What is the Difference Between PTSD and Complex PTSD?

Quick Summary

“PTSD and Complex PTSD (C-PTSD) both involve symptoms like re-experiencing, avoidance, and a sense of current threat. Complex PTSD includes these PTSD symptoms plus “disturbances in self-organization (DSO)”: ongoing difficulties with emotion regulation, a persistently negative self-concept, and relationship problems. C-PTSD is recognized in ICD-11, often linked with prolonged, repeated interpersonal trauma, and may call for a more staged, skills-plus-processing approach.”

PTSD vs Complex PTSD (C-PTSD) Comparison

Feature	PTSD	Complex PTSD (C-PTSD)
Core symptoms	Re-experiencing (e.g., intrusive memories, nightmares), avoidance, sense of current threat (hypervigilance/startle)	PTSD symptoms + DSO
Disturbances in self-organization (DSO)	Symptoms affecting mood, thinking, or arousal may be present, but they are not the main focus of the diagnosis	Present: emotion regulation difficulties, negative self-concept, relationship disturbances
Typical trauma pattern	Can follow single-event or repeated trauma	Often associated with prolonged or repeated interpersonal trauma where escape felt difficult (e.g., chronic childhood abuse/neglect, captivity, domestic violence)
Identity impact	Trauma-related beliefs may shift self-view	More pervasive shame, guilt, worthlessness, or a “damaged” sense of self
Relationship impact	Avoidance or mistrust may occur	More persistent problems with trust, closeness, boundaries, or feeling safe with others
Emotion regulation	Heightened arousal and reactivity	Broader dysregulation (anger, numbness, overwhelm, rapid shifts) tied to DSO
Treatment implications (high-level)	Often responds well to evidence-based trauma-focused approaches	May benefit from a phased plan when DSO is prominent: stabilization and skills (grounding, emotion regulation, values-based coping) plus trauma-focused work, tailored pacing

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Understanding Trauma, PTSD, and Complex Trauma

A lot of confusion comes from the fact that these words describe different things.

• Trauma describes an experience (or ongoing experiences) that overwhelm the nervous system and a person’s sense of safety.

• PTSD is a specific diagnosis with defined symptom clusters. Not everyone who experiences trauma develops PTSD. (American Psychiatric Association, 2022)

• Complex trauma typically describes a pattern of exposure: repeated, prolonged, interpersonal trauma (often in childhood or in situations where leaving was not possible). It is not, by itself, a diagnosis. (Herman, 1992)

• Complex PTSD (C-PTSD) is a diagnosis recognized in ICD-11 that includes the core PTSD symptoms plus additional symptoms often called Disturbances in Self-Organization (DSO). (Cloitre et al., 2018; National Center for PTSD, 2025)

How these terms are commonly used

People often use these terms when they are trying to understand:

• “Trauma vs PTSD”: usually reflects questions about the difference between exposure and diagnosis.

• “Complex trauma vs PTSD”: often reflects questions about how chronic, repeated trauma can change symptoms, identity, and relationships.

• “Complex PTSD vs PTSD”: typically reflects questions about the ICD-11 diagnosis and the role of DSO.

Key takeaway: These terms overlap, but they are not interchangeable. When they get blended together, people often feel misinformed or misunderstood.

What Makes Complex PTSD Different?

In ICD-11, Complex PTSD includes the PTSD symptom clusters plus Disturbances in Self-Organization (DSO). DSO is the part that often makes people say, “Standard PTSD explanations do not fully fit me.” (Cloitre et al., 2018; National Center for PTSD, 2025)

Disturbances in Self-Organization (DSO)

DSO refers to patterns that can develop after prolonged, repeated trauma, especially when the trauma occurred in conditions of limited escape, control, or protection.

