Part 2: Understanding Symptoms
Understanding the differences between CPTSD & PTSD Part 1 discussed different types of responses to traumatic stress and the major differences between how PTSD and CPTSD are formed. Part 2 will focus on differences in symptoms. It is recommended that you check out Part 1 before proceeding.
*Disclaimer: This blog is for educational and informational purposes only. It is not intended to treat or diagnose. Reading this blog does not create a therapist/client relationship with Sahra Riccardi, ATR-BC, LPC. If you find this information to be relevant to you, you are encouraged to connect with a licensed mental health care professional who specializes in treating PTSD or C-PTSD. If you are interested in Online Therapy in Pennsylvania for PTSD or C-PTSD, or becoming a client of Embodied Expressions Therapy, please connect with me by visiting:
Post Traumatic Stress Disorder (PTSD) has been listed in the DSM (Diagnostic and Statistical Manual of Mental Disorders) since 1980. However, efforts to include Complex Post Traumatic Stress Disorder (CPTSD, C-PTSD) or some other form of developmental trauma diagnosis (such as "Disorders of Extreme Stress, Not Otherwise Specified” (DESNOS)) to capture this distinct set of symptoms have been unsuccessful.
The failure to include a CPTSD or DESNOS diagnosis in the DSM means that individuals are not able to be given the most appropriate diagnosis. In the US, this means that clinicians are often forced to select a “next-best” diagnosis in order to allow clients to receive insurance coverage for care. This has resulted in diagnoses of PTSD, Depression, Anxiety, Panic Disorder, Substance-Related Disorders, Dissociative Disorders, Bipolar Disorder, and Personality Disorders (most commonly, Borderline Personality Disorder) when in reality, the individual is presenting with responses to prolonged, chronic exposure to trauma.
Here is a breakdown of some of the big similarities and differences between Post Traumatic Stress Disorder (PTSD) and Complex Post Traumatic Stress Disorder (CPTSD, C-PTSD):
Exposure to Trauma:
In "classic" or “simple” Post Traumatic Stress Disorder (PTSD), exposure typically involves direct experience or witnessing exposure to threat. Usually the event is a single instance or within a specific context such as combat veterans or first responders
In Complex PTSD (CPTSD) exposure is often chronic, and spans large developmental periods. Often the trauma is familial, or within the context of close interpersonal relationships. (For more about exposure/causes of CPTSD click here)
In both PTSD and CPTSD, significant thought disturbances may be present. In PTSD, this generally looks like intrusive, involuntary, and recurring thoughts about the event(s). In CPTSD, this can also be true, but also can include general inability to concentrate or focus. This can be severe enough to result in misdiagnosis of attention-related concerns.
A major difference between PTSD and CPTSD is the disturbance in self-concept. In CPTSD, the individual often experiences serious injury to their relationship with self. This can present as persistent feelings of self-loathing, self-contempt, harsh or rigid expectations for the self, being hypercritical of the self, having a strong “inner critic” (often internalized messages from the abuser), and toxic shame. Because the individual had to orient themselves around survival, they may have a poor sense of identity, may struggle to identify (and express) emotions, wants, and needs.
In both PTSD and CPTSD, significant disruptions to sleep may be present. In PTSD, this typically involves nightmares which either directly relate to the trauma or involve feelings related to the trauma.
In CPTSD, the disturbances may be more broad and can include general insomnia, difficulty resting, general nightmares and night terrors. Rest itself can make the body feel threatened.
Both PTSD and CPTSD involve flashbacks. In PTSD, it is typically easier to connect these experiences to the traumatic event and the flashbacks tend to be visual or somatic (body or sensory based).
In CPTSD, both somatic and visual flashbacks may be present. However, a defining feature of CPTSD is “Emotional Flashbacks” which involve feeling sudden and intense emotions (such as fear, abandonment, rage, shame etc.) that feel like feelings from childhood/when the abuse occurred. These can be much trickier to identify (they’re often confused for/minimized as “mood swings”) and are often described as feeling “confusing,” “coming out of nowhere” or feeling “crazy.”
