PTSD and Complex PTSD: What Are They and How Do They Differ?
By David Hennessy, Clinical Psychologist
PTSD and Complex PTSD: What Are They and How Do They Differ?
Post-Traumatic Stress Disorder and Complex Post-Traumatic Stress Disorder are trauma-related conditions that may look similar on the surface, yet differ in ways that matter for understanding a person’s lived experience and support needs.
Trauma can disrupt a person’s sense of safety, predictability, and connection. While many people experience trauma without developing long-term psychological difficulties, others find that its effects persist and shape emotional responses, relationships, and self-understanding.
What Is PTSD? Post-Traumatic Stress Disorder
Post-Traumatic Stress Disorder is a mental health condition that may develop after a person experiences or witnesses a traumatic event involving threat to life, serious injury, or violation of bodily integrity [1].
This may include:
- Serious accidents or natural disasters
- Physical or sexual assault
- Sudden loss of a loved one
- Combat or war exposure
- Threats to life or bodily integrity
Common PTSD Symptoms
PTSD symptoms typically include [1,2]:
- Flashbacks, intrusive thoughts, or nightmares
- Avoidance of reminders associated with the trauma
- Negative changes in thoughts, mood, or self-view
- Hyperarousal, such as irritability, sleep disturbance, or feeling persistently on edge
PTSD can significantly affect daily functioning, relationships, and a person’s felt sense of safety. For a diagnosis, symptoms must persist for more than one month and cause clinically significant distress or impairment [1].
What Is Complex PTSD?
Complex PTSD is a condition recognised in the International Classification of Diseases Eleventh Revision. It is related to PTSD but involves additional and distinct features [2,3].
Complex PTSD typically develops following repeated or prolonged interpersonal trauma, particularly in contexts where escape was limited or impossible. This trauma often occurs during formative developmental periods, though it can also arise in adulthood.
This may include:
- Ongoing childhood emotional, physical, or sexual abuse
- Long-term domestic or family violence
- Captivity, trafficking, or coercive control
- Prolonged exposure to unsafe, chaotic, or neglectful environments
How Complex PTSD Differs
In addition to the core symptoms of PTSD, Complex PTSD is characterised by persistent difficulties across three broad areas [2,3]:
- Emotional regulation
- Sense of self and identity
- Relationships and interpersonal trust
These difficulties may be experienced as:
- Emotions that feel overwhelming, muted, or difficult to regulate
- Chronic shame, guilt, or a pervasive sense of worthlessness
- Deeply held negative self-beliefs and a damaged sense of identity
- Difficulty forming, maintaining, or feeling safe within relationships
These patterns reflect understandable adaptations to long-term threat and relational harm. They are not indicators of personal weakness or lack of effort.
Treatment Options
Both PTSD and Complex PTSD are treatable. Effective treatment is typically individualised and paced, particularly for Complex PTSD, where establishing emotional safety and trust is foundational [4,5].
Evidence-based approaches include:
- Trauma Focused Cognitive Behavioural Therapy [4]
- Eye Movement Desensitisation and Reprocessing [4]
- Schema Therapy, particularly for Complex PTSD [5]
- Sensorimotor Psychotherapy and Internal Family Systems [6]
- Compassion-Focused Therapy and mindfulness-based therapies [7]
Learn more about trauma informed psychological support.
Rather than erasing traumatic experiences, therapy aims to reduce their ongoing impact, strengthen emotional regulation, and support greater flexibility, agency, and quality of life.
Psychologists, Doctors, and PTSD: Working Together
Psychologists often work collaboratively with general practitioners and psychiatrists to provide coordinated, ethical, and person-centred care for people experiencing PTSD or Complex PTSD.
Psychological therapy is usually the first line of treatment [4]. Medication may be considered when symptoms remain severe despite therapy, when there are co-occurring conditions such as anxiety or depression, or when a person is temporarily unable or unwilling to engage in therapy.
Medication does not process trauma directly, but it may reduce symptom intensity and create greater capacity to engage in psychological treatment.
Enquiries and Appointments
https://hennessyclinicalpsychology.com/contact/
References and Resources
- American Psychiatric Association. (2022). DSM 5 TR: Diagnostic and Statistical Manual of Mental Disorders (5th ed., text rev.).
- World Health Organization. (2019). International Classification of Diseases Eleventh Revision. https://icd.who.int
- Brewin, C. R., Cloitre, M., Hyland, P., Shevlin, M., Maercker, A., Bryant, R. A., & van Ommeren, M. (2017). A review of current evidence regarding the ICD 11 proposals for diagnosing PTSD and Complex PTSD. British Journal of Psychiatry, 210(6), 351–356. https://doi.org/10.1016/j.cpr.2017.09.001
- Cusack, K., Jonas, D. E., Forneris, C. A., Wines, C., Sonis, J., Middleton, J. C., & Gaynes, B. N. (2016). Psychological treatments for adults with PTSD. Annals of Internal Medicine, 165(9), 635–644. https://doi.org/10.1016/j.cpr.2015.10.003
- Cloitre, M., Garvert, D. W., Brewin, C. R., Bryant, R. A., & Maercker, A. (2013). Evidence for proposed ICD 11 PTSD and Complex PTSD. Journal of Anxiety Disorders, 27(8), 849–856. https://doi.org/10.1016/j.janxdis.2013.09.002
- van der Kolk, B. A. (2005). Developmental trauma disorder. Psychiatric Annals, 35(5), 401–408. https://doi.org/10.3928/00485713-20050501-06
- Gilbert, P. (2014). The origins and nature of compassion-focused therapy. British Journal of Clinical Psychology, 53(1), 6–41. https://doi.org/10.1111/bjc.12043
- Australian Psychological Society – Understanding Trauma
- Blue Knot Foundation – Support for Complex Trauma
- Phoenix Australia – Trauma Treatment Guidelines
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- Managing Strong Emotions and Emotional Regulation
- Therapy for Anxiety
- Therapy for Depression
- Grief, Loss, and Ongoing Bonds
