June 27th marks an important day in the calendar: PTSD Awareness Day. As individuals, it’s crucial for us to recognize the significance of this day and shed light on the experiences of those living with post-traumatic stress disorder (PTSD). In this blog post, we’ll delve into the differences between PTSD and complex post-traumatic stress disorder (C-PTSD). It’s important to note that while I have lived with the effects of PTSD and C-PTSD, I am not clinically trained, and this blog post serves purely as an informational resource, urging readers to seek professional help if needed.

Let’s dive in!

Post-traumatic stress disorder (PTSD) is a common mental disorder in the US, with about 8 million adult cases annually. However, there are variants of this condition. For example, after suffering a string of stressful events, a form of PTSD called complex PTSD (C-PTSD) may develop. The symptoms of this kind of PTSD condition may be debilitating, and its treatment can be very challenging.

What is Post-Traumatic Stress Disorder?

Post-traumatic stress disorder (PTSD) is a fear-based condition that develops after a person has seen or experienced a traumatic or abusive event. In 1980, the American Psychiatric Association (APA) released the 3rd edition of the Diagnostic and Statistical Manual, which is their system for putting diagnoses into groups. This edition formally recognizes PTSD as a mental disorder. The criteria for diagnosing the condition have changed over time.

The DSM-5 manual clarifies that to be diagnosed with PTSD, a person must have either been through or seen an event that involved a significant injury, sexual violence, or the threat of death.

PTSD symptoms

It’s important to remember that some situations can still be stressful for some people, even if they don’t fit in any official clinical criteria for a PTSD diagnosis.

PTSD may cause a wide range of symptoms, including:

Avoiding certain things or scenarios

When you have PTSD, you may steer clear of any situations or routines that bring up the traumatic experience, such as crowded places or driving.

Exaggeratedly negative views of oneself, other people, and the general world

When you have PTSD, you might stay away from people, stop trusting them, and start thinking the world is dangerous.

Hyperarousal

Hyperarousal refers to a state of constant vigilance or restlessness. It can make it difficult for you to concentrate or go to sleep. It’s also possible that you’d react erratically to loud or unexpected noise.

Somatic signs

Somatic symptoms appear outwardly but have no apparent cause in the patient’s medical history. For example, anytime anything triggers memories of the traumatic incident, you can have nausea or dizziness.

Intrusions (or reliving the traumatic event)

Here, you feel as if that terrifying event is happening again. Post-traumatic stress disorder can cause nightmares, flashbacks, and emotional pain when just thinking about the traumatic event.

Nevertheless, one need not have been the direct target of a traumatic event to acquire post-traumatic stress disorder. The suffering of others has the potential to cause you to experience trauma as well.

Secondary Trauma

Sometimes, those who work with trauma survivors, for example, medical staff, therapists, aid workers, and firefighters, are more likely to grapple with a type of PTSD called secondary trauma. Generally, secondary trauma can develop after prolonged exposure to the suffering of others. Examples of this are:

Observing the suffering of others, whether it be physical or emotional
listening to traumatic or emotionally distressing stories of others
Observing the terrible wounds sustained by others

A 2020 National Center for Biotechnology Information (NCBI) publication notes that 15% and 35% of social workers show signs of secondary traumatic stress. In earlier research from 2013, which the NCBI also published, it was found that about 19% of mental health care providers who work with people in the military show signs of secondary traumatic stress, such as avoidance, intrusion, and arousal.

But secondary PTSD isn’t just a problem for people who work in fields where they help people in difficult situations. It can happen after a single traumatic event or a series of them, like when a child witnesses domestic violence at home.

It is important to remember that this greater spectrum of symptoms of PTSD increases the likelihood of overlap with other mental health issues like depression and panic attacks. Also, not everyone who encounters potentially stressful events develops PTSD. One study found that 5%–67% of children and teens who go through traumatic events develop PTSD.

It is also worth noting that children from ethnic minorities are likely to develop PTSD because they are more likely to witness or be victims of assault. They are also prone to more severe symptoms. The reasons for this increased sensitivity are complicated and need more research.

Moreover, PTSD is more likely to happen after a traumatic event involving a relationship (like a sexual assault or physical violence in the family) than after a traumatic event that does not include a relationship (like a slip and fall or a natural disaster).

What’s Complex PTSD?

Complex PTSD is a subtype of PTSD. Similar to general PTSD, it may also arise from a single traumatic experience. But it is often brought on by long-term or repeated stress, especially traumatic events that one was exposed to while still a child.