Memory loss is common in both PTSD and CPTSD. However, in PTSD, the memory loss tends to be more localized to the traumatic event or context. In CPTSD, large chunks or gaps of time are often reported to be inaccessible. For example “I can’t remember 3rd grade” or “I can’t remember my grandfather in my childhood.”
Both PTSD and CPTSD can include dissociation (feeling checked out, numb, losing time), depersonalization (not feeling real, feeling detached from the body or self), or derealization (nothing in the world/environment feels real).
In CPTSD, there can be more chronic dissociation as well as significant developmental disruptions and experiences of regression. Because Complex PTSD takes place over prolonged periods of time, major developmental tasks and needs can go unmet.
Emotional Disturbances occur following both “simple” and “complex” trauma. The major difference is that an adult who experiences a single-instance or single-context trauma has a much stronger foundation for safety and emotional processing than someone who has been through prolonged, complex trauma. In PTSD, negative alteration in mood tends to present as agitation, anxiety, anger, and aggressive outbursts. The individual can typically see that this shift began following exposure to the trauma.
In CPTSD, there tends to be a chronic and lifelong pattern of emotional dysregulation including chronic feelings of being unsafe/threatened, anxiety, depression, loneliness, and abandonment. Individuals with CPTSD may not be able to connect this to their early experiences and may label themselves as “moody” or “dramatic.” This is often a result of both normal and appropriate emotions related to maltreatment and missed developmental opportunities for co-regulation, attunement with a safe caregiver, self-soothing, and self-compassion.
Damage to Worldview
Both PTSD and CPTSD involve some damage to worldview and altered beliefs about the self. In PTSD, the individual can generally see that this shift occurred post-trauma. In PTSD, the individual develops through childhood with a healthy self-concept. Post Traumatic changes may include new beliefs that the world is inherently dangerous or that they are permanently damaged. PTSD may also involve Moral Injury which is a result of being placed in situations or roles that conflict with one’s beliefs.
In CPTSD, there may not be any safe or healthy worldview to resource from. The individual may always have felt (and rightly so) that the world is unsafe. In C-PTSD, the child has grown up on “high alert,” searching for threats to safety or threats of abandonment. Their entire worldview may have been oriented around survival and their sense of self and purpose may also be survival oriented. For example, some children learn/believe that they need to be “perfect” in order to be worthy of love. When the love or safety never comes, they believe it is because they aren’t good enough or worthy (not that the caregiver is wrong). This can have a snowballing effect into adult relationships.
Impact on the body
Both PTSD and C-PTSD have body-based symptoms. In PTSD this most commonly looks like hyper vigilance and exaggerated startle responses. However, in both conditions, the body may become “stuck” in a survival response (fight, flight, freeze, appease) resulting in chronic dysregulation.
Due to the more chronic, prolonged nature of C-PTSD, individuals are more likely to have chronic body issues including serious health issues such as autoimmune issues and chronic pain and tension.
Both PTSD and C-PTSD involve avoidance symptoms. In PTSD, the individual typically tries to avoid exposure to cues or triggers relating to the trauma. They may avoid people, places, things, and situations that could remind them of the trauma.
In CPTSD, the individual tends to avoid within relationships. This can look like avoidance of nurturing relationships, intimacy, or sharing. It also can look like poor boundaries or self-abandonment in relationships (people-pleasing, codependency) in an attempt to avoid abandonment. This is particularly devastating, as it limits the survivor’s opportunities to have safe, corrective emotional experiences with others. Additionally, trigger avoidance is typically much more difficult in CPTSD since the context of the abuse is most often in family/caregiving relationships, which are harder to fully extricate from.
If you believe you may be experiencing symptoms of PTSD or C-PTSD, you are encouraged to seek out therapy with a licensed mental health professional who specializes in treating these issues. Not all therapists are trained in treating PTSD and not all therapists know about C-PTSD (remember-it’s not in the DSM yet!), so take your time and be choosy!
If you are in Pennsylvania and are interested in becoming a client of Embodied Expressions Therapy, please connect with me by visiting: