CPTSD V PTSD

What's the difference?

Well, there's a few...

Causes, symptoms, and solutions can differ between the two. It can be helpful to understand which you may be dealing with in order to attain the proper treatment and support. Let's go through these step-by-step:

Causes:

Usually, PTSD is resultant of a single-incident trauma versus C-PTSD which is caused by prolonged trauma(s) over time. Whereas PTSD could result from things like a car accident, a sexual assault, or a single-incident injury, C-PTSD is more likely due to things like emotional abuse or neglect over time, continual domestic violence, or living with an alcoholic parent. These examples are intended to reflect that the nature of the cause is different between PTSD and C-PTSD. What is considered a trauma may also differ from person to person. It is important to remember that what may qualify as a trauma to someone else, may not be traumatizing to you and that's ok and completely normal. Remaining non-judgmental is essential so we may honor everyone's experience as different, but equal to our own.

Symptoms:

Interestingly enough, there is a diagnosis for PTSD in the DSM-V, but not one for C-PTSD. Below are the DSM-V symptoms of PTSD as provided by BrainLine:

DSM-5 Criteria for PTSD

All of the criteria are required for the diagnosis of PTSD. The following text summarizes the diagnostic criteria:

Criterion A: stressor (one required):

The person was exposed to: death, threatened death, actual or threatened serious injury, or actual or threatened sexual violence, in the following way(s):

- Direct exposure

- Witnessing the trauma

- Learning that a relative or close friend was exposed to a trauma

- Indirect exposure to aversive details of the trauma, usually in the course of professional duties (e.g., first responders, medics)

Criterion B: intrusion symptoms (one required):

The traumatic event is persistently re-experienced in the following way(s):

- Unwanted upsetting memories

- Nightmares

- Flashbacks

- Emotional distress after exposure to traumatic reminders

- Physical reactivity after exposure to traumatic reminders

Criterion C: avoidance (one required):

Avoidance of trauma-related stimuli after the trauma, in the following way(s):

- Trauma-related thoughts or feelings

- Trauma-related external reminders

Criterion D: negative alterations in cognitions and mood (two required):

Negative thoughts or feelings that began or worsened after the trauma, in the following way(s):

- Inability to recall key features of the trauma

- Overly negative thoughts and assumptions about oneself or the world

- Exaggerated blame of self or others for causing the trauma

- Negative affect

- Decreased interest in activities

- Feeling isolated

- Difficulty experiencing positive affect

Criterion E: alterations in arousal and reactivity:

Trauma-related arousal and reactivity that began or worsened after the trauma, in the following way(s):

- Irritability or aggression

- Risky or destructive behavior

- Hypervigilance

- Heightened startle reaction

- Difficulty concentrating

- Difficulty sleeping

Criterion F: duration (required):

Symptoms last for more than 1 month.

Criterion H: exclusion (required):

Dissociative Specification: In addition to meeting criteria for diagnosis, an individual experiences high levels of either of the following in reaction to trauma-related stimuli:

Depersonalization. Experience of being an outside observer of or detached from oneself (e.g., feeling as if "this is not happening to me" or one were in a dream).

Derealization. Experience of unreality, distance, or distortion (e.g., "things are not real").

Delayed Specification. Full diagnostic criteria are not met until at least six months after the trauma(s), although onset of symptoms may occur immediately.

Now, as you can see, PTSD has very specific diagnostic criteria and possible symptoms. C-PTSD, not being in the DSM, does not have such a list, but this does not invalidate its existence or the severity of the symptoms you experience. Additionally, although the DSM-V does not have such a diagnosis, the ICD-11(diagnostic manual used outside the United States) does. Here is what is written as the diagnostic criteria for Complex PTSD from the World Health Organization's website for C-PTSD:

"...All diagnostic requirements for PTSD are met. In addition, Complex PTSD is characterized by severe and persistent:

1) Problems in affect regulation

2) Beliefs about oneself as diminished, defeated or worthless, accompanied by feelings of shame, guilt or failure related to the traumatic event and...

3) Difficulties in sustaining relationships and in feeling close to others.

These symptoms cause significant impairment in personal, family, social, educational, occupational or other important areas of functioning. "

Here is also a helpful visual to demonstrate C-PTSD symptoms:

Based on these two different diagnosis, we can see that C-PTSD includes all of the symptoms of PTSD, with additional changes to beliefs about oneself, the world, and relationships.

From my experience (and as noted in the infographic), you may experience somatization of symptoms (i.e. physical effects resulting from transfer of the trauma to your body). For more on how this occurs, I will refer you once more to The Body Keeps the Score, by Bessel van der Kolk. However, I do want to stress the importance of attaining timely treatment for both PTSD and C-PTSD so that the trauma symptoms do not persist and create long-term mental, physical, and social harm.

For more on causes and symptoms, please listen to Dr. Tracey Marks's video:

Treatments:

The video shares a few helpful trauma treatments, notably EMDR to which you may know I am partial. Therapy itself is one part of a broad array of potential treatments to alleviate symptoms of trauma. Medications, support groups, exercise, meditation, and body work (e.g. yoga) can all help with PTSD and C-PTSD. However, here I would like to focus on the potential therapies to eliminate the cause of the trauma, thus reducing the need to utilize symptom management. Let's review the types of treatment for both PTSD and C-PTSD so you may best understand your options.

CPTSD and PTSD can be treated by the following:

Eye Movement Desensitization and Reprocessing (EMDR): Use of bilateral stimulation to move traumatic memories from being stored maladaptively in the brain, to being stored in the adaptive information processing center (AIP). Through this, when memories are thought of, they are no longer disturbing to the patient. Here is helpful information for better understanding EMDR from the EMDRIA website. You may also wish the watch the video below:

Prolonged Exposure (PE): PE is generally used to desensitize individuals to their traumatic memories. Patients may avoid triggers due to the severity of the emotional reaction to the memory. By safely exposing the client to the memory over and over, the patient's anxiety reaction may decrease.

Trauma-Focused Cognitive Behavior Therapy (TF-CBT): TF-CBT uses CBT strategies targeted to the symptoms of trauma. The treatment may help clients to change their distorted thinking and behavioral patterns that have resulted from traumas. Please refer to this helpful infographic below:

I would recommend EMDR for both PTSD and C-PTSD, with EMDR for C-PTSD being integrated with Schema-Focused Therapy, especially when working with childhood trauma. As TF-CBT is more focused on work with children and adolescence, it may be a better approach for C-PTSD itself.

Please let me know if this was helpful and, as always, I encourage you reach out for treatment and support from a therapist near you.

All the best,

~ Kelsey