PTSD and C-PTSD: The similarities and the differences
The 11th revision to the World Health Organisation’s International Classification of Diseases (ICD-11) (published in 2018) now defines two distinct ‘sibling’ conditions, Post Traumatic Stress Disorder (PTSD) and Complex PTSD (C-PTSD), both of which fall under a general parent category of ‘Disorders specifically associated with stress’.
The C-PTSD definition describes the more complex reactions that are typical of individuals exposed to chronic trauma. The addition of this C-PTSD definition as distinct one from PTSD allows greater precision in diagnosis and more personalised and effective treatment.
It’s been said that ‘Complex-PTSD is simply PTSD which is more complex’ and in some cases, this is true (although PTSD by it’s very nature is very complex and complicated too!). As sibling conditions, PTSD and C-PTSD share many causes, a very specific shared ‘symptom profile’ and the treatments are based on very similar modalities – so this is why all the content on our website is designed for everyone affected by PTSD AND C-PTSD – we don’t define between the two in our support as the majority of our information and resources will cross over the two conditions. We want to provide support and information to everyone affected by any type of PTSD (any symptoms that are as a result of experiencing trauma) and that includes whether you have a medical diagnosis or not.
However, it’s also useful and important to know how the two conditions are different – and what extra support might someone with C-PTSD need, or what additional symptoms might they experience.
The first difference between PTSD and C-PTSD is the cause.
The differences and similarities in causes of PTSD and C-PTSD
Both PTSD and C-PTSD are caused by experiencing traumatic events. The defining characteristic of a traumatic event is its capacity to cause fear, helplessness, or horror as a response to the threat of injury or death, and therefore can affect anyone.
C-PTSD, on the other hand, often develops over sustained, repeated or multiple forms of traumatic events such as victims of bullying, emergency service workers, ‘chronic sexual, psychological, and physical abuse or neglect, or chronic intimate partner violence, victims of kidnapping and hostage situations, victims of slavery and human trafficking, prisoners of war, and prisoners kept in solitary confinement for a long period of time.’
C-PTSD can happen to anyone who has been exposed to long-term trauma, but it is more often seen in people who experienced trauma during an earlier stage of development, or were abused by someone they thought they could trust, such as a caregiver or protector. Because of this, often the impact on the nervous system around attachment or relationships becomes more deeply ingrained.
That said, studies have found that some people who’ve experienced multiple traumas develop PTSD, and others who’ve experienced one trauma develop C-PTSD – so the number, intensity or duration of traumas you experience don’t necessarily make a diagnosis of PTSD vs C-PTSD easier. This is just one reason why there can be confusion when making a diagnosis.
PTSD and C-PTSD diagnosis
PTSD itself was only formally recognised as a discrete diagnostic category in the 1980s, and as of March 2022, C-PTSD still isn’t recognised as a separate condition in the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5), which is the handbook often used by psychiatrists and psychologists in the USA and many other countries around the world.
This creates confusion and potential misdiagnosis, as in the UK, the NHS and medical professionals generally follow the ICD-11, which does define it as a distinct condition – but some still take cues, or get their knowledge from the DSM-5.
Additionally, as C-PTSD is still a relatively ‘new’ condition and term (even with the update to ICD-11), some doctors may not even be aware of its existence yet, which makes it hard for people suffering to get an official diagnosis. You may also find some doctors or therapists still use one of the terms ‘enduring personality change after catastrophic experience (EPCACE)’ or ‘disorders of extreme stress not otherwise specified (DESNOS)’.
Since there is no specific test to determine whether you have CPTSD or PTSD, the one common option that professionals may take is to ask you to write down your symptoms (physical and emotional) and log it as frequently as possible. Tracking your symptoms such as your feelings, thoughts, and actions, will allow your GP, mental health professionals or psychologist to determine if you have C-PTSD or PTSD more accurately, as both conditions share many symptoms, but they also have distinctions too.
The differences and similarities in symptoms of PTSD and C-PTSD
Though they often result from different types of trauma, PTSD and CPTSD share many important symptoms, including:
- Re-experiencing the trauma through intrusive memories, flashbacks, and nightmares
- Avoiding people, places, or thoughts that remind you of the trauma
- Changes in your mood and thinking including feeling distant from other people and having overwhelming negative emotions
- Feeling on edge and becoming irritable, easily frightened, or having difficulty concentrating or sleeping
C-PTSD is characterised by having the core symptoms of PTSD; that is, all diagnostic requirements for PTSD are met, and also having 3 additional categories of symptoms: difficulties with emotional regulation, an impaired sense of self-worth, and interpersonal problems which may manifest as some of the following (although it’s important to note that people with PTSD may also experience these):
- Difficulty controlling emotions. It’s common for someone suffering from C-PTSD to lose control over their emotions, which can manifest as explosive anger, persistent sadness, depression, and suicidal thoughts. They may feel like they’re living in a dream or have trouble feeling happy.
- Preoccupation with an abuser. It is not uncommon to fixate on the abuser, the relationship with the abuser, or getting revenge for the abuse.
- Negative self-view. C-PTSD can cause a person to view themselves in a negative light. They may feel helpless, guilty, or ashamed. They often have a sense of being completely different from other people.
- Difficulty with relationships. Relationships may suffer due to difficulties trusting others and a negative self-view. A person with C-PTSD may avoid relationships or develop unhealthy relationships because that is what they knew in the past.
