Misdiagnosis of CPTSD is common. The lack of knowledge and understanding of CPTSD is huge. Worst of all, the unwillingness to help and support, within our Healthcare Systems, is heartbreaking.
Misdiagnosis
Complex Post Traumatic Stress Disorder (CPTSD) is frequently misdiagnosed as Emotionally Unstable Personality Disorder (EUPD), previously known as Borderline Personality Disorder (BPD).
CPTSD is kind of like a subset of PTSD but it looks quite different. Complex PTSD comes from long-term exposure to trauma and/or neglect; oftentimes it stems from childhood sexual, physical, and emotional abuse, neglect, or long-term trauma whereby escape would be seemingly impossible or too dangerous. We see CPTSD in survivors of long-term childhood abuse, human trafficking, refugees, or people that have experienced long-term domestic violence or intimate partner violence.
The chronic nature of the trauma and the inescapability of it, for whatever reason, be it age or risk to life, makes CPTSD quite different from PTSD which in contrast is far more episodic. PTSD is usually caused by trauma seen in combat, a car accident, or a natural disaster, it is one event as opposed to long-term, often years, of trauma building up incident by incident with no safe attachments and no escape in sight.
There’s a tremendous crossover between PTSD and CPTSD; flashbacks, night terrors, dissociation, fugue states, emotional dysregulation, and hypervigilance. There are core differences that mean behavioural patterns, cognitive thinking and rationale, relationship issues, and disturbances in the sense of self, present in a way that lessens the likelihood of CPTSD being ‘misdiagnosed’ as PTSD. Instead, CPTSD is often labeled as EUPD (previously BPD) and a myriad of other diagnoses such as panic disorder, depression, anxiety, etc.
EUPD (previously BPD) has a large overlap with CPTSD and it’s something the entire field of psychology struggles with. Particularly, here in the UK where CPTSD is basically unheard of, definitely by primary care services and oftentimes by secondary care services. It is simply not a diagnosis many clinicians are given much information about, only psychiatrists and trauma-specialised psychologists are ‘in the know’. This leaves the survivor feeling more alienated, further dissociated, self-blaming, and reinforces the fear of relationships.
EUPD is a fear-based Personality Disorder, it is led almost exclusively by a chronic fear of abandonment. This is something that you don’t see so much of in CPTSD survivors, there is some level of it in all of us, but with CPTSD it is more the fear of the relationship itself as opposed to abandonment. People who have CPTSD feel that relationships and interpersonal spaces are unsafe places to be.
EUPD (BPD) sufferers usually have an unstable sense of identity, almost as if they don’t know who they are. Whereas people with CPTSD have a distorted sense of self, viewing themselves as shameful, to blame, and effectively just a bad person. They know who they are, it’s simply a warped view induced by the trauma. The two views are very different.
EUPD (BPD) is a mental health condition with the highest rate of suicide, higher than depression, anxiety, PTSD, or any other illness. Suicidal ideation or gestures and self-harming behaviours are more congruent with EUPD. This is a tricky one though, as there is still a high risk in CPTSD clients due to the sheer level of trauma and distorted sense of self. Self-harming behaviours and suicidal intention is dangerous and more of a classic symptom of EUPD, but we can see it in CPTSD if the person has been retriggered or is going through new trauma.
We know that something EUPD and CPTSD have in common is early trauma. It is often the case that a person with EUPD has suffered childhood abuse or trauma however, not all have. Not every person out there in the world with EUPD has a history of significant, chronic, childhood trauma, EUPD can be hereditary. With Complex PTSD this is far, far more likely to be the case; there has to have been at least one period in their life where they have experienced long-term, chronic, repetitive, and inescapable trauma. Most often, though not exclusively, this trauma is experienced in early childhood and then follows them as a ‘blueprint’ as they go through life; leading CPTSD survivors to unintentionally fall into unsafe relationships, abusive marriages etc.
Ignorance
I write a fair bit about Complex PTSD. In part, this is because I do a fair amount go work for the CPTSD Foundation and I am a survivor myself. That being said, I have experienced firsthand that ignorance of the condition within our healthcare system both private and public.
The UK is not trained to deal with Complex trauma the professionals and clinicians are seemingly terrified to deal with it, likely because they feel they lack the training. We love calling ourselves ‘Trauma-informed’ and ‘Trauma led’, and yet there is such a gap in the understanding of what ‘trauma’ can actually look like.
When domestic abuse charities claim to be ‘Trauma informed’ and run programs, women’s refuges, man entire county hotlines for advice, yet none of the staff have even heard of CPTSD … there is a problem.
When band 8a Community Mental Health Nurses, decide to book a patient with CPTSD in for a session with two clinicians each week, simply as a deterrent to stop the patient from disclosing any trauma (because THEY feel unqualified to deal with it) … we have a problem.
When counsellors and psychotherapists have ‘Trauma’ on their bio but haven’t heard of CPTSD let alone completed any training/CPD on the subject, nor have they knowingly treated any patient with CPTSD … we have a problem.
