• Karolina Christopher

What is the Difference Between PTSD and C-PTSD?

Updated: Mar 18

By Karolina Christopher

Clinical labels related to trauma and post-traumatic stress can be confusing. Find out more about different types of trauma and how they relate to symptoms of PTSD and C-PTSD.

Sophie’s Story

Sophie* did not think that her life had been anything out of the ordinary. Things hadn’t always been easy, but she told herself that it probably wasn’t that bad and that others had it worse. It wasn’t until she came to therapy to get help with her panic attacks that she began to reflect on some events that had happened while she was in secondary school.

With her therapist’s help, Sophie was able to recognise how her step-dad’s harsh expectations of her had led to excessive worry and debilitating perfectionism.

* Names and details have been changed.

What is the Definition of Trauma?

The word trauma is no longer unusual in everyday conversation, yet it can sound big and scary. You might also have heard it used all too readily to describe a mishap: ‘I thought I’d forgotten the tea bags – I was traumatised!’

Perhaps you believe that trauma must be caused by some extreme event – one that you haven’t experienced. In therapy, many people are surprised to learn that the difficulties they struggle with may be symptoms of PTSD (post-traumatic stress disorder) or C-PTSD (complex PTSD). So, what’s the lowdown?

Put simply, a trauma is a frightening or distressing event that surpasses our ability to cope. As you probably know, when we are faced with stress, our nervous system activates the fight/flight system (there are further aspects to this response, but let’s keep it simple for now).

This survival mechanism, fine-tuned by evolution to keep us safe, is automatic and happens in milliseconds. In the wild, for example, animals depend on it when they need to fight off a rival or flee from a predator. Once the danger has passed, calm ensues as the animal’s physiology returns to its resting state.

The brilliant mind and my late psychology lecturer, Elizabeth Sykes, liked pointing out that ‘humans, too, belong to the animal kingdom!’ – that is to say, our initial alarm response functions in pretty much the same way.

On the other hand, human brains are a great deal more complex, which makes us more susceptible to post-traumatic stress.

Occasional stress is a normal part of life and without it, we might not get much done! However, stress caused by life-threatening or distressing events can cause long-lasting negative effects.

What Is the Difference Between PTSD and C-PTSD?

The difference between PTSD and C-PTSD is not completely clear-cut, but as a guiding principle it can be said that PTSD stems from a one-off traumatic event or experience, while C-PTSD is the result of prolonged or repeated exposure.

So, for example, someone may develop PTSD after surviving a life-threatening illness or accident, sexual assault, or a natural disaster. Symptoms of PTSD can also follow an experience of being a victim of crime, witnessing violence, or having a difficult childbirth,

By contrast, C-PTSD typically stems from trauma in the early attachment relationship or other close relationship; therefore, it is also known as ‘developmental trauma,’ ‘early relational trauma,’ or ‘interpersonal trauma.’

In the case of early relational trauma, symptoms come from living through a recurring trauma such as growing up in a family context that is abusive in some way, including neglect and verbal abuse.

In addition, it is now well documented that a wide range of experiences can constitute complex trauma, including bullying, infertility and pregnancy loss, and any forms of abuse including discrimination or harassment, and racism.

While early trauma may not be physically life-threatening (though it could be), it seriously undermines the child’s sense of safety, acceptance, and belonging. This can leave deep, long-lasting wounding and affect areas such as self-esteem, healthy boundaries, and emotional regulation.

It is important to note that, for a small child, loss of safety or acceptance does feel life-threatening. The abuse can be subtle, including excessive criticism or even ‘unspoken’ disapproval of the child. Complex trauma is not always easy for the sufferer to recognise as it is often embedded in the life story itself.

Many of the symptoms of PTSD and C-PTSD are similar and may include heightened anxiety, physical sensations, intrusive thoughts, difficulty concentrating, and distress when encountering reminders of the traumatic event (known as ‘triggers’). The symptoms can vary from mild to severe.

PTSD was first diagnosed in war veterans, who experienced flashbacks and other debilitating symptoms after returning from battle. One reason why people dismiss their own experience of trauma, or do not recognise it as such, is that compared to war it doesn’t seem ‘as bad.’ Remember, however, that what causes trauma is any stressor that overwhelms the nervous system to the point that we feel feel unable to cope.

There is also a lesser known trauma response known as PTED, which follows an experience of great injustice. I have written about PTED here.

Sophie’s Story in Context

Let’s now briefly return to Sophie’s story. Sophie reported that she had suffered ‘inexplicable’ panic attacks during her teenage years, but that things got better when she moved away from home.