- Hopelessness – you don’t think you’ll ever change or that life will ever get better
- Detachment from the trauma. A person may disconnect from themselves (depersonalisation) and the world around them (derealisation). Some people might even forget their trauma.
- Loss of a system of meanings. This can include losing one’s core beliefs, values, religious faith, or hope in the world and other people.
- Problems with self-esteem. Those with complex PTSD may feel worthless or blame themselves for their trauma. They may believe bad things happen because of something in them.
The differences and similarities in treatments of PTSD and C-PTSD
Despite the multiple traumas, and additional symptoms present in C-PTSD, both people with PTSD and C-PTSD can heal, although the journey for those with C-PTSD may be longer.
There are a number of different approaches to treating PTSD and C-PTSD. Eye Movement Desensitisation and Reprocessing is an approach that is particularly effective in treating these issues, although it is used with some modifications when treating C-PTSD as opposed to PTSD. With PTSD, the time it takes to prepare for the EMDR therapy may be shorter in duration, as well as the length of time it takes to work through the trauma.
C-PTSD treatment typically includes all the elements of standard PTSD treatment as a phase-based model with additional interventions or therapies included to provide strategies to:
- Manage strong emotions
- Create supportive relationships
- Address feelings of worthlessness and guilt
This may be especially important if you have experienced early trauma like child abuse, as you may have never learned how to trust other people or feel safe in the world. People with C-PTSD often have a greater challenge recognising the impact their condition has on them because it has become entwined with their fundamental understanding of the world and themselves. It became part of their foundation in the world. As such, as part of the treatment or C-PTSD, people are building a new foundation, one of stability, consistency, and safety in order to heal. They are learning that relationships can be safe, that they can be vulnerable and stay safe, and that connections help with healing.
In addition, there is much more extensive work involved in preparing for the EMDR therapy and helping someone to be able to regulate their emotions, maintain a sense of being present during the trauma work, and develop trust in the therapist. The trauma work itself can also take much longer, as it needs to be paced in a way that is more manageable and not de-stabilising.
Both PTSD and C-PTSD can take a toll on the quality of your life. Now that you know the difference between PTSD and CPTSD, if you feel that you recognise any of these symptoms in yourself or a friend or loved one, it’s essential to seek out professional support through your GP or other mental health professional who can guide you towards a sustained recovery.
If they’re distinct conditions, why are you called PTSD UK?
Well, firstly ‘Disorders specifically associated with stress UK’ is a little less snappier – but on a serious note, the ‘PTSD’ part in our name encompasses both conditions – so we feel this does not exclude anyone from our support.
Breaking down what the term Post Traumatic Stress Disorder means – it’s a condition which has developed after a trauma. And that terms covers both PTSD and C-PTSD.
Additionally, as there are overlapping symptoms, causes and treatments, the majority of the information, resources and tools we have on our website will be useful for everyone affected by either of these sibling conditions – both of which are part of the PTSD ‘family’.
Finally, we want to support and create a community – not a further division based on labelling. Whilst we fully acknowledge the differences in the conditions (and that it’s important for a diagnosis and treatment to understand these differences) many people with both PTSD and C-PTSD will have experienced stigma, negativity and feelings of isolation – and very often they’ll experience very similar symptoms and reactions to their traumatic experiences – so we’re here for everyone affected by Post Traumatic Stress Disorder, whichever form that takes.
- Cloitre, M., Garvert, D. W., Weiss, B., Carlson, E. B., & Bryant, R. A. (2014). Distinguishing PTSD, Complex PTSD, and Borderline Personality Disorder: A latent class analysis. European journal of psychotraumatology, 5, 10.3402/ejpt.v5.25097. https://doi.org/10.3402/ejpt.v5.25097
- Hunt, E. J., Wessely, S., Jones, N., Rona, R. J., & Greenberg, N. (2014). The mental health of the UK Armed Forces: where facts meet fiction. European journal of psychotraumatology, 5, 10.3402/ejpt.v5.23617. https://doi.org/10.3402/ejpt.v5.23617
- Karatzias T et al (2019). Psychological interventions for ICD-11 complex PTSD symptoms: systematic review and meta-analysis. Psychological Medicine 1–15. https://doi.org/10.1017/ S0033291719000436
- Karatzias, T., Cloitre, M., Maercker, A., Kazlauskas, E., Shevlin, M., Hyland, P., Bisson, J. I., Roberts, N. P., & Brewin, C. R. (2018). PTSD and Complex PTSD: ICD-11 updates on concept and measurement in the UK, USA, Germany and Lithuania. European journal of psychotraumatology, 8(sup7), 1418103. https://doi.org/10.1080/20008198.2017.1418103
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Treatments for PTSD
It is possible for PTSD to be successfully treated many years after the traumatic event occurred, which means it is never too late to seek help. For some, the first step may be watchful waiting, then exploring therapeutic options such as individual or group therapy – but the main treatment options in the UK are psychological treatments such as Eye Movement Desensitisation Reprogramming (EMDR) and Cognitive Behavioural Therapy (CBT).
Traumatic events can be very difficult to come to terms with, but confronting and understanding your feelings and seeking professional help is often the only way of effectively treating PTSD. You can find out more in the links below, or here.