In the scientific literature, complex PTSD often takes the following forms:

Childhood abuse or neglect
Sexual abuse
Racism
Violence, both physical and mental
Traumatic memories of torture and warfare

Common symptoms of complex PTSD include:

Difficulty regulating emotions

Having trouble controlling your emotions can show up in several ways, such as being unable to stay calm, being obsessed with death, or having suicidal thoughts.

Detachment

People with C-PTSD may also feel detached and alone at times. This is in addition to the usual changes in rational thinking that accompany ordinary PTSD.

Personal criticisms

Persons with complex PTSD may feel helpless, ashamed, guilty, and stigmatized. They fear at times that they don’t belong in this world.

Misperceived notions of the perpetrator

People with complex PTSD may obsess over their relationship with the person who hurt them or how they can get revenge.

A breakdown in the meaning-making system

This can show up in many ways, such as losing faith, hope, or fundamental values and beliefs.

Problems in interpersonal relationships

People with C-PTSD often avoid others, struggle with deep mistrust, or keep looking for someone to rescue them.

In What Ways Can Complex Trauma Impact Interpersonal Relationships?

Having healthy relationships is one of the most important ways that people who have been through complex trauma can start to change how they see the world. Sadly, they tend to avoid making contacts and push away support networks.

Someone with C-PTSD generally has trouble keeping up with friends and family because they have difficulty trusting others and are often alone. The patient has a hard time setting and keeping healthy boundaries and feeling emotionally safe in relationships. This makes it more likely that they will relive traumatic events from their past.

It is easy for someone in a relationship with a trauma survivor to mistake the condition for other mental disorders. For example, people who act in unpredictable ways with other people are more likely to be assumed to have a borderline personality disorder (BPD), which is not necessarily true. It is crucial to emphasize that those with complex PTSD have a stronger sense of self than those with BPD, and people with BPD do not generally have an unreasonable dread of being alone like people with C-PTSD.

What Are the Clinical Differences Between PTSD and Complex PTSD?

Based on the DSM-5 and WHO’s ICD-11, one way PTSD and complex PTSD are different is how they are defined. The APA’s diagnostic manual, DSM-5, does not include complex PTSD as a recognized standalone medical diagnosis. So, while it’s true that some people may have more severe PTSD symptoms than others, the DSM doesn’t give C-PTSD its own diagnostic criteria based on the severity of symptoms a patient has.

But because the World Health Organization sees complex PTSD as a separate mental disorder, it has been included in its ICD-11 categorization system. This guide says that C-PTSD has some of the same symptoms as PTSD but primarily focuses on specific traits that often accompany long-term trauma.

A 2017 study (using the ICD-11 criteria for diagnosing illnesses) found that C-PTSD is more common than PTSD among trauma patients. The following is the nature of common symptoms of C-PTSD identified in both the ICD-11 and the DSM-5:

powerful and often occurring
nature of being avoidant
relating to the reactive nature

The DSM-5 adds low self-esteem and a general lack of desire to live to the list of symptoms for post-traumatic stress disorder. In the ICD-11, these symptoms are called “disturbances of self-organization” (DSO), which may mean that a complex PTSD diagnosis is more likely.

According to ICD-11, the DSO symptoms include:

Difficulty in regulating one’s emotions (emotional dysregulation).
Having trouble getting along with others and keeping relationships going.
Having a poor opinion of oneself (low self-esteem issues).

As was already said, being in stressful situations for a long time or repeatedly may make you more likely to develop symptoms of complex PTSD. In most cases, only one severe traumatic exposure can lead to PTSD. However, a single traumatic event can be all it takes to cause C-PTSD in some people.

How Racial Trauma Is Connected to PTSD and C-PTSD

Racial trauma, or race-based traumatic stress, often happens to persons of color who are maltreated because of their race. It includes all of the mental, emotional, and psychological problems that can come from being around racism and prejudice.

A person may develop PTSD if they are the target of racism, xenophobia, microaggressions, or other types of abuse or brutality because of their race. Complex post-traumatic stress disorder is more likely to happen in places where racism is daily and part of the culture. The effects of systemic racism or growing up in a community that is hostile to people of different races are great examples.

