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The Difference Between PTSD & Complex PTSD, a Neuroscience Perspective 🧠
Different Traumas, Different Impacts: Exploring the Varied Effects of PTSD and Complex PTSD (6min read)
PTSD arises from a single trauma, causing stress responses and flashbacks.
C-PTSD results from prolonged trauma, leading to emotional and relational difficulties.
Both affect key brain areas, but C-PTSD's impacts are broader.
Chronic trauma can result in persistent stress and physical symptoms.
Understanding these disorders guides treatment strategies.
Brain plasticity enables healing from both conditions.
Today, we are going to dive deep into one of my favorite topics, trauma!
We’ll be talking about two flavors specifically, PTSD & its lesser-known counterpart, CPTSD, or Complex Post Traumatic Stress Disorder!
I hope that by the end you’ll understand these 2 things are very different, and I believe should be treated as such!
CPTSD is what I focus on, and see the most in my own practice & clients.
68% of people struggle with relational trauma/CPTSD, it's just not talked about much, in fact, I generally see more people with CPTSD than PTSD overall, people just don't know there's a difference.
Let’s dive in.
To truly understand the difference between these two things, we need to break each down to see how they overlap!
PTSD is commonly associated with soldiers returning from war, or survivors of a singular traumatic event, such as a car accident, natural disaster, or assault.
The brain, a malleable organ continually adapting to experiences, reacts to such traumatic incidents by altering its stress response system.
Imagine driving on a quiet road when suddenly a deer springs in front of your car.
Your heart pounds, adrenaline surges, and you swerve to avoid it.
Now, imagine feeling that level of alarm and fear every time you get in the car, or even just see a deer, months after the event.
This is an oversimplified way to think about the lived experience of someone with PTSD.
Complex PTSD: A Different Beast
While PTSD springs from a single or a few traumatic events, Complex PTSD is born from prolonged exposure to trauma or abuse, often in childhood or intimate relationships.
This could include persistent domestic violence, chronic neglect, or long-term emotional abuse.
The trauma is repetitive, pervasive, and inescapable.
They both have crossover symptoms like flashbacks, panic, dissociation, memory loss, & shifts in personality & behavior, but there are some additional symptoms that come with CPTSD:
Difficulties with emotional regulation
Difficulties with interpersonal relationships
A sense of hopelessness or despair
Struggling to form and maintain secure attachments and relationships
Here’s an example I see nearly daily…
Imagine a woman who has experienced repeated emotional abuse from a partner, they may find it difficult to trust others, even years after the abusive relationship has ended.
She may struggle with feelings of worthlessness, a distorted self-image, and emotional flashbacks to the abusive events.
She may also have difficulty managing her emotions and may feel persistently "on edge".
This constant hyperarousal of her Nervous System is like an alarm system that won't turn off.
These are hallmarks of Complex PTSD.
So, what’s going on in the Mind, Brain & Body that causes these kinds of symptoms?
What’s Happening in the Mind, Brain & Body?
If you’d like an in-depth review of this, I suggest you read my blog called “The Neuroscience of Trauma.”
I’ll cover the basics here because I believe that understanding the basic Neuroscience of PTSD/CPTSD is important so that you can feel empowered to take your mental health into your own hands!
The most important thing to understand is that this kind of trauma is stored in the body, brain, and mind, not just the mind.
The Neuroscience of PTSD
PTSD is strongly linked to three key areas of the brain.
The amygdala, our emotional processing center, often becomes hyperactive, pushing the individual into a state of heightened fear and anxiety.
Meanwhile, the prefrontal cortex - the part of our brain that regulates emotions and makes decisions - may become underactive, making it harder to control these intense feelings.
Lastly, the hippocampus, our memory center, can shrink under the stress, causing fragmented memories and flashbacks.
What About CPTSD?
Neurologically, C-PTSD shares much with its PTSD sibling, but the impacts are often broader and more profound, extending to the person's self-concept and relationships.
In C-PTSD, repeated trauma can severely disrupt the development and functioning of the brain, especially when it occurs during childhood when the brain is most malleable.
The prefrontal cortex can become chronically inhibited, which impacts the person's ability to regulate their emotions and may lead to outbursts of anger or periods of numbing.
