Trauma can take many forms. You may have heard of post-traumatic stress disorder (PTSD). Most people have at least heard of PTSD, as it relates to veterans. Did you know it impacts many others as well? Have you heard of complex post-traumatic stress disorder (complex PTSD orCPTSD)? People often ask how CPTSD and PTSD are similar and different. I want to help more people have a deeper understanding of what they are experiencing and ultimately get the help they deserve.
My goal, as a trauma-informed therapist, is to raise awareness and treat trauma of all kinds. When I use the word “trauma,” I am incorporating all aspects of trauma, all kinds of trauma that impact the nervous system. Trauma describes the adverse effect of any experiences that felt unsafe, physically, sexually, or emotionally, or was perceived as a threat to life or survival. This includes profound emotional neglect and attachment trauma.
People can experience different kinds of symptoms depending on their experience. Trauma can come from a single incident, or from recurring incidents of emotional, physical, or sexual trauma. Trauma that develops within an important early relationship, as with a parent or caregiver, can lead to attachment trauma that is complex, developmental and relational and anything in between. Relational, attachment, and complex trauma are some of the traumatic variations we see most often at Brickel & Associates.
You may be asking what complex PTSD feels like or wondering if you’re facing PTSD or CPTSD. My goal is to help you see how the two are similar and different, so you can find the most helpful resources and support.
How Trauma Relates to PTSD and CPTSD
PTSD (post-traumatic stress disorder) is often associated with a one-time experience or a single-incident trauma. Complex, relational and developmental trauma often results in what we call, CPTSD (complex post-traumatic stress disorder) — a form of PTSD.
Complex trauma incorporates all the symptoms of PTSD. CPTSD is different, however, from single-incident trauma because the impact on the nervous system around attachment or relationships becomes more deeply ingrained. CPTSD is relationship trauma.
Complex PTSD Recovery Steps
Those struggling with PTSD and CPTSD can heal. The journey for those with CPTSD just might be longer. The steps may include:
- Noticing the need and reaching out for that initial moment of help – believing that help is available and deserved can be the first step.
- Finding a trauma-informed therapist to build a therapeutic relationship.
- Building a foundation, in therapy, of stability and security to learn how to navigate life in general in the present day.Once having that foundation, practicing those skills in life’s current relationships.
- Noticing the insecure, anxious or confusing feelings that can happen in relationships. Paying special attention to if those feelings are current or old.Are they familiar?
- Repairing these relational responses in the present day to develop secure attachment, to be able to trust others who are safe, and find emotional wellbeing.
Healing CPTSD starts with understanding how traumatic past relationships made a path toward distrust and hypervigilance.
Hurtful relationships left painful reminders that live on with you in your present life. Stepping back to see how the residue of the past may be tarnishing a new relationship is paramount. Learning that some relationships harm and other kinds of relationships heal allows for a change.
Unfortunately, as of June 2021, the diagnostic manual (DSM) for mental health includes only diagnostic criteria and codes describing PTSD. However, more therapists and mental health professionals are recognizing CPTSD as a separate condition that warrants specific treatment and support.
What is Single Incident Trauma?
PTSD can happen at any point in life. It can develop after a car accident, a severe weather event, a mugging, a war, a medical event, a disaster or an attack. It is related to a single event or situation in which a person feels unable to escape danger or feel safe.
Single-incident trauma often results inPTSD (post-traumatic stress disorder).
Single-incident trauma can often allow for healing faster if the individual who experienced the trauma has asecure foundation from childhood. When we treat single incident trauma, it usually resolves easier, leaving less residue on the nervous system. Single incident traumas are often treated using a therapy likeEMDR.
What is Complex PTSD (CPTSD)?
Complex trauma, on the other hand, often develops during an earlier stage of development, over repeated incidents, involving a relationship that is supposed to be safe.
The brain and nervous system adapt to expecting ongoing danger, often compromising the development of a healthy sense of self and the world. These adaptations then become deeply instilled in a person’s thinking, feeling, and functioning. For example, you may develop constant hypervigilance or hyperarousal as a means of coping with a childhood history of abuse and/or neglect.
Because of this, complex trauma is deeper and often takes longer to repair and heal.
