PTSD is a relatively well-known condition that many people have heard of, and they may even have an acquaintance who has experienced this. Complex PTSD is not as recognisable, and therefore those who suffer from this challenging condition may struggle to share their diagnosis or their feelings about it with others in their life – even their loved ones. 

Here, we are looking at the difference between PTSD and Complex PTSD, the symptoms and how they differ, how to explain the condition and its triggers to someone who has no experience of this, how diagnosis works, how your loved ones can support you, and where to seek further support for this condition. 

At Augmentive, we aim to provide holistic, tailored mental health support to everyone so they can live their life to the fullest, so if you have questions about Complex PTSD, we’re here to help. 

What is PTSD? 

PTSD stands for Post-Traumatic Stress Disorder, which is a mental health condition caused by someone experiencing or witnessing a traumatic event in their life. People with PTSD often struggle with their own triggers (things around them or situations that cause them to feel symptoms of the condition), and may avoid certain situations that remind them of the trauma they experienced. This can disrupt daily life and persist for years without treatment. 

Past traumas can cause a person to feel fear, which triggers the fight-or-flight response to help an individual avoid potential danger. PTSD happens when this response becomes difficult to switch off. Many people will recover from trauma symptoms over time, while others continue to experience them through PTSD. 

According to PTSD UK, 4 in 100 people in the UK are thought to have various forms of PTSD, and it has been found to affect women aged 16-24 most often, with 12.6% screening positive for the condition. 

What is Complex PTSD? 

Complex PTSD may also be referred to as C-PTSD. It is a condition that has been around for a long time, but has not been properly recognised until recently. Many people question how it differs to better-known PTSD, and according to the Foundation for Post-Traumatic Healing and Complex Trauma Research, Complex PTSD is the result of “ongoing, inescapable, relational trauma”, while PTSD is the result of one past incident, and may not be related to another person causing harm. 

"Complex PTSD is when people are experiencing symptoms of PTSD alongside other symptoms for a longer period of time. They may struggle to control their emotions, feeling angry towards the world and experience a constant feeling of hopelessness and worthlessness. They may compare themselves to other people, feel different and avoid relationships and friendships. When PTSD symptoms are presented with the symptoms mentioned above this is when it becomes complex." - Dr Hina Rehman, Psychiatrist

An example of PTSD could be a major car accident, while an example of Complex PTSD could be several years of abuse experienced during childhood. Relationship elements such as betrayal and loss of safety are key factors in Complex PTSD and set it apart from PTSD. Another difference between PTSD and Complex PTSD is the fact that PTSD can result from a trauma experienced at any age, while Complex PTSD often results from childhood experiences. Complex PTSD can also be the result of sustained abuse, neglect, captivity, oppression, witnessing violence, and more. 

In the past, doctors have considered creating a separate diagnosis for this type of trauma, exploring names such as EPCACE (Enduring Personality Change After Catastrophic Experience), and DESNOS (Disorders of Extreme Stress Not Otherwise Specified). More recently, the idea that Complex PTSD could be another variation of PTSD in the traditional sense is a more accepted theory. Studies suggest this disorder has a 1-8% prevalence in the population and could have up to a 50% prevalence in mental health facilities.

What are the symptoms of Complex PTSD?

You may be familiar with the symptoms of PTSD which are thought to happen when the body activates a particular stress reaction in response to triggers. This is called hyperarousal, and it can cause feelings of irritability, anger, guilt, shame, fear or emotional numbness. 

It can also cause physical symptoms such as trouble sleeping, difficulty focusing, anxiety, panic attacks, self-destructive behaviour (such as alcohol abuse), and vivid memories or flashbacks. Anticipating one or more of these symptoms can lead to an individual with PTSD avoiding triggers and suppressing their trauma as a way of managing symptoms, but this is not a long-term solution. 

Complex PTSD can cause many of the same symptoms as PTSD, however those who suffer from this condition may also experience: 

• Emotional dysregulation
• Feelings of emptiness or hopelessness
• Feelings of worthlessness
• Feeling like people don’t understand their trauma 
• Feeling resentful or distrustful of the world
• Feeling like they don’t fit in or are different to others  
• Avoiding relationships with other people (including friendships), or struggling to manage them 
• Experiencing dissociative symptoms like derealisation (feeling like the world is not real)
• Physical symptoms like headaches, chest pains or stomach pains
• Suicidal feelings
• Emotional flashbacks that cause intense feelings from the trauma to reemerge during certain present-day triggers 

Why is Complex PTSD so hard to explain to others?

