What are the Differences Between PTSD, C-PTSD, Developmental & Relational Trauma?
Anika Sawatsky, MA, REGISTERED CLINICAL COUNSELLOR IN CHILLIWACK, BC
One of the questions I get asked often in my practice in Chilliwack and online is the difference between Post-Traumatic Stress Disorder (PTSD) and Complex Post-Traumatic Stress Disorder (Complex PTSD or C-PTSD). Although some elements overlap with each, there are distinct differences between PTSD and C-PTSD. Developmental or Relational traumas refer to the context in which the traumas have occurred.
Post-Traumatic Stress Disorder
PTSD occurs after having been exposed to a traumatic event, causing extreme distress to the point it interferes with regular daily life. Although the diagnosis of PTSD was historically used in cases of veterans returning from war, we know that PTSD can follow exposure to a wide variety of direct and indirect traumatic events. A traumatic event is described in the Diagnostic and Statistical Manual, fifth edition (DSM-5) as being one that involved death or threatened death, actual or threatened serious injury, or actual or threatened sexual violence.
Once a person has experienced, whether directly or indirectly, a traumatic event, there are several additional experiences that would make them meet the criteria for PTSD. Following the traumatic event and for at least one month, the person would experience one or more intrusion symptoms, one or more avoidance symptoms, and two or more altered mood and reactivity symptoms, all of which cause significant distress or impairment in functioning. It is important also that this disturbance is not caused by another medical or psychiatric disorder or any substances such as medication or alcohol.
Intrusion symptoms can include distressing dreams, flashbacks, and/or distress at internal or external cues of the traumatic exposure. Avoidance symptoms include actively avoiding or making efforts to avoid internal or external reminders of the trauma.
Symptoms in the altered mood category must have begun or worsened after the traumatic event and can include:
the inability to remember an important aspect of the event
persistent and exaggerated negative beliefs or expectations about oneself, others, or the world
persistent, distorted cognitions about the cause or consequences of the traumatic event that lead the individual to blame themselves or others
persistent negative emotional state
markedly diminished interest or participation in significant activities
feelings of detachment or estrangement from others
persistent inability to experience positive emotions
Symptoms of altered reactivity can include irritable behaviour and angry outbursts (with little or no provocation) typically expressed as verbal or physical aggression toward people or objects, reckless or self-destructive behaviour, hypervigilance, exaggerated startle response, problems with concentration and sleep disturbances.
In other words, when someone is experiencing symptoms of PTSD, they are continually outside of their window of tolerance and experiencing persistent perceptions of heightened current threats.
Complex Post Traumatic Stress Disorder
Complex post-traumatic stress disorder, sometimes called complex PTSD or C-PTSD, has many of the same characteristics of post-traumatic stress disorder (PTSD), but there are a few key differences. Complex PTSD is not listed in the DSM-5 but is included in the International Classification of Diseases 11th Revision (ICD-11), which is the global standard for diagnostic health information developed by the World Health Organization. Complex PTSD can arise after being exposed to repeated or ongoing traumatic events, as opposed to the requirement of one index trauma as required for the diagnosis of PTSD. Complex PTSD typically arises from childhood experiences such as ongoing physical, sexual or emotional abuse, neglect, or repeated exposure to domestic violence. This is also referred to as relational or developmental trauma. It can also be triggered by other threatening and horrific events such as torture, concentration camps, genocide campaigns, slavery and other forms of prolonged violence. One of the key differences between C-PTSD and PTSD is that C-PTSD is known for emotional flashbacks whereas in PTSD there are specific memory flashbacks. Emotional flashbacks are characterized by intense feelings that arise that are similar to what was felt during or adjacent to traumatic or neglectful experiences in childhood. They can be confusing and difficult to label for the person who is experiencing them.
Symptoms can include:
Emotional flashbacks
Difficulties controlling emotions and angry outbursts
Numbing or dissociation
Distrust of others and the world
Inner conflict
Feelings of helplessness, emptiness, or hopelessness
Feelings of being damaged or worthless
Relationship issues
Physical symptoms (ie. Chronic pain, chest tightness, nausea, etc)
Anxiety and depression
What does this look like?
People who have experienced complex trauma may find it challenging to maintain healthy relationships with others because the injury from developmental trauma primarily occurs in a relational context. A person’s ability to be able to be securely attached to their relationships may be impacted. They may either find it difficult to have boundaries with others and notice that they are taken advantage of in friendships or they may find themselves in abusive relationships. Some may put others’ needs first and to the detriment of their own needs. Conversely, they may feel that in order to protect themselves from being hurt or taken advantage of, they need to be completely self-sufficient; they may feel that relying on others is a weakness. They might have difficulty trusting others and avoid relationships altogether. Another way this shows up in relationships is that people will replay the same toxic cycles in relationships; this is because they have confused what is “familiar” with what is “safe.”
How can Counselling Help?
If you notice that you are finding relationships challenging, that you have perfectionistic tendencies, that you are playing out unhealthy patterns in relationships with others, or that you are experiencing emotional flashbacks - counselling can help you develop insight and address the trauma that you have experienced. Talking to a therapist can help you to understand yourself more and develop autonomy and meaning while in a relationship with others. They can also help break unhealthy patterns to create new ways of relating to others that feel more autonomous and respectful of your and the other person’s boundaries.
References
https://www.verywellmind.com/what-is-complex-ptsd-2797491
https://icd.who.int/browse11/l-m/en#/http%253a%252f%252fid.who.int%252ficd%252fentity%252f585833559
https://cptsdfoundation.org/2022/11/14/treating-complex-relational-trauma/
https://www.verywellmind.com/ptsd-in-the-dsm-5-2797324