How are PTSD and CPTSD Different?
Relationships are likely triggering for a person with CPTSD. A survivor of single-incident trauma may be triggered by lots of things — sounds, smells, etc. — but not usually by relationships or attachments. That is what makes CPTSD particularly challenging to treat, as healthy relationships are fundamental to recovering from trauma. If a close relationship is what has harmed you in the first place, it may take longer to develop the trust needed to heal and recover from CPTSD.
Unlike survivors of single-incident trauma, complex trauma survivors (those with CPTSD) are likely:
- Experienced abuse or neglect during their formative years from a primary caregiver or person who was involved in a close relationship in their life.
- Had a hard time figuring out what was right or wrong because the behaviors of caregivers didn’t make sense.
- Could not be present with others in their daily life at the time, because it was not safe.
- Struggle to be present, in their life as adults, because everyday life and relationships still feel unsafe.
- May not know how to “do” relationships.
- May continue to experience similar traumas in new relationships.
- Have an imprint of past trauma on their nervous system.
- Live in a “triggered” state of hyperarousal or hyperarousal, because it’s how they learned to survive.
- May not even be aware they have experienced complex trauma, having to live with symptoms instead of narrative memories.
- May not realize they have survived anything, let alone something so influential in their development.
- May not see any separation from who they are as a person and the complex trauma that happened to them.
- Are consumed by trauma symptoms every day.
- May not realize that they can experience life any differently.
How Are All Traumas Similar?
All forms of trauma are similar because the experience leaves people feeling unsafe and in danger. Trauma-informed therapist, Lisa Ferentz, LCSW lists these common characteristics of trauma:
- A traumatic event, either witnessed or experienced, representing a fundamental threat to one’s physical integrity or survival.
- Responses involve a range of possible emotions including intense fear, helplessness, horror, disempowerment, anger or rage
Yes, you can reclaim your life after trauma!
Trauma survivors don’t always know there is another way to experience life than to battle fear and symptoms every day. They may need to learn that in adulthood they can heal, nurture themselves with compassion, or even re-parent their inner child who is crying out in pain. They may also learn that there are consistent, caring,safe people in the world. Trauma survivors may not realize that they can experience life any differently, but they can!
Healing From Complex Trauma and CPTSD
Trauma survivors who have experienced complex trauma often have a greater challenge recognizing trauma’s impact because it has become entwined with their fundamental understanding of the world and themselves. It became part of their foundation in the world. In therapy, survivors are building a new foundation, one of stability, consistency, and safety in order to heal. They are learning that relationships can be safe, that they can be vulnerable and stay safe, and that connections help with healing.
Healing is possible!
- 3 Concepts to Help Trauma Survivors Move Forward into Healthier Relationships
- Loving a Trauma Survivor: Understanding Childhood Trauma’s Impact on Relationships
- Book:A Practical Guide to Complex PTSD | Dr. Arielle Schwartz
- Workbook:Transforming the Living Legacy of Trauma: A Workbook for Survivors and Therapists by Janina Fisher
Robyn is a Licensed Marriage and Family Therapist with 20+ years of experience providing psychotherapy, as well as the founder and clinical director of a private practice, Brickel and Associates, LLC in Old Town, Alexandria, Virginia. She and her team bring a strengths-based, trauma-informed, systems approach to the treatment of individuals (adolescents and adults), couples and families. She specializes in trauma (including attachment trauma) and the use of dissociative mechanisms; such as: self-harm, eating disorders and addictions. She also approaches treatment of perinatal mental health from a trauma-informed lens.
Robyn also guides clients and clinicians who wish to better understand the impact of trauma on mental health and relationships. She has a wide range of post graduate trauma and addictions education and is trained in numerous relational models of practice, including Emotionally Focused Couple Therapy (EFT), the Psychobiological Approach to Couple Therapy (PACT), and Imago therapy. She is a trained Sensorimotor Psychotherapist and is a Certified EMDRIA therapist and Approved Consultant. Utilizing all of these tools, along with mindfulness and ego state work to provide the best care to her clients. She prides herself in always learning and expanding her knowledge on a daily basis about the intricacies of treating complex trauma and trauma’s impact on perinatal distress.