In plain language, DSO often shows up as:

• Ongoing emotion regulation difficulties (big swings or emotional shutdown)

• A painful self-story (shame, worthlessness, or a chronic sense of defectiveness)

• Persistent relational disruptions (distance, mistrust, or intense fear of closeness)

Clinical tools like the International Trauma Questionnaire (ITQ) were designed to assess ICD-11 PTSD and C-PTSD and include items that map directly to the DSO domains. (Cloitre et al., 2018; National Center for PTSD, 2025)

Emotion regulation difficulties

This is more than “hyperarousal.” Some people notice:

• a rapid jump from calm to overwhelmed

• a long recovery time after stress

• numbness or shutdown when emotions feel unsafe

Important nuance: emotion regulation problems do not mean you are “too emotional.” They often reflect a nervous system that learned to protect you through speed, intensity, or disconnection. (Cloitre et al., 2018)

Negative self-concept

Many people with complex trauma describe feeling:

• ashamed rather than simply afraid

• guilty even when they logically know they were not at fault

• fundamentally flawed or “less than,” especially in relationships

This can look like chronic self-criticism, perfectionism, people-pleasing, or avoidance that is fueled by the belief, “If I make a mistake, I will be rejected.” (Herman, 1992; Cloitre et al., 2018)

Relationship and attachment impacts

Complex PTSD often carries a strong relational signature:

• difficulty trusting intentions

• pulling away or going numb when closeness increases

• intense sensitivity to abandonment, criticism, or power dynamics

• uncertainty about boundaries (over-giving, over-accommodating, or shutting down)

These patterns are not character flaws. They often make sense as adaptations to environments where safety depended on predicting, pleasing, or staying invisible. (Herman, 1992; National Center for PTSD, 2025)

Why ICD-11 Recognizes Complex PTSD

People sometimes assume that if a diagnosis is not in the DSM, it is “not real.” That is not accurate.

• ICD-11 is the World Health Organization’s global classification system used widely for health reporting.

• DSM-5-TR is a U.S.-based diagnostic manual used heavily in clinical training, research, and insurance contexts.

ICD-11 includes Complex PTSD to improve clarity in trauma presentations where the core PTSD symptoms are present and the DSO domains are prominent and impairing. (Maercker et al., 2022)

What recognition does and does not mean

• It does mean: clinicians have a structured way to describe a trauma presentation that includes PTSD plus significant identity, regulation, and relationship impacts.

• It does not mean: that everyone with chronic trauma “must” have Complex PTSD, or that DSM-based PTSD is somehow inferior.

Different systems emphasize different aims. Clinically, what matters most is whether the framework helps you and your provider understand your symptoms and choose a helpful treatment plan. (American Psychiatric Association, 2022; Brewin et al., 2017)

How C-PTSD Treatment and Pacing May Differ

This is not a treatment plan or medical advice. It is a high-level overview of what often changes when DSO symptoms are prominent.

1) Pacing and stabilization often matter more

When someone is living with strong DSO patterns, treatment often starts by building skills that increase stability and capacity, such as:

• grounding and present-moment skills

• emotion regulation and distress tolerance

• strengthening supportive routines and safe relationships

This is consistent with major clinical guideline approaches that emphasize evidence-based care and tailoring to the individual’s presentation and co-occurring needs. (VA/DoD, 2023)

2) The targets are broader than fear memories

Standard PTSD care often focuses on reducing re-experiencing, avoidance, and hyperarousal. With complex PTSD, therapy may also focus on:

• repairing a shame-based self-story

• practicing boundaries and healthy assertiveness

• building a steadier sense of identity and values

3) ACT-consistent framing can be helpful

In my work, I often use ACT-informed skills to support recovery by strengthening psychological flexibility, including:

• noticing trauma-driven thoughts without obeying them

• making room for emotions without getting trapped by them

• reconnecting with values, meaning, and chosen direction

This is not about forcing positivity. It is about reclaiming life space from trauma’s rules. (Hayes et al., 2016; VA/DoD, 2023)

Why Many People Feel “Standard PTSD Explanations Don’t Fit”

If you have lived through repeated trauma, you may recognize this:

• It is not only fear. It is shame, disconnection, and a belief that something is wrong with you.

• It is not only flashbacks. It is a persistent sense of danger in relationships.

• It is not only avoidance. It is a whole pattern of living smaller to avoid getting hurt again.

When trauma happened in relationships, it often leaves “relational footprints.” That can affect self-trust, boundaries, communication, and the ability to feel safe with safe people. (Herman, 1992; Cloitre et al., 2018)

A gentle reflection

If you are unsure where you fit, consider:

• When I feel triggered, do I mostly feel fear, or do I also feel shame and defectiveness?