Given how mean some people are to those not of their color and how widespread racism is in some neighborhoods, it shouldn’t be surprising that racial trauma can take a massive toll on the victim’s mental health. The following are signs of race-based post-traumatic stress, as identified by the Association for Behavioral and Cognitive Therapies:

A lack of appetite
Anxiety and depression
Flashbacks and nightmares
Lack of confidence in oneself (low self-esteem)
Difficulty concentrating
Disgraceful emotions such as shame and embarrassment
Increased reactivity
Avoidance behaviors
Insomnia
Having a hard time focusing

Race-based trauma can have effects that build up over time, which can lower the quality of life and shorten the lifespan.

Treatment Options for Traumatic Stress: C-PTSD Vs. PTSD care

Ordinary PTSD and complex PTSD have some of the same symptoms, but they are different enough that they need different approaches to get better.

Treatment for Posttraumatic Stress Disorder

The conventional technique for dealing with PTSD is trauma-centered therapy. The patient can recall and deal with their traumatic experience in a safe and controlled setting thanks to these therapies. The patient will eventually get used to the stressful situation to the point that it will no longer hurt them. PTSD therapy options include:

EMDR (eye movement desensitization and reprocessing)

EMDR is a popular treatment for post-traumatic stress disorder. In this therapy, a therapist guides you through eye motions to alter how your brain handles trauma memories.

CBT (cognitive behavioral treatment)

CBT is another popular PTSD therapy that teaches you how to replace unhelpful ideas, attitudes, and actions with more beneficial ones. It can help you learn to react differently to traumatic stimuli and modify the way you think about your fear.

ET (Experiential Therapy)

ET is also an effective method for dealing with post-traumatic stress disorder. Experiential activities have been shown to produce 80 percent more significant gains than standard talk therapy alone. Methods such as role-playing, art, and drama activities help uncover and deal with repressed trauma memories.

Things such as role-playing, art, and drama activities are used in ET to help uncover and deal with repressed trauma memories. Experiential therapies include trauma-informed yoga therapy, psychodrama, internal family systems, equine therapy, music therapy, and narrative therapy.

Yoga

Very little research exists on the effects of yoga on PTSD (or C-PTSD). However, it is a well-known fact that practicing yoga may have a soothing impact.

Yoga is a contemplative activity that emphasizes being in the present moment while at the same time focusing your attention on your breath and your mental and physical state. Such training has been demonstrated to reduce physiological arousal and increase ANS (autonomic nervous system) adaptability to triggers and stimuli in people with PTSD. The intrusive flashbacks and other symptoms of PTSD and C-PTSD are less likely to occur while practicing yoga.

Psychodrama

In psychodrama therapy, patients act out scenes from their lives to process and resolve emotional issues and trauma. The treatment is often delivered in a group setting. A therapist acts as a guide, instructing the patient on how to create therapeutic psychodramas.

Internal family systems

IFS therapy program aims to help patients develop their capacity to deliberately and compassionately attend to their “vulnerable areas,” but with much self-compassion. The aim is to develop the ability to effectively “be with” or withstand or absorb distressing stimuli.

Music Therapy

Patients struggling with post-traumatic stress disorder may find that listening to music written expressly to treat it helps them divert their attention from upsetting thoughts.

When struggling with a mental condition, listening to calming music may alleviate your suffering and evoke memories of better, more serene times, which is very therapeutic.

Other common experiential therapies include:

Recreational therapy.
Gestalt therapy.
Equine therapy.
Poetry treatment.
Animal-assisted therapy.
Therapeutic play.
Meditation.
Art therapy.
Drama therapy.

MAT (medication-assisted-treatment)

Medication is another alternative for managing PTSD, and MAT options for this condition include:

Antidepressants: mood-lifting drugs like sertraline (Zoloft) and paroxetine (Paxil)
Drugs used to treat anxiety, such as clonazepam (Klonopin).

Medication-assisted treatment aims to reduce or eliminate drug withdrawal symptoms and cravings so that the person can focus on behavioral therapy.

Treatment for C-PTSD.

Common treatments for C-PTSD generally consist of all those used in standard PTSD interventions. However, it often includes a component of skill-building.

It is advised that those with complex PTSD begin engaging in routine activities, little by little, as soon as possible. Some examples of these activities include:

Making new friends
finding a job
maintaining a regular fitness routine
adopting a new hobby

When attempting to treat C-PTSD, it is critical to make an effort to build some sense of trust in others. Complex PTSD is treatable but will require time and a strong therapy commitment. A therapist may employ the three stages listed below to carry out therapy.

Step 1. Stabilization

Conventional treatments for C-PTSD often include a component enhancing interpersonal abilities.

If you’ve had a rough start due to child abuse, you could learn to trust others and establish a sense of security. Talking to a therapist might help you overcome emotions of mistrust and reconnect with loved ones.