She frequently shares insights, resources and links to mental health news on Facebook and Twitter as well as in her blog at BrickelandAssociates.com
To contact Robyn directly:
C-PTSD is caused by ongoing trauma which lasts for months or years, while PTSD may be caused by a single traumatic event. The symptoms of C-PTSD are also more complex and may take longer to treat. Recovering from trauma is a journey. A therapist can support and guide you.Why is C-PTSD not recognized? ›
Although its inclusion was reconsidered for DSM-5, complex PTSD was again excluded because there was too little empirical evidence supporting Herman's original proposal that this was a separate diagnosis.Is C-PTSD the same as PTSD in DSM-5? ›
Diagnosis of C-PTSD
7 As a result, the DSM-5 lumps symptoms of C-PTSD together with PTSD. Many mental health professionals do recognize C-PTSD as a separate condition, because the traditional symptoms of PTSD do not fully capture some of the unique characteristics shown in people who experienced repeat trauma.
There are four defensive responses that develop out of childhood trauma and CPTSD: Fight, Flight, Freeze, and Fawn.How do you explain CPTSD? ›
Complex post-traumatic stress disorder (complex PTSD, sometimes abbreviated to c-PTSD or CPTSD) is a condition where you experience some symptoms of PTSD along with some additional symptoms, such as: difficulty controlling your emotions. feeling very angry or distrustful towards the world.How do you recognize CPTSD? ›
- vivid flashbacks (feeling like the trauma is happening right now)
- intrusive thoughts or images.
- intense distress at real or symbolic reminders of the trauma.
- physical sensations such as pain, sweating, nausea or trembling.
It is hypothesized that traumatic experiences lead to known PTSD symptoms, empathic ability impairment, and difficulties in sharing affective, emotional, or cognitive states.Does having CPTSD make you Neurodivergent? ›
PTSD is also considered a form of neurodivergence. However, this is an acquired neurodivergence (meaning it is situational and can be resolved through treatment). At this point, the person may return to their neurotypical baseline.How debilitating is CPTSD? ›
The symptoms of complex PTSD are highly debilitating and can cause chronic emotional disquiet. However, with caring, compassionate, expert treatment its symptoms can be managed and its life-altering effects controlled. An individual recovering from complex PTSD faces a long, challenging road.Is C-PTSD overdiagnosed? ›
Despite the popular use of this term, actual prevalence rates demonstrate that PTSD is not overdiagnosed by those whose job it is to diagnose: the epidemiologists and the mental health professionals.
C-PTSD is very often comorbid with dissociative disorders, including dissociative identity disorder (DID) or other specified dissociative disorder (OSDD).Is C-PTSD a dissociative disorder? ›
We Call it Complex PTSD Dissociation
Essentially, complex PTSD dissociation is a stress response that causes a broken mental and emotional link between things or experiences you would normally associate with one another. You process life very differently to accommodate the upsetting way you learned to see the world.
- Not having enough social support.
- Being young at the time of the traumatic event.
- Having a history of other mental health conditions.
- Experiencing additional stress on top of the initial trauma, such as losing a loved one, home, or job.
Symptoms of complex PTSD
dizziness or nausea when remembering the trauma. hyperarousal, which means being in a continual state of high alert. the belief that the world is a dangerous place. a loss of trust in the self or others.
- Establishment of safety. This process can take a considerable time, and you should not feel discouraged by this. ...
- Remembrance and mourning. This step involves the safe, structured retelling of the trauma. ...
- Reconnection to ordinary life.
Problems regulating emotions, including chronic sadness, anger, or suicidal thoughts. Negative self-perception, including feelings of guilt, shame, or powerlessness. Dissociation from reality, including loss of memory, flashbacks, or periods of feeling disconnected from one's mind or body.Should you tell people you have C-PTSD? ›
You do not need to tell everyone about your PTSD. Share the information with those people who are going to be understanding, trustworthy, nonjudgmental, and supportive. In other words, don't share the news with the family gossip or the loved one likely to criticize you about the disorder.What not to say to C-PTSD? ›
- Give easy answers or blithely tell your loved one everything is going to be okay.
