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Post-traumatic Stress Disorder, or PTSD, is the classic trauma diagnosis that most of us are familiar with. It began with what was then called “shell shock” for soldiers in both WWII and Vietnam. Then psychologists who worked with those soldiers began the development of what would become PTSD.
In recent times, PTSD has surpassed the concerns of veterans and widened to include sexual assault survivors, accident survivors, and anyone who has experienced actual or threatened death, serious injury, or sexual violence. Classic PTSD differentiates between what we now call Big T and Little t traumas.
Big T traumas are considered extraordinary, significant, and leave the individual feeling powerless and out of control. These traumas often threaten our physical body and make us feel helpless. They include things like war, natural disasters, or sexual violence. Little t traumas, on the other hand, are considered more normal or every day stressors but can build up and have a cumulative effect on the person experiencing them. These traumas are things like financial instability, divorce, bullying, emotional abuse, or loss of an important relationship. Keep these concepts in mind as we proceed as they are important to the differentiation between PTSD and CPTSD.
Now, let’s go through the hallmark features of both PTSD and CPTSD so we can get a sense for where they overlap and where they are different.
PTSD Criteria
In order to be diagnosed with PTSD, you must meet the following criteria:
1. You’ve been exposed to actual or threatened death, serious injury, or sexual violence. You may either experience it directly, witness it, or learned that it happened to someone important.
2. You experience intrusive symptoms of at least one of the following:
Recurring memories or dreams about the trauma
Flashbacks - feeling like you are back to where you were at the time of the trauma, often feel powerless, can have a visual component
Intense or prolonged distress when exposed to triggers of the trauma - you might feeling very sad, scared, or angry whenever you are triggered
Physiological reactions to triggers of the trauma - this can be things like a racing heart, difficulty breathing, or an upset stomach
3. You avoid triggers of the trauma due to the distress they cause and can can include internal (thoughts, memories, feelings) or external (sights, sounds, smells, etc) reminders.
4. You’ve experienced negative changes in your mood or thinking after the trauma. This can include…
Difficulties remembering important aspects of the traumatic event
Persistent and exaggerated negative beliefs
Blaming yourself or others for the trauma even when there is no evidence of fault
Negative emotional states like feeling depressed, paranoid, or anxious
Not getting pleasure from activities that you previously found pleasurable
Feelings of detachment or estrangement from others
Persistent inability to feel positive emotions
5. You will also experience alterations in your arousal and reactivity. This can include…
Irritability or angry outbursts
Reckless or self-destructive behavior
Hypervigilance
An exaggerated startle response
Difficulties concentrating
Sleep issues - either sleeping too much or not able to sleep enough
CPTSD Criteria
Complex PTSD is not yet recognized as a formal diagnosis in the DSM but is being recognized by survivors and trauma professionals as a real and distinct form of traumatic injury. Complex PTSD is a more severe form of PTSD that results from repeated traumas. These repeated traumas can be big T, little t, or a mix of both. However, it’s important to note that even a short period of repeated little t traumas is enough to trigger some of these symptoms.
In Complex PTSD, the person not only experiences the injury of trauma but they experience so many of them for so long (or at such an important stage of their life) that it negatively impacts their development as a person. Folks struggling with CPTSD will often experience symptoms of classic PTSD but will also have…
1. More emotional flashbacks than visual ones
2. Toxic shame and self-abandonment - you have learned through repetitive trauma that you are to blame or that you are bad or deserve what has happened to you. This isn’t true but the belief alone can wreak havoc on our lives.
3. Social anxiety - many folks with CPTSD find the world to be an unsafe place and find other human beings to be unsafe since for many of us our trauma came at the hands of other people.
4. Other developmental delays due to the long-term trauma - this can take the shape of an underdeveloped social or work life, a lack of personal identity, or difficulties with executive functioning like concentration, focus, discipline, planning, or strategizing.
So what does this differentiation mean if you’re someone struggling with the impact of trauma? There are a few implications…
1. Find a professional who specializes In trauma.
Trauma is not all made the same and expertise about one form of trauma does not automatically translate into expertise into all forms of trauma. However, it’s hard to find a thearpist who specializes in your issue and takes your insurance so if you can’t find someone who specializes in your type of trauma, then at least find a therapist who understands trauma.
2. Recovery strategies for PTSD and CPTSD overlap but there are distinctions.
On average, treatment for CPTSD will take additional strategies and more time than treatment for PTSD due to the impact on the person’s development and identity. Additionally, some classic treatments for PTSD either aren’t as effective or require modifications to work as effectively with complex PTSD. Furthermore, relational healing is particularly helpful for folks with CPTSD as they learn to trust and connect with others.
3. Just because CPTSD is not yet an official diagnosis does not mean you won’t qualify for help.
There are diagnostic codes that encompass the experience of folks with CPTSD and if you’re working with an experienced trauma professional they will understand how to diagnose you so that your insurance will cover your treatment.
If you think you’re someone who is struggling with either PTSD or CPTSD then I encourage you to reach out for help now. A good trauma therapist can help you to sift through what happened to you and help you move on in a constructive and healthy way. If you can’t find a good therapist or afford one, then start looking for free or online support groups for PTSD (you can start here.)
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References
1. Jones, Dr. Edgar. “Shell Shocked.” Monitor on Psychology, American Psychological Association, June 2012, https://www.apa.org/monitor/2012/06/shell-shocked.
2. VA.gov: Veterans Affairs. PTSD and DSM-5. (2013, June 6). Retrieved September 30, 2021, from https://www.ptsd.va.gov/professional/treat/essentials/dsm5_ptsd.asp. _
3. Loewe, K. (2020, December 1). Trauma is more than you think it is. CENTER FOR ESTABLISHING RECOVERY. Retrieved September 30, 2021, from https://www.establishingrecovery.com/recovery-blog/2020/8/9/trauma-is-more-than-what-you-might-think.
4. Sussex Publishers. (n.d.). Different types of trauma: Small 't' versus large 't'. Psychology Today. Retrieved September 30, 2021, from https://www.psychologytoday.com/us/blog/trauma-and-hope/201703/different-types-trauma-small-t-versus-large-t.
5. American Psychiatric Publishing. (2013). Diagnostic and statistical manual of mental disorders: Dsm-5.
6. Walker, P. (2013). Complex ptsd: From surviving to thriving: A guide and map for recovering from childhood trauma. Azure Coyote.