Some people find that “grounding” practices help them cope with painful or abusive experiences from their past. The goal is to make traumatic memories less frightening and reduce the frequency and intensity of flashbacks and nightmares.

Step 2. Trauma-focused therapy

Trauma-informed therapies are safe because they don’t make survivors feel more traumatized or bad about themselves for trying to deal with their experiences. Instead, they focus on the possibility of healing and growth. In programs that use a trauma-informed approach, people who have been through traumatic events are seen as unique people who have been through very unusual things and have done the best they could under the circumstances.

Treatment for C-PTSD often includes most of the approaches mentioned earlier for treating PTSD in a therapy that focuses on trauma, although the following are given greater priority:

Dealing with thoughts of inadequacy and guilt
Handling deep emotions
Developing mutually beneficial interpersonal connections

These are some of the most often-used treatments for complex PTSD:

Psychotherapy (talk therapy). Psychotherapy can take place either one-on-one with a therapist or in a group environment with many therapists working together
Prolonged Exposure therapy
CBT
DBT
Experiential Therapies like Trauma-Informed Yoga
Medications

If you’re struggling to rein in negative thoughts, these therapies may help. Your therapist will sit down with you to choose the most appropriate therapy plan for you, and then they will monitor how well it works.

Step 3. Reintegration

The last stage of talk therapy is putting one’s newfound abilities to use in building meaningful relations. The challenge comes for specific individuals who may find it difficult to follow through. A therapist may recommend antidepressants if they feel the patient is still not stable enough to be reintegrated back into society. After these medications have hidden the trauma symptoms, you will then be able to go on to talk therapy, and finally, you will be able to put the skills you have acquired to the test.

The Long Road to Recovery from Complex Post-Traumatic Stress Disorder

Those with PTSD or CPTSD may recover from their symptoms, as we have learned. However, those with complex post-traumatic stress disorder may have a long road ahead. PsycheAlive.org identifies the following as potential steps in the recovery process:

The first step is realizing you need assistance and taking the initiative to seek it out, together with the conviction that you deserve and can receive it.
Identifying a trauma-informed therapist with whom to develop a therapeutic connection
Establishing a safe and secure treatment base to handle modern living stresses better. After acquiring this knowledge, it’s time to put it to use in your existing relationships.
Taking note of the doubts, fears, and confusion that might arise in close relationships. Focusing on whether or not the emotions in question are fresh or old is essential. Do you recognize them?
Gaining emotional stability and self-confidence requires fixing damaged social ties.

Managing Post-Traumatic Stress Disorder and Complex PTSD Independently

Unfortunately, treating PTSD takes a long time, and people with more severe cases may have to wait even longer. That’s why you need to learn how to deal with and eventually get rid of these diseases’ painful symptoms and signs, even if you have to do it on your own. Among the methods that might aid in your self-managed recovery are:

● Seek comfort from loved ones

Complex PTSD, like PTSD, is associated with social isolation. Talk to a close friend, colleague, or family member if you ever feel completely overwhelmed, furious, frightened, or scared.

● Practice mindfulness

Depression, anxiety, and tension are common reactions to any PTSD. Mindfulness is a technique for enhancing present-moment awareness and overcoming emotional suffering.

● Keep a journal of your thoughts.

The journaling process has been shown to help people with PTSD deal with unwanted thoughts, flashbacks, and nightmares. Keeping a journal could be helpful in therapy as a way to write down your symptoms so that you and your therapist can talk about them.

● Read self-help resources and join a support group.

Peer support groups and self-help books may also be helpful for people with complex PTSD. Among the many books that might be of use are:

● The Body Keeps Score: Written by a medical doctor, Bessel van der Kolk.

● Complex PTSD: From Surviving to Thriving, authored by Pete Walker

Peer support groups help lower emotional discomfort among trauma survivors, including despair, loneliness, and social anxiety. In these groups, patients and their loved ones may express and process challenging emotions such as anger, sadness, and grief and learn how to cope with them from their peers.

Final Thoughts

Before going to therapy, it can help to know a lot about the different types of trauma disorders. The stress you’re experiencing probably has its roots in a terrible incident or series of events from your past. Whether you believe you are going through ongoing trauma or have just had one traumatic event, you may seek the help of a therapist who has been trained to deal with such disorders. If post-traumatic stress disorder symptoms negatively affect your quality of life, you may want help from a qualified expert.

June 27th is PTSD Awareness Day – How is PTSD Different from Complex PTSD?