What Is Complex PTSD and How Is It Different from PTSD?

By now, almost everyone has heard of Post-Traumatic Stress Disorder (PTSD). Many equate the diagnosis with war veterans, survivors of violence, accidents and other single-incident traumas. PTSD typically results from experiencing a single life-threatening event or witnessing a life-threatening event. Complex PTSD (CPTSD) is essentially PTSD due to repeated, prolonged trauma exposure. 

The Similarities of PTSD and CPTSD

Trauma-Induced: Both conditions are triggered by experiencing or witnessing deeply distressing, terrifying, or life-threatening events.

Nervous System Dysregulation: In both PTSD and C-PTSD, the brain's threat-detection system (specifically the amygdala) becomes hypersensitive, while the areas responsible for calming the threat response (like the prefrontal cortex) become underactive. This keeps the body in a prolonged fight-or-flight response.

Dissociation: Flashbacks, depersonalization (feeling detached from one's body), or derealization (feeling like the world around you isn't real) can occur in both conditions as a coping mechanism to survive intense emotional overwhelm.

Shared Symptoms PTSD CPTSD

Both share four main categories of symptoms including:

Reexperiencing

• Flashbacks, nightmares, intrusive memories

Avoidance

• Avoiding reminders of the trauma

Hyperarousal

• Hypervigilance, sleep problems, startle response

Mood Changes

• Negative thoughts, emotional numbing

The Core Differences between PTSD and CPTSD

Core differences include the type of trauma. For instance, PTSD trauma is considered single-incident. In other words, there was one traumatic event which caused the person to believe they were going to die or instilled enough fear of death due to the witnessing of the death or trauma of another person. Maybe there was a single or discrete traumatic event (accident, assault, disaster)

CPTSD is different inasmuch as it points towards prolonged, ongoing trauma - trauma such as childhood abuse, trauma within a long-term relationship, trauma experienced due to human trafficking, repeated sexual or physical assault and/or domestic violence. CPTSD adds a secondary layer of profound psychological disruptions.

Additional CPTSD Symptoms

Emotional Regulation - People with CPTSD experience difficulty managing intense emotions; chronic emptiness or shame. This can manifest as explosive anger, chronic anxiety, persistent sadness, or long periods of emotional numbness and dissociation.

Self-Perception/Identity - They experience deep feelings of worthlessness, guilt, feeling permanently damaged. This goes far beyond low self-esteem; it is a profound sense of brokenness, and shame.

Profound Relationship Difficulties - Because the trauma often occurs at the hands of a caregiver or trusted figure, the ability to form secure attachments is fractured. Someone with C-PTSD may find it incredibly difficult to trust others, feel permanently isolated or alienated, and feel abandoned.

Dissociation - Some may experience feeling detached from themselves or their world. They may feel like they are an observer in their own lives, feel like a ghost and even see the outside world in a dreamlike state. 

The Practical Distinction: A Single Event vs. A Broken Foundation

Think of standard PTSD as a severe injury caused by a sudden storm. A specific event occurred, and the brain is stuck trying to process that specific threat.

Think of C-PTSD as living in a house with a compromised structural foundation. Because the threat was continuous and inescapable, the person had to adapt their entire personality, defensive strategies, and coping mechanisms just to survive daily life.

Further, PTSD is a diagnosis in the DSM-5-TR. CPTSD is not recognized in the DSM-5-TR but is recognized in the ICD-11. Because health insurance companies require a DSM-5-TR code to establish the medical necessity of treatment, clinicians cannot bill directly for CPTSD. What this means for clients it that if using insurance, CPTSD is typically rolled into a PTSD diagnosis even though there are clear differences. Even though this workaround is legal and standard practice, it leaves the formal chart underrepresenting the true nature of the patient's condition.

Treatment Approaches

Because C-PTSD impacts the relational foundation and the self-concept, treatment typically requires a highly specialized, phased approach. Rather than just processing a specific memory, therapy focuses heavily on:

1. Establishing Safety and Stabilization: Learning grounding techniques and emotional regulation skills to manage distress in the present.This may take longer than a client wants, as there is a lot of trauma attached to current emotions and emotional stability.

2. Trauma Processing: Utilizing specialized modalities like EMDR (Eye Movement Desensitization and Reprocessing) or somatic therapies to safely process the layers of chronic trauma.

3. Relational Healing: Rebuilding a sense of trust, addressing attachment styles, and learning to establish healthy boundaries.

