Video summary
The primary distinction between standard post-traumatic stress disorder (PTSD) and complex PTSD (CPTSD) lies in the nature of the traumatic experience. While typical PTSD arises from a single, discrete event with a clear beginning and end, CPTSD is the result of multiple forms of prolonged, sustained, or repeated interpersonal trauma. This often stems from experiences such as child abuse, exposure to domestic violence, or working in high-stress environments like law enforcement where individuals feel chronically unsafe and disempowered. Consequently, those with CPTSD do not perceive an end to their feelings of powerlessness or hopelessness, leading to significant functional impairments that are far more severe than those seen in standard PTSD cases.
Beyond the core symptoms of re-experiencing trauma, avoidance, mood alterations, cognitive changes, and hypervigilance, individuals with CPTSD frequently suffer from profound difficulties in emotional regulation and self-organization. This dysregulation is not merely psychological but involves actual physiological changes in the brain's threat response system and HPA axis, causing a rapid swing between feeling emotionally numb and becoming enraged. Furthermore, their sense of self may become fragmented, leading to dissociation, while their ability to trust others and maintain relational security is often compromised, resulting in unpredictable responses to people based on their current stress levels.
There is also a significant clinical overlap between CPTSD and borderline personality disorder (BPD), which complicates diagnosis and treatment. While BPD criteria involving terror of abandonment and alternating idealization are not part of the PTSD or CPTSD diagnoses, these conditions share many features, particularly regarding attachment insecurity and histories of abuse. Research indicates that 81% of adults diagnosed with BPD report histories of physical and sexual abuse, emotional neglect, or witnessing domestic violence, suggesting that traumatic experiences and compromised primary attachments are key contributors to both disorders. Both groups show alterations in the volume of the hippocampus and amygdala, areas of the brain responsible for processing fear and emotion, confirming that these conditions involve tangible structural changes in the brain rather than just being "all in their heads."
Recognizing the complex interplay between CPTSD, PTSD, and BPD is essential for effective clinical practice to ensure no symptoms are overlooked or misattributed. Although CPTSD is not yet officially recognized as a distinct psychiatric diagnosis in the DSM-5, there is ongoing discussion about including it in future manuals due to its unique symptom profile. Clinicians must understand that while these disorders can coexist and share biological markers, they are not identical; failing to distinguish between them could lead to missed opportunities for addressing specific symptoms like emotional dysregulation or attachment issues. Ultimately, acknowledging the significant overlap ensures that patients receive comprehensive care that addresses both the trauma history and the resulting personality changes without conflating distinct diagnostic criteria.
Read the full video transcript
Hey there everybody and welcome to
today's presentation on complex PTSD or
CPTSD.
What it is and some helpful
interventions. I'm your host Dr. Donna
Lee Snipes.
The biggest difference between
post-traumatic stress disorder and
complex post-traumatic stress disorder
is that PTSD or post-traumatic stress
disorder typically occurs after a single
event, a discrete event that has a
beginning, a middle, and an end. So
people's sense of safety, their sense of
security, and disempowerment is limited
to, if you will, that particular event
and things that remind them of that
event in the future.
CPTSD, on the other hand, is associated
with multiple forms of prolonged,
sustained, or repeated interpersonal
trauma. This can be from child abuse,
exposure to domestic violence, being in
a domestically violent relationship, or
even soldiers or people who are in law
enforcement, emergency services,
any situation where a person is
regularly feeling like they are unsafe
and disempowered and that their life or
the life of someone they care about is
in peril.
CPTSD,
complex PTSD, results in significantly
greater functional impairments than
people with PTSD. And this makes sense.
With CPTSD,
the person doesn't see an end to their
sense of powerlessness, their sense of
hopelessness.
They start experiencing
um changes in literally in their brain
structure. They start experiencing
changes in their perception of the world
because it feels increasingly hopeless
and dangerous and negative and chaotic
to them.
So, it makes sense that they're going to
have more severe symptoms than someone
who experiences
PTSD.
Complex PTSD includes the core PTSD
symptoms of re-experiencing, like
flashbacks and nightmares,
avoidance of reminders of the trauma,
you know, whether it happens once or it
happens every day, you don't want to
remember it,
mood alterations, so this can be anger,
anxiety, irritability, depression,
cognitive changes, a lot of times people
with PTSD become more negative and they
may have more difficulty being flexible
in the way they perceive the world or
think about things,
and hypervigilance. They tend to become
more uh easily startled and more aware
of everything that's going on, which can
be exhausting.
And because they are
um
operating from a place of fear, a place
where they don't feel safe or empowered,
they're also noticing
all of those negative or threatening
stimuli a lot more than the average
person.
In addition to those symptoms, people
with CPTSD
often experience difficulties with
emotional dysregulation, which means
they may go from feeling numb or flat to
being enraged at the drop of a hat. And
that is due to alterations in the
functioning of their threat response
system or their HPA axis. It's not just,
you know, all in their head. There are
actual physiological changes that result
in what I call the flat and the furious.
So, going from being kind of calm to
being dysregulated, to feeling
completely emotionally out of control.
They may also experience changes in
their sense of self-organization,
including body integrity, which means
they may not, you know, kind of have a
sense of themselves, or they may
dissociate a lot.
And relational security, their sense of
an the ability to trust other people
often changes, and they may have
um
alterations or variations in how they
respond to people depending on their
stress levels.
Note, you know, for clinicians out
there, CPTSD is not currently accepted
as a psychiatric diagnosis in the DSM-5,
and they're talking about considering it
for future manuals.
There's significant overlap between the
symptoms of borderline personality
disorder and complex persona- complex
post-traumatic stress disorder.
All of the new or revised PTSD symptoms,
which also overlap with borderline
personality symptoms, are
cardinal features of
complex PTSD.
Two borderline personality disorder
criteria related to attachment
disorganization or insecurity are not
included in the diagnosis of PTSD or
CPTSD.
Those two criteria are ter- terror of
abandonment or rejection
and alternating idealization and
devaluation.
Um from a clinical standpoint, it's
important to recognize that people with
BPD don't have to have these criteria in
order to be diagnosed with BPD.
Um however, uh people with PTSD or
CPTSD,
this is not a
uh symptom that we will will commonly
see.
81% of adults diagnosed with borderline
personality reported histories of
physical and sexual abuse, witnessing
domestic violence, emotional abuse and
neglect, or living with impaired
caregivers.
Traumatic experiences and a compromised
primary attachment, that means insecure
attachment, have been hypothesized as
key contributors to borderline
personality.
People with borderline personality or
PTSD,
uh both of them, show alterations in
hippocampal and amygdala volume. Those
are areas in your brain that are
responsible for fear and emotion
processing. So, there are actual brain
changes that happen in people who
experience trauma and develop PTSD,
CPTSD, or borderline personality.
Adults with borderline personality also
are at risk for abuse or revictimization
in adulthood.
Why am I talking about BPD? Because
there is such significant overlap
between these three diagnoses, CPTSD,
PTSD, and BPD, that it's important to
recognize uh that they may coexist and
to effectively
um
recognize the different symptoms, so
we're not missing, so we're not failing
to address a symptom.