The complex PTSD vs PTSD comparison is gaining relevance in psychology. Complex PTSD has recently been included in diagnostics, meaning it is important that we understand and take this condition seriously.
Some people with complex PTSD might qualify their experience with, “Nothing that dramatic actually happened to me…” As South Africans, we often shrug off or even laugh away niggling discomfort about the past. But a trauma diagnosis doesn’t only apply for physical violence.
Trauma is a multilayered term. This is perhaps best understood by comparing complex PTSD vs PTSD, seeing where the conditions overlap and where they differ. The two conditions stem from different kinds of trauma. While the symptoms and treatment for the two diagnoses can be similar, there are some meaningful distinctions to consider.
Importantly, both complex PTSD and PTSD can be treated. When individuals with trauma histories receive compassionate, trauma-informed care from mental health professionals, they can experience meaningful support along and facilitation of the journey towards healing and good mental health.
What Is PTSD?
PTSD, which stands for post-traumatic stress disorder, results when you have endured a single, identifiable traumatic event or a short, contained series of traumatic events.
These events are terrifying or distressing. They could be things like accidents or assaults but also serious health issues (like being admitted to ICU or having a difficult birth delivery) and exposure to such events (in the cases of police officers and hospital doctors, for instance).
Symptoms of PTSD in adults
The symptoms of PTSD in adults can be grouped into four categories:
- Re-experiencing: flashbacks, nightmares, intrusive memories
- Avoidance: people, places, topics associated with the trauma
- Hyperarousal: hypervigilance, difficulty sleeping, easily startled
- Other negative shifts: low mood, irritability, feeling disconnected from oneself and world, dissociation, unexplained physical symptoms
(PTSD in children can present slightly differently, including symptoms like wetting the bed or having stomach- and headaches.)
What Is Complex PTSD or C-PTSD?
“Complex trauma” is the experience of prolonged, repeated and/or inescapable trauma. Complex post-traumatic stress disorder (C-PTSD) is an increasingly recognised diagnosis resulting from complex trauma. Complex PTSD was first coined in the 1990s but has recently been added as a new diagnosis to the World Health Organisation’s 11th International Classification of Disease (ICD-11), which charts various medically-recognised conditions.
The complex PTSD vs PTSD comparison cannot be simplified to say that C-PTSD is “a lot of PTSD”. The recognition of C-PTSD is distinct from PTSD. This is because the nature of the trauma, and the causes, are different.
C-PTSD arises from prolonged, repeated trauma and/or coercive interpersonal violence that makes escaping the trauma difficult. This could entail interpersonal abuse, neglect, exploitation, or violence. The traumatic event does not need to be physical but can be psychological. Examples include childhood abuse, domestic violence, human trafficking or war.
Complex PTSD can also result from systemic traumas like discrimination and colonialism. This is because these systems violently undermine a person’s sense of safety and belonging.
People are more at risk of developing C-PTSD if they lack social support; have other mental or chronic physical health conditions; or have a history of intergenerational trauma in their families or communities.
Symptoms of Complex PTSD
The symptoms of complex PTSD include those associated with PTSD. However, it is possible to distinguish complex PTSD by the addition of the following symptoms:
- Difficulty controlling emotions, struggling to feel positive emotions, dissociating when stressed
- Intense feeling of worthlessness, guilt and shame
- Persistent interpersonal difficulties
Complex PTSD vs PTSD Difference
The key differences between Complex PTSD and PTSD are the cause and the symptoms. While PTSD stems from a single traumatic event or a series of traumas in a short period of time, complex PTSD results from repeated, prolonged trauma and/or inescapable trauma.
PTSD symptoms like hypervigilance or flashbacks overlap with those of complex trauma. However, complex PTSD will also cause you to struggle with managing your emotions; to have a low sense of self-worth; and/or to struggle persistently with relationships.
Intergenerational Trauma & C-PTSD in South Africa
The enduring violence of Apartheid and colonialism has a negative impact on many South African communities. Gang violence, poverty, the experience of being a refugee or an exile, for example, can all lead to C-PTSD.
