PTSD and Complex PTSD (C-PTSD) are both responses to traumatic experiences, but they are not exactly the same. Discover what causes PTSD and C-PTSD, how they can affect you, and what can help you move towards recovery.
Post-Traumatic Stress Disorder (PTSD) is probably a term that most people have heard of. You may associate it with experiences such as military combat, serious accidents or natural disasters.
But trauma can affect people in many different ways, and not everyone who experiences trauma develops PTSD.
There is also another condition called Complex Post-Traumatic Stress Disorder (C-PTSD). Although C-PTSD includes the symptoms associated with PTSD, it can involve additional difficulties, particularly around emotions, relationships and the way a person feels about themselves.
The two conditions are closely related, but understanding the differences can be helpful if you are trying to make sense of your own experiences or those of someone you care about.
What is PTSD?
Post-Traumatic Stress Disorder is a psychological response that can develop following a traumatic or frightening experience.
Trauma might include:
- A serious accident
- Physical or sexual assault
- Childhood abuse
- Domestic abuse
- Military combat
- Serious illness or medical trauma
- Witnessing someone being seriously injured or killed
- Natural disasters
- Other experiences involving serious threat or danger
Most people who experience a potentially traumatic event do not develop PTSD. Many experience distress for a period of time and gradually recover. However, for some people, the effects of the trauma continue and begin to interfere with everyday life.
PTSD can develop soon after a traumatic experience, but symptoms can also appear much later.
What are the symptoms of PTSD?
PTSD is generally associated with four main areas of difficulty.
1. Re-experiencing the trauma
This can include:
- Flashbacks
- Intrusive memories
- Distressing thoughts or images
- Nightmares
- Feeling as though the traumatic experience is happening again
- Strong emotional or physical reactions to reminders of the trauma
A flashback can be particularly distressing because it may not feel like simply remembering something that happened in the past. Instead, the person can feel as though they are experiencing aspects of the event in the present.
2. Avoidance
Someone experiencing PTSD may begin avoiding anything that reminds them of what happened.
This could include avoiding:
- Particular places
- People
- Conversations
- Films or television programmes
- Driving
- Travelling
- Certain smells or sounds
- Situations that feel unsafe
Avoidance can provide temporary relief, but it can also gradually restrict a person’s life.
3. Changes in thoughts and feelings
PTSD can affect the way someone thinks about themselves, other people and the world.
They may experience:
- Feelings of guilt or shame
- Negative thoughts about themselves
- Feeling emotionally numb
- Loss of interest in things they previously enjoyed
- Difficulty experiencing positive emotions
- Feeling detached from other people
- Difficulty trusting others
4. Hyperarousal and feeling constantly on guard
The nervous system can remain in a heightened state of alertness following trauma.
Someone may:
- Startle easily
- Feel constantly on edge
- Become irritable or angry
- Have difficulty concentrating
- Experience sleep problems
- Feel anxious or unsafe
- Constantly scan their surroundings for danger
The World Health Organization describes this heightened sense of danger and increased vigilance as an important feature of PTSD.
What is Complex PTSD?
Complex Post-Traumatic Stress Disorder (C-PTSD) is closely related to PTSD but involves additional difficulties. C-PTSD is recognised as a separate diagnosis in the World Health Organization’s ICD-11 classification.
Someone with C-PTSD experiences the core symptoms of PTSD, including re-experiencing, avoidance and a heightened sense of threat. However, they also experience what are sometimes described as disturbances in self-organisation.
These involve three additional areas:
- Difficulty regulating emotions
- A persistently negative sense of self
- Difficulties with relationships
This means that C-PTSD can affect not only how someone responds to reminders of trauma, but also their relationship with themselves and with other people.
What causes Complex PTSD?
C-PTSD is particularly associated with repeated or prolonged traumatic experiences, especially when the person has felt trapped, unable to escape or unable to change what was happening.
Examples can include:
- Childhood physical or sexual abuse
- Childhood neglect
- Prolonged domestic abuse
- Repeated sexual abuse
- Torture
- Slavery or trafficking
- Prolonged exposure to violence or war
C-PTSD is particularly associated with trauma that happens during childhood or trauma involving someone the person trusted or depended upon. However, it is important not to assume that everyone who experiences prolonged trauma will develop C-PTSD, or that someone who experiences a single traumatic event cannot experience complex difficulties.
Trauma affects everyone differently.
PTSD vs C-PTSD: What is the difference?
The easiest way to understand the difference is to think of C-PTSD as involving the core symptoms of PTSD plus additional difficulties that can develop following prolonged or repeated trauma.
| PTSD | C-PTSD |
|---|
| Can develop after a traumatic experience | Often associated with prolonged or repeated trauma |
| Re-experiencing | Re-experiencing |
| Avoidance | Avoidance |
| Hyperarousal / feeling on guard | Hyperarousal / feeling on guard |
| Changes in thoughts and feelings | Changes in thoughts and feelings |
| — | Difficulty regulating emotions |
| — | Persistent negative beliefs about oneself |
| — | Shame, guilt or feelings of worthlessness |
| — | Difficulties trusting people |
| — | Problems with relationships and intimacy |
The distinction is recognised within ICD-11, where C-PTSD includes PTSD symptoms alongside difficulties with emotional regulation, self-concept and relationships.
How can C-PTSD affect the way you feel about yourself?
One of the most painful aspects of C-PTSD can be the effect that prolonged trauma has on a person’s sense of self.
Someone may believe:
- “There is something wrong with me.”
- “It was my fault.”
