By Sheri Van Dijk, MSW, author of Distress Tolerance Made Easy, and DBT Workbook for Emotional Relief
PTSD and complex post-traumatic stress disorder (CPTSD) are two common diagnoses in individuals who have experienced trauma; we’ll be looking in more detail at each of these diagnoses, including symptoms and diagnostic criteria, in chapter one, where you’ll be able to assess which (if either) of these diagnoses makes sense for you. For now, I’ll mention that the main difference is generally the frequency of the trauma: PTSD tends to be caused by a single traumatic event; CPTSD is usually related to a series of traumatic events or one prolonged event that lasts months or years. CPTSD may also include developmental trauma, when traumatic events occur early in life and disrupt normal sequences of brain development. If you think this description of CPTSD describes you, but you haven’t received a diagnosis of CPTSD, this may be because CPTSD is not recognized as a diagnosis in the Diagnostic and Statistical Manual (DSM), the publication largely used in North America to diagnose mental health problems. In 2018, CPTSD was included as a diagnosis in the International Classification of Diseases (ICD), published by the World Health Organization (WHO) and largely used throughout the rest of the world. So, whether you receive a diagnosis of CPTSD or not will depend in part on where you live and which manual is used by the professional diagnosing you. Advocates continue to work to have CPTSD included in future editions of the DSM with many professionals working in the trauma field recognizing CPTSD as a separate condition that the diagnosis of PTSD doesn’t fully encompass.
Following are three examples to help you begin to understand “simple” PTSD, CPTSD, and CPTSD involving developmental trauma.
PTSD: Casey Casey was working the night shift as a clerk at a convenience store when two men came in wearing masks. One of them pointed a gun at Casey and demanded she call her coworkers to the front of the store. She felt she had no choice, and when her coworkers came in, they were made to sit on the floor while the robbers ransacked the cash register and safe. It was over in minutes, but felt like it lasted for hours. They called the police and, while the men were never caught, the three coworkers were grateful no one was hurt. For months after the robbery, Casey couldn’t work. She found herself having nightmares, intrusive memories, and flashbacks, seeing the gun in her face, and hearing the threatening voices of the robbers. Even though she knew it was over and she was safe, Casey had a constant feeling of dread and the lingering belief that she was going to die. She couldn’t go near the store without having a panic attack and she struggled with anxiety when she had to run errands.
CPTSD: Peter Peter had been married to Amelia for twenty-three years; they had three children, the youngest now sixteen. Everyone thought they were a happy, successful couple, but what they didn’t see was that Amelia’s drinking was out of control. She was verbally and emotionally abusive to Peter when she was drinking and there were even times when she would hit him. One night, in an alcoholic rage at their son for coming home late, Amelia grabbed him by the arm and dislocated his shoulder. They lied at the hospital and said he had fallen down the stairs. Living with Amelia’s drinking and her abusive behavior for so long, Peter was constantly filled with dread. His sleep and physical health were suffering, he worried incessantly about when Amelia would go on a rampage again, and he walked on eggshells trying to prevent this from happening. Peter felt a lot of shame—for being in this situation where he felt like he had no control, for being a bad father and unable to protect his children, and for being a bad husband that Amelia had turned to drinking in the first place. He was also isolating himself, unable to bear the exhaustion of having to pretend all the time, and not wanting others to see the reality of his life.
CPTSD Involving Developmental Trauma: Marlowe Marlowe was the oldest of four children and her parents divorced when she was ten. She and her siblings stayed with their mom, who was bitter and resentful and never let them forget that their dad had left them. Her words hurt them regularly: they were never good enough, their attempts to help around the house were always criticized, and she was very vocal about her disappointments, yelling and screaming her frustrations at them. Now twenty-four years old, Marlowe was beginning to realize that it wasn’t normal or acceptable for her mother to drag her up the stairs by her hair, or to choke her, just because Marlowe had done something she didn’t like. She was also realizing how neglected she and her siblings had been as children, recalling her mother’s refusal to buy her deodorant or shampoo and how she had often gone to school in clothes that were so worn you could see through the fabric. As a young adult, Marlowe struggled with feelings of worthlessness and she had a hard time setting healthy limits in her relationships with others, often trying to please others at the cost of meeting her own needs. She was living on an emotional rollercoaster, struggling with depression at times, and regularly experiencing high anxiety.
PP. 4-6 Excerpt taken from The Dialectical Therapy Skills Workbook for CPTSD
Sheri Van Dijk, MSW, is a psychotherapist and renowned dialectical behavior therapy (DBT) expert. She is author of many books with New Harbinger, including Don’t Let Your Emotions Run Your Life for Teens and The DBT Workbook for Emotional Relief. Her work has focused on using DBT skills to help people manage their emotions and cultivate lasting well-being. In recent years, Sheri has been specializing in complex trauma.
