1.1 Complex PTSD
Complex posttraumatic stress
disorder (CPTSD) is a new diagnosis in the 11th revision of the
International Classification of Diseases (ICD-11). CPTSD is a sibling to
posttraumatic stress disorder (PTSD) under the general parent category
of “disorders specifically associated with stress” (Maercker et al.,
2013). The diagnosis of Complex PTSD was introduced to address the kinds
of problems that clinicians reported observing related predominately to
multiple and chronic forms of trauma exposure as distinct from those
related to single event trauma (Keeley et al. 2016). However, research
has shown that individuals can develop PTSD rather than CPTSD after
multiple and chronic traumas and, conversely, that individuals with
single event traumas can develop CPTSD (Cloitre et al., 2013), likely
depending on vulnerability and protective factors. For these reasons,
the presence of chronic or repeated traumas is considered a risk factor
rather than a requirement for the diagnosis of CPTSD.
ICD-11 PTSD consists of three core
symptom clusters: re-experiencing trauma, avoidance of trauma reminders,
and a heightened sense of threat. CPTSD consists of the three PTSD
clusters as well as three additional clusters described as
“disturbances in self-organization” (DSO) symptoms: affect
dysregulation, negative self-concept, and disturbances in relationships
with the latter symptoms representing the effects of chronic trauma on
these three critical psychological and social domains of functioning
(Maercker et al., 2013).The presence of childhood trauma (such as sexual
or physical abuse) can disrupt socio-emotional development and generate
problems in emotion regulation and relational capacities represented in
CPTSD. Individuals who experience repeated or chronic trauma beginning
in adulthood may have had good emotion regulation, self-concept and
relational capacities but these can deteriorate in the context of severe
sustained or multiple forms of trauma as is experienced, for example, by
refugees (Nickerson et al. 2016). Reviews of current evidence regarding
ICD-11 PTSD and CPTSD support the construct validity of these diagnoses
and clarify their clinical characteristics (Brewin et al., 2017; Redican
et al., 2021).
Individuals with CPTSD will report re-experiencing of traumatic
experiences in either nightmares or flashbacks; avoidance of
trauma-related reminders (thoughts, feelings or places) and a chronic
sense of threat. Affect dysregulation is broadly represented by
emotional reactivity in which affected individuals are quick to
experience emotions such as anger or sadness and/or report overall
emotional numbing. Individuals view themselves in extremely and
persistently negative ways, including as worthless or a failure, often
associated with feelings of shame and guilt. There are difficulties in
managing relationships with a tendency to avoid or withdraw from
relationships particularly under conditions of stress or conflict.
The diagnosis of CPTSD as well as PTSD can be assessed via a reliable
and valid 18-item self-report measure, the International Trauma
Questionnaire (ITQ; Cloitre et al., 2018). It has been translated into
over 30 languages and is freely available (see
globaltraumameasures.com). A clinician assessed version of the ITQ has
been developed and is in the final stages of validation (Roberts et al.,
2019).