C-PTSD, PDSD and Type 2 PTSD explained

What is C-PTSD?

Complex PTSD is a relatively new diagnosis and was developed to reflect the fact that some individuals present with additional symptoms following trauma not captured with a traditional PTSD diagnosis.

Both PTSD and C-PTSD result from the experience of something deeply traumatic and can cause flashbacks, nightmares, and insomnia. Both conditions can also make you feel intensely afraid and unsafe even though the danger has passed. However, despite these similarities, there are characteristics that differentiate C-PTSD from PTSD.

The main difference between the two disorders is the frequency of the trauma which caused it. While PTSD is usually caused by a single traumatic event, C-PTSD is caused by long-lasting, repeated or continuous trauma that continues or repeats for months, even years (commonly referred to as “complex trauma”).

This type of repeated exposure PTSD is referred to in many different ways: complex PTSD (C-PTSD), Prolonged Duress Stress Disorder (PDSD), rolling PTSD, Chronic Post Traumatic Stress Disorder, Severe Post Traumatic Stress Disorder, Type 2 PTSD, Cumulative Stress Disorder, Complex Trauma Disorder, and Chronic Stress Disorder (but for the purposes of this page information, we’ll call it C-PTSD).

How is C-PTSD caused?

C-PTSD results from many experiences, but some examples are:

  • Repeated exposure to disaster, accidents, deaths or violent acts (including emergency service workers)
  • Child abuse or neglect
  • Frequent need to deliver traumatic news to others e.g doctors
  • Living under severe threat for an extended period of time
  • Being forced to be a sex worker
  • Domestic abuse
  • Cult membership
  • Having to witness ongoing abuse or violence of another
  • Regular and repeated exposure to verbal abuse, emotional abuse or threats
  • Long-term exposure to bullying
  • Kidnappings, hostage taking, prisoner of war
  • Frequent sexual victimisation or abuse
  • Regular, long-term feelings of captivation or powerlessness

We know that trauma can have lasting effects on our brains (specifically the amygdala, hippocampus, and prefrontal cortex). These parts of our brain control our memory function and our response to stressful situations.

With continued or repeated exposure to a stressor, people’s physiological and brain functions have to continue at an extreme level. The nervous system also continues to function at the above normal level entering the exhaustion stage.

What are the symptoms of C-PTSD?

PTSD and C-PTSD have very similar symptoms but C-PTSD also has 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.
  • 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.

Symptoms of complex PTSD can vary, and they may change over time. All of these symptoms can be life-altering and cause significant impairment in personal, family, social, educational, occupational, or other important areas of life.

C-PTSD is often misdiagnosed

There are frequent cases of ‘misdiagnosis of borderline personality disorder (BPD). The two share many symptoms such as low self-worth, suicidal thinking, and out of control emotional responses. And both can be linked to child sexual abuse.

It is possible to have both borderline personality disorder and C-PTSD. But if you feel the treatment for BPD, focussing on the ways you relate and regulate your emotions, is not working, and you know you experienced trauma, it’s perhaps worth looking into treatments for trauma as well.’

What are the treatments for C-PTSD?

Both PTSD and C-PTSD need the assistance of an experienced mental health professional to diagnose and help treat the disorder, but just like PTSD, C-PTSD is treatable.

Treatment for the two conditions is similar, although may take longer in the case of C-PTSD, but you may want to discuss some of your additional symptoms of complex trauma that your doctor or therapist may also need to address.

NICE guidance updated in 2018 recommends the use of trauma focused psychological treatments for Post Traumatic Stress Disorder (including C-PTSD) in adults, specifically the use of Eye Movement Desensitisation Reprocessing (EMDR) and trauma focused cognitive behavioural therapy (CBT).

Please remember, these aren’t meant to be medical recommendations, but they’re tactics that have worked for others and might work for you, too. Be sure to work with a professional to find the best methods for you.

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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.