Complex PTSD is a difficult condition to explain to anyone who does not have it, especially if your trauma originates from a series of emotional or psychological incidents that some people may not consider to be ‘trauma’ in the way that one major traumatic incident might be recognised. While many people will understand the root causes and symptoms of PTSD, some can be sceptical or even judgemental about Complex PTSD because they do not understand it and have not experienced the symptoms and emotions themselves. The societal stigma surrounding mental health concerns can make talking about your Complex PTSD difficult, but it is important not to suppress or belittle your feelings simply because they do not meet someone else’s criteria for trauma. It is common for those with the condition to experience feelings of shame, fear of judgement, difficulty trusting and more, especially when they are frequently met with scepticism from people who compare their past experiences with those of other people. 

The relational dynamics and deep-rooted emotional trauma involved with Complex PTSD mean that everyone experiences this condition differently. Symptoms can span from emotional dysregulation to distorted self-perception, and the nuance involved means they are often invisible to other people. 

Research shows it is also common for those with PTSD in the traditional sense to suppress their unpleasant feelings, practise emotional avoidance, avoid closeness with loved ones, or even treat them badly in order to push them away, so keep in mind that as well as stigma and hesitation from other people, sometimes an individual with Complex PTSD could make it extremely difficult for anyone else to help them. 

If you have a loved one with PTSD or Complex PTSD, you may find our guide on this topic helpful: What To Do When Someone With PTSD Pushes You Away.

What are some common triggers for Complex PTSD?

Just like PTSD, Complex PTSD can be triggered by situations, objects or people, as they create unwanted reminders of past traumatic experiences and cause associated emotional and physiological responses. 

Some triggers may seem typical, such as:

• Conflict – Situations involving arguments, confrontation, and more 
• Anniversaries – Days that remind the person of past trauma, such as certain holidays throughout the year or a specific date 
• Loss – Losing a loved one, whether due to bereavement or separation, can cause feelings of rejection, grief, abandonment and more
• Intimacy – Being vulnerable with anyone can lead to feelings of fear, mistrust, or fear of abandonment, particularly for those who have experienced relational trauma

Other triggers could be more specific to a situation, such as:

• Parenting – Situations where parenting responsibilities are required, which could give rise to unresolved issues relating to childhood neglect or abuse
• Physical touch – Certain types of physical intimacy with a romantic partner could trigger memories of violence in someone with Complex PTSD
• Environmental cues – Certain smells, sounds or places may trigger memories of events from the past, causing vivid memories and intense emotional reactions

Someone with Complex PTSD may find that people in their life do not understand their triggers, or may question their legitimacy. Complex PTSD triggers are often unique to the individual and their experiences, so it is common for unusual things to trigger symptoms which could prompt questions from loved ones or acquaintances. 

“I have [a] trigger that is a certain type of comforter made of down feathers. I know some people see down feathers to be the best quality of bedding but for me, they are not soft and warm. They make me feel strangled…  I associate it with the abuse I endured and the feeling of being strangled with the weight of my abuser on top of me. No matter how much I tell myself that the abuse happened a long time ago, the feel of that type of comforter takes me back every time.”
– Elizabeth Woods via CPTSDFoundation.org

If you suffer from Complex PTSD, remember that any triggers you have will likely be related to the past trauma you have faced, and other people in your life may not need to fully understand them in order to acknowledge and accept them, and offer support to you. 

How can I explain my Complex PTSD and its triggers?

Whether your triggers involve a certain sound, smell, location, temperature, type of food, feeling, object, day, time, situation, season, type of person, or something else, you should not feel shame or fear around others finding out about these triggers, as this will only further compound negative feelings about your condition. Understand the importance of working on these triggers so they no longer control your life, but also don’t be afraid to do this in your own time and never force yourself (or feel forced by others) into situations that you do not want to be in.

If you would like to discuss your triggers with a loved one, it can help to:

• Acknowledge what your triggers are if you have never thought about this before.
• Speak to people you know will have empathy and compassion for your situation, and seek to understand more about the condition – choose people you trust.
• Give a brief overview of Complex PTSD when telling someone that you have this, so they understand it is a recognised condition. It can help to explain that as a child’s brain develops during their early years, most people experience support, stability and safety during this time. Other children may have experiences that are detrimental to their mental health and can leave a lasting impact. Although not a definite prediction for a child’s future, Adverse Childhood Experiences (known as ACEs) can have a huge impact and can lead to violence, victimisation, health issues, and more. 
• If you feel you can, share more about the traumatic experiences that led to the development of your triggers. Equally, if you do not feel ready to tell others about what has happened to you, you do not need to share this information in order to talk about specific triggers and how they affect you. Your loved ones should be able to accept how you are feeling without knowing why just yet. 
• It can help to use examples of when your triggers have arisen in the past, and how these make you feel in the moment. This way, your loved ones can better understand why you have certain strong reactions to things. 
• Ask them how they are feeling about your Complex PTSD too. It is important to remember that by telling a loved one about this, they may feel confusion, worry, or a sense of guilt for not realising sooner or not being able to help you in the past.  
• Let them know what you need from them. This could simply be someone to chat to every so often when you are feeling down, a specific type of support, or a set of instructions for what to do if and when one of your triggers causes you distress. In most cases people will want to help, so let them know how best to do this.

