CPTSD Named New Diagnosis Category for Complex Trauma
Complex post-traumatic stress disorder (CPTSD) is now recognized as a sibling diagnosis for PTSD in guidelines updated by the World Health Organization. A new study finds CPTSD occurs in 1% to 8% of the general population, and in half of patients at mental health facilities.
July 15, 2022
Complex post-traumatic stress disorder (CPTSD) is a new diagnosis category in the International Classification of Diseases (ICD-11) issued by the World Health Organization (WHO).
The sibling diagnosis of post-traumatic stress disorder (PTSD), CPTSD is defined as “a severe mental disorder that emerges in response to traumatic life events” in a new study published in The Lancet. The study says the disorder is prevalent in 1% to 8% of the general population and up to half of patients at mental health facilities. 1
For the study, an international team aligned with the University of Zurich summarized CPTSD symptoms, which features “three core post-traumatic symptom clusters, along with chronic and pervasive disturbances in emotion regulation, identity, and relationships,” the researchers said.
“Individuals with complex PTSD typically have sustained or have multiple exposures to trauma, such as childhood abuse and domestic or community violence,” they added.
CPTSD vs. PTSD
PTSD is one of the most widely known responses to trauma. However, experts have long recognized that some trauma victims or survivors exhibit a broader pattern of psychological changes, most commonly after prolonged or repetitive events, such as exposure to war, sexual abuse, domestic violence, or torture. They have called for a separate diagnosis of CPTSD for decades. 2
At least 29 studies from more than 15 countries have documented the differences between CPTSD and PTSD.3
A 2018 report published in the Journal of Psychiatric Practice says, “Complex PTSD, or developmental PTSD, refers to the constellation of symptoms that may result from prolonged, chronic exposure to traumatic experiences, especially in childhood, as opposed to PTSD, which is more typically associated with a discrete traumatic incident or set of traumatic events.” 4
The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) does not currently acknowledge CPTSD as a separate condition.
“Although it has been a controversial diagnosis and is not included in the DSM-5, lines of evidence support its distinct profile and utility,” the researchers wrote.
According to the updated ICD-11, a clinician must determine that a person meets all the criteria for traditional PTSD and show problems with self-regulation, low self-esteem, a sense of shame or guilt related to past trauma, and problems maintaining relationships with others before diagnosing complex trauma.
The updated ICD-11 also added self-organization disturbances, which are excessive or heightened emotional responses, feelings of worthlessness, and persistent difficulties in sustaining relationships and in feeling close to others, to the list of PTSD symptoms.1
Complex Trauma vs. ADHD
The Lancet study provides clinical assessment and treatment guidelines for CPTSD and identifies diagnostic differences between complex trauma and related mental health disorders such as severe depression, bipolar disorders, psychoses, or personality disorders.
Trauma symptoms often overlap with other mental health disorders. For example, “when someone experiences trauma, it impacts the same areas of the brain affected by having attention deficit hyperactivity disorder. So, you have less emotional regulation, and verbal and behavioral impulse control and more reactivity,” said Sharon Saline, Psy.D., during ADDitude’s Mental Health Out Loud event titled “Youth Traumas and Anxieties Today” on June 10, 2022.
People with trauma and/or ADHD may be disorganized, restless, or distractible. The source of these symptoms typically helps to differentiate between ADHD and trauma, Dr. Saline said.
“The source of those feelings is very different,” she said. “With trauma, you continually feel like you’re on alert for threat or danger. Sometimes there can be a kind of dissociation, a feeling of unreality, or being outside of your body. You might feel guilty or ashamed, particularly if you’ve been the victim of abuse. And there are feelings of fear, helplessness, uncertainty, vulnerability, and increased arousal and agitation.
“ADHD is a largely inherited disorder with pervasive symptoms of inattention, hyperactivity, or impulsivity that can cause significant functional limitations. In PTSD or CPTSD, traumatic events cause the brain to change and include physiological, cognitive, and emotional changes in how a person processes stressful information and situations. The symptoms are not inherited.”
Complex trauma is increasingly common among youth populations today. “About half of all children will experience a traumatic event in their lifetime from abuse, violence, terrorism, disaster, or what we call ‘traumatic loss,’ with many experiencing more than one such event, and others living with chronic or complex trauma with no time for healing between events,” Dr. Saline said.
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1Maercker, A., Cloitre, M., Bachem, R., Schlumpf, Y.R., Khoury, B., Hitchcock, C., Bohus, M. (2022). Complex Post-Traumatic Stress Disorder. The Lancet. https://doi.org/10.1016/S0140-6736(22)00821-2
2Maercker, A. (2021). Development of the new CPTSD diagnosis for ICD-11. Borderline Personality Disorder and Emotion Dysregulation.https://doi.org/10.1186/s40479-021-00148-8
3Cloitre, M., Brewin, C. R., Bisson, J. I., Hyland, P., Karatzias, T., Lueger-Schuster, B., Maercker, A., Roberts, N. P., & Shevlin, M. Evidence for the coherence and integrity of the complex PTSD (CPTSD) diagnosis: response to Achterhof et al., (2019) and Ford (2020). European Journal of Psychotraumatology. 11(1), 1739873. https://doi.org/10.1080/20008198.2020.1739873
4Rosenfield, P. J., Stratyner, A., Tufekcioglu, S., Karabell, S., McKelvey, J., & Litt, L. (2018). Complex PTSD in ICD-11: A Case Report on a New Diagnosis. Journal of Psychiatric Practice. 24(5), 364–370. https://doi.org/10.1097/PRA.0000000000000327