Experiencing Co-Occurring Post-Traumatic Stress Disorder and Complex Post-Traumatic Stress Disorder

Posted On June 25, 2021

In previous posts in this series, we have discussed post-traumatic stress disorder (PTSD) as though it occurs alone. Unfortunately, thinking that PTSD acts alone would be incorrect. Many other diagnoses that a person with PTSD can have include complex post-traumatic stress disorder (CPTSD).

This piece will explore what happens when a person suffers from both diagnoses, PTSD and CPTSD, at the same time.

The Similarities and the Differences Between PTSD and CPTSD

While both PTSD and CPTSD have some overlapping symptoms, there are some significant differences.

The similarities of the symptoms of CPTSD and PTSD begin in the fact that they are both trauma-related disorders. Both are highly disruptive to a person’s life, and both cause brain changes to occur.

The differences, however, set them apart from one another. For one, while PTSD is listed in the Diagnostic and Statistical Manual of Mental Disorder edition 5 (DSM-5) complex post-traumatic stress disorder has yet to make an appearance.

Another difference is that while post-traumatic stress disorder is formed because of a single traumatic event and is found at any age, complex post-traumatic stress disorder occurs because of multiple or a series of traumatic events, usually in childhood.

Both disorders are caused by the person feeling out of control and trapped.

Outside of war, PTSD is caused by a one-time traumatic incident like the following:

• Car Accident
• Tornado or Other Natural Disaster
• Mugging
• Rape

CPTSD is caused by a different type of trauma, such as follows:

• Sexual Abuse
• Emotional Abuse
• Neglect
• Physical Abuse
• Mental Abuse
• Narcissistic Abuse
• Domestic Abuse
• Human Trafficking
• Living as a Prisoner of War
• Living in a War Zone
• Surviving a Concentration or Internment Camp

You might now be able to distinguish between the two disorders and their causes.

Comparing the Symptoms of PTSD and CPTSD

While comparing two mental health diagnoses may seem like comparing apples to oranges, it is vital to understand the differences in the symptoms to comprehend how having both PTSD and CPTSD is horrific.

First, let us look at the symptoms of PTSD. The symptoms of post-traumatic stress disorder are as follows:

• spontaneous or involuntary, and intrusive distressing memories of the traumatic events
• recurrent distressing dreams
• flashbacks or other dissociative reactions
• intense or prolonged psychological distress at exposure to triggers
• physiological reactions to reminders of the traumatic events
• persistent avoidance of distressing memories, thoughts, or feelings
• inability to remember an important aspect of the traumatic events
• persistent and exaggerated negative beliefs or expectations about oneself,
• persistent, distorted blame of self or others
• persistent fear
• chronic guilt
• chronic shame
• markedly diminished interest in significant activities
• feelings of detachment or estrangement from others
• persistent inability to experience positive emotions
• aggressive behavior
• reckless or self-destructive behavior
• hypervigilance
• an exaggerated startle response
• problems concentration
• clinically significant distress or impairment in social, occupational, or other critical areas of functioning

Second, let us examine the symptoms of CPTSD:

• Losing memories of trauma or reliving them
• Difficulty regulating emotions that often manifest as rage
• Depression
• Suicidal thoughts or actions
• Sudden mood swings
• Feeling detached from oneself
• Feeling different from others
• Feeling ashamed
• Feeling guilty
• Difficulty maintaining relationships
• Difficulty trusting others
• Seeking our or becoming a rescuer
• Feeling afraid for no obvious reason
• Having a feeling of always on the alert
• Becoming obsessed with revenge on the perpetrator
• Feeling a loss of spiritual attachment and either ignoring or depending upon religion for self-worth

One can see that while some of the symptoms overlap, there are distinct differences in how the two diagnoses present.

The Hell of Having Both PTSD and CPTSD

Like the World Health Association, more mental health professionals are recognizing that complex post-traumatic stress disorder not only exists but can coexist with post-traumatic stress disorder.

Soldiers returning from war and first responders sometimes find themselves in the grips of experiencing PTSD from their work while at the same time suffering because of abuse they experienced as a child.

