PTSD vs CPTSD and Why You Keep Getting Misdiagnosed
Episode 106
You've been in therapy for years. It's helping, but not really.
You've tried CBT, positive thinking, breathing exercises, thought records, challenging cognitive distortions. You've done all the coping skills. You've tried so hard to reframe your thinking.
And you still feel fundamentally broken.
Maybe you got diagnosed with generalized anxiety disorder. Maybe major depression. Maybe borderline personality disorder. Maybe they thought you were bipolar because your moods swing so dramatically.
You tried the treatment they recommended. You did the work. And mostly, you still feel like you're drowning.
Here's what's probably happening: you have complex PTSD, not the anxiety disorder or personality disorder you were diagnosed with. And the treatment you've been getting was never designed for what you're actually dealing with.
The Question Nobody Asked
When you showed up to therapy and talked about the panic attacks, the depression, the relationship problems, the way you can't seem to hold it together even though you're trying so hard, did anyone ask you:
What was your childhood actually like?
Not "did anything traumatic happen?" in that narrow way we commonly think about trauma. But what was it actually like to be a kid in your house?
Did you feel safe? Were your parents emotionally available? Did you have to walk on eggshells? Did you have to take care of your parents' emotions? Were you allowed to be a kid, or did you have to grow up way too fast?
Because here's the thing: if you grew up in an environment of chronic stress, chaos, neglect, abuse, emotional unavailability, or unpredictability, your brain and nervous system adapted to survive that.
Those adaptations are what's creating your symptoms now.
But instead of anyone recognizing that, you got diagnosed with a mood disorder, an anxiety disorder, or a personality disorder. You got treated for the symptoms. No one looked at the cause.
Why CBT Isn't Working for You
Let me be clear: CBT isn't bad. It's evidence-based. It works really well for certain things.
But it was never designed for complex trauma.
CBT operates on the idea that your thoughts create your feelings, and if you can change your thoughts, you can change your feelings. For someone with a phobia or anxious thought patterns that developed in adulthood, that can work.
But if your nervous system learned before you could even talk that the world is dangerous and people can't be trusted, you can challenge those thoughts all day long and your body still knows what it knows.
You know how many times I've heard people say some version of: "I know logically that I'm safe now. I know my partner isn't going to hurt me. I know I'm not actually in danger. But my body doesn't believe it."
That's not a thinking problem. That's a nervous system problem.
Your nervous system developed in an environment where it had to be on high alert to keep you safe. It learned to scan for danger constantly. It learned that relationships are unpredictable and potentially harmful. It learned that your needs don't matter or that expressing them gets you hurt.
These are not thoughts you can just reframe. These are deeply wired survival responses.
PTSD vs Complex PTSD: What's the Difference?
This is where understanding the difference between PTSD and complex PTSD becomes so important.
PTSD (the way it was originally understood) is about a specific traumatic event. Something that happened: a car accident, an assault, combat, a natural disaster.
Your nervous system got overwhelmed, and now you have intrusive memories, nightmares, flashbacks, hypervigilance. You're stuck in that moment.
The treatment for PTSD makes sense: help you process that memory, help your nervous system understand that the danger is over, get you unstuck from that moment in time.
For people with PTSD from a single incident or even a few incidents, this approach really works.
Complex PTSD is completely different.
Complex PTSD comes from chronic, ongoing trauma, usually in childhood, and it's usually relational.
We're talking about:
Growing up with a parent who was rageful or emotionally absent
Growing up with neglect or emotional abuse that was constant but hard to name
Having a parent who was sometimes loving and sometimes terrifying, and you never knew which one you'd get
There's no single event to process. There's an entire childhood where your nervous system was learning how the world works, how relationships work, and who you are because of it.
It was learning in an environment that was fundamentally unsafe.
So you don't just have flashbacks to process. You have a whole way of being in the world that was shaped by trauma.
You don't just have anxiety. You have a nervous system that never learned what calm feels like.
You don't just have relationship problems. You have attachment wounds from the people who were supposed to teach you that relationships are safe.
You don't just have low self-esteem. You have a core sense of shame that was installed in you before you had the language to understand it.
What Complex PTSD Actually Looks Like
Let me get specific because this is where people finally see themselves:
Emotional flashbacks: You're not seeing images from your past necessarily. You're suddenly feeling the way you felt when you were little. That overwhelming terror, that shame, that sense of being small and powerless and wrong. You don't know where it came from. There's no trigger you can identify. You just suddenly feel like you're five years old.
