional symptoms, I understand why my therapist of 10 years ago didn’t consider PTSD to be a suitable diagnosis for me. It’s not her fault either, as neither of us knew then that C-PTSD existed. I often felt as though I had a “mild” version of PTSD, according to what the books said I should be experiencing, but then had this other part of me that was much more intense that I couldn’t understand.

Around five years ago, I became acquainted with the concept of C-PTSD and I dived into reading about it. I felt a wave of relief and belonging. It matters to me and many others that we have a category to fit into. Likewise, if you take a look at the symptom list for C-PTSD, you’ll see that there are often a lot of feelings of being “alone,” somehow different, or particularly damaged. Therefore, just knowing that there is a name for the disorder, that other people have it, and people are working on ways of treating it, can be quite healing in itself.

3. Treatment

The very first thing I want to say in regards to treatment is this: If you have C-PTSD and you have found that treatment thus far in your life has been unhelpful, distressing, confusing, unpredictable or has even made things worse… you aren’t alone and there are probably reasons behind this.

One reason is that it is a new concept, and not yet widely known or even researched. Another reason is that a lot of practitioners may not be properly trained in how to address trauma in any of its forms, let alone when it is complex. Lastly, it is believed by some that some of the treatments normally used for PTSD or other anxiety disorders, could actually cause further distress, especially if not modified. There is a lot of discussion around the nervous system and dysregulation and how this could impact treatments that were previously assumed would be helpful — but instead may cause the individual (or their nervous system) to shut down or have a negative reaction.

On a positive note, I have noticed that a lot of therapists already follow a lot of the C-PTSD recommendations, often instinctually, without necessarily having been trained to specifically do so. Happily, we are also starting to get some great books, trainings, podcasts, support groups, and more — and I find that all to be very hopeful and promising! I will leave a small list of some helpful books below.

There are also some new thoughts around what medications might be helpful, and some doctors are starting to experiment with these possibilities. Just recently, my psychiatrist started me on a medication typically used for slowing the heart, but we have found great success in using it to keep my nervous system steady, and preventing hypervigilance. I’m not offering that as a suggestion, but rather as an example that things can and do change for the better, in time.

C-PTSD and PTSD do indeed have lots of similarities, but as I’ve outlined here today, there are a variety of distinctions that are important to understand. Recognizing these differences can help with feeling understood, finding the right treatment, and guide you to getting the support that’s needed. I’ve only scratched the surface of this topic, but I hope it’s been helpful, or you’ve learned something new.

As promised here are a few books you may find useful:

• “The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma” by Bessel van der Kolk M.D.
• “The Polyvagal Theory in Therapy: Engaging the Rhythm of Regulation” by Deb Dana.
• “Complex PTSD: From Surviving to Thriving” by Pete Walker.
• “Healing Trauma: Restoring the Wisdom of Your Body” by Peter A. Levine.
• “The Complex PTSD Workbook: A Mind-Body Approach to Regaining Emotional Control and Becoming Whole” by Dr. Arielle Schwartz

There are lots of other great books, videos, podcasts and websites on this topic, so be sure to do some looking around. Please share your favorite resources or other thoughts and ideas you have about this in the comments.

If you enjoyed this article, please take a moment to check out some of my other articles here on The Mighty. If you’d like to follow along with my journey, you can find me on Instagram as @mentalhealthyxe.