PTSD vs. C-PTSD – What to Know About Complex-PTSD

Post-traumatic stress disorder is a chronic condition that may develop following exposure to a traumatic event, either through experiencing or witnessing it. PTSD is closely linked to other anxiety disorders, with its hallmark symptoms including re-experiencing the event, avoidance behaviours, changes in mood and cognitions, and increased arousal.

Complex post-traumatic stress disorder (C-PTSD) is a second type of anxiety disorder connected to the exposure of trauma, however, it’s associated with chronic and repeated traumas, as opposed to one specific traumatic event. Although there is some controversy regarding the existence of the disorder as separate from PTSD, it is nevertheless a very debilitating and difficult disorder to cope with. Both PTSD and C-PTSD benefit from trauma therapy, professional counseling, and psychotherapy as well as other multi-faceted treatment approaches.


History of C-PTSD

Complex trauma
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C-PTSD was first described by Judith Herman in 1992, as a condition separate from PTSD that occurs after repeated or sustained traumatic exposures, and in addition to PTSD symptoms, is characterized by disturbances in interpersonal relationships, somatic sensations, affect regulation, dissociation, and sense of self. C-PTSD has since been recognized as a separate diagnosis in the International Classification of Diseases (ICD-11) published by the World Health Organization (WHO) but remains under a single broad category of PTSD in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5).




Unlike PTSD, which is often characterized as developing following a significantly distressing event such as a car accident or seeing combat, C-PTSD is associated with experiencing repeated traumas over months or years. The traumas that may result in C-PTSD are often interpersonal and occur when escape from the situation is not possible due to physical, psychological, maturational, environmental, or social constraints. Common C-PTSD triggering events include childhood sexual abuse, domestic abuse, sex trafficking, refugee experiences, being a civilian war victim, genocide campaigns, or other forms of organized violence. C-PTSD is more likely to occur when traumatic events are experienced at a younger age, as in the case with childhood abuse. A Diagnosis of C-PTSD requires the same symptoms of PTSD, as well as disturbances in self-regulatory capacities, which include difficulties regulating emotions and affect, disturbances in relationships, negative self-concept, adversely affected belief systems, dissociation, and somatic distress.


Symptoms of C-PTSD

complex PTSD
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To meet the criteria for C-PTSD, one must display PTSD symptoms as well as the symptoms specific to C-PTSD.


PTSD Symptoms:


PTSD includes 4 categories of symptoms:

  1. Re-experiencing symptoms
  2. Avoidance symptoms
  3. Arousal symptoms
  4. Cognitive and mood symptoms


To receive a diagnosis of PTSD, the individual must have experienced a traumatic event and have at least one symptom from re-experiencing and avoidance, and at least two symptoms from cognitive and mood and arousal. Symptoms must be present for at least one month.


Re-experiencing symptoms

  • Flashbacks
  • Nightmares
  • Intrusive, frightening thoughts, images, or sensations
  • Physical sensations of stress such as tremor, pain, or nausea

This is the most common PTSD symptom.


Avoidance symptoms

  • Avoiding any person, place, event, or thing that acts as a reminder of the traumatic event
  • Avoiding talking about the experience
  • Avoiding thoughts and feelings related to the trauma

This can result in individuals being very isolated or withdrawn or may lead to turning to drugs and alcohol to numb emotions.


Arousal symptoms

  • Irritability
  • Anxiety
  • Angry outbursts
  • Easily startled or stressed
  • Insomnia
  • Difficulty concentrating
  • Increased reckless or self-destructive behaviour

Arousal symptoms are typically more constant and can make a person feel stressed and tense. These symptoms may make accomplishing daily tasks such as eating and sleeping difficult.


Cognitive and mood symptoms

  • Memory loss
  • Negative beliefs
  • Low self-esteem and self-worth
  • Depression
  • Anxiety
  • Feelings of detachment


C-PTSD Symptoms:


Symptoms more specific to C-PTSD include:


Emotion regulation difficulties

  • Uncontrollable emotion
  • Explosive anger
  • Intense feelings of sadness and depression
  • Bitterness


Negative self-concept

  • Low self-esteem
  • Low self-worth
  • Feelings of guilt or shame


 Difficulty with relationships

  • Have a difficult time trusting others
  • Feeling disconnected
  • Avoid relationships or enter into unhealthy ones


Changes in consciousness

  • Dissociation
  • Voluntary or involuntary thought suppression, minimization, or denial of traumatic events
  • Forgetting of traumatic events
  • Emotional detachment
  • Feelings of being in a trance-like state


Changes in belief systems

  • Loss of faith in religion
  • Strong sense of hopelessness about the world
  • Extreme changes in long-held values


 Somatic distress

  • Tension headaches
  • Gastrointestinal disturbances
  • Abdominal, back, or pelvic pain
  • Insomnia

Somatic symptoms are durable and typically increase over time.


C-PTSD Treatment

PTSD therapy
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Although some studies suggest that complex trauma and C-PTSD respond less well to conventional treatments than PTSD and other anxiety disorders, there are still many promising and effective treatment options available to those suffering from C-PTSD and other mental health conditions associated with trauma.

Traumatic disorders are very complicated, and it’s important to consult with a trained mental health professional for treatment. Talking about trauma or relaying the events of a traumatic experience can have serious adverse consequences to the individual who is suffering, therefore it’s paramount to seek out a trauma counselor or therapist before beginning treatment. Professional care will ensure the individual receives the safest treatment plan. 

A trauma counselor may begin treatment with education about trauma and focus on emotional regulation interventions before having the individual narrate their traumatic memories. This is to promote the responsiveness of treatment and ensure the individual feels safe throughout the treatment experience. 

Treatment options include psychotherapy, medications, or a combination of the two. Eye movement desensitization and reprocessing (EMDR) is an interactive technique used to help desensitize the individual to their traumatic memories and thoughts and has been shown to help improve PTSD symptoms and may be beneficial in treating C-PTSD as well.

Reconsolidation therapy ™ is another PTSD treatment that uses a blood-pressure-lowering medication in conjunction with psychotherapy to help patients heal from their traumatic memories.

 Additionally, meditation and mindfulness have been identified as helpful second-line interventions for those suffering from emotional dysregulation and dissociation symptoms and may prove helpful in treating C-PTSD, alongside other treatment protocols.


Whether C-PTSD is officially recognized as separate from PTSD or not, it remains a pervasive and debilitating disorder for many. However, treatment options are available, with C-PTSD potentially requiring a more personalized treatment approach. Nevertheless, you can heal from both C-PTSD and PTSD; for more information on healing from trauma disorders and My Recon Therapy, please visit our trauma therapy services and treatment programs, or feel free to contact us with any questions. 

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