GPs are not allowed to prescribe the type of medication required nor are they able to diagnose Complex PTSD, this has to be done by a psychiatrist and yet, GPs are not trained to recognise the signs of CPTSD. They haven’t heard of it, nor have the crisis teams or community mental health teams they refer to, so it goes untreated or worse, treated as depression, anxiety, panic attacks I.e the things a GP is allowed to diagnose and treat. Referrals are made for NHS counselling, but the NHS delivers CBT as an (almost) mandatory response and CBT simply is not the therapy to aid CPTSD.
‘Do no harm’ is what our Nurses and doctors swear to uphold; so it is understandable that when faced with Complex trauma and the symptoms it presents, they shrink away from the patient in fear of causing ‘more harm than good’. Counsellors and therapists preemptively worry themselves sick about transference, attachment issues, and possible complications around flashbacks or dissociation. Before the patient knows what is happening they have been referred to, as the professional cannot tell the difference between the terrifying *cluster B* that is EUPD/BPD and Complex PTSD. Heaven knows finding a therapist willing to try and treat EUPD is hard enough.
This fear of ‘doing more harm than good’ and effectively passing the buck, (the ‘buck’ being a trauma survivor!), is so incredibly ironic. People with CPTSD are afraid of the relationship space, they blame themselves for their trauma, and they view themselves as too much, too disgusting, too shameful, and quintessentially bad as humans. The way the healthcare field reacts, that ‘passing the buck’, does nothing but retraumatise and consolidate this distorted sense of self. The sad truth is that the system is set up in such a way, due to the lack of training and general understanding, that the ‘do no harm’ actively becomes ‘doing more harm than good’.
As a professional, clinician, front-line support worker, and educator … if you want to claim being ‘trauma-informed’ and ‘trauma led’ then you need to do the research and get a good grasp of CPTSD because it is all around us, unseen, unheard and untreated. The links below are excellent for much more in-depth knowledge.
About Me:- Who am I?
Well, first off what does that even mean? How do I answer that? As a human being I am always growing and developing, we are not human-dones now are we? Who I am today is technically, a little more than who I was yesterday and a little less than I will be tomorrow.
For the ‘traditionalists’ … I’m from the South of the UK. I have a Law Degree, almost finished with my Counselling and Psychology degree and I work with teenagers as a progression mentor, a large number of whom suffer with challenging behaviour, mental health conditions and physical impairments. I have a published book called ‘Maybe it’s just a thing…’ and I used to teach music privately, having retired from performing on stage.
Thank you for a wonderful article. I believe in today’s world, trauma and crisis need to be addressed as a foundational part of Clinical curriculum as well as part of Clinical Ethics and Scope of Practice.
Thank you for the above blog. I, too am finding that so many of our professionals lack basic understanding of cPTSD. It’s taken me 4 decades to be formally diagnosed. Yet, when I presented at A&E, last year with severe chest pains, and mentioned I had cPTSD, and was feeling retraumatised at the abhorrent ways the staff were treating me, the Senior Sister mocked and laughed, and mimicked, ‘oh apparently she has cPTSD!’ I was in too much pain to be able to stand up for myself. Having been told my entire life that I’m crazy and delusional, and need to be medicated or even locked up… receiving my cPTSD diagnosis, was a huge relief. Finally there was an explanation for the awful ways I had been feeling, which I simply couldn’t explain, nor put a name to.
Would you say there is a string correlation with c/PTSD and Autism, ADHD, and other Neurodiversities? I am awaiting to be tested. This further helped me to understand why I’ve been different, to all those around me, my entire life. Of 7 children, I thought, felt, and reacted totally differently, to the others. I was often punished, for my presentations, bullied, mocked, and picked on daily. I still stand out from my peers, which often results in workplace bullying, and being mistreated, by most of the professionals I encounter. They simply do not understand, or choose not to understand the complex nature of cPTSD, combined with additional factors, such as Neurodiversities.
I think it is important to talk about the more subtle causes of CPTSD.
I was never outright abused in the classical sense, but I grew up with a codependent mother and a father who was terrified by her emotional volatility. I was blamed for her bouts of hysterical crying and saying she wanted to die and nobody loved her or cared about her (in hindsight probably attention-seeking behaviour).
This, along with constantly needing to monitor her moods, was enough to cause my CPTSD. It took me years to figure it out. Many people probably feel like they grew up in a “relatively normal” home. There are more subtle forms of abuse and neglect though and we beed to talk about them!
Thank you for educating us.
This makes so much sense now, why i have never felt safe in life.
I remember being a fearful child. Few years back I had a flashback where i realized i have never felt safe in life. I knew I had a lot of trauma in the past but intill I had a major emotional flashback in spring i then connected the dots and thought Oh thi is PTSD So I now have a Therapist who I love and the support and education we get from CPTSD Foundation helps so much.