A landmark study in 2013 suggested that 73.8% of the South African population have experienced a potentially traumatic event. Among this group, the average person will have experienced 4.3 potentially traumatic events.
Intergenerational trauma is something I see time and again in my therapy clients. Intergenerational trauma refers to one generation’s trauma – perhaps that of our parents living through Apartheid – being passed down to younger generations and causing negative emotional and behavioural patterns. This is something that “born-frees” often talk about as a heavy load on their shoulders.
Not everyone who experiences a traumatic event develops PTSD or C-PTSD. But the risk of C-PTSD is heightened when there isn’t sufficient social support, which is sadly often the case in our country. It’s important to note that these risk factors are failures of systems like government, and not the fault of the individual or the family.
The importance of treating C-PTSD in South Africa
With the many simultaneous, ongoing crises our country faces, so many South Africans become numb to or normalise this very distressing reality. While there can be a protective element in this behaviour, we shouldn’t allow this to mask what may be a diagnosis of C-PTSD.
So often I hear from patients that they feel weak or silly – or their family members regard them this way — for seeking mental healthcare support when their ancestors lived through “worse” times without professional support.
Because of the activism and resistance of previous generations, however, society has changed and mental healthcare has become more accessible (although it is still not accessible enough). We should not undermine the distress of young (and old!) South Africans; we should recognise any mental health conditions present and use the resources that are available to support them.
Can Complex PTSD Be Treated?
Yes, there is significant and growing research that indicates we can treat C-PTSD. The recent recognition of the C-PTSD diagnosis by the World Health Organisation opens up the possibility that more people will have their symptoms accurately diagnosed and therefore receive the treatment they really need.
Psychotherapy or “talk therapy” is a key component of treating complex PTSD. Treatment for C-PTSD needs to take into account the layered symptoms and causes. As such, significant results will not likely be achieved in the short-term.
In complex PTSD therapy, psychologists work to establish a greater sense of safety and stability in clients, before processing the trauma itself in a contained way and then integrating this insight into a more positive self-identity and healthier relationships. Dialectical Behaviour Therapy (DBT)’s emphasis on practical skill development is helpful here, as is trauma-focused Cognitive Behaviour Therapy (CBT).
But often people find that process of exploring the trauma extremely painful and difficult to get through. This is where newer treatments like BrainWork Recursive Therapy (BWRT) come in.
BWRT is based on neuroscience. By readjusting the brain’s conditioned response patterns through guided exercises, it is possible for clients to address certain traumas without fully verbalising the event. Despite traumatic realities, individuals and communities can and do cultivate health and wellbeing within them. Professional therapy as a treatment integrates this into the healing process.
Choosing Healing over Managing and Coping
Over time, individuals with C-PTSD and families with intergenerational trauma have developed coping strategies that are now so familiar and “natural” that you may actually really think you’re “fine”.
But there is a difference between barely coping and true healing. Instead of only working around or ignoring deep-seated pain and distress, therapy offers a safe, supported space for exploring and easing these difficult feelings.
Working with a trauma-informed therapist can help you understand where your behavioural patterns originated. In therapy, this deep insight can be transformed into a greater sense of safety in the world, relationships that aren’t threatening but nourishing, and a kinder and healthier relationship with yourself.
Frequently Asked Questions (FAQs) about Complex pTSD vs PTSD
Commonly asked questions about complex PTSD and PTSD are answered here:
Is C-PTSD in the DSM-5?
No, complex PTSD is not a recognised diagnosis in the DSM-5 due to overlap with PTSD and Borderline Personality Disorder symptoms. While C-PTSD is recognised on the World Health Organisation’s (International Classification of Diseases) ICD-11, it remains to be seen whether/how it will be included in the DSM-6 which is expected to be released by 2030.
Why Is misdiagnosis of C-PTSD common?
Symptoms of C-PTSD like feeling worthless or struggling with relationships mean that complex trauma is sometimes misdiagnosed as depression or borderline personality disorder. You might also have both complex trauma and another mental health condition like depression. Because of the complexity of the symptoms, C-PTSD treatment is often longer and more flexible than for PTSD.
