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Complex post-traumatic stress disorder (CPTSD) is