PTSD and CPTSD – is there a difference?

Most of us are familiar with PTSD (Post Traumatic Stress Disorder), but what about CPTSD (Complex Post Traumatic Disorder)? The Diagnostic and Statistical Manual of Mental Health Disorders – the official reference guide for mental health therapists – does not acknowledge this disorder as a separate diagnosis when, in fact, it has distinct differences from PTSD, and it is a disorder that unknowingly and severely impacts thousands of Americans every year.

Briefly, PTSD is a condition resulting from a single event or a series of isolated traumatic events over a short period of time, which can have a life changing impact. War, a horrific car accident, a natural disaster, a sexual assault – these are some events that can cause PTSD.

Individuals affected by PTSD may relive the incident through recall memories and flashbacks that replay the trauma in their mind, resulting in a physical response such as terror, anger or guilt.

CPTSD differs in that most cases start in childhood with a series of traumatic events repeated over a long period of time. These can include physical abuse, emotional abuse, sexual abuse, emotional invalidation or neglect, or living with a parent who is an alcoholic. 

The trauma gradually accumulates as a child is growing up, and ultimately shapes the child’s development and personality, causing behavioral issues, relationship problems and a wide range of other mental health issues.

Unfortunately, unlike PTSD, CPTSD is much harder to recognize, diagnose and treat because the victim was so young when the traumatizing incidents took place, and he/she cannot remember what happened. Consequently, therapists may misdiagnose CPTSD as borderline personality disorder, generalized anxiety disorder or depression.

The signs and symptoms of PTSD and CPTSD are similar, hence, another reason why CPTSD can be misdiagnosed.

Here are a few of the signs: social anxiety, loss of focus, anger, addiction, withdrawal, detachment from others, chaotic relationships with friends, trouble in school, perceiving the world as full of distrust and danger, lack of motivation, difficulty managing emotions, and high emotional intensity – most people measure between 20 to 30; victims of CPTSD can measure between 60 and 100. The victim radically changes how he/she views the world.

Like PTSD, individuals with CPTSD may have memories of the traumatic event. They also may react with a strong surge of uncontrollable feelings and emotions they can’t understand. They often say, “What is wrong with me?” Their flashback of the memory is in the form of unexplained emotions and feelings.

How is CPTSD treated?

I recommend that an individual who suspects he/she is suffering from CPTSD seek out a therapist who knows and understands the differences between PTSD and CPTSD and is equipped with the training and skills to treat victims of trauma. Initially, therapy will focus on stabilizing the person so he/she can begin to understand their feelings and emotions and start working on improving their relationships with others.

Even though there really is no “one size fits all” treatment modality for CPTSD, I find dialectical behavioral therapy (DBT) and EMDR (Eye Movement Desensitization and Reprocessing) can be effective. DBT focuses on mindfulness, emotion regulation, distress tolerance and interpersonal effectiveness skills to help individuals manage their emotions. EMDR uses repeated eye movements to help resolve unprocessed memories. EMDR is based on the idea that negative thoughts, feelings and behaviors are the result of unprocessed memories. The therapist will move a finger from side to side, and the person will follow the movement with his/her eyes while the person recalls the traumatic memory. The goal is to desensitize the person to the trauma so eventually, when they recall the memory, they will not have a strong adverse reaction to it.

If the cause of the CPTSD stems from a parent, family therapy is important, however, I often see a lot of denial. If the parent wants the child’s behavior to change, the parent also has to change.

Ultimately, the goal of therapy is to help the client identify the trauma, begin educating himself or herself about it, and start to practice techniques to manage it. Therapists also have to realize that the kids they are treating really don’t know what is causing their trauma because the memories often are not there.

As therapy progresses, clients often say to me, “things make so much more sense now.” With practice and time, they will learn the skills to manage CPTSD successfully.

Many therapists at The Center for Relationship and Sexual Health are trained to treat PTSD and CPTSD. To learn more, call the center at 248.399.7447.

Susan Ruma is a licensed master clinical social worker who uses a strengths-based approach as well as Cognitive Behavioral Therapy (CBT) when working with individuals, couples, families and adolescents. She also is trained to work with clients suffering from PTSD and CPTSD. She has facilitated support groups using mindfulness exercises to manage anxiety and mood disorders. To schedule an appointment with Susan, call The Center for Relationship and Sexual Health at 248.399.7447 or visit the center’s website at, and click on “Our Therapists.”

To schedule an appointment with Susan, call The Center for Relationship and Sexual Health at 248.399.7447 or visit the center’s website at, and click on “Our Therapists.”