What is Complex Post-traumatic Stress Disorder

By Hattie Gladwell,
updated on Oct 25, 2019

What is Complex Post-traumatic Stress Disorder

They are two similar conditions, but triggered in different ways – and each comes with its own range of symptoms. Here’s what you need to know about CPTSD vs PTSD

Anxiety, racing heart, nightmares, and flashbacks making you relive the worst moments of your life, over and over again. Many of us are familiar with the concept of post-traumatic stress disorder (PTSD); an anxiety condition which may develop after being involved in, or witnessing, traumatic events. First identified in war veterans, it can also be triggered by a wide range of traumatic experiences.

But just knowing what PTSD is, doesn’t convey the true, debilitating reality for those experiencing it. It’s trying to live your daily life, not knowing when or what might trigger those flashbacks. It’s feeling on high alert, constantly on guard, all the time. It’s the world moving on around you, and trying to move with it, only to be snapped back and trapped reliving your darkest moments.

Sometimes these symptoms are a sign of PTSD, but what you may not have heard of is another similar condition that has some key differences: complex post-traumatic stress disorder (CPTSD).

What is CPTSD?

woman with brown hair looking down at the ground

CPTSD is a form of PTSD that is vastly different from the traditional diagnosis. Unlike PTSD, which can develop at any age, CPTSD generally arises after someone experiences long-lasting, on-going trauma from an early age. It is also common in people who have experienced multiple traumas, or were harmed by someone close.

Alongside traditional PTSD symptoms, which can include nightmares, anxiety, feeling unsafe, and a lack of trust in people, CPTSD has additional symptoms that can often be confused with borderline personality disorder (BPD).

These symptoms include difficulty in controlling emotions, feeling hostile or distrustful towards the world, feelings of emptiness, worthlessness, or being damaged, feeling that nobody understands, and having regular suicidal thoughts. People with CPTSD may also experience dissociative symptoms, such as depersonalisation or derealisation.

What are the key differences between CPTSD and PTSD?

One of the main differences between the conditions is in the form of flashbacks. For PTSD, these are usually quite visual, but most people who experience CPTSD have emotional flashbacks instead. This is where you have the intense feelings you originally felt during the trauma, such as fear, shame, sadness, or despair.

Dr Elena Touroni, a consultant psychologist and co-founder of the Chelsea Psychology Clinic, in London, says the main difference is that PTSD tends to happen as a result of one very traumatic event, whereas CPTSD occurs when that trauma has been prolonged, and typically stretched over a very long period of time.

“CPTSD shares the same symptoms as PTSD but typically presents alongside additional symptoms, too,” says Dr Touroni. “Those affected will likely suffer from flashbacks and distressing images, and/or nightmares of the trauma itself, sleeping difficulties, problems concentrating, and a racing heart – all common symptoms in PTSD.

“They’ll experience difficulties regulating their emotions, disassociation, an unstable sense of identity, and problems with relationships, too.

“Because the trauma was so prolonged, people experiencing CPTSD will usually carry very heavy feelings of hopelessness. They might even believe they are responsible for what happened to them.”

Because the trauma was so prolonged, people with CPTSD will usually carry feelings of hopelessness

Dr Touroni explains that because having difficulties with regulating emotions is a common feature of CPTSD, people experiencing it might find it hard to identify or control their emotions, which can cause problems in their relationships – exemplified also by feelings of mistrust.

What is it like to experience CPTSD?

We spoke with Elena, 28, was diagnosed with CPTSD in 2017. She struggled with her mental health from a young age, but her diagnosis only came after an inpatient stay.

She was initially wrongly diagnosed with borderline personality disorder by a psychiatrist, which Elena says she knew wasn’t right. After several months of working with her psychotherapist, her diagnosis was eventually corrected.

For Elena, CPTSD mainly presents as anxiety and depression. “It affects my life so much,” she explains. “I have flashbacks, my dreams and sleep are really affected, I have no confidence in anything I do, and constantly seek reassurance.

“I attempted to end my life when I was 17. I’ve been on and off medication since I was 15. Only after I had my complete breakdown in 2017 has it started to get better, and now I can live a pretty much normal life, although I still have flare ups. All of my flashbacks are emotional, the only visuals I’ll have are in my dreams.”

Elena says she feels her CPTSD differs from PTSD, because it wasn’t just one event that caused it.

“I have so many traumatic memories, and flashbacks are so common for me from so many things,” she says. “Only now that I have been having therapy for years, and have been reading so much about the science of trauma, am I finally realising how each of these little traumas has built up and affected me over time. I lost my relationship, job and home because of it.”

Portrait of a 40 year old person that identifies as gender queer, non-binary

Chloe, 24, also has CPTSD, which is the result of a number of medical traumas from the age of 16. She says: “I was surprised when I was diagnosed with CPTSD, because I didn’t realise you could get it from medical trauma. I’ve always been quite unlucky with my health, but two near-death experiences have really affected me.

“In 2011 I fell ill, and was misdiagnosed at the hospital. I had pneumonia, but because it wasn’t caught early enough it collapsed my lung. I ended up in an intensive care unit, and had two litres of fluid drained from my lung.”

In 2015, Chloe fell ill again, after experiencing symptoms such as severe weight loss and stomach cramps for two years, but doctors told her it was ‘women’s troubles’.

“I ended up in hospital with suspected appendicitis,” she says. “I had my appendix removed, but I continued to get worse. I was lying in a hospital bed in horrendous pain when I started hearing popping sounds from my stomach.

“My large bowel had actually started to perforate. I was rushed to theatre, had a three-hour operation to remove my large intestine, and woke up with a stoma bag. I was traumatised.”

Chloe says that now her anxiety about her health and misdiagnosis has increased – if she starts to feel remotely ill she will panic and have an emotional flashback, giving her the same feelings she had both times in hospital.

These experiences have changed her personality and dependency on people, making her more of an emotional person, who has difficulty controlling her moods.

“I struggle with suicidal feelings, and feelings of hopelessness,” she says. “I’m in therapy and working on it, but I know I’ve got a long road ahead of me. I’m thankful to have a correct diagnosis so I know what I’m working with, and so I can understand my symptoms better.”

What to do if you think you have CPTSD

For anyone concerned about their mental health, the first thing you should do is speak to your GP, and get in touch with a mental health professional.

Specifically with CPTSD, Dr Touroni says: “Trauma that has happened over a long period of time can sometimes take time to unravel, so I’d encourage people to be patient with themselves.

“Healing is very much possible, but it can take time. When someone has felt very powerless, it is about building up that sense of self and empowerment gradually. Practise self-care as much as possible, and do the things that nourish you. Getting outdoors, plenty of fresh air, grounding techniques, and practising mindfulness breathing exercises, can all be really beneficial.”

To find a counsellor helping with CPTSD and PTSD visit counselling-directory.org.uk

By Hattie Gladwell

Hattie Gladwell is a freelance mental health journalist. She is a passionate advocate for mental health and mental illness and dedicates her social media to raising awareness of both.

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