These brave souls find that while they are dedicated to completing their missions, they suffer from emotional flashbacks that are strongly associated with complex post-traumatic stress disorder.

Life with both disorders can leave a person with self-doubt, self-doubt, and low self-esteem that hampers their ability to conduct their lives well.

Healing from PTSD and CPTSD

Because these two dynamic diagnoses are similar yet so different, healing from having them both is an arduous task. While, again, some of the treatments overlap, they are still quite different.

Treatments or PTSD include the following:

Psychotherapy. Also known as talk therapy, psychotherapy is an essential tool in healing from post-traumatic stress disorder. There are many psychotherapy types, including cognitive therapy, exposure therapy, and eye movement desensitization and reprocessing (EMDR).

• Cognitive therapy helps survivors recognize the ways their thinking (cognitive patterns) keeps them stuck in their negative beliefs about themselves and the world.  

• Exposure therapy helps survivors safely face both situations and memories that are frightening to them. The hope is that exposing one to similar events, places, or objects will lessen the impact of flashbacks and nightmares. A new approach is to use virtual reality to allow survivors to re-enter the setting to which they were initially exposed that caused the PTSD.

• Eye movement desensitization and processing (EMDR) combines exposure therapy and a series of guided eye movements to help the survivor process traumatic memories and change the way they react to them.

Medications. Medications are also used to treat PTSD to alleviate the anxiety and depression that often accompanies it. There are distinct differences in the approaches to each one while maintaining some of the same strategies.

Treatments for CPTSD are as follows:

Psychotherapy. Psychotherapy alone or in a group helps survivors identify negative thought patterns and replacing them with healthy ones using specific healing tools. In psychotherapy the survivor is gently coaxed to tell what happened to them and to learn coping skills that will aid in the emotional flashbacks and other symptoms that may inhibit their lives. This CPTSD treatment is different from the psychotherapy offered in PTSD because the memories of the events are primarily from childhood abuse, where the memories treated in post-traumatic stress disorder are from the recent past.

EMDR. Eye movement desensitization and reprocessing helps to treat CPTSD. By asking the survivor to remember a traumatic event while moving one’s eyes from side to side, the survivor becomes desensitized to the memory putting it into the past where it belongs. However, there is a debate among the medical community on whether using EMDR to treat complex post-traumatic stress disorder is safe and effective. Some practitioners worry that memories of traumatic events may surface too quickly and cause further traumatization.

Like with post-traumatic stress disorder, medications are commonly given to help alleviate some of the co-occurring conditions that often accompany CPTSD such as depression and anxiety disorders.

A Personal Perspective

Having experienced co-occurring PTSD and CPTSD, I have an inside perspective of what it is like and how I have managed to move on despite them.

When I was a little girl, shortly after I was born, I became the victim of severe and repeated childhood sexual abuse and neglect. As I grew, the symptoms of PTSD made me to have nightmares and live in persistent fear, while CPTSD caused me to withdraw into my own little world.

My fear of the world and withdrawal caused me to experience isolation. I lost contact with other children, and in adulthood, this isolation continues as I try to avoid relationships from forming and live alone.

My complex post-traumatic stress disorder has been treated with traditional psychotherapy where I sat with a therapist and told her about what happened alone in her office. I have also experienced drama and art therapy that have helped me a great deal.

A Final Message

PTSD and CPTSD have overlapping symptoms, but there are some significant differences. Both are trauma-related disorders that have huge impacts on a survivor’s life.

Although complex traumatic-stress disorder isn’t yet mentioned in the DSM-5 (the bible of the American Psychiatric Association) and PTSD is, living with either disorder is complex and screams for treatment from a mental health professional.

If you have been exposed to a traumatic event or a series of traumatic events chances are you have one or both post-traumatic stress disorder and complex post-traumatic stress disorder. Help is available, and you are not alone, as millions of us understand what you are going through.

Did you hear that? You are not alone.

“Just be true to yourself. Listen to your heart. The rest will follow. Everyone has problems. You aren’t alone.” ~ Samantha Tonge

“A fine glass vase goes from treasure to trash, the moment it is broken. Fortunately, something else happens to you and me. Pick up your pieces. Then, help me gather mine.” ~Vera Nazarian