The Difference Between PTSD and Complex PTSD
Understanding PTSD and C-PTSD: Key Differences and Why They Matter
What Is PTSD? Core Symptoms and Causes
Post-Traumatic Stress Disorder (PTSD) is a mental health condition outlined in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR), published by the American Psychiatric Association (APA). It is widely used in the U.S. and Canada to guide diagnosis and treatment. To be diagnosed with PTSD, an individual must meet criteria in several areas:
Exposure to Trauma: Directly experiencing, witnessing, or learning about a traumatic event involving actual or threatened death, serious injury, or sexual violence.
Intrusion Symptoms: Recurrent, involuntary, and distressing memories, dreams, or flashbacks related to the trauma.
Avoidance: Persistent efforts to avoid trauma-related thoughts, feelings, or external reminders.
Negative Alterations in Cognition and Mood: Difficulty remembering details of the trauma, persistent negative beliefs, distorted blame, and emotional numbness.
Arousal and Reactivity Changes: Hypervigilance, irritability, difficulty concentrating, exaggerated startle response, and sleep disturbances.
Exposure to trauma in PTSD is often—though not always—a single event. Common examples include natural disasters, sexual assault, or combat experiences, sometimes referred to as “shock trauma.” When the body is unable to process the trauma or complete its natural stress response cycle, PTSD symptoms may develop. However, it’s important to remember that trauma affects people differently. Two individuals can experience the same event but have vastly different outcomes depending on various factors, such as resilience, support systems, and biology.
Understanding Complex PTSD: Key Features
Complex PTSD (C-PTSD)—sometimes called Developmental Trauma, Relational Trauma, or Developmental Trauma Disorder—differs from PTSD in significant ways. While it is not recognized as a standalone diagnosis in the DSM-5-TR, it is officially included in the International Classification of Diseases (ICD-11) published by the World Health Organization (WHO).
C-PTSD often results from prolonged or repetitive trauma where escape was difficult or impossible, such as ongoing abuse or captivity. The diagnosis includes all the symptoms of PTSD, plus additional features referred to as “Disturbances in Self-Organization” (DSO):
Affective Dysregulation: Difficulty managing emotions, such as trouble calming down or feeling emotionally numb.
Negative Self-Concept: Persistent feelings of worthlessness, guilt, or failure.
Disturbed Relationships: Challenges forming or maintaining close relationships, often feeling disconnected or mistrustful of others.
How PTSD and C-PTSD Symptoms Overlap and Differ
While C-PTSD is often linked to prolonged trauma, the diagnosis depends on the overall symptom profile, not just the nature of the trauma. This means someone exposed to repeated trauma may meet the criteria for PTSD or C-PTSD based on their specific symptoms.
As a clinician, I often see common trauma symptoms among those who meet the criteria for PTSD and C-PTSD:
Intrusion Symptoms: These are commonly noticed as flashbacks, but they don’t always appear as vivid, conscious memories. Flashbacks can manifest as bodily sensations or emotions, such as feeling helpless, powerless, or even a sense of being younger than you are.
Avoidance: Avoiding anger—both in oneself and others—is common. Many individuals associate anger with rage because that was what was modeled for them in the past.
Alterations in Cognition: This often shows up as the person internalizing the shame of the perpetrator. For instance, they may blame themselves for returning to an abuser or believe they somehow deserved the mistreatment.
Arousal and Reactivity: People with PTSD almost always have a heightened startle response and tend to be hypervigilant, particularly about safety in certain situations.
In addition to above, these are some common examples of how trauma symptoms manifest in C-PTSD:
Affective Dysregulation: This shows up as disproportionate emotional reactions to seemingly minor situations. This may present in ways that are surprising, even to the person experiencing them.
Negative self-concept: This often appears as low self-esteem or a deep sense of unworthiness. Those with developmental or relational trauma may struggle with self-acceptance, often because they grew up without caregivers who embraced all parts of who they were.
Disturbed relationships: These frequently show up as a tendency to remain guarded. You might be the life of the party, yet still avoid letting people see your most vulnerable, “broken” parts. This is often a protective mechanism learned in childhood, when those around you were unable to handle your emotional needs or the complexity of your experiences.
Why Identifying Trauma Symptoms Matters
When you hear examples like ongoing abuse or captivity, you might think C-PTSD doesn’t apply to you. But consider this: as a child, you likely didn’t have the option to escape living with your caregivers. If you grew up in a home with neglect or dysfunctional family patterns, you may have experienced prolonged trauma. Symptoms of C-PTSD might manifest in adulthood as difficulty regulating emotions, feelings of unworthiness, or struggles in relationships. If this resonates, seeking guidance from a licensed mental health professional can help you understand and heal.
Remember, healing is a journey, and understanding your experiences is an important step toward growth and resilience.
Resources:
American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (5th ed., text rev.). American Psychiatric Publishing.
National Center for PTSD. (2021). Complex PTSD and the ICD-11: Recognizing and differentiating PTSD and complex PTSD. PTSD Research Quarterly, 32(2). https://www.ptsd.va.gov/publications/rq_docs/V32N2.pdf
World Health Organization. (2021). International classification of diseases for mortality and morbidity statistics (11th revision). https://icd.who.int/en/