Is it Complex PTSD or Complex Trauma? And Does It Matter?
Guest Blog Post by Anita Meyer, LICSW
We often hear the terms complex post traumatic stress disorder (CPTSD) and complex trauma used interchangeably, but are they the same, and more importantly, does it matter?
The term complex trauma is used to describe a vast number of things, which can be confusing. Someone might use the term complex trauma to refer to:
- more than one traumatic incident,
- dissociative symptoms,
- history of chronic childhood abuse and neglect,
- blocked Eye Movement Desensitization and Reprocessing (EMDR) targets,
- difficult case conceptualizations,
- cases that require a lot of consultation, and
- cases that do not easily fit with EMDR standard protocol.
The term complex PTSD (also known as CPTSD), in contrast, is a diagnostic term that refers to specific types of symptoms.
Before the “does it matter?” question can be answered, it is necessary to delve into the origins of diagnoses. Who decides which diagnoses exist? There are two primary sources of mental health diagnoses: the ICD, the International Classification of Diseases , and the DSM, the Diagnostic and Statistical Manual of Mental Disorders. The ICD, currently in the 11th revision, is developed by the World Health Organization (WHO), and it covers all diseases, not just mental health, and as the name implies, it’s international. The DSM, currently in the 5th edition, is developed by the American Psychiatric Association (APA), only covers mental disorders, and is only used in the United States.
Is CPTSD a separate diagnosis from PTSD?
It depends on who is being asked. The ICD recognizes CPTSD as a variant of PTSD (WHO, 2019), characterized by additional and more enduring symptoms, typically arising from prolonged or multiple traumatic experiences. The DSM does not recognize CPTSD as a distinct diagnosis. Of note, the American version of the ICD-10 does not recognize it either. This may be one of the reasons why the term complex trauma is so often used interchangeably.
So, what is the difference between PTSD and CPTSD?
Post-traumatic stress disorder (PTSD) in general is re-experiencing the trauma, avoidance of people, places, or thoughts that remind a person of one or more traumatic events, often accompanied by negative thoughts and a feeling of detachment from the world, and/or hypervigilance and reactivity. This is by no means an exhaustive list of symptoms; there are more that reflect a more complete picture of PTSD symptomatology (APA, 2022).
Alternatively, CPTSD includes all the PTSD criteria plus disturbances in self-organization (DSO) (WHO, 2019). Disturbances in self-organization have three categories:
- difficulty regulating emotions,
- relationship problems, including an inability to trust others,
- and a generally negative image of self.
A broader list of DSO symptoms includes difficulties managing emotions, including heightened emotional reactivity or emotional numbing, negative self-concept, persistent negative beliefs about oneself, including feelings of worthlessness or viewing oneself as a failure, disturbances in relationships, difficulties in forming and maintaining close relationships, feeling distant or cut off from others, and finding it challenging to stay emotionally close to people (Powers et al., 2022; WHO, 2019). More specifically, examples of DSO symptoms within the therapy space can include rejection of compliments, frequent anxiety about psychosocial stressors, a pattern of relationship disruptions that result in distancing themselves, and even inconsistent attendance in therapy. This may sound familiar, especially to those who are trained in Dialectical Behavior Therapy (DBT), because it overlaps with the criteria for borderline personality disorder (BPD). In fact, the reason the APA is hesitant to include CPTSD in the DSM is because of its similarities to BPD (Ford & Courtois, 2014). To better understand this issue, it’s important to compare and contrast these two diagnoses next.
Are CPTSD and BPD the same?
Although there are noticeable similarities, it is essential to examine the distinctions too. CPTSD is classified as a trauma- and stressor-related disorder (WHO, 2019; Rowe, 2019); BPD is classified as a personality disorder (APA, 2022). CPTSD includes a persistent negative sense of self, whereas BPD includes a fluctuating sense of self. Interpersonal difficulties are common to both; however, CPTSD is often characterized by avoidance and disconnection, whereas with BPD there are efforts to connect with others to avoid feelings of abandonment and can include behaviors of self-harm to regulate intolerable emotion (Powers et al., 2022). Given the similarities and nuanced distinctions, differentiating between these two diagnoses can be challenging. The following are some best practices to help in this regard.
EMDR therapist best practices
- Conduct a thorough and ongoing Phase 1 history taking
Although this may be obvious, it is important to keep in mind that EMDR therapy’s Phase 1, history taking, never ends. Pertinent parts of a client’s history can be missed for many reasons; sometimes therapists do not ask, and sometimes the therapist does not know the client well enough yet to understand the best way to elicit necessary information. Sometimes clients fail to mention important life details; they may not believe certain information is relevant, or they are simply not ready to disclose. Be ready to gather additional information throughout treatment.
- Be open to change and pivot when needed
When additional information is revealed that impacts consideration of a differing diagnosis and/or treatment, even if in the middle phase of treatment, be ready to pivot. Familiarize yourself with research that features EMDR therapy with clients who have CPTSD (de Jongh et al., 2019; Rowe, 2019)
- Get Consultation
Similar to history taking, consultation never ends either. Many EMDR therapists think of consultation as necessary for the completion of EMDR basic training and EMDRIA™ Certification, but ongoing consultation is an essential part of all therapy careers. Consultation can assist with teasing out the nuances of overlapping symptoms to reach a more accurate diagnosis.