• Do my symptoms show up mainly around reminders of an event, or do they show up broadly in relationships and self-worth?

• Is the hardest part managing memories, or managing the way my body and identity respond in everyday life?

These questions are not for self-diagnosis. They are a starting point for clearer language and better support.

Further Reading & References

Further Reading (Helpful Resources)

• Complex PTSD: history and definitions (VA National Center for PTSD)

• Complex PTSD: assessment and treatment (VA National Center for PTSD)

• International Trauma Questionnaire (ITQ) overview (VA National Center for PTSD)

• ISTSS prevention and treatment guidelines (overview page)

• Online trauma therapy: what to expect

• PTSD and relationships

References (Research & Evidence)

• American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (5th ed., text rev.; DSM-5-TR). American Psychiatric Association Publishing

• Brewin, C. R., Cloitre, M., Hyland, P., Shevlin, M., Maercker, A., Bryant, R. A., et al. (2017). A review of current evidence regarding the ICD-11 proposals for diagnosing PTSD and complex PTSD. Clinical Psychology Review, 58, 1-15.

• Cloitre, M., Shevlin, M., Brewin, C. R., Bisson, J. I., Roberts, N. P., Maercker, A., Karatzias, T., & Hyland, P. (2018). The International Trauma Questionnaire: Development of a self-report measure of ICD-11 PTSD and complex PTSD. Acta Psychiatrica Scandinavica, 138(6), 536-546.

• Hayes, S. C., Strosahl, K. D., & Wilson, K. G. (2016). Acceptance and commitment therapy: The process and practice of mindful change (2nd ed.). Guilford Press.

• Herman, J. L. (1992). Complex PTSD: A syndrome in survivors of prolonged and repeated trauma. Journal of Traumatic Stress, 5(3), 377-391.

• Maercker, A., Cloitre, M., Bachem, R., Schlumpf, Y. R., Khoury, B., Hitchcock, C., & Bohus, M. (2022). Complex post-traumatic stress disorder. The Lancet, 400(10345), 60-72.

• National Institute for Health and Care Excellence. (2018, last reviewed 2025). Post-traumatic stress disorder (NG116).

• National Center for PTSD. (2025). Complex PTSD. U.S. Department of Veterans Affairs.

• U.S. Department of Veterans Affairs & U.S. Department of Defense. (2023). VA/DoD clinical practice guideline for the management of posttraumatic stress disorder and acute stress disorder

• World Health Organization. (2025). ICD-11: International classification of diseases (11th revision).

Frequently Asked Questions

• What is the difference between trauma and PTSD?

  Trauma is the experience of overwhelming threat or violation. PTSD is a diagnosis with specific symptom clusters and an impairment requirement. Many people experience trauma without meeting criteria for PTSD, and many people experience trauma-related distress that deserves support regardless of diagnosis.

• Is chronic PTSD the same as Complex PTSD?

  Not exactly. People sometimes use “chronic PTSD” informally to mean long-lasting PTSD symptoms. Complex PTSD is a specific ICD-11 diagnosis defined as PTSD plus DSO symptoms (emotion regulation difficulties, negative self-concept, and relational disturbances).

• Why is Complex PTSD not in the DSM-5-TR?

  The DSM-5-TR recognizes PTSD and includes ways to describe different presentations, but it does not include Complex PTSD as a distinct diagnosis. ICD-11 includes Complex PTSD as a separate diagnosis to improve clinical clarity for people who have PTSD plus prominent DSO symptoms.

• Can someone have both PTSD and Complex PTSD?

  In ICD-11 terms, Complex PTSD includes the core PTSD symptom clusters plus DSO symptoms. So within that framework, clinicians typically use one label depending on which criteria are met. In practice, you can meet PTSD criteria and also experience additional difficulties in identity and relationships, which is why clear assessment matters.

• Does Complex PTSD require different treatment?

  Not always different, but often different emphasis. When DSO symptoms are prominent, treatment commonly includes careful pacing, stabilization skills, and attention to shame, identity, and relationship patterns, alongside evidence-based trauma care.