- Stop your loved one from talking about their feelings or fears.
- Offer unsolicited advice or tell your loved one what they “should” do.
- Blame all of your relationship or family problems on your loved one's PTSD.
Self-destructive behavior, such as drinking too much or driving too fast. Trouble sleeping. Trouble concentrating. Irritability, angry outbursts or aggressive behavior.Is Cptsd on the autism spectrum? ›
CPTSD and ASD are different conditions, although certain aspects of the symptoms can overlap. Talk to a doctor if you are concerned that you or someone you know may have one of these conditions. There are many options for managing the symptoms, which allow for a fulfilling and happy life.
Stress results in acute and chronic changes in neurochemical systems and specific brain regions, which result in longterm changes in brain “circuits,” involved in the stress response. Brain regions that are felt to play an important role in PTSD include hippocampus, amygdala, and medial prefrontal cortex.Are people with CPTSD manipulative? ›
Self-concept: Signs that Complex PTSD has impaired a person's self image may be evident in a tendency toward self-abuse, manipulation, and self medicating.What are the positives of CPTSD? ›
Adults who managed this attachment trauma as children learned many adaptive survival skills that they may utilize in adulthood. A sense of responsibility, competence, and a valuing of connection are among strengths adults with a CPTSD history can carry.Why is CPTSD so hard to treat? ›
PTSD is hard to treat
Instead of feeling like a normal memory, trauma memories feel like they are still happening, right now in the present. At the same time, the brain stays in fight or flight mode, constantly feeling threatened even when the person is safe.
The startle response is a normal evolutionary adaptation that readies human beings for a fight or to flee. When it occurs, your heart races, you may sweat, you breathe faster, your muscles tense causing you to jump, and you feel intense fear.How does C-PTSD affect memory? ›
Current theories of posttraumatic stress disorder (PTSD) propose that memory abnormalities are central to the development and persistence of symptoms. While the most notable memory disturbances in PTSD involve memory for the trauma itself, individuals often have trouble remembering aspects of everyday life.Can C-PTSD cause personality disorder? ›
Studies have shown a relationship between PTSD and antisocial personality disorder. Some studies have found that people with PTSD have higher rates of antisocial personality disorder than people without PTSD.What not to do with C-PTSD? ›
Get enough rest, eat a healthy diet, exercise and take time to relax. Try to reduce or avoid caffeine and nicotine, which can worsen anxiety. Don't self-medicate. Turning to alcohol or drugs to numb your feelings isn't healthy, even though it may be a tempting way to cope.How do you calm down with triggered C-PTSD? ›
- Get to know your triggers add. You might find that certain experiences, situations or people seem to trigger flashbacks or other symptoms. ...
- Confide in someone add. ...
- Give yourself time add. ...
- Try peer support add. ...
- Find specialist support add. ...
- Look after your physical health add.
Also, since people living with complex post-traumatic stress disorder qualify for a diagnosis of post-traumatic stress disorder, the Social Security Administration will consider them disabled.
About 6 out of every 100 people (or 6% of the U.S. population) will have PTSD at some point in their lives. Many people who have PTSD will recover and no longer meet diagnostic criteria for PTSD after treatment.What happens if C PTSD goes untreated? ›
If left untreated, complex PTSD can become life-threatening. It raises the risk of developing anxiety, depression, addictive behavior, self-harm, and suicidal thoughts. Chronic pain, fatigue, and changes in eating and sleeping patterns are all possible physical health problems.Why is CPTSD not in the DSM-5? ›
During the trials for the DSM IV Roth, S., Newman, E., Pelcovitz, D., van der Kolk, B., & Mandel, F. S. (1997) found that 92% of individuals who had the proposed Complex PTSD diagnosis met the criteria for the PTSD. This was why it was not included in the DSM5.Can C-PTSD cause delusions? ›
Recent data suggest that the presence of psychotic symptoms in patients suffering from posttraumatic stress disorder (PTSD) may represent an underrecognized and unique subtype of PTSD. Among combat veterans with PTSD, 30% to 40% report auditory or visual hallucinations and/or delusions.What are the 17 symptoms of complex PTSD? ›
- Vivid Flashbacks. A PTSD flashback is when you relive your traumatic experience, and it feels like it is happening all over again right in that moment. ...