- Use an assessment tool to identify client diagnoses
The International Trauma Questionnaire (ITQ) is an 18-item questionnaire that acts as an assessment tool for PTSD and complex PTSD (Cloitre, 2018). It is a public domain assessment, which means it is free for therapists to use. It’s very easy to administer and to score. Many other websites offer access to free assessments such as the National Center for PTSD or Novo Psych Assessments.
Finally, does language matter?
Does it matter whether the term Complex PTSD or complex trauma is used? Words matter and language matters. Although rigidity is rarely the best approach, it is important to be specific in choice of terms. Remembering that the term complex trauma can be interpreted in multiple ways is also important. Accurate diagnoses matter too. Diagnoses do not dictate treatment, but they certainly guide it. Being able to distinguish between PTSD, CPTSD, and BPD will have a direct impact on treatment and therapist focus.
Anita Meyer has over 35 years of clinical experience. She is an EMDRIA Approved Consultant™ specializing in CPTSD, dissociation, and sexual abuse survivors and is the founder of Liberating Lives in Washington. Meyer also collaborates with Thrive Training and Publications to provide EMDRIA Advanced Trainings on various topics including CPTSD.
References
American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (5th ed., text rev.). https://doi.org/10.1176/appi.books.9780890425787
Beckford, J., Birke, J., Krakowczyk, J. B., Hesse, S., Hinney, A., Doorie, N., Schneider, J. S., Komlenac, N., Bauerle, A., & Teufel, M. (2025). PTSD and CPTSD in the new ICD-11 – A latent profile analysis. Psychiatry Research, 344, 116350. https://doi.org/10.1016/j.psychres.2024.116350
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. https://doi.org/10.1111/acps.12956
de Jongh, A., Bicanic, I., Matthijssen, S., Amann, B. L., Hofmann, A., Farrell, D., Lee, C. W., & Maxfield, L. (2019). The current status of EMDR therapy involving the treatment of complex posttraumatic stress disorder. Journal of EMDR Practice and Research, 13(4), 284–290. https://doi.org/10.1891/1933-3196.13.4.284
Ford, J. D. & Courtois, C. A. (2014). Complex PTSD, affect dysregulation, and borderline personality disorder. Borderline Personality Disorder and Emotion Dysregulation, 1(9). https://doi.org/10.1186/2051-6673-1-9
Horesh, D., & Lahav, Y. (2024, September). Introduction to In Session special issue: Psychotherapy for complex PTSD. Journal of Clinical Psychology, 80(12), 2321-2325. https://doi.org/10.1002/jclp.23739
Horesh, D., & Lahav, Y. (2024, April). When one tool is not enough: An integrative psychotherapeutic approach to treating complex PTSD. Journal of Clinical Psychology, 80(7), 1689-1697. Open access: https://doi.org/10.1002/jclp.23688
International Trauma Consortium. (n.d.). International Trauma Questionnaires (ITQ). Trauma Measures Global. Retrieved September 25, 2026, from https://www.traumameasuresglobal.com/ptsd
Novopsych Pty Ltd. (n.d.). Assessments. Novopsych. Retrieved September 25, 2026, from https://novopsych.com/assessments/
Powers, A., Petri, J. M., Sleep, C., Mekawi, Y., Lathan, E. C., Shebuski, K., Bradley, B., & Fani, N. (2022). Distinguishing PTSD, complex PTSD, and borderline personality disorder using exploratory structural equation modeling in a trauma-exposed urban sample. Journal of Anxiety Disorders, 88:102558. https://doi.org/10.1016/j.janxdis.2022.102558
Rowe, T. (2019). The efficacy of eye movement desensitization and reprocessing (EMDR) in individuals diagnosed with either C-PTSD or PTSD. Dissertation Manuscript. Northcentral University.https://search.proquest.com/openview/fc6814696b057674565b9714e9856775/1?pq-origsite=gscholar&cbl=18750&diss=y
Shapiro, F. (2018). Eye movement desensitization and reprocessing (EMDR) therapy: Basic principles, protocols, and procedures (3rd ed.). Guilford Press.
Shevlin, M., Hyland, P., Roberts, N. P., Bisson, J. I., Brewin, C. R., & Cloitre, M. (2018). A psychometric assessment of disturbances in self-organization symptom indicators for ICD-11 complex PTSD using the International Trauma Questionnaire. European Journal of Psychotraumatology, 9(1):1419749. https://doi.org/10.1080/20008198.2017.1419749
U.S. Department of Veterans Affairs, National Center for PTSD. (n.d.). Measures by type. Retrieved September 25, 2026, from https://www.ptsd.va.gov/professional/assessment/list_measures.asp
World Health Organization. (2019). International statistical classification of diseases and related health problems (11th ed.). https://icd.who.int/
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