Post-traumatic stress disorder is the acronym used to describe PTSD – a mental health condition triggered by traumatic events.
Such events might occur in isolation (single event trauma) or be chronic (repeated trauma).
Complex PTSD stands for complex post-traumatic stress disorder and refers to a type of developmental trauma that occurs over long periods, often without being able to escape the situation (i.e., growing up in a dysfunctional family home or having abusive parents/caregivers).
Post – traumatic stress disorder (PTSD)
PTSD is a mental health condition triggered by exposure to a traumatic event or a series of events.
When people experience trauma, they often seek to integrate their experiences of trauma by adapting and adjusting to whatever tragedy has befallen them.
It is ubiquitous for individuals to experience PTSD symptoms for days or weeks following a traumatic experience as they attempt to integrate such experiences and come to terms with whatever has happened.
However, once successful integration occurs, the PTSD symptoms begin to dissolve.
When an individual is unable to integrate their traumatic experiences, the PTSD symptoms may persist and, in some cases, may even get worse.
According to trauma experts, trauma symptoms are classified as symptoms of PTSD when they persist for four weeks (or longer).
Traumatic memories and events
In the past, post-traumatic stress disorder was a stress-related disorder associated with war veterans and those working in the military and personal combat service.
Terms such as ‘shell shock’ get strongly referenced for those who served in the military, with many war veterans developing PTSD and C-PTSD post-service.
Traumatic events that can trigger PTSD
However, PTSD is not a condition reserved only for war veterans; it can (and does) affect civilians and gets triggered by many other events, such as:
- Being involved in a natural disaster
- Being involved in a car accident
- Being the victim of emotional abuse
- Being the victim of sexual abuse
- Sudden loss of a close loved one.
- Having a traumatic operation or surgical procedure
- Witnessing a violent assault
- Combat fatigue
- Loss of support system (in the case of grief, illness, or other loss)
Symptoms of PTSD
There is a range of PTSD symptoms that someone may experience, and depending on the circumstances and nature of the trauma, symptoms can vary between people.
Broadly, the symptoms of PTSD include:
- Flashbacks and intrusive thoughts related to a traumatic event
- Physiological distress (as if the event is happening all over again)
- Pervasive avoidance behaviours, i.e., avoiding people, places, objects, conversations, and reminders about the traumatic incident.
- Adverse alteration in mood and thoughts about oneself and the world in general
- Hyperarousal – getting startled and constantly feeling on guard.
- Experiencing angry outbursts and difficulties with concentration
- Disturbed sleeping patterns
The diagnostic criteria for a PTSD diagnosis are when a person experiences symptoms of PTSD that last longer than a month.
In addition, the symptoms must be significant enough to interfere with daily living and cause severe distress and complications in all aspects of a person’s life, including personal and professional.
PTSD symptoms usually begin within three months after a traumatic event; however, symptoms can start later.
Symptoms may last weeks, months, or even years and must be unrelated to other health conditions and mental disorders (such as depression or substance abuse), medications, and other illnesses.
As mentioned earlier, the symptoms of PTSD get grouped into four categories:
- Intrusive – flashbacks, nightmares, and intrusive thoughts related to a traumatic incident
- Avoidance – Trying to avoid places, people, objects, and reminders about a traumatic event that may trigger distressing memories
- Alterations in mood and cognition – Unable to recall certain aspects of a traumatic event, blaming themselves or others for what happened, experiencing ongoing horror, fear, anger, shame, or guilt, and feeling estranged or detached from others
- Alterations in reactivity and arousal – Angry outbursts, easily startled, sleep problems, difficulty concentrating, and reckless or self-destructive behaviour.
What is complex PTSD?
Complex PTSD is essentially PTSD that is more complex and often gets triggered in those who experienced complex trauma such as physical, verbal, and sexual abuse in childhood.
People with complex PTSD usually have a history of chronic, repeated trauma over a significant period without the opportunity to escape.
Such trauma usually gets tied to an interpersonal relationship during the childhood developmental phase.
Symptoms of complex PTSD
There are similarities between the symptoms of PTSD and C-PTSD.
However, additional features of complex PTSD make both conditions uniquely separate diagnoses.
The symptoms of C-PTSD include:
- Feeling ineffective
- Feeling constantly under threat.
- Isolation and social withdrawal
- Feeling damaged
- Profound feelings of shame, hostility, and feeling different from the person you once were before the trauma
- Experiencing a severe disturbance in self-organisation, such as affect regulation, dysfunction in managing interpersonal relationships, and a negative self-concept
- A loss of a system of meanings (i.e., a loss of religious faith, loss of hope, or a loss of core values and beliefs)
- Distorted perceptions of the perpetrator – a person may become preoccupied with the relationship with the perpetrator or consumed by revenge.
- Detachment from others
- Experiencing difficulty regulating emotions such as anger, sadness, fear, etc.
Over the years, there has been much controversy and debate over whether complex PTSD should have its distinct diagnosis, mainly because the symptomatology of C-PTSD overlaps with other mental health conditions.