Understanding which pattern fits your experience matters, not just for naming what you've been through, but for shaping how we approach healing. In my practice, I work with both PTSD and C-PTSD using EMDR and Somatic EMDR, approaches that work directly with the nervous system rather than relying on talk alone. For clients with more complex trauma histories, we move carefully, building safety and internal resources first, before any deeper processing begins. If you recognize yourself in either of these patterns, you don't have to keep carrying it alone.

Julie Artinian Callaway, LLC | Trauma-Informed Therapy & EMDR in Ann Arbor, MI | Telehealth in Ohio & Florida

What to Expect in Your First EMDR Session

If you've been considering EMDR therapy but aren't sure what actually happens in a session, you're not alone. It's one of the most common things people tell me when they reach out : they're curious, maybe a little nervous, and they want to know what they're walking into before they begin.

The first thing I want you to know is this: your first session won't look like what you've seen online. There are no metronomes swinging in front of your face, and you won't be asked to relive your most painful memories right away. EMDR is a careful, structured process and it begins long before any trauma processing takes place.

We Start by Getting to Know Each Other

Your first EMDR session is primarily a conversation.

Before any EMDR-specific techniques are introduced, we spend time building a foundation of trust and understanding. I'll ask about what brings you to therapy, what you're hoping to work through, and get a general sense of your history and background. You don't need to share everything at once. Nothing is pushed or rushed. We move at your pace from the very first session.

This matters more than people expect. The relationship between therapist and client is one of the most important factors in effective trauma treatment and that takes time to build. There's no shortcut, and I wouldn't want one.

Understanding Your History

EMDR therapy follows a structured eight-phase protocol, and the first phase is history taking: exploring your personal history, current symptoms, and the experiences you'd like to work through.

This phase helps me understand not just what happened, but how it's affecting you now. In your body. In your relationships. In the way you move through ordinary days. Together we'll begin to identify the specific memories or experiences that may be contributing to what you're feeling today.

Depending on your history, this phase can take one session or several. We don't move forward until it feels right to both of us.

Building Your Internal Resources First

Before any trauma processing begins, we spend significant time in what's called the preparation phase, and this is one of the things that sets EMDR apart.

Preparation means building the internal resources you'll need to feel safe and supported throughout the process. This includes nervous system regulation tools: practical techniques to help you stay grounded, manage emotional intensity, and return to a place of calm when things feel overwhelming. We might work on breathing exercises, grounding practices, or a safe place visualization for example, a mental image you can return to inside and outside of sessions whenever you need it.

I won't move into trauma processing until I'm confident your nervous system has enough stability and support to handle what comes up. This isn't something we rush through. It's some of the most important work we do together.

What Processing Actually Feels Like

When we do begin processing, and this often happens in a later session, not the first, you won't be asked to describe your trauma in detail or relive it the way talk therapy sometimes requires.

Instead, you'll bring a specific memory or experience to mind while following a form of bilateral stimulation: this might be eye movements, gentle tapping, or alternating tones through headphones. The bilateral stimulation engages both sides of the brain simultaneously, helping it reprocess the memory in a way that gradually reduces its emotional weight.

Many people describe the experience as watching scenes from their life unfold from a distance—more like observing than reliving. The memory doesn't disappear, but over time it loses the emotional intensity and hold it once had. One way to think about it is this: before reprocessing, the memory may feel like a vivid, full-color image directly in front of you, demanding your attention.

After reprocessing, that same memory is still there, but it resembles an old black-and-white photograph tucked away in a corner, gathering dust. It remains part of your story, but it no longer dominates the present. What once felt overwhelming begins to feel like something that happened in the past, rather than something that is still happening now.

The pace of this work is always guided by you. If something feels like too much, we slow down. If you need to stop, we stop. Your sense of control matters throughout every part of the process.

You Don't Have to Have It All Figured Out

One of the most important things I want you to know before your first session is that you don't need to arrive with a perfectly organized understanding of your own history or a clear sense of exactly what you want to work on.

Most people come in feeling uncertain, sometimes a little scared. That's okay. The first session is simply a chance to meet, ask questions, and get a feel for whether this is the right fit. There's no pressure to commit to anything before you're ready. In fact, there’s never pressure from me.

EMDR is one of the most well-researched treatments available for trauma, PTSD, and anxiety. But more than anything, it's a collaborative process, one that moves at your pace, honors your comfort, and keeps your sense of safety at the center of every session.