- “I am worthless.”
- “I can’t trust myself.”
- “Nobody could really love me.”
- “I don’t deserve good things.”
These beliefs can become deeply ingrained, particularly when the trauma occurred during childhood or involved someone who was supposed to provide care, safety or protection. Feelings of shame, guilt, defeat and worthlessness are commonly associated with C-PTSD.
It is important to remember that these beliefs can be consequences of trauma rather than accurate reflections of who someone is.
How can PTSD and C-PTSD affect relationships?
Relationships can be particularly difficult following trauma. Someone may desperately want closeness while simultaneously finding it difficult to trust people.
They may:
- Find it difficult to let people get close
- Fear being abandoned
- Expect other people to hurt or reject them
- Find it difficult to trust
- Become very sensitive to perceived rejection
- Avoid relationships altogether
- Feel disconnected even when surrounded by people
- Struggle to communicate their needs
These difficulties are not necessarily a sign that someone doesn’t want relationships. Sometimes, they are understandable protective responses that developed because relationships or other people were previously associated with danger.
C-PTSD specifically includes difficulties with relationships and feeling connected to others as part of its additional symptom profile.
PTSD, C-PTSD and emotional regulation
Another important difference is emotional regulation.
Following prolonged trauma, emotions can sometimes feel overwhelming and difficult to control.
Someone may experience:
- Sudden intense anger
- Panic or fear
- Emotional overwhelm
- Feeling unable to calm down
- Emotional numbness
- Feeling disconnected or “zoned out”
- Rapid changes in emotional state
This does not mean that someone is deliberately behaving irrationally or trying to be difficult. Their nervous system may have learned to respond very strongly to perceived threats. Learning to recognise these responses and developing healthier ways of managing difficult emotions can therefore be an important part of recovery.
Can PTSD turn into C-PTSD?
It is probably more helpful to think of PTSD and C-PTSD as different trauma-related conditions rather than thinking of one simply “turning into” the other.
Someone who has experienced repeated or prolonged trauma may develop C-PTSD, while another person exposed to similar circumstances might develop PTSD or experience other psychological difficulties. The nature of the trauma, its duration, when it occurred, the person’s circumstances and many other factors can influence how they respond.
There is also considerable overlap between PTSD and C-PTSD, which is why professional assessment is important if you are struggling with trauma-related symptoms.
Can you have PTSD and C-PTSD at the same time?
The diagnostic distinction is that C-PTSD includes the symptoms of PTSD, together with the additional C-PTSD symptoms. So it isn’t generally a case of having two completely separate conditions.
It is also possible for people with complex trauma to experience other mental health difficulties alongside PTSD or C-PTSD. This is one reason why it is important not to try to diagnose yourself based solely on an online article.
A qualified healthcare or mental health professional can help you understand what you are experiencing and identify the most appropriate treatment.
What can help with PTSD and C-PTSD?
The good news is that PTSD and C-PTSD can be treated.
There isn’t one approach that works for everyone, and treatment may need to be adapted according to the individual, their symptoms and their circumstances.
Evidence-based psychological treatments for PTSD include trauma-focused Cognitive Behavioural Therapy (CBT) and EMDR (Eye Movement Desensitisation and Reprocessing). The World Health Organization identifies trauma-focused psychological interventions and EMDR among the treatments with the strongest evidence for PTSD.
For C-PTSD, treatment may also need to address the additional difficulties associated with prolonged trauma.
This can include developing:
- Emotional regulation skills
- A greater sense of safety
- Healthy coping strategies
- A more compassionate view of yourself
- Confidence in relationships
- Trust
- Understanding of trauma responses
- Strategies for managing dissociation or emotional overwhelm
Specialist services may use a phased approach, particularly where someone has significant difficulties with emotional regulation, relationships or feeling safe.
Can hypnotherapy help with PTSD or C-PTSD?
Hypnotherapy may form part of an individualised approach to working with trauma-related difficulties, depending on the person’s circumstances and the therapist’s training and experience. Hypnosis can provide a deeply relaxed state in which therapeutic techniques can be used to help develop feelings of safety, calm and control.
For some people, hypnotherapy may be useful for working on areas such as:
- Anxiety and stress
- Relaxation
- Sleep difficulties
- Feeling safe and secure
- Confidence
- Unhelpful emotional responses
- Fear and avoidance
- Developing more positive ways of responding to triggers
The Rewind Technique is another approach sometimes used when working with traumatic memories. It aims to reduce the emotional response associated with a traumatic memory without requiring the person to repeatedly describe every distressing detail.
However, PTSD and C-PTSD can be complex conditions. Whilst Hypnotherapy can be very helpful as part of a wider approach which works with various aspects of trauma, it should not be presented as a guaranteed cure or as a replacement for appropriate medical or psychological treatment.
Moving Forward After Trauma
Living with PTSD or C-PTSD can sometimes feel as though the past is controlling the present.
A sound, smell, situation or relationship can suddenly bring back feelings associated with what happened. You may find yourself avoiding situations, struggling with relationships or feeling that something is fundamentally wrong with you.
But these responses can make sense when viewed through the lens of trauma. Your mind and nervous system have learned ways of trying to protect you. The fact that those protective responses may no longer be helpful does not mean that there is something wrong with you.
With the right support, it is possible to develop new ways of responding, feel safer in the present and begin to build a different relationship with the past.
If you are experiencing symptoms of PTSD or C-PTSD, consider speaking to your GP or an appropriately qualified mental health professional about the support and treatment options available to you.
