PTSD vs. Complex PTSD: What’s the difference?

Not to bore you with definitions right off the bat, but to get the basics laid out first thing: PTSD is a mental health diagnosis in the DSM-5 (Diagnostic & Statistical Manual of Mental Health Disorders) that pertains to “exposure to or actual threatened death, serious injury, or sexual violence.” Complex PTSD (or C-PTSD) is technically not accounted for in the DSM-5 (though most therapists would argue that it should be!), and may occur when an individual has experienced multiple or ongoing traumas. PTSD and C-PTSD have some overlap in symptoms and presentation, but they also have some areas of differentiation. If you’ve ever been confused about the two, or have had a hard time making sense of your own experiences and where things land, I’ve got you covered and am going to break down the differences and similarities between the two.

Let’s start with the basics of PTSD. PTSD may occur after a person experiences a dangerous or unsafe situation. Not everyone who experiences and unsafe/dangerous event ends up experiencing a post-traumatic response. By the DSM-5 definition, PTSD symptoms may include intrusive and distressing memories of the traumatic event, nightmares/repeated distressing dreams of the event, avoidance of stimuli that are associated with the traumatic event, marked distress at exposure to the event (e.g. distress from thinking about it, talking about it, receiving reminders of it), flashbacks, hypervigilance, high levels of irritation, difficulties with concentration, and reckless of self-destructive behavior (note that this list is non-exhaustive and includes the most common symptoms).

As mentioned earlier, PTSD most typically occurs after an acute trauma, which is an isolated event or single-incident trauma. Some examples of events that may result in PTSD include:

• Car accidents

• Natural disasters

• Rape or sexual assault

• Physical assault

• Sudden death of a parent/caregiver/spouse/other significant loved on (particularly witnessing the death)

• Miscarriage or infant loss

Again, this list is non-exhaustive, but captures many of the most common events that may result in a PTSD diagnosis. Generally speaking, when someone has experienced one of the events above, they are very aware of the connection between their PTSD symptoms and the event — it can feel like a clearly traceable cause and effect. Many people with PTSD may also experience symptoms of anxiety and depression if PTSD is left untreated.

C-PTSD, or Complex PTSD, can often be harder for the individual to recognize on their own. This is largely because C-PTSD results from multiple events or ongoing circumstances/dynamics. It may be helpful to identify examples of situations that could result in C-PTSD early on in discussion:

• Experiencing childhood neglect

• Experiencing childhood physical abuse

• Experiencing childhood sexual abuse

• Domestic violence (witnessing domestic violence between parents as a child, or experiencing domestic violence in an adult romantic relationship)

• Emotional abuse (from a caregiver, or in an adult romantic relationship)

• Prolonged exposure to a parent/caregiver’s severe mental illness

• Medical/health-related trauma

When looking at a list of these examples, it may initially seem as though these things would all be obvious to detect while they’re happening. However, the reality is that events/dynamics/circumstances that result in C-PTSD are often challenging for the individual to recognize while they’re in the midst of it. This can make symptoms of C-PTSD harder to identify, and can often result in untreated trauma because the individual doesn’t recognize that their present day symptoms are tied to long-standing past experiences. Symptoms of C-PTSD may include:

• Symptoms that overlap with PTSD:

  • Feeling on edge, irritable, or hypervigilant

  • Avoidance of reminders of the trauma

  • Intrusive memories, flashbacks, and nightmares

  • Changes in mood and thinking

  • Anxiety- and depression-like symptoms

• Symptoms of C-PTSD that do not typically overlap with PTSD:

  • Long-term difficulties regulating emotions

  • Difficulties maintaining long-term relationships

  • Feeling damaged, worthless, or broken; general struggles with self-esteem

  • Struggles with sense of self

  • Feelings of mistrust towards the world

People sometimes ask if C-PTSD is “worse” than PTSD, or vise versa. Every case of PTSD/C-PTSD is different, so while it may not make sense to say that one is “worse” than the other (since both can be intense and disruptive to daily life), C-PTSD is often more enduring than PTSD. This may be because the events are typically more complicated in nature (e.g. they often involve complex relationship and interpersonal dynamics, they are generally longer-lasting, and they are often harder to make sense of than a singular incident). It’s also important to note that although C-PTSD is not a formal diagnosis in the DSM-5, it isn’t any less real. This was excluded as a diagnosis

It’s important to keep in mind that both PTSD and C-PTSD are treatable. If you’re interested in understanding more about trauma, I’d suggest reading an earlier post, How Trauma Impacts the Brain.

Disclaimer: This blog post is meant for information purposes only. Reading this blog post or carrying out tools discussed in this blog post is not a substitute for therapy or any form of mental or physical health care. Please consult a mental health professional if you are struggling with PTSD or trauma symptoms.