If you're ready to take a first step, I offer a free 15-minute consultation — no obligation, just a chance to connect and see if this feels right for you.

Julie Artinian Callaway is a trauma-informed therapist in Ann Arbor, Michigan, specializing in EMDR and Somatic EMDR for adults. Telehealth sessions are available for clients in Ohio and Florida.

7 Unexpected Signs of High Emotional Intelligence

Emotional intelligence (EQ) is often defined as the ability to recognize, understand, and manage emotions in ourselves and our relationships with others. While many people associate high emotional intelligence with kindness or empathy, some of its strongest indicators are found in subtle everyday habits.

1. They Can Accurately Identify Their Emotions

One of the most overlooked signs of emotional intelligence is emotional awareness. Rather than describing themselves as simply "fine" or "stressed," emotionally intelligent individuals can identify the nuances of their emotional experience. They recognize the difference between disappointment and grief, frustration and anger, nervousness and excitement. This ability to accurately name emotions helps them respond thoughtfully instead of reacting automatically.

2. They Pause Before Reacting

People with high emotional intelligence understand that emotions provide valuable information, but they do not let emotions dictate every decision. When faced with conflict, criticism, or stress, they are more likely to create a moment of space between what they feel and how they respond. This pause often leads to better decisions, healthier communication, and fewer regrets.

3. They Practice Healthy Boundaries

Contrary to popular belief, emotional intelligence is not about pleasing everyone. Emotionally intelligent people recognize their limits and communicate them clearly. They can care deeply about others while also protecting their own time, energy, and well-being. Healthy boundaries allow them to maintain relationships without sacrificing themselves in the process.

4. They Lead with Curiosity Rather Than Judgment

Curiosity is a powerful but often underappreciated component of emotional intelligence. Rather than immediately assuming they know why someone behaved a certain way, emotionally intelligent individuals seek understanding. They ask questions, remain open to different perspectives, and listen to understand rather than simply waiting for their turn to speak. This mindset reduces defensiveness and fosters stronger connections.

5. They Communicate Directly and Respectfully

Emotionally intelligent individuals tend to communicate with clarity, honesty, and respect. They are able to express their needs, feelings, and concerns without becoming overly aggressive or passive. When conflict arises, they focus on finding solutions rather than assigning blame, which helps strengthen trust and resolve misunderstandings more effectively.

6. They Demonstrate Genuine Empathy

Empathy is one of the most recognized aspects of emotional intelligence, but it is often misunderstood. Empathy does not require agreement; it involves understanding another person's perspective and emotional experience. Emotionally intelligent people recognize that different individuals may respond differently to the same situation and make room for those differences without dismissing them.

7. They Invest in Healthy Relationships

People with high emotional intelligence tend to cultivate strong, resilient relationships over time. They take responsibility when they make mistakes, repair misunderstandings, and prioritize trust and connection. Their emotional skills allow them to navigate challenges while maintaining meaningful relationships with others.

The Good News: Emotional Intelligence Can Be Developed

Unlike personality traits that may feel fixed, emotional intelligence is a set of skills that can be strengthened over time. Through self-awareness, reflection, intentional communication, and practice, anyone can improve their ability to understand emotions, navigate relationships, and respond more effectively to life's challenges.

The goal is not to eliminate difficult emotions, but to develop a healthier relationship with them. In many ways, emotional intelligence is less about controlling emotions and more about learning how to work with them wisely.

Written by Julie Artinian Callaway, LLC - LMSW, LPC, LISW, a trauma-informed therapist in Ann Arbor specializing in EMDR therapy for anxiety, trauma, and emotional healing.

How to Stop People-Pleasing Without Feeling Selfish

Have you ever noticed how one criticism can stay with you for days while ten compliments barely register? You're not imagining it. Psychologists refer to this as the "negativity bias”, our tendency to pay more attention to negative information than positive information. Research suggests that when it comes to beliefs about ourselves, many people are more likely to absorb criticism than praise, especially if they already struggle with self-doubt. In fact, the other day I was having a discussion with a friend about this very thing. My friend noted that she has an easier time putting herself down and thinking negatively about herself than believing something good about herself. 

Many people-pleasers worry that if they stop putting others first, they'll become selfish, uncaring, or difficult. In reality, healthy relationships require both kindness and boundaries.

People-pleasing often develops as a way to avoid conflict, gain approval, maintain connection, or feel safe in relationships. While it may create short-term comfort, over time it can lead to resentment, exhaustion, anxiety, and a loss of connection with your own needs.

