Trauma: What is the Difference Between PTSD and Complex PTSD

Unfortunately, experiencing trauma is not an uncommon experience. It is estimated that 50-60% of people will experience a traumatic situation at least once in their life. Experiencing trauma does not always lead to the development of Post Traumatic Stress Disorder (PTSD). People have both protective factors and risk factors that play into the equation on whether someone develops PTSD after experiencing a trauma or not. Protective factors are things like having a good support group, optimism, healthy coping skills, having resiliency as a trait, self-efficacy, and having a secure attachment style. Risk factors are poor/unhealthy coping skills, previous traumatic experiences, having experienced adverse childhood events (ACEs), family history of trauma or depression, substance use, lack of social support, and ongoing stress. 

So, if someone has more risk factors than protective factors and they experience a traumatic event, it is more probable that this person may develop PTSD. PTSD is really a disorder of the nervous system because after experiencing a traumatic event the nervous system is not able to recover and regulate itself again, which is why past history with traumatic events or ACEs is a risk factor. 

We all have a part of our nervous system called the autonomic nervous system and it is comprised of two parts: the sympathetic nervous system and the parasympathetic nervous system. The sympathetic nervous system is the like the gas pedal and it activates everything. When faced with a threat it becomes extremely activated and engages something called the fight-flight-freeze response. This is an instinctual response that can help us survive in life-threatening situations. The parasympathetic nervous system is the brake pedal and slows things down. It is usually referred to as our “rest and digest” system. Ideally, we want to spend about 95-97% of our day in a parasympathetic response. Unfortunately, most of us spend the majority of our day in a sympathetic response, which is why ongoing stress is also a risk factor. 

When we refer to the Diagnostic Statistics Manual 5 (DSM-5), it includes the diagnosis of PTSD, but not Complex PTSD (C-PTSD). Psychologists and therapists have been advocating for C-PTSD to be added to the DSM but this has not been successful yet. So, as I discuss the differences between PTSD and C-PTSD please be aware that there is not an official diagnosis for C-PTSD yet despite the evidence that shows it deserves its own diagnosis. PTSD commonly happens after one traumatic event such as a car accident, natural disaster, a sudden and unexpected loss of someone close, being assaulted in a single episode, ect. C-PTSD is developed after/during ongoing trauma or in highly stressful situations such as being abused mentally, physically, emotionally, or sexually by a parent, family member, or partner. Emotional neglect from a parent or partner is also seen in the development of C-PTSD as well. It’s not uncommon for singular incidents, like mentioned above, to also be thrown into someone’s experiences and add to the C-PTSD.

The diagnosis of PTSD includes four categories of symptoms: flashbacks/intrusive thoughts, avoidance, mood/emotional changes, and hyper-vigilance. C-PTSD also includes these four categories but the symptoms present very differently. In PTSD flashbacks are often sensory based like replaying the visual memory of the traumatic experience in your head and in C-PTSD flashbacks are more likely to be emotional flashbacks. Emotional flashbacks are sudden, and sometimes prolonged, regressions to an emotional state that are related to a past traumatic event/s. They’re more of a feeling and are often described as being thrown back into the emotions or emotional state surrounding the trauma or neglect. This is probably one of the most distinctive features of C-PTSD. It can make day-to-day life very difficult and often has a large impact on one’s social, intimate, and occupational functioning. Usually, someone with C-PTSD has an insecure attachment that leads to being anxious, avoidant, or a combo of both in relationships. Individuals with C-PTSD also have more physical health concerns as well, which is a topic for another day.

In regard to mood/emotional changes, I often see a difference between PTSD and C-PTSD. In PTSD there may be some depression and/or anxiety that is related to the traumatic event. Often people will be worried and anxious about this event happening again and will avoid people, places, and situations that may potentially harm them again. This can happen with C-PTSD as well but I often see individuals with C-PTSD who have chronic depression and anxiety. The difference is the length and sometimes the intensity. In PTSD, the duration is shorter and isolated to the incident. In C-PTSD, it is chronic and cyclical in some fashion. Often I see people feeling mildly depressed with anxiety as their baseline with periods of moderate to severe depression and intense anxiety. Now, this is not the case for everybody with PTSD or C-PTSD. I am making generalizations based off of the majority of what I see working with my clients. Everybody is different and the symptoms they present with are unique to them.

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