Borderline personality disorder
According to research, mental health disorders such as Borderline Personality Disorder and PTSD share similar features of complex PTSD.
People living with Borderline Personality Disorder have similar core symptoms to those observed in complex PTSD, for example:
- Reckless and self-destructive behaviours
- Impulsive behaviour
- Impaired relationships with others
According to Trauma Practice, the ICD-11 has a separate classification for PTSD and complex PTSD.
What is the difference between PTSD and complex PTSD?
Much research has gotten conducted to establish the critical differences between PTSD and C-PTSD.
However, there is still a considerable disparity over whether C-PTSD should have its distinct diagnosis.
There is a common acceptance within the mental health community that both PTSD and C-PTSD are different conditions in terms of clinical presentation and symptomatology.
However, according to researcher Heather Jones, ‘further research is warranted to determine the productivity of specialised treatment for C-PTSD versus the use of treatment designed for PTSD’ (Verywell Mind, March 2021).
Single traumatic events versus repeated trauma
Perhaps one of the main features that separate PTSD and C-PTSD from each other is the nature of the trauma (s) experienced by trauma survivors.
Although traumatic events trigger both mental disorders, the severity of trauma symptoms is likely to differ depending on the circumstances and other variables (such as co-occurring physical and mental health conditions).
For example, PTSD usually gets triggered by a traumatic event such as a car accident, natural disaster, or an isolated assault. In contrast, complex PTSD is the result of prolonged, repeated trauma.
In cases of prolonged trauma, the person is usually under control – either physically or emotionally by an abuser for extended periods and without any means of escape.
Progressive, long-term traumas can occur in many instances but typically involve:
- Long-term repeated domestic violence
- Long-term physical (and sexual) child abuse
- Prisoners of war camps
- Concentration camps
- Organised child exploitation rings
- Prostitution brothels
Previously, the components of complex trauma mainly focused on childhood trauma.
However, recent studies suggest that the duration of traumatic exposure is strongly associated with C-PTSD rather than the individual’s age.
Some risk factors put people at higher risk of developing C-PTSD, including:
- Experiencing multiple traumas
- The harm getting caused by someone close to the victim
- Experiencing trauma at an early age
- Being unable to escape a traumatic event or being rescued from the challenging event was unlikely or impossible
Similar conditions to C-PTSD
There are similar conditions to C-PTSD that have distinct features of complex trauma, with some mental disorders more widely recognized than others.
For example, a mental health condition called EPCACE, which stands for Enduring Personality Changes After Catastrophic Events, shares similar indications to C-PTSD and gets triggered by traumatic events.
According to research, EPCACE no longer gets recognized by the WHO (World Health Organisation), which uses complex PTSD.
Furthermore, many mental health professionals prefer the term EPCACE and still use it in today’s clinical practice.
DESNOS is the acronym used to describe the mental health condition Disorders of Extreme Stress Not Otherwise Specified.
Such a term is often used in some clinical practises (especially in the United States) and is the equivalent to complex PTSD; additionally, the symptoms and risk factors of DESNOS are similar.
Treating complex PTSD
Since complex PTSD is a relatively new condition, trauma experts and mental health professionals are still working on effective treatment options.
However, there are practical treatments available to those who are suffering from trauma symptoms which involve:
- Talk therapy, which helps to process trauma
- Exposure therapies in which people confront their memories in a safe space
- Cognitive Behavioural therapies, which focuses on thought patterns and behaviours
EMDR stands for Eye Movement Desensitisation Reprocessing.
In EMDR therapy, the client recalls a traumatic event while following a bilateral stimulus (one that glides from one side of the body to the other), leading to back-and-forth eye movements.
EMDR is a pioneering trauma treatment for conditions like PTSD and complex PTSD.
Studies suggest that trauma experts are working on modifying specific aspects of EMDR therapy for clients presenting with dissociative issues.
When a person dissociates, they separate themselves from their feelings or thoughts.
Dissociation is a common symptom in those with C-PTSD, and it might be beneficial for therapists to work through a client’s dissociative problems before fully engaging in EMDR.
Essentially, the difference between PTSD and complex PTSD is simple; the term ‘complex’ denotes that a person got exposed to multiple traumatic experiences and thus, will take a lot longer to unpack and work through.
Trauma treatments like EMDR aim to help the brain eventually ”stand down’’ and not continuously sound the alert button, even after sustained, multiple, or repeated traumas. Sorting through complex trauma might prove challenging at first.
However, resolving the effects of trauma (and the symptoms) are worth persevering for; no matter what experiences a person may have endured in the past, it is possible to live a life free from the clutches of trauma and move beyond the pain.
If you think you might be experiencing some of the trauma symptoms mentioned in this article, perhaps it’s time to speak to a trauma specialist who will help.
Dan Brennan, MD, April 2021: What to know about complex PTSD and its symptoms
Trauma Practice: What is the difference between PTSD and Complex PTSD and Heather Jones, Verywell Mind researcher, March 2021: Signs of Complex PTSD