The Difference Between Trauma, PTSD, and Complex PTSD + A Video

What is the difference between trauma, PTSD, and complex PTSD ( c-PTSD)? I’m going to be talking about what each of those terms means because they often mean very different things. First, I’ll discuss some of the diagnostic criteria for PTSD are. Then, I’ll discuss some of the diagnostic criteria for complex PTSD and why it’s a new diagnosis that isn’t common in the United States. 

So what is the difference between trauma, PTSD, and complex PTSD? 

When someone uses the term trauma, it’s usually in a pretty broad sense. Sometimes they are describing something that happened to them. Sometimes they are describing something like PTSD or complex PTSD. But, the term trauma itself is just a general term describing an emotional response to a terrible event. 

The traumatic event could be any number of things.  And you can have trauma or have experienced trauma without necessarily meeting the criteria for a diagnosis of PTSD or complex PTSD.

Examples of traumatic events: 

• A physical or life-threatening event (e.g. domestic abuse, car accident)
• Psychological trauma
• Neglect
• Sexual abuse or assault
• Medical trauma
• Community violence (e.g. gang-related violence, interracial violence, police or citizen altercations)
• School violence or bullying
• Military trauma
• Traumatic grief or separation
• Natural disasters
• Force displacement (e.g. refugees)
• War, terrorism, or political violence

Trauma can also result from being a witness to any of the above traumatic events, even vicariously (witnessing the event indirectly). Sometimes we can have trauma from hearing about events or being a secondary witness to an event.   

The term complex trauma can also be used in a more generalized sense to describe an emotional response to experiencing or witnessing prolonged or repeated exposure to traumatic events. 

What is PTSD (Posttraumatic stress disorder)

PTSD is an official diagnosis of a mental health disorder caused by experiencing a traumatic event.  

Here is a summary of the criteria for a diagnosis of PTSD for adults, adolescents, and children older than six years. These diagnostic criteria are based on the Diagnostic & Statistical Manual (DSM-5).

The first criteria are exposure to actual or threatened death, serious injury, or sexual violence in one or more of the following ways: either by directly experiencing the traumatic event, witnessing in person, the events that occurred, learning that the traumatic event occurred to a close family member or close friend, or experiencing repeated or extreme exposure to adverse details of the traumatic event (e.g. first responders collecting human remains, police officers repeatedly exposed to details of child abuse.)

Criterion B is the presence of one or more of the following intrusive symptoms associated with the traumatic events, beginning after the traumatic event occurred:

• Recurrent involuntary or intrusive distressing memories of the event 
  • For children, this may be a repetitive play that centers around themes or aspects of the traumatic event
• Recurring, distressing dreams in which the content or effect of the dream are related to the traumatic event
  • For children, these may be frightening dreams without recognizable content
• Dissociative reactions (e.g. flashbacks) during which the individual feels or acts as if the traumatic event were recurring
  • In children, this may be a reenactment during play
• Intense or prolonged psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event 
• Marked physiological reactions to internal or external cues that symbolize or resemble aspects of the traumatic.

Criterion C is persistent avoidance of stimuli associated with the traumatic event: 

• Avoiding memories, thoughts, feelings, or anything closely associated with the traumatic event.
• Avoidance or efforts to avoid external reminders (e.g. avoiding certain places, situations, people, conversations, activities, or objects that might arouse distressing memories, thoughts, or feelings)

Criterion D is negative alterations in cognition and mood, beginning or worsening after the traumatic event:

• Inability to remember important aspects of what happened (typically explained by dissociative amnesia and not better explained by a head injury, alcohol, or drugs.)
• Persistent or exaggerated negative beliefs or expectations about oneself, others, or the world (e.g. thoughts/feelings of “I am bad”, “I can’t trust anyone”, “the world is completely dangerous”.)
• Persistent distorted cognitions about the cause or the consequences of the traumatic event. (e.g. blaming themselves or others for what happened)
• Persistent negative, emotional state (a persistent state of fear, anger, guilt, or shame)
• Markedly diminished interest or participation in significant activities.
• Feelings of detachment or estrangement from others and persistent, inability to experience positive emotions.

Criteria E includes marked alterations in arousal and reactivity associated with the traumatic event, beginning or worsening after the traumatic event occurred:

• Irritable behavior and/or angry outbursts (e.g. verbal or physical aggression towards other people or objects)
• Reckless or self-destructive behaviors
• Hypervigilance
• Problems with concentration
• Exaggerated startle response
• Sleep disturbances (trouble falling asleep, staying asleep, or restless sleep)

Symptoms must be present for more than one month after the event and they must cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

The Difference Between PTSD and Complex PTSD

First, it’s important to note that complex PTSD (c-PTSD) is not currently a DSM diagnosis. And unfortunately, most insurance companies in the US use the DSM-5 for diagnostic criteria. So currently, even if a clinician has a good understanding of complex PTSD and thinks that their client may be suffering from complex PTSD, they're probably going to use a PTSD diagnosis with specifiers to clarify what is going on with the client.  