23 yrs ago I went out on disability. I was experiencing a lot of anxiety. I was told I had panic disorder. I was told I had a chemical imbalance in which I was put on many medications. Those medications destroyed my teeth. In which I lost them all. My insurance does not pay for dental so I been without teeth for 17yrs. The pain of not having teeth echo’s that shame from my past. I am constantly reminded I am not good enough or do not fit in when I am rejected by the peers around me and when I look for employment. A core component of cptsd is shame. I am caught in a catch 22 with this untreated dental of keeping that shame thriving. 🙁
2012 – I was told I had BPD. After reading up on it it wasn’t really fitting. I had none of the symptoms. I never self harmed. I had an eating disorder. Anorexia. What I learned now is where there is addiction and eating disorders there is trauma. I fought that provider to remove that DX. A BPD DX to someone with CPTSD is harmful. The stigma attached to BPD that we are bad and will never change really reinforces those core trauma beliefs that are bad. Therapists don’t want to take on clients with BPD and for a few yrs I fought to get that amended from my records.
2016 – Saw a new therapist. She said I did not have BPD and the anxiety/panic I was having was not the biggest issue it was the trauma from my childhood. It was the 1st time in 15 yrs I ever heard complex trauma. Sadly that therapist went out of network and 8 yrs later (2024) I am still seeking a therapist who understands what complex trauma is…….
When you are on Medicare/Medicaid the “choice” of providers are already stacked against you. Let alone find someone who knows what cptsd is and is skilled at treating it is like trying to find a needle in a hacksack at this point. What is mind numbing how can soc sec give me a disability with no way of treating what I have?? I understand it’s all political that CPTSD is not in the DSM…
I have had therapist who are trauma informed tell me I need to forget the past it’s only hurting me. That I should not focus on the childhood part and just get help for PTSD. PTSD is not the same. In a book I read recently said PTSD is as we know a singular event like a car accident. Where as CPTSD is like being in that same car accident every week over 20 yrs…. It’s not the same.
We deserve better help than what is out there!!! When I call places for help they think it’s so simple go up on psychology today and there is a help. Trauma informed doesn’t mean they treat trauma. They acknowledge it so they do not retraumatize the person. Sadly my last therapist who claimed to be a trauma specialist caused harm because she did not know what she was doing. She did not understand the body responses. eSpecially when I was triggered/under a great deal of stress from my interpersonal relationships (key cptsd issue) I would clench my jaw at night. This went on for months the clenching in which I damaged the trigeminal never in my jaw. What is messed up I have to have “brain” surgery in which they do a craniotomy to decompress (microvascular decompression) that nerve. That is a prime example of what bad therapy looks like.
Hello. I’m late to the game here, but I wanted say this after reading your article for the 3rd time. I loved this article of yours. I especially tuned into your comments about CPTSD being a relationship struggle as opposed to an abandonment issue with BPD. I’d like to see you write more about that. I have CPTSD and I’m fairly sure ADHD as well. Anyway, I’d like to read more from you.
Something I notice about myself is that I struggle to retain information about CPTSD and have to constantly relearn what I knew so well last week. I wonder how common that is.
Jesse D.
Hello. Thank you ever so much for getting this article out there. It is a total win for me to finally have arrived at a valid explanation – for the overlap and interplay of different causes and in the resultant condition I find myself living.
My sincere gratitude goes to you and to the publisher. I believe now for the first time, I can safely take steps towards professional evaluation and continue learning about devices of, and for, more positive behaviour.
I am armed with the explanatory capacity to, sadly, audit my own potentially dangerous-to-me diagnosis!!!
Many thanks,
James D
I have recently come out of a relationship with a guy that 100 % has this. I knew he was kind of different to any guy I had dated before . He was though loving , kind & attentive. However had all the symptoms of c-ptsd . Little snippets of his child hood he would give me & his his mum had bipolar & dad’s behaviour. It was not until we had split up through him self sabotaging our relationship that I really looked into why he was behaving this way. I had worked in mental health for years & dealt with eupd but this was not quite the same. I can not diagnose him but I don’t think he has a diagnosis of years of depression & Anxiety but not the actual c- ptsd itself . It’s sad it came to this but it’s to late it’s not up to me to inform him. He has cut me out of his life & struggles with stubbornness & deep hurt that he cuts people out of!
I am late to read this too.
Yes, ppl on the Autism Spectrum usually come with ptsd and or cptsd as well.
I was dxed at 17, through a psychiatrist my parents were seeing as BPD, I always knew I wasn’t.
I found out on my last (58th birthday) that I am well on the Spectrum. I come with all the problems that late Dxed ppl come with.
I had an eating disorder for 40 years, I suffer from MDD, big emotions, a learning disability, executive functioning difficulties, GAD, horrible shame, insomnia, teeth grinding, phobias, high functioning & high masking.
I have lost friends and family as no one understands.
I live in Canada and can’t find anyone who will work with me, paid ( incl psychology today,) or unpaid bc I am ASD with active trauma.
I won’t call crisis lines anymore, they don’t understand.
My active trauma/cptsd comes from my mistreatment in our (free to all) mental health system.
I validate and am validated by all the blog comments.
And, thank you LWK, getting it. You definitely understand the mental health system; not only in the UK, but all over the globe.
Pls, keep up the fight, our fight, and definitely my lost fight.
Erin 🇨🇦