Complex PTSD, also known as C-PTSD, is a mental health condition that develops in response to either a single traumatic event, but more often entails a prolonged or a series of experiences of severe trauma. Unlike traditional PTSD, which is typically triggered by a single traumatic event, complex PTSD is usually underpinned by ongoing exposure to severe trauma over an extended period.
Individuals with complex PTSD often experience a range of difficult symptoms that can significantly impact their quality of life. These symptoms may include issues with emotional regulation, a sense of worthlessness or badness, persistent feelings of shame and guilt that may be related to the traumatic event, difficulties forming and maintaining relationships, including difficulties with being close to others.
Complex PTSD can hence significantly impact the individuals social, romantic, and professional relationships, which often leads to increasing isolation and alienation. This may perpetuate the feelings of inadequacy, worthlessness and further diminish one’s self-esteem.
Complex PTSD also has high comorbidity with suicidal ideation, addiction, substance abuse, and symptoms of depression and anxiety.
Treatment of Complex PTSD
Psychotherapy is considered the first-line or primary treatment for complex PTSD. However, treatment may, at times, also involve medication.
Through therapy, individuals can explore their past traumas and develop coping mechanisms for managing symptoms. Psychotherapeutic treatment will often be of longer duration than in the case of PTSD and may need to involve special attention to co-morbid disorders and other symptoms, such as depression, anxiety, addiction, substance abuse.
Diagnosing complex PTSD can be challenging due to the overlap of symptoms with other mental health conditions such as personality disorders, especially borderline personality disorder (BPD), depression and anxiety disorders. A comprehensive evaluation by a qualified healthcare professional is essential to accurately diagnose and develop an appropriate treatment plan. Treatment of complex PTSD may also involve psycho-education and counselling support.
A non-judgemental and supportive attitude from their social circle is fundamental in offering help to someone struggling with C-PTSD.
Differentiating Between Complex PTSD and Borderline Personality Disorder (BPD)
Because of their overlapping symptoms and other characteristics, complex PTSD and borderline personality disorder (BPD) can be misdiagnosed, which is why it is important to perform a thorough differential diagnosis. Only the right diagnosis can then lead to an effective and safe treatment.
Borderline Personality Disorder (BPD) is a distinct personality disorder characterised by unstable self-image, intense emotions, impulsivity, and difficulties in relationships. Individuals with BPD also present with fears of abandonment or separation, and may exhibit self-destructive behaviours and suicidal ideation.
Complex PTSD typically stems from prolonged exposure to traumatic events and will need to involve all symptoms of PTSD for diagnosis. It will also need to involve the memory of the traumatic event, which in the case of BPD is not a diagnostic requirement. Conversely, in the case of BPD, PTSD symptoms do not need to be present.
Additionally, whilst both C-PTSD and BPD can be characterised by a sense of diminished self-worth and self-esteem, in the case of C-PTSD there is normally a persistent and stable sense of poor self-worth, whilst in the case of BPD there will normally be some shifting between feelings of inadequacy, on one hand, and self-idealisation or inflated sense of self-worth on the other. Also, with BPD, the shifts in the sense of self will often be accompanied by shifts in the experience of others.
Fears of abandonment and separation are another differentiating factor as they are an important part of BPD but are not necessarily present with complex PTSD.
Because of the overlap in the characteristics between BPD and C-PTSD, individuals that may fit the diagnosis of BPD more may be misdiagnosed with C-PTSD. Additionally, because of the controversies associated with diagnosing personality disorders, some mental health professionals may shy away from diagnosing them and may lean towards the diagnosis of C-PTSD instead.
Ales Zivkovic, MSc (TA Psych), CTA(P), PTSTA(P), Psychotherapist, Counsellor, Supervisor
Ales Zivkovic is a psychotherapist, counsellor, and clinical supervisor. He holds an MSc in Transactional Analysis Psychotherapy awarded by Middlesex University in London. He is also a Provisional Teaching and Supervising Transactional Analyst (PTSTA-P) and a Certified Transactional Analyst in the field of Psychotherapy (CTA-P). Ales gained extensive experience during his work with individuals and groups in the UK National Health Service (NHS) and his private psychotherapy, counselling, and clinical supervision practice in central London, UK. He was also a member of the United Kingdom Council for Psychotherapy (UKCP). Ales works with individuals, couples, and groups. In clinical setting, he especially focuses on the treatment of issues of childhood trauma, personality disorders, and relationship issues. A large proportion of his practice involves online psychotherapy as he works with clients from all over the world. Ales developed a distinct psychotherapeutic approach called interpretive dynamic transactional analysis psychotherapy (IDTAP). More about Ales, as well as how to reach him, can be found here.
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