That being said, the International Classification of Diseases (ICD-11) identifies complex PTSD as a separate condition. That is exciting for the mental health field! 

The World Health Organization (WHO) recently released the 11th edition of the International Classification of Diseases. This release was presented at the world health assembly on May 25th, 2019. It will be adopted by member states on January 1st, 2022.  

That is a huge push for Complex PTSD to become a recognized condition. I personally think that's important because the varied profile that we see in complex PTSD and the treatment for complex PTSD is typically quite different than that of just PTSD.  

Because complex PTSD is a relatively recent concept, we're still working on getting it recognized throughout the mental health community.  

What is Complex PTSD?

Complex post-traumatic stress disorder is the result of multiple traumatic events occurring over a period of time, often referred to as complex trauma.

It's typically interpersonal and typically the result of prolonged or repeated abuse, neglect, or torture (physical, emotional, or sexual). It can also be the result of a combination of traumatic events.

The causes of Complex PTSD include: 

• Multiple incidents of child abuse, particularly child physical abuse and child sexual abuse
• Prolonged domestic violence
• Concentration camp experiences
• Torture
• Slavery
• Campaigns of genocide

What are the symptoms of complex PTSD? And how do they differ from those of just PTSD?  

In the ICD-11, three symptoms of PTSD criteria must be met and these include:

• The re-experiencing of trauma (e.g. recurring dreams, flashbacks)
• Avoidance of trauma reminders (e.g. avoiding situations, people, conversations, and other reminders of what happened)  
• A heightened sense of threat (e.g. hypervigilance, exaggerated startle response) 

In addition to these three symptoms of PTSD, there must also be a symptom in each category of three disturbances of self-organization (DSO). 

You will notice these are also pretty similar to the PTSD diagnosis in the DSM.  But I think they look a little bit different in the complex PTSD diagnosis.  

The three domains of disturbances of self-organization (DSO) include emotional dysregulation, interpersonal difficulties, and negative self-concept.

Emotional dysregulation:

• General difficulty managing emotions
• Can present as unexpressed anger or internalized rage resulting from the trauma which may lead to self-destructive, reckless, or risk-taking behaviors

Interpersonal Difficulties: 

• Persistent difficulty in sustaining relationships or in feeling close to other people
• Social and interpersonal avoidance
• Feeling distant or “cut off” from other people
• Never feeling truly close to another person
• Continued dysfunctional relationship patterns

Negative Self-Concept

• Persistent beliefs about oneself as diminished, defeated, worthless
• Deep and pervasive feelings of shame, guilt, or failure
• Fragmented identity (e.g. feeling disconnected from parts of self)
• The belief that one is contaminated, bad, or evil

In addition, the complex PTSD diagnosis requires that all PTSD diagnostic criteria are met, including exposure to a traumatic event. If you have a complex PTSD diagnosis, it supersedes the PTSD diagnosis. So you wouldn't get a diagnosis of both.

Complex PTSD and Comorbid Conditions

Complex PTSD is often comorbid with other disorders. Some research has analyzed the symptoms between complex PTSD, PTSD, and borderline personality disorder. Many people with borderline personality disorder (BPD) either have PTSD or meet the diagnostic criteria for complex PTSD.  

They're still considered a separate disorder because a significant number of people with borderline personality disorder do not meet the criteria for complex PTSD and vice versa. So they are two separate disorders, but there is a high co-morbidity rate, meaning a significant portion of people diagnosed with one will also meet the criteria for diagnosis of the other.

People with complex PTSD, in general, meet more of the criteria for the DSM diagnosis of post-traumatic stress disorder with dissociative symptoms (e.g. depersonalization and derealization.)

These include things like feeling detached from oneself or like an outside observer of your life, feeling like you’re in a dream, like you or your body are unreal, or that the world is not real. This also includes feeling like the world is distant or distorted.

Because of this, complex PTSD has a high comorbid rate with dissociative disorders, such as dissociative identity disorder. This kind of goes along with the negative self-concept and fragmented identity. That can start to go into the realm of a dissociative disorder. Complex PTSD can also have a higher comorbid rate with conditions such as eating disorders. And obviously, a lot of people with complex PTSD are misdiagnosed with things like generalized anxiety or depression.  

If you think that you or a loved one has experienced traumatic events and suffering any of the symptoms mentioned in this article, help is available. 

Find Trauma Therapy Near You

If you live near Grand Island, Nebraska you can search here for Nebraska Trauma Therapy.

Other great resources for finding a trauma therapist include: 

• Psychology Today
• Therapy Den

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