Signs You May Be People-Pleasing

• You have difficulty saying no.

• You feel responsible for other people's emotions.

• You avoid expressing disagreement.

• You often apologize, even when you've done nothing wrong.

• You prioritize others' needs while neglecting your own.

• You worry excessively about disappointing people.

This helps explain why people-pleasers often find it easier to believe, "I'm disappointing everyone," than "I'm doing enough." The negative story feels more convincing, not necessarily because it's true, but because our brains are wired to treat potential threats and mistakes as especially important.

The people pleaser may be likely to say “yes” to every request, every invitation, and then fear the repercussions when they realize they cannot possibly keep all of the promises to friends, family, coworkers, etc: when they have to back out of one, two, or three obligations.

Many of my clients tell me they know how to place a boundary out there but when it comes to holding the boundary they fold. They fold because they are afraid that if they hold the boundary others will get angry and hold a grudge towards them.

Imagine your friend asks you to help them on a weekend that you’re busy. As a people-pleaser, you may want to be there for your friend, even though you have committed to something else that is just as important.

Why it Develops

Many people who struggle with people-pleasing learned early on that keeping others happy helped them feel safe, connected, or accepted. Maybe it was growing up in a home where mom or dad had addiction or mental health issues, where emotions were unpredictable. Maybe criticism was frequent, or love felt tied to your behavior, you may have become skilled at reading the room and adjusting yourself to meet other people's needs.

Some children learn that being easygoing, helpful, or responsible earns praise and approval. Over time, they become experts at anticipating what others want while paying less attention to their own feelings, needs, and boundaries.

The difficulty is that what once helped you navigate relationships as a child may no longer serve you as an adult. A pattern that once protected you can eventually lead to exhaustion, resentment, anxiety, and a diminished sense of self.

Practical Strategies for Breaking the People-Pleasing Pattern

You don't have to stop being a caring person. The goal isn't to become less considerate, it's to stop disappearing in your relationships.

Many people-pleasers automatically say "yes" before checking in with themselves. Before committing to something, pause and ask: Do I actually want to do this? Do I have the time and energy for it? Does this align with my values and priorities?

One of the simplest ways to break the habit is to give yourself permission to delay your response. Instead of answering immediately, try saying, "Let me check my schedule and get back to you." Creating even a small pause can help you make a thoughtful decision rather than an automatic one.

It's also important to recognize when you've overcommitted. If you've made a promise and later realize you can't follow through, be honest. Tell your friend, sibling, coworker, or partner that you've overextended yourself. Most people respect honesty more than resentment or avoidance. While it may feel uncomfortable, acknowledging your limits is a sign of self-awareness, not failure. Sometimes repairing relationships means admitting that you took on more than you could realistically manage and asking for understanding.

Another helpful practice is learning to tolerate disappointment, both your own and other people's. One of the hardest parts of overcoming people-pleasing is realizing that someone can be disappointed with your decision and still care about you. Healthy relationships can withstand reasonable boundaries.

Finally, spend some time reconnecting with your own wants and needs. Many people-pleasers become so focused on taking care of others that they lose touch with themselves. Ask yourself: What do I need right now? What matters most to me? What would I choose if I weren't worried about disappointing someone?

People-pleasing doesn't change overnight. It often begins with small moments of honesty, self-reflection, and choosing yourself when your instinct is to automatically choose everyone else.

Next Steps

If you struggle with people-pleasing, you're not alone. Many people find themselves stuck in patterns of putting others first, avoiding conflict, or seeking approval at the expense of their own needs. These behaviors often develop for good reasons, but over time they can leave you feeling exhausted, resentful, disconnected from yourself, or uncertain about what you truly want.

The good news is that change is possible. Learning to set boundaries, trust yourself, and express your needs doesn't mean becoming selfish or uncaring. It means creating relationships that allow space for both you and the people you care about.

Therapy can provide a supportive environment to explore the roots of people-pleasing, understand the beliefs that keep the pattern in place, and practice new ways of relating to yourself and others. Over time, many people discover that they can remain kind and compassionate without sacrificing their own well-being.

If you're ready to begin that process, I invite you to reach out. Together, we can explore what is getting in the way of living more authentically and help you build relationships that feel more balanced, fulfilling, and true to who you are.

Written by Julie Artinian Callaway, LLC - LMSW, LPC, LISW, a trauma-informed therapist in Ann Arbor specializing in EMDR therapy for anxiety, trauma, and emotional healing.