What is CPTSD?
Complex post-traumatic stress disorder is a mental health condition that can develop after experiencing chronic or ongoing trauma. Also known as complex PTSD, C-PTSD, and CPTSD, someone experiencing complex post-traumatic stress disorder will experience symptoms of PTSD as well as additional, more severe symptoms someone with PTSD may not typically have. Whether you have a diagnosis of PTSD or complex PTSD is not based on what kind of trauma you experienced. It is based on the symptoms you experience.
What is the difference between PTSD and CPTSD?
The main differences between PTSD and CPTSD are the cause of trauma, severity of symptoms, and overall impact on life. Typically, PTSD happens after a single traumatic event, for example, a car accident, an assault, or a natural disaster, while CPTSD is more likely to develop in response to long-term, repeated trauma, for example, childhood abuse, domestic violence, captivity or torture.
Although both share symptoms, someone with CPTSD may have more intense, pervasive symptoms than someone with PTSD. CPTSD can also have a more significant impact on functioning, including on someone’s self-esteem, relationships, and work.
While professionals recognise some types of trauma can have additional symptoms to PTSD, there are disagreements about whether complex PTSD is a type of PTSD, or a separate condition. Experts also disagree on what it should be called.
Some professionals may refer to complex PTSD as enduring personality change after catastrophic experience (EPACACE). Others may call it disorders of extreme stress not otherwise specified (DESNOS).
C-PTSD has been officially recognised by the World Health Organisation (WHO) since 2018. It is included in the International Classification of Diseases (ICD-11).
Symptoms of complex PTSD
Complex PTSD has additional symptoms to PTSD. These can vary from person to person, but often include flashbacks or nightmares about the trauma, feelings of being on edge or experiencing hyper-arousal (difficulty sleeping, irritability, hypervigilance, or trouble concentrating), avoiding certain memories or feelings, and feelings or guilt or isolation.
Symptoms of CPTSD are more complex, and can involve profound changes in identity, emotional regulation, and relationships. In addition to meeting all the diagnostic requirements for PTSD, someone with CPTSD will experience additional severe and persistent symptoms. These can include:
- Affective dysregulation: Difficulty managing emotions, often leading to intense feelings of anger, sadness, or emotional numbness.
- Negative self-concept: Persistent feelings of shame, guilt, or worthlessness, often accompanied by a sense of being permanently damaged.
- Interpersonal difficulties: Problems with relationships, such as difficulty trusting others, feeling disconnected from people, or struggling to maintain healthy, supportive relationships.
- Physical symptoms: Chest pains, dizziness, headaches, or stomach aches.
- Dissociative symptoms: For example, depersonalisation or derealisation.
- Suicidal feelings.
- Feelings of emptiness or hopelessness.
People who experience complex PTSD may be particularly likely to experience ‘emotional flashbacks’. This is when you experience intense feelings you originally felt during a traumatic event or period of time. For example, these might include feelings of despair, fear, sadness or shame. You may not realise you are having a flashback, and may instead react to events you are experiencing now as if they are causing these feelings.
Dissociation and CPTSD
Chronic dissociation or hearing voices can be a common symptom experienced by people with CPTSD. When confronted with traumatic reminders during therapy, some people may dissociate.
Dissociative symptoms do tend to improve with PTSD treatment, however those with CPTSD may experience more pervasive dissociation, for example, they may lose awareness of their environment during a therapy session and in everyday situations. If you are experiencing CPTSD, you may need to address dissociation with your therapist first to get the most out of treatment.
Misdiagnosis of CPTSD
People with complex PTSD may be misdiagnosed with borderline personality disorder (BPD), also known as emotionally unstable personality disorder (EUPD). Both share symptoms such as trouble controlling emotional responses, low self-worth, and suicidal thinking. Both can also be linked to childhood sexual abuse.
It is possible to experience both BPD and complex post-traumatic stress disorder at the same time. If you’re worried that your diagnosis may not fit how you feel or what you are experiencing, discussing your worries with a mental health professional can help to ensure you find the right treatment options to help you.
Getting an accurate diagnosis can also be challenging as symptoms can be similar to a number of other disorders, including major depressive disorder, bipolar, generalised anxiety, panic disorder, OCD, eating disorders, learning disabilities, ADHD, substance abuse disorders, dissociative disorders, conversion disorders, and psychotic disorders.