Identity confusion: You struggle with knowing who you are, not in a philosophical way, but in a very real day-to-day way. Someone asks what you want for dinner and you don't know. Someone asks what you like to do and you go blank. You've spent your whole life reading the room, adapting, becoming what other people need, and you never developed a solid sense of yourself.
Relationship chaos: Maybe you're attracted to people who aren't good for you because chaos feels normal. Maybe you push anyone away who gets too close because closeness feels dangerous. You have no idea what a boundary is or how to set one because you never saw healthy boundaries modeled, or when you tried to set one, it got dismissed.
All-or-nothing emotions: You're either completely numb and can't feel anything, or you're completely overwhelmed and feel everything all at once. People tell you to regulate your emotions, and you want to laugh because you can't regulate what you were never allowed to have in the first place.
Deep shame: You struggle with this sense of being fundamentally defective. Not that bad things happened to you, but that something is wrong with you at your core. That if people really knew you, they'd leave. That you're too much and not enough all at the same time.
High functioning exterior: You're probably really high functioning on the outside. You've learned to perform. You've learned to achieve. You've learned to make sure nobody sees how much you're struggling because that's what you had to do to survive. So you look fine. Your therapist might not even realize how much you're dealing with because you've gotten so good at hiding it.
Why Misdiagnosis Happens So Often
Why do so many people with complex PTSD get diagnosed with everything except complex PTSD?
First: Complex PTSD still isn't in the DSM-5, which is what most therapists in the US use. It's in the ICD-11 (International Classification of Diseases), but not in our diagnostic manual. So a lot of clinicians literally don't have it on their radar.
Second: Most therapists aren't actually trained in trauma. They were trained in other modalities that work for certain things but miss the trauma piece entirely.
Third: When you show up with anxiety, depression, or relationship chaos, that's what gets diagnosed. We treat the symptoms we can see. If nobody asks about your childhood in a meaningful way, nobody connects those symptoms to their source.
Fourth: I'm going to be really honest here. Personality disorder diagnoses, especially borderline personality disorder, have been a catch-all for women who are "difficult to treat." Women who have big emotions and relationship problems and a history of self-harm.
Somehow it's become easier to label someone as having a personality disorder than to recognize that their personality was shaped by trauma.
I'm not saying borderline personality disorder isn't real. I'm saying that a lot of what gets diagnosed as BPD is actually complex trauma.
What Actually Helps
Trauma-focused therapy: Therapy that addresses what happened to you and also what didn't happen to you, and how those things shaped your nervous system.
Body-based approaches: EMDR, somatic work, Internal Family Systems, Sensorimotor Psychotherapy, Somatic Experiencing. Approaches that work with your body and nervous system, not just your thoughts.
Nervous system regulation: Learning what safety feels like in your body. Building capacity to tolerate emotions without getting completely overwhelmed. This has to come first before you can do deeper trauma processing.
Relational healing: Working with a therapist who understands that the wounds were relational and the healing has to be relational too. You need to experience a relationship where you're not performing, where you're not too much, where you can literally just be.
Time: Probably more time than you want it to take. More time than the traditional mental health system usually wants to give you. Because you're not just healing from events. You're building a foundation you didn't get to build the first time around. You're learning things that were supposed to be learned in childhood. You're rewiring a nervous system that was wired for survival.
There's no six-week protocol for this. This is deep foundational work.
You Are Not the Problem
Here's what I really want you to hear:
If therapy hasn't worked for you in the past, you are absolutely not the problem. You didn't get the right treatment for what you're actually dealing with.
If the skills didn't help, it's not because you're doing it wrong. It's because they weren't designed for complex trauma.
If you've been diagnosed with five different things and none of them quite fit, it's because everyone's been looking at your symptoms instead of your story.
There's nothing about you that's broken. There's nothing about you that's too much. You are absolutely not untreatable.
Your system adapted brilliantly to survive in an environment that hurt you. These adaptations made sense. They kept you alive. The problem is they're making your adult life really hard at this point.
And now, you get to do something different. You get to go slowly, carefully, compassionately, teaching your nervous system that the danger is over. That you're allowed to take up space. That relationships can be safe. That you can trust yourself.
It's hard work. It's slow work. But it's possible.
Ready to work with therapists who get this? If you're in Pennsylvania and looking for trauma-focused therapy that actually addresses complex PTSD, connect with our team.
Next episode: Sarah's conversation with Dr. Judith Herman, the psychiatrist who gave us the framework for understanding complex PTSD in 1992 and has spent her career making sure people like you get seen and get the right help.
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