The Inflamed Nervous System
Emotional abuse or neglect puts you in survival mode constantly and hyperactivates things like your amygdala, HPA Axis & Autonomic Nervous System (ANS).
When these systems are activated, chemicals like adrenaline & cortisol are released.
These are stress chemicals, and short bursts/periods can be beneficial for our survival.
In fact, exercise releases these kinds of chemicals too, I wanted to mention this so that you don’t think these things are always bad.
The difference between trauma that leads to CPTSD and exercise is that you don’t exercise for months or years at a time.
You have a break. Your mind, brain, and body have a chance to recover and recuperate!
Sadly, people who are experiencing mental or emotional abuse don’t ever get to recover, they’re stuck in these situations, which means they stay in a hyper-activated state.
This chronic stress state creates low-grade inflammation in the mind, brain, and body which can lead to the symptoms we talked about earlier.
This comes from this trauma being stored in our bodies.
How Does Trauma Get Stored in the Body?
You may be wondering how trauma that happens outside of us gets stored in our body, so let me explain.
What happens over time as we’re stuck in these traumatic situations, is that your Peripheral NS is taking in the sensory input (abuse).
This signal goes through your nerves and brain, to the mind and when trauma gets to the mind it says to the brain, "I can't deal with this, you hold on to it please."
To which the brain says, "I don't have extra space up here, each nerve is accounted for... I'll have to send this back down to the body..."
So, the brain sends a signal to the hypothalamus, which turns the trauma into an endocrine/hormonal message, not just a nerve or electrochemical message, and stores it back in the body through our hormones & immune system.
It can get stored in our muscles, facia, skin, etc., and show up as chronic pain, eczema, muscle tension, headaches, etc.
This is how trauma gets stored in our bodies, and this is a very important thing to understand when trying to heal CPTSD!
It’s also why Bottom Up methods are more effective (in my experience with clients & based on research) for treating trauma and CPTSD.
Recognizing the distinction between PTSD and C-PTSD is not just an academic exercise. It is vital for developing targeted therapeutic strategies.
I have written extensively on this topic!
If you’d like to learn about Top-Down vs. Bottom-Up methods for healing CPTSD, I suggest you read, “Top-Down or Bottom-Up for Healing Trauma?”
I’ve also written about the exact methodology, Internal Family Systems, that I use with my trauma clients!
You’ve Got This
The journey of understanding and healing from PTSD or C-PTSD is not an easy one.
But know this: the brain, with its remarkable plasticity, can heal and adapt.
You are not defined by your past.
Like the ever-changing landscape of our minds, there is always room for growth, transformation, and healing.
Until next time… Live Heroically 🧠
"The posttraumatic stress disorder field trial: evaluation of the PTSD construct--criteria A through E." Davidson, J.R.T., et al. (1998) in The American Journal of Psychiatry.
"A Review of Hippocampal Structural Alterations in Posttraumatic Stress Disorder" by Karl A. et al. (2006) in Neuropsychobiology.
"Amygdala Hyperreactivity in Borderline Personality Disorder: Implications for Emotional Dysregulation" by Donegan, N.H., et al. (2003) in Biological Psychiatry.
"The Development of Chronic Post-Traumatic Stress Disorder After Four or More Consecutive Hours of Monotonous Driving" by Broadbent, E. et al. (2004) in Applied Cognitive Psychology.
"Complex PTSD: Symptoms, behaviors, and controversy." by Nickerson, A., et al. (2015) in Asian Journal of Psychiatry.
"Emotion Modulation in PTSD: Clinical and Neurobiological Evidence for a Dissociative Subtype" by Lanius, R.A., et al. (2010) in The American Journal of Psychiatry.
"Developmental Trauma Disorder: Pros and Cons of Including Formal Criteria in the Psychiatric Diagnostic Systems" by Van Der Kolk, B.A. (2013) in BMC Psychiatry.
"Cortisol function among early school-aged homeless children" by Cutuli, J.J., et al. (2010) in Psychoneuroendocrinology.
"The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma" by Van der Kolk, B. (2014). Viking.
"Trauma, PTSD, and Resilience A Review of the Literature" by Bonanno, G.A., et al. (2011) in Trauma, Violence, & Abuse.