Complex PTSD (C-PTSD) and PTSD
What is Complex PTSD?
Complex PTSD (CPTSD) is a form of post-traumatic stress that results from prolonged or repeated exposure to traumatic experiences, often in relationships where there was little chance to escape—such as ongoing abuse, neglect, or control in childhood, intimate partnerships, or institutional settings. Unlike traditional PTSD, which typically stems from a single traumatic event, CPTSD involves deep disruptions in a person’s sense of self, relationships, and emotional regulation. People with CPTSD may experience intense feelings of shame, chronic anxiety, emotional numbness, flashbacks, difficulty trusting others, and a persistent sense of being “not good enough” or unsafe. For example, a person might constantly second-guess themselves, feel overwhelmed by criticism, shut down during conflict, or have a deep fear of abandonment—even in safe relationships. Therapy for CPTSD is phase-based, focusing on 1) stabilization and grounding, 2) trauma reprocessing, and 3) integration for the purpose of creating safety, building emotional resilience, processing trauma memories at a manageable pace, and restoring a sense of empowerment and identity.
What is Traditional PTSD
Post-Traumatic Stress Disorder (PTSD) is a mental health condition that can develop after experiencing or witnessing a single life-threatening or highly distressing event—such as a car accident, natural disaster, physical assault, or combat exposure. PTSD can leave individuals feeling stuck in a heightened state of fear, even long after the danger has passed. Common symptoms include intrusive memories or flashbacks, nightmares, avoidance of reminders of the trauma, emotional numbness, irritability, and hypervigilance. For example, someone with PTSD might have difficulty sleeping, feel constantly on edge in crowded spaces, or avoid driving after a car crash. Therapy for PTSD involves helping clients feel safe, process the trauma in a way that reduces its emotional intensity, and regain control over their thoughts, emotions, and sense of safety in the world.
How are CPTSD and PTSD similar and different?
Similarities
Trauma-based: Both are responses to traumatic experiences and involve disruptions to the nervous system and sense of safety.
Core Symptoms: Each includes hallmark PTSD symptoms—such as intrusive memories or flashbacks, avoidance of trauma reminders, emotional numbing, and hyperarousal (e.g., insomnia, irritability, exaggerated startle response).
Impact on Functioning: Both can significantly impair relationships, work, self-regulation, and daily life.
Treatment Approaches: Trauma-informed therapies like EMDR, somatic experiencing, and trauma-focused cognitive behavioral therapy can be adapted for both, with adjustments depending on severity and complexity.
Differences
Cause and Duration of Trauma:
PTSD typically results from a single, identifiable traumatic event such as a car accident, natural disaster, assault, or combat exposure.
CPTSD develops from repeated or chronic trauma, especially interpersonal trauma like childhood abuse, neglect, domestic violence, or captivity—often over months or years.
Relationship to the Perpetrator:
PTSD often involves trauma inflicted by an external threat or stranger.
CPTSD frequently stems from betrayal trauma, where the perpetrator is a trusted caregiver, authority figure, or intimate partner.
Impact on Sense of Self:
Individuals with PTSD may experience fear, helplessness, or hypervigilance, but their core identity often remains intact.
Those with CPTSD frequently struggle with a fragmented or negative self-concept, pervasive shame, chronic self-blame, or a sense of being damaged or unworthy.
Emotional Regulation:
PTSD may involve emotional numbing or intense anxiety in response to triggers.
CPTSD is often marked by chronic emotional dysregulation, which can include difficulty identifying or expressing emotions, intense anger, emotional shutdown, or mood instability.
Relational and Attachment Patterns:
People with PTSD may withdraw socially to avoid reminders of trauma but can generally maintain relationships.
People with CPTSD often have long-term struggles with trust, boundaries, intimacy, and feeling safe in relationships due to attachment injuries.
Cognitive and Behavioral Symptoms:
PTSD involves flashbacks, nightmares, hyperarousal, and avoidance of reminders of the traumatic event.
CPTSD may also include these symptoms, but adds persistent negative self-beliefs, dissociation, hopelessness, and a sense of emotional disconnection or meaninglessness.
Recovery Process:
PTSD often responds well to shorter-term trauma-focused therapies once safety is established.
CPTSD usually requires longer-term, phase-based therapy focused on building safety, emotional regulation, relational repair, and identity reconstruction.
***This distinction is crucial, as individuals with CPTSD often go undiagnosed or misdiagnosed, leading to inadequate treatment. Understanding the deeper layers of relational and developmental trauma allows for more compassionate, effective care.
How can trauma emerge during spiritual practice, meditation, or yoga?
Trauma can emerge during spiritual practice when individuals engage in practices that trigger unresolved emotional or psychological wounds. While spiritual practices can be transformative and healing, they can also lead to the surfacing of past trauma due to various reasons:
Mindfulness and Present-Moment Awareness: Practices like mindfulness and present-moment awareness can bring individuals into direct contact with their emotions and experiences. This heightened awareness may lead to the reemergence of past traumatic memories or suppressed feelings.
Body-Centered Practices: Body-centered practices, such as yoga or somatic meditation, can release stored trauma and tension in the body, potentially bringing up past traumatic experiences that were not fully processed.
Meditative States: Deep meditative states or altered states of consciousness can sometimes lead to the surfacing of repressed memories or traumatic experiences.
Reliving Past Trauma: Some forms of therapeutic or spiritual practices intentionally encourage individuals to revisit past traumatic experiences to process and heal from them.
Ego Dissolution: Spiritual practices that involve ego dissolution or dismantling the sense of self may lead to vulnerability and the reemergence of unresolved trauma.
Spiritual Awakening: A sudden and profound spiritual awakening may trigger unresolved trauma as the individual experiences a radical shift in consciousness.
Emotional Release: Spiritual practices that involve emotional release work or cathartic experiences may bring up unresolved trauma.
Revisiting Past Relationships: Engaging in spiritual practices that encourage forgiveness or reconciliation with past relationships may resurface traumatic memories linked to those relationships.
Transpersonal Experiences: Transpersonal or mystical experiences can be transformative, but they can also evoke feelings of vulnerability and the surfacing of unresolved emotional issues.
Loss of Boundaries: Some forms of spiritual practice emphasize dissolving boundaries or experiencing oneness with all things, which can be disorienting and overwhelming, especially for individuals with a history of trauma.