What Is the Difference Between CPTSD and PTSD?
Clinically reviewed by: Eamonn McKay, LMFT
Written by: Joshua Marcus
Most people go through a traumatic event at some point in their lives. Whether it is the loss of a loved one or a traffic accident, it leaves an indelible mark on the person, sometimes upending how they thought their life would pan out. In certain cases, the impact of a traumatic event leads to the development of a mental health condition.
The most well-known mental illness associated with trauma is Post-Traumatic Stress Disorder (PTSD), a condition which can make it feel like the trauma is still ongoing. However, increasing recognition is being given to a condition similar to PTSD known as Complex Post-Traumatic Stress Disorder (CPTSD).
What is the difference between PTSD and CPTSD? This article will go into the definition of PTSD and CPTSD, exploring the necessity of the different categorizations and going into the symptoms, causes, and treatment of each.
What Is the Difference Between CPTSD and PTSD?
PTSD and CPTSD are both psychological disorders that can develop after someone experiences trauma. The difference underlying PTSD and CPTSD is the type and duration of trauma experienced.
PTSD develops after experiencing or witnessing a traumatic event, including accidents, violence, loss, injury, and captivity.
In contrast, CPTSD may occur in people who experience a repeated or prolonged period of trauma. Common examples include childhood neglect, repeated physical and sexual abuse, war, living as a refugee, housing instability, and captivity.
Although all the events that may lead to PTSD and CPTSD are considered as traumas, the type of trauma affects the symptoms the person experiences and the treatment required.
What is Post-Traumatic Stress Disorder or PTSD?
Post-traumatic stress disorder or PTSD is a common mental health condition that can develop after a person experiences or witnesses a traumatic event. While it is normal and healthy to experience symptoms of stress during and immediately after the event, as the body and mind go into survival mode, PTSD causes these symptoms to continue for months or years later.
The body’s stress response during a traumatic event is a self-defense mechanism. It makes you hyperaware of your environment, keeping watch for potential threats. Your body is prepared for fight or flight. Your emotional reactions are amplified.
These responses are no longer helpful when the trauma has passed, but rather impede your ability to function as normal. They lead to the common symptoms of PTSD, including:
Vivid flashbacks
Intrusive thoughts
Nightmares or insomnia
Physical sensations such as sweating, nausea, and trembling
Emotional dysregulation
Hypervigilance
Agitation
Avoidance of thoughts or places associated with the traumatic event
What is Complex PTSD?
Complex PTSD or CPTSD is a mental health condition separate but closely related to PTSD. Although there is still debate within the psychiatric world over whether it requires a distinct diagnosis, it is widely accepted that certain patterns occur in people who have suffered from complex trauma.
What is complex trauma?
Complex trauma refers to an experience that is not limited to one specific event. Rather, the trauma is repeated or ongoing, potentially including various kinds of traumas. This leads to struggles with self-image, warped defense mechanisms, difficult interpersonal relationships, and other chronic symptoms. When the complex trauma occurs during childhood, it has a particularly strong impact on the person’s worldview, approach to life, and internal and external sense of safety.
In some cases, the events of complex trauma which are repeated or prolonged would be considered traumatic even if they occurred on a single occasion. For example, any occurrence of sexual abuse is traumatic. Its repeated occurrence is what leads to the complexity of the trauma response.
In other cases, it is particularly the duration or repetition of the occurrence that makes it traumatic. For example, a child may not experience their parents’ absence for a few hours one night as traumatic. However, when it occurs every night, the child begins to feel unsafe, unloved, and unworthy. They may struggle to get proper nutrition and be subjected to responsibilities for which they do not have the capabilities or capacity.
How does complex trauma affect a person?
As we’ve discussed regarding PTSD, traumatic events trigger a stress response intended to help the person react appropriately to the threat. Complex trauma also triggers the stress response but its impact goes beyond the immediacy of these reactions.
When a person is subjected to complex trauma, the duration or consistency of the experience causes them to start thinking of themselves in distorted ways. They may begin to believe that they deserve the trauma due to some inherent lack of worth. When the trauma is perpetrated by a loved one, this messaging may be imposed on them explicitly or they might simply assume that the perpetrator is doing it because they are unloveable.
Associated feelings of shame and guilt become intense and are internalized. So too do feelings of anxiety and fear, as the world seems like a scary place where danger lurks around every corner.
