The Difference Between PTSD and CPTSD

“I heard a glass smash, and just immediately got this flight response,” Angelo recalls at one of our sessions. “I had to get out of there.”

The week before, Angelo went over to his boyfriend’s house. He was hosting dinner with some friends. Everyone was sharing a bottle of wine, laughing, and having fun when, suddenly, across the room, a glass fell on the floor and shattered.

Panicked, Angelo ran into the bathroom and locked the door. He sat on the floor with his hands over his ears while his heart raced in his chest. He couldn’t believe what just happened. He was so embarrassed over his behavior that he left his new boyfriend’s home and has not seen him since.

Source: DanaTentis/Pixabay

Few of us would be so startled by a glass shattering. It might turn heads, but someone without the symptoms of posttraumatic stress affecting their behavior would have realized there was no impending threat of harm in a broken glass. But survivors of trauma usually have a more heightened startle reflex and may overreact to smaller, even insignificant stimuli. Angelo’s racing heart and sense of impending doom was a symptom of his trauma.

In any discussion about trauma, it is important to have a discussion about posttraumatic stress disorder (PTSD) and complex posttraumatic stress disorder (CPTSD). People often use both interchangeably, and the symptoms for both can often look alike. But they are actually different diagnoses, resulting from different types of traumas.

Previous generations may have only ever heard a PTSD diagnosis, reserved only for veterans who returned from combat. CPTSD was not a diagnostic label until the late 1980s, and only more recently acknowledged by many in the mental health field. Still, most people have little understanding of the disorders, and my clients can sometimes be confused when we discuss them.

While I try to focus more on symptoms and experiences and less on diagnostic labels, I will provide a brief informational overview to dispel some of this confusion.

PTSD usually develops after a traumatic event: Something happens once over a shorter period of time and then ends. A car accident, or surviving a traumatic event such as a mass casualty or shooting, for example, are the kinds of traumatic events with a clear beginning and an end that could lead to PTSD. The brain understands that the traumatic event has stopped, but the traumatic responses go on.

With CPTSD, on the other hand, the event is ongoing, occurring again and again, over many months or years, and often relational in nature. People experiencing it never know when or if the event will end. Often, they are in an environment where they cannot escape over a long period of time, as with family-of-origin trauma (Giourou et al., 2018). It would be like going through a car accident a couple times a week for years, never knowing when it will happen again, or if it will ever stop. The brain never gains the understanding that the event, or threat, has ended. Thus, our reactions to current events that have nothing to do with our history can often give us the same reaction, as if we are back in our childhood. It is for this reason that many clinicians are starting to recognize the similarities between CPTSD symptoms and many of the clinical features present in borderline personality disorder (Giourou et al., 2018).

Like soldiers returning from a battlefield who panic at gunshots or hit the ground after hearing fireworks, our brain reacts to trauma before we have the ability to form logic about the situation. The soldier is already on the floor before they have time to react and say, “Wait, I am no longer in battle. I am home in New Hampshire.” In the same way, Angelo was unable to say, “Wait, I am not at home with my parents. I am safe with my boyfriend,” before he reacted out of fear.

This is not to say anything about the severity of the trauma experienced from a single event, or that PTSD is in any way “less severe” or less traumatic than CPTSD. Understanding the two is not about ranking one as better or worse but, rather, distinguishing the kinds of events that could lead to either.

Many symptoms look the same in PTSD as in CPTSD. Both have symptoms of re-experiencing, avoidance, and hyperarousal, among other similarities. But, to meet criteria for CPTSD, one must have symptoms of PTSD, "plus three additional clusters of symptoms namely emotional dysregulation, negative self-cognitions and interpersonal hardship" (Giourou et al., 2018).

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However, our diagnostic system is often outdated, is often culturally insensitive, and is certainly not a one-size-fits-all approach. Often, these labels can be culturally insensitive and not trauma-informed. What PTSD looks like in a woman of color might present differently in a white woman, for example. This is why I like to focus more on symptomatology and healing when working with survivors. My goal is to help them develop an understanding of how their symptoms and reactions make sense in the context of their traumatic experiences. No matter the differences or similarities, the more important reason for knowing these two diagnoses is to understand the reason behind our behaviors and how they make sense in the context of our trauma history.

A diagnosis is not as important as the person and their experiences when it comes to healing, but it can be good to have an overview of these diagnoses and symptoms. When working with many clients, I like to instruct them to focus on the symptoms and feelings and less on labeling any sort of diagnosis. Still, many like to know more about their symptoms, and assigning a diagnostic label can make them feel more empowered. Clients will commonly say, “It feels like I understand it now,” when we discuss these diagnoses. Understanding why we react certain ways to stimuli can help reduce the shame and frustration that come from a lack of awareness and help improve self-compassion and self-understanding.

If you believe you are suffering from PTSD or CPTSD due to long-term trauma or childhood abuse, seek the support of a licensed mental health therapist. Search Psychology Today for a therapist who specializes in family dynamics and childhood trauma.

Excerpted, in part, from my book Breaking the Cycle: The 6 Stages of Healing from Childhood Family Trauma.