How is Complex PTSD diagnosed?

The first step in getting a diagnosis for Complex PTSD is often an assessment by a mental health professional to evaluate your symptoms, how long they last, how severe they are, and how they impact your life. When seeking a diagnosis of PTSD or Complex PTSD, it can help to keep track of your symptoms in advance of seeing your doctor so you can discuss in what scenarios these tend to happen. You can do this by keeping a log of your symptoms. Keep in mind you may need to talk about your trauma history in order to provide context for the symptoms you are experiencing. 

Once other mental health conditions have been ruled out, PTSD may be explored. Although the idea of Complex PTSD has been around for a long time, it is not mentioned in the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders, otherwise known as the DSM-5. For this reason, it is not recognised as a condition, which can make diagnosis difficult – in many cases, a more general diagnosis of PTSD may be given in order to start addressing symptoms. 

However, the World Health Organization has stated in its 11th revision of the International Disease Classification that Complex PTSD is separate from PTSD, so the condition is becoming more recognised and many health professionals will take steps to properly diagnose and treat it as such. 

You should also keep in mind some symptoms of Complex PTSD bear similarities to Borderline Personality Disorder (BPD), so the condition is commonly incorrectly diagnosed. If you have been given a diagnosis that you feel does not match your symptoms and how you are feeling, you can bring this up with your doctor or mental health professional – getting the correct treatment is important, so do not delay this if you are worried you have the wrong diagnosis. 

How can my loved ones help?

Complex PTSD can be an incredibly isolating condition to live with, so seeking understanding and help from loved ones can start you on a path to feeling safer when facing triggers, and more able to discuss your needs.

When discussing Complex PTSD with your family and friends, you may want to suggest they work on:

• Learning more about Complex PTSD to enhance their understanding of how the condition can develop 
• Fostering a safe, validating environment for you to share your feelings 
• Practising empathy and patience when you are experiencing triggers
• Active listening without judgement so you can have more open communication about your condition 
• Supporting you with any therapy and self-care activities that may promote your wellbeing 
• Having flexibility and understanding during episodes of emotional dysregulation or emotional numbing – studies have found emotional numbing can negatively impact family relationships if family members start to emotionally withdraw support, so it is important that they find a balance between giving you space and persevering with helping you.
• Having patience with you throughout your triggers – in many cases, loved ones can become frustrated or angry with someone who suffers from PTSD, so having patience can make a huge difference
• Offering practical assistance with daily tasks if you are struggling to manage things while seeking a diagnosis 
• Respecting your boundaries if you are not ready to discuss past traumas openly so you do not begin to push people away as an avoidance mechanism 
• Providing unconditional love, acceptance and consistent support throughout your journey 

The importance of support from loved ones cannot be overstated, as one study involving combat veterans found that the level of PTSD they experienced was related to the support they received from their significant other. Higher levels of support were associated with lower levels of PTSD, and although this study relates to PTSD in the traditional sense, it could lead to similar results for those with Complex PTSD. 

Where can I get more support for Complex PTSD?

There is a growing library of Complex PTSD resources online as the condition gains recognition, so you may find more information on this through organisations such as:

• Mind UK
• PTSD UK
• CPTSD Foundation

Aside from seeking a diagnosis of Complex PTSD from your GP, there may be local support groups in your area, and private therapy options are always available, offering bespoke care for Complex PTSD. At Augmentive we believe those suffering from this condition should receive individualised professional support that takes into account their specific symptoms and the traumatic experiences that have led to them. 

“At times I felt nothing was going to end the distress, experiencing more than 10 flashbacks a day... It was a long process of recovery, with lots of bumps along the road, but the right medication and long-term therapy with someone I came to trust, has changed my life.” 
– Anonymous, via Mind.org.uk

Whether you’re feeling off-kilter or want to shake up your routine, our state-of-the-art mental wellbeing platform gives you quick and seamless access to world-class support on your terms, from private PTSD assessments and reviews to broader private mental health care.

If you have a question about mental health, like the relationship between hyper independence and trauma, we’re here to assist on your journey. Our free 15 minute consultation can guide you to the most relevant specialists to answer your questions and discuss next steps.

DISCLAIMER: The content published by Augmentive is not designed to treat, diagnose, cure, or prevent any disease or condition. Always consult your GP or a qualified healthcare provider with any questions regarding a medical condition and before starting any diet, exercise, or other health-related programme.