The strength of these emotions, along with the need to constantly react to threats or crises, leads to emotional dysregulation. Children undergoing complex trauma may not yet have had the opportunity to learn emotional regulation in the first place due to the lack of stability in their lives.
In addition, they learn not to trust others, having potentially suffered due to the worst impulses of the people around them. Interpersonal relationships seem like a field covered in landmines, with the ever-present possibility that someone will hurt them if they grant them their trust.
The symptoms of CPTSD
Many of the symptoms of PTSD and CPTSD overlap. However, the specific effects of complex trauma are at the core of several additional symptoms unique to CPTSD.
They include:
Emotional dysregulation (difficulty managing emotions).
Intense and persistent feelings of guilt, shame, and worthlessness.
Distorted self-concept and identity, including beliefs that they are unloveable, incompetent, or deserving or destined for struggle.
A fearful perception of the world and an excessive focus on potential challenges and pain.
Interpersonal struggles, often leading to tumultuous relationships, codependence, trust issues, and/or the avoidance of intimacy and vulnerability.
Treatment for Post-Traumatic Stress Disorder (PTSD) and Complex PTSD (CPTSD)
Therapy is the first-line treatment for PTSD and CPTSD. The therapy approaches used share similarities, although CPTSD often requires additional therapy modalities.
The main therapies used for the treatment of PTSD and CPTSD are:
Cognitive-behavioral therapy (CBT): During CBT, the person learns skills to challenge distorted thoughts and perceptions associated with PTSD and CPTSD. In doing so, the thoughts and associated emotions lose their power. These skills are useful both during and outside of therapy.
Prolonged Exposure Therapy (PE): This is a type of CBT during which the person, in the safety of the therapy environment, is gradually exposed to elements associated with the trauma. These include memories and thoughts of traumatic events and, when appropriate, items and places connected to the events.
Eye Movement Desensitization and Reprocessing (EMDR): EMDR uses eye movements and tapping while the person recalls the trauma as a way of reprocessing the memories. Their vividness is reduced, as are the emotions associated with them. Research consistently shows EMDR to be one of the most effective treatments for PTSD, with evidence indicating that this extends to CPTSD.
Cognitive Processing Therapy (CPT): A type of cognitive-behavioral therapy specifically designed to treat Posttraumatic Stress Disorder (PTSD) by helping individuals identify and challenge unhelpful thoughts and beliefs related to their traumatic experiences, ultimately leading to a more balanced and accurate understanding of the event.
Internal Family Systems (IFS): This therapy views the mind as a system of interconnected "parts" and can be a valuable approach for trauma, helping individuals identify and heal their wounded and protective parts, fostering self-compassion and resilience.
In addition to the above therapies, treatment for CPTSD often includes dialectical behavior therapy (DBT). DBT is a mindfulness-based therapy that teaches emotional regulation, distress tolerance, and interpersonal effectiveness skills. Through techniques including body scans, meditation, radical acceptance, and reframing, it helps the person become adept at finding and maintaining balance with a stronger appreciation for life in all its complexities.
Medications for PTSD and CPTSD
There are no specific medications for PTSD and CPTSD. Psychiatric medications are used as a complementary treatment to therapy, helping treat the symptoms as well as co-occurring disorders like depression and anxiety.
Common medications prescribed for PTSD and CPTSD include:
SSRIs and SNRIs: Antidepressants which help improve mood, manage anxiety, and reduce intrusive thoughts.
Prazosin: This antihypertensive developed as a treatment for high blood pressure may be effective at reducing nightmares associated with PTSD and CPTSD.
Antipsychotics: Common examples include risperidone (Risperdal) and quetiapine (Seroquel). Antipsychotics can have severe or long-term side effects and are only used in cases of severe or treatment-resistant PTSD and CPTSD.
Seeking Help for CPTSD
Both post-traumatic stress disorder and complex PTSD are serious mental health conditions which cause distress and impede day-to-day functioning. While PTSD and CPTSD are connected, people with CPTSD experience symptoms which may not affect people with PTSD.
If you have gone through a traumatic event and are still experiencing stress symptoms, you may be suffering from PTSD. If you have suffered repetitive or persistent trauma, even if decades have passed, you may be suffering from CPTSD.
Find a therapist specialized in PTSD and CPTSD with Octave to start your healing journey today.