What causes complex PTSD?
Complex PTSD can affect anyone, at any age, who has been through a traumatic or repeated traumatic events. You may be more likely to develop complex PTSD if you have lived through traumatic events such as:
- domestic violence
- childhood abandonment, abuse or neglect
- sexual abuse
- sex trafficking, torture, or slavery
- war
- repeatedly witnessed abuse or violence
You may also be more likely to develop C-PTSD if:
- you were hurt by someone you trusted and were close to (a parent, grandparent or carer)
- you were unable to escape the traumatic experience
- the trauma happened at a young age
- you were alone when the trauma happened
- you have experienced more than one kind of trauma
- you are still in contact with the person who caused the trauma
- trauma lasted over a long period of time
While it is typically thought that complex PTSD is caused by trauma that continues or is repeated over a longer period of time (months or years), it’s important to note that some people with long-lasting trauma may experience PTSD, while some people who experience a single traumatic event experience C-PTSD.
Treatment for complex PTSD: How counselling can help
If you think you may have symptoms of CPTSD, speaking with your GP can be the first step towards getting a diagnosis and support. Your GP might refer you to a mental health specialist for assessment or treatment after carrying out an initial assessment.
If you have C-PTSD, you may be offered similar treatment options to those used for PTSD. There are currently no specific guidelines from the National Institute for Health and Care Excellence (NICE) for complex PTSD.
GPs do not typically offer medication for PTSD. Your GP might recommend medication if you have certain symptoms, such as trouble sleeping or depression.
Some people find that standard treatment for PTSD is helpful. This can include therapy such as:
- Trauma-focused cognitive behavioural therapy (TF-CBT): Based on cognitive behavioural principles and using exposure techniques to help develop coping skills, as well as process thoughts and beliefs.
- Eye movement desensitisation and reprocessing (EMDR): EMDR is a type of therapy that is thought to help reduce symptoms like flashbacks and anxiety using eye movement similar to how your brain processes experiences while you sleep.
Some people also find group therapy, art therapy, or dialectical behaviour therapy (DBT) to be helpful. However, current NICE guidelines highlight that these have not been designed for those with PTSD so they should not be the only form of treatment used. Combining group, art or DBT therapy with TF-CBT or EMDR may help.
Many people with complex PTSD need more long-term, intensive support. It’s important to get support for other related problems you might experience. This includes dissociation, depression, drug or alcohol use.
Therapy can help introduce you to strategies designed to help manage strong emotions, address feelings of worthlessness and guilt, and help you create supportive relationships. Those with complex PTSD can have greater difficulty recognising how their condition may impact them. Working with a counsellor can help you to build new understandings, learn how relationships can be safe, make it possible to be vulnerable and stay safe, and connect with others, which can help us to heal.
Working with a therapist offers you the opportunity to talk without fear of judgment. Therapy offers a safe space to talk openly and explore issues you are facing. A therapist can introduce you to new ways of coping that you can continue to use.
The importance of the therapeutic relationship
The therapeutic relationship is the trust and collaborative bond between you and your therapist. Built on empathy, mutual respect, and hope, your therapist should be nonjudgemental and create a safe space where you can share your concerns.
Your therapist can help you work towards personal growth and healing, towards increasing self-awareness and building new ways of coping. They can also help you with other barriers that might be affecting how you engage with trauma-focused therapy. This could include helping with substance misuse, dissociation, emotional dysregulation, negative self-perception, or interpersonal difficulties.
Developing a good, safe therapeutic relationship is an important part of seeking support for CPTSD. Therapy for CPTSD requires longer-term work with a therapist. Having extra time to help develop trust between yourself and your therapist through having longer or more therapy sessions can be one way to help develop a therapeutic relationship.
Trauma-informed care
Trauma-informed care is now more commonly offered by the NHS. Staff, including trauma-informed therapists, offering trauma-informed care should:
If you are looking to work with a private therapist, working with someone who offers trauma-informed therapy can help. Your therapist should take into account how your trauma may impact you, tailoring their approach to fit your situation.
Resources
- NHS Inform - PTSD and CPTSD self-help guide
- PTSDUK