- Nightmares. ...
- Self-Isolation. ...
- Depression. ...
- Substance Abuse. ...
- Emotional Avoidance. ...
- Feeling on Edge, or Hyperarousal. ...
- Memory Loss.
Complex post-traumatic stress disorder is entirely treatable with the right combination of compassion, patience, and trust. Someone can work to disempower the trauma that cripples them and practice positive coping skills in the context of well-rounded support and guidance.What is the duration of CPTSD? ›
The course of the illness varies: Although some people recover within 6 months, others have symptoms that last for a year or longer. People with PTSD often have co-occurring conditions, such as depression, substance use, or one or more anxiety disorders.Is it possible to have PTSD and Cptsd? ›
Many other diagnoses that a person with PTSD can have include complex post-traumatic stress disorder (CPTSD).How do I know if I have BPD or C-PTSD? ›
Individuals with cPTSD tend to have a more stable sense of Self but struggle with consistent feelings of low self-worth, guilt, and shame. Individuals with BPD, on the other hand, have a more unstable sense of Self – they may not know who they are at their core and frequently change their interests and hobbies.What is the difference between ICD 11 C-PTSD and PTSD? ›
ICD-11 PTSD detects some individuals with significant impairment who would not receive a diagnosis under DSM-IV or DSM-5. ICD-11 CPTSD identifies a distinct group who have more often experienced multiple and sustained traumas and have greater functional impairment than those with PTSD.
- Your Skin may scar more easily. ...
- You may not be able to sleep. ...
- Your ears may ring. ...
- You might gain weight – particularly around your stomach. ...
- Your Digestion may change. ...
- You may get frequent aches and pains. ...
- You may find it challenging to build and maintain muscle.
Examples of CPTSD's symptoms are prolonged feelings of terror, worthlessness, helplessness, distortions in identity or sense of self, hypervigilance. There exists strong relationships between CPTSD and repetitive adverse childhood experiences, especially among survivors of harmful foster care.Do people with C-PTSD lack empathy? ›
It is hypothesized that traumatic experiences lead to known PTSD symptoms, empathic ability impairment, and difficulties in sharing affective, emotional, or cognitive states.How debilitating is C-PTSD? ›
The symptoms of complex PTSD are highly debilitating and can cause chronic emotional disquiet. However, with caring, compassionate, expert treatment its symptoms can be managed and its life-altering effects controlled. An individual recovering from complex PTSD faces a long, challenging road.Is C-PTSD on the autism spectrum? ›
CPTSD and ASD are different conditions, although certain aspects of the symptoms can overlap. Talk to a doctor if you are concerned that you or someone you know may have one of these conditions. There are many options for managing the symptoms, which allow for a fulfilling and happy life.What is the prognosis for C-PTSD? ›
CPTSD is a serious mental health condition that can take some time to treat, and for many people, it's a lifelong condition. However, a combination of therapy and medication can help you manage your symptoms and significantly improve your quality of life.Is C-PTSD more chronic than BPD? ›
cPTSD is more chronic than BPD and often requires long-term treatment. cPTSD can be disabling if left untreated. cPTSD has often been misdiagnosed as BPD. cPTSD and BPD have some symptoms in common, but cPTSD is more complex than BPD.Is CPTSD overdiagnosed? ›
Despite the popular use of this term, actual prevalence rates demonstrate that PTSD is not overdiagnosed by those whose job it is to diagnose: the epidemiologists and the mental health professionals.Is CPTSD a new diagnosis category in post-traumatic stress disorder? ›
The updated ICD now includes a new diagnosis for complex post-traumatic stress disorder (complex PTSD). New symptoms—such as self-organization disturbances—were added to the previous symptoms of PTSD, which include flashbacks, nightmares, avoidance, social withdrawal and hypervigilance.Is CPTSD a diagnosis in the DSM-5? ›
PTSD is included in a new category in DSM-5, Trauma- and Stressor-Related Disorders. All of the conditions included in this classification require exposure to a traumatic or stressful event as a diagnostic criterion.