PTSD and complex PTSD (C-PTSD) are quite similar and sometimes mistaken for the same condition. Both are associated with trauma and may include flashbacks, nightmares, avoidance, and an ongoing sense of threat.
The main difference is how an individual is affected by the trauma beyond the basic symptoms of PTSD. C-PTSD could lead to emotional regulation problems, self-critical thoughts, and interpersonal relationship problems.
So, when people ask about PTSD versus C-PTSD, it is incorrect to assume that PTSD is related to one incident and C-PTSD is chronic and prolonged. There’s more to it.
In this article, we will discuss the differences in the causes, symptoms, diagnoses and treatment for PTSD and C-PTSD, as well as the recent changes to the ICD-11 and DSM-5-TR.
What Is PTSD?
Post-traumatic stress disorder (PTSD) is a mental health condition that can develop after experiencing or witnessing a traumatic event. It can affect the way a person thinks, feels, and responds to everyday situations, with symptoms sometimes continuing long after the traumatic event has ended. But not everyone exposed to a trauma will develop PTSD, and the symptoms can vary from person to person.
What Is C-PTSD?
Complex post-traumatic stress disorder (C-PTSD) includes symptoms of PTSD and other problems referred to as disturbances in self-organisation (DSO). This condition is more likely associated with chronic, repetitive trauma, and various categories of interpersonal trauma are hard to avoid.
What Causes PTSD and C-PTSD?
PTSD and C-PTSD can both develop after trauma, but the circumstances can be different. Knowing the similarities and differences helps explain how the two conditions are connected.
Similarities Between PTSD & C-PTSD Causes
PTSD and C-PTSD can develop following many of the same traumatic experiences. These can include:
- Physical or sexual violence
- Childhood abuse
- Domestic or family violence
- War and armed conflict
- Torture
- Serious accidents or injuries
- Natural disasters
- Witnessing serious injury, violence, or death
- Other experiences involving actual or threatened death, serious injury, or sexual violence
The above traumatic experiences can be associated with either PTSD or C-PTSD.
Difference Between PTSD & C-PTSD Causes
The main difference is the pattern and circumstances of the traumatic exposure.
Trauma associated with PTSD can include:
- A single serious accident or injury
- A sudden assault
- A natural disaster
- A one-time traumatic event
- Witnessing a sudden traumatic death or serious injury
- Repeated exposure to traumatic events
C-PTSD is more strongly associated with:
- Prolonged childhood abuse or neglect
- Ongoing domestic or familial violence
- Multiple physical or sexual assaults
- Torture or prolonged capture
- Human trafficking or prolonged exploitation
- Long-term exposure to war, conflict or other violent conditions
- Traumatising relations when escape isn’t possible
Trauma can occur in different forms and can result in both PTSD and C-PTSD. Experiences involving prolonged, repeated or difficult-to-escape trauma are strongly associated with C-PTSD, although the relationship between trauma characteristics and C-PTSD is complex.
PTSD and C-PTSD: Similarities and Differences in Symptoms
The two conditions share some symptoms, but they are not identical.
Overlapping Symptoms
Both PTSD and C-PTSD include the following symptom groups:
- Re-experiencing trauma
- Avoiding trauma reminders
- Persistent threat or danger
People with either condition may also experience difficulties with sleep, concentration, mood, and other aspects of everyday functioning.
Key Differences: How C-PTSD Goes Beyond PTSD
The presence of DSO (disturbances in self-organisation) is what differentiates C-PTSD from PTSD. The DSO comprises the following:
- Emotional regulation
- Negative self-concept
- Relationships
An individual with C-PTSD may have emotional dysregulation, an extremely negative self-concept, or relational issues. These problems, along with the other symptoms of C-PTSD, distinguish it from PTSD.
For a more detailed explanation of C-PTSD symptoms, see our guide to the symptoms of complex PTSD.
C-PTSD vs PTSD Diagnosis
Although they are closely related, the two conditions are diagnosed differently depending on the diagnostic system used.
Diagnosing PTSD
There is no single blood test, brain scan, or other physical test that can definitively diagnose PTSD. A clinical diagnosis is made through the assessment of an individual’s history with trauma, the presence and duration of associated symptoms, and the degree to which the symptoms disrupt the individual’s everyday life.
The clinician must also consider the possibility that another mental health condition could be explaining the individual’s symptoms.
Diagnosing C-PTSD
Under the ICD-11, C-PTSD is diagnosed when a person meets the criteria for PTSD and also has persistent difficulties across all three areas of DSO.
The International Trauma Questionnaire (ITQ) can be used to assess the ICD-11 symptoms of PTSD and C-PTSD. However, a questionnaire does not replace a professional clinical assessment.
ICD-11 vs DSM-5-TR
The classification system being used also matters.
The ICD-11 recognises both PTSD and C-PTSD as distinct conditions, and the DSM-5-TR recognises PTSD, but not C-PTSD.
The ICD-11, published by the World Health Organization (WHO), recognises PTSD and C-PTSD as separate diagnoses. C-PTSD includes the three main symptom groups of PTSD as well as disturbances in self-organisation.
The DSM-5-TR, published by the American Psychiatric Association (APA), provides diagnostic criteria for PTSD but does not list C-PTSD as a separate diagnosis. Instead, it includes other conditions related to trauma and stress.
Therefore, someone researching C-PTSD will find different diagnoses and terminology depending on the diagnostic system or framework used in the healthcare setting.
Australia has not implemented ICD-11 nationally across its health system; therefore, ICD-10-based classifications are still widely used in Australian healthcare settings.
Conditions That Can Overlap With PTSD and C-PTSD
Symptoms of PTSD and C-PTSD can be seen in other mental health conditions as well. So, knowing these overlaps can help differentiate incidents with similar symptoms because different conditions require different diagnoses.
C-PTSD vs BPD
C-PTSD and borderline personality disorder (BPD) can sometimes look similar, but they are distinct conditions with distinct diagnostic criteria.
C-PTSD includes the symptoms of PTSD with additional issues of self-organisation. BPD can include fear of abandonment, unstable relationships, disturbance of identity, impulsivity, and self-destructive behaviour.
A history of trauma is also an important part of C-PTSD, whereas trauma exposure is not required for a diagnosis of BPD. The two conditions can also occur together.
Dissociative Subtype of PTSD
Dissociation can also occur in PTSD. The DSM-5-TR recognises a dissociative subtype of PTSD, which involves experiences of depersonalisation or derealisation.
This is different from C-PTSD. The dissociative subtype is a feature of PTSD, while C-PTSD is a separate diagnosis recognised in ICD-11, which includes the symptoms of PTSD as well as problems with emotions, self-image and relationships.
Dissociation can occur in C-PTSD, but it is not required for the diagnosis.
Are PTSD and C-PTSD Treated Differently?
There is considerable overlap between the treatment approaches used for PTSD and C-PTSD.
Treatment Approaches for PTSD
Evidence-based treatments for PTSD can include:
- Eye movement desensitisation and reprocessing (EMDR)
- Cognitive processing therapy (CPT)
- Prolonged exposure (PE)
- Trauma-focused cognitive behavioural therapy (CBT)
Medication can also be discussed as appropriate, especially if symptoms persist or are present or occur alongside other mental health issues.
Treatment Approaches for C-PTSD
The same trauma-based therapies can be applied to the treatment of C-PTSD.
However, C-PTSD requires a broader approach to DSO treatment. This may involve difficulty managing emotions, building a more stable and positive sense of self, developing relationships, and fostering a sense of safety.
Some people may need to work on stabilisation and coping skills before moving further into trauma processing. Not all treatment sequences work for all people with C-PTSD.
PTSD and C-PTSD Treatment Differences
There is not much difference in how PTSD and C-PTSD are treated. Many of the same treatments can be used for both.
However, people with C-PTSD may need support that also addresses the wider effects of trauma, known as disturbances in self-organisation (DSO).
Looking for Help With PTSD or C-PTSD?
If trauma-related experiences are affecting your relationships, work, sleep, or everyday life, professional support can help you understand what you are experiencing and what treatment options may be appropriate.
At ExpertMinds, our mental health professionals can evaluate your situation and develop a personalised treatment plan. Your plan may include psychiatric or psychological evaluations and/or interventions, as well as prescription of medications and/or ongoing support and care.
You do not need to work out for yourself whether your symptoms are PTSD, C-PTSD or another condition before seeking help. A qualified professional can help you make sense of the symptoms and discuss next steps.
Frequently Asked Questions
Does C-PTSD equal PTSD?
No. C-PTSD includes the core features of PTSD but also involves additional difficulties associated with DSO. Under the ICD-11, PTSD and C-PTSD are recognised as separate diagnoses.
Is it possible to have PTSD and C-PTSD?
The ICD-11 does not include PTSD and C-PTSD as overlapping, but rather as distinct, with the core features of PTSD being part of the C-PTSD diagnosis. One may be able to manifest the symptoms of PTSD and C-PTSD; however, at the same time, one can have other co-occurring mental health conditions as well.
What is the difference between complex PTSD and PTSD?
Describing C-PTSD as “worse” than PTSD isn’t very helpful. While both involve problems, the intensity and effects of either disorder can be different for each person with C-PTSD.
Why is C-PTSD not in the DSM-5-TR?
PTSD is a diagnosis that is included in the DSM-5-TR, but it is not recognised as a separate disorder from C-PTSD. The ICD-11 has a different focus and identifies two types of trauma: PTSD and C-PTSD.
Does EMDR work for C-PTSD, as it does for PTSD?
Yes. EMDR can be used as part of trauma-focused treatment for people with C-PTSD, just as it can for PTSD. The approach may be tailored to the person’s individual needs and circumstances.
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