How Relational Trauma Differs From Complex PTSD

Trauma of any type is a complex and multifaceted experience that can manifest in various forms. Two concepts that often surface when discussing trauma are Complex Post-Traumatic Stress Disorder (C-PTSD) and relational trauma. Both have significant implications for an individual’s mental and emotional well-being, but they differ in several key aspects, hinging on the differences between an experience and an outcome.

Relational trauma is an experience.

Relational trauma, also known as interpersonal trauma, refers to traumatic experiences that occur within the context of relationships. As I define it in my work, relational trauma, specifically childhood relational trauma, is the kind of trauma that results over the course of time in the context of a power-imbalanced and dysfunctional relationship (often between a child and caregiver) that results in a host of complex and lingering biopsychosocial impacts for the individual who endured the trauma.

The key characteristics include:

• Repeated Exposure. Relational trauma usually results from ongoing exposure to unhealthy dynamics, betrayal, manipulation, or other harmful behaviors within relationships. Relational trauma survivors may experience a sense of perpetuity, as the trauma tends to be recurrent.
• Relationship-Centered. As the name suggests, relational trauma is inherently tied to the dynamics of personal relationships. This trauma typically arises from within family units, romantic partnerships, close friendships, or other interpersonal connections.
• Emotional Impact. The emotional toll of relational trauma can be profound. Relational trauma survivors may struggle with issues like trust, self-esteem, self-worth, and attachment difficulties, which are often deeply rooted in their traumatic experiences.
• Complexity. Relational trauma can be intricate, as it often involves multiple traumatic events and varied forms of abuse or neglect within a single relationship or across several relationships.

Seen through this lens, we can understand that relational trauma is an experience (or set of experiences) that someone might move through, whether this is in childhood, adolescence, or adulthood.

However, Complex PTSD is an outcome that can sometimes (but not always) result from the experience of relational trauma.

Complex PTSD is a result.

Complex Post-Traumatic Stress Disorder (C-PTSD) is a result, a condition that often develops as a consequence of prolonged and repeated exposure to trauma, especially (but not necessarily always) of an interpersonal or relational nature. C-PTSD is not a term in the current Diagnostic and Statistical Manual of Mental Disorders, the field's bedrock clinical diagnostic guide, but the World Health Organization’s International Classification of Diseases (ICD-11) now includes complex PTSD (CPTSD) under the general parent category of "Disorders specifically associated with stress." So while the term Complex PTSD is widely known, what you’re more likely to see on a medical chart is Post Traumatic Stress Disorder (PTSD), PTSD dissociative subtype, or Other Specified Trauma and Stressor-Related Disorders, as mental health practitioners in the U.S. rely on the DSM.

Bearing this in mind, what does C-PTSD as a result look and feel like? As the ICD-11 defines it, multiple factors must be present to make a diagnosis, including:

• Exposure to an event or series of events of an extremely threatening or horrific nature, most commonly prolonged or repetitive events from which escape is difficult or impossible.
• Following the traumatic event, the development of all three core elements of Post-Traumatic Stress Disorder, lasting for at least several weeks.
• Severe and pervasive problems in affect regulation.
• Persistent beliefs about oneself as diminished, defeated, or worthless, accompanied by deep and pervasive feelings of shame, guilt, or failure related to the stressor.
• Persistent difficulties in sustaining relationships and feeling close to others.
• The disturbance results in significant impairment in personal, family, social, educational, occupational, or other important areas of functioning.
• Suicidal ideation and behavior, substance abuse, depressive symptoms, psychotic symptoms, and/or somatic complaints may be present.

For a full list of the diagnostic criteria of PTSD and tangential diagnoses included in the DSM, click here.

The million-dollar question is: If Complex PTSD is a result, an outcome that might occur to someone who lives through the experience of relational trauma, does that mean that everyone will experience Complex PTSD if they have experienced relational trauma? Not necessarily.

How and what symptoms manifest for someone after they move through the experience of relational trauma can vary, because two individuals who live through a nearly identical set of circumstances can manifest impact (eg: symptomology) differently from each other.

It's analogous to raindrops passing through a cold front and coming out the other side shaped into snowflakes. The crystalline structures of the snowflakes are utterly different from each other after moving through that experience after having closely remembered each other before it.

When it comes to human experience, the impact of moving through a relational trauma may differ from person to person depending on variables such as the individual’s age at the time the trauma occurred, their gender, their inherent temperament, any external and internal coping mechanisms, whether or not they were the focus of or witness to the abuse or not old enough to remember it, and their inherent resilience, among others.

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So while Complex PTSD is one metaphorical crystalline structure a raindrop can manifest into (as many who endure relational trauma backgrounds do), it’s not the only shape a snowflake can take after passing through the proverbial cold front of relational trauma experiences.

How do I begin to heal?

However the experience of relational trauma may manifest itself for you – as Complex PTSD or not – please know that recovery will likely require multi-dimensional work as the wounding itself is multi-dimensional: There’s the relational wounding component and the need for relational healing, which, I believe, can happen in the context of a safe, supportive relationship with a trauma therapist. The directory here at Psychology Today is a wonderful place to begin looking for a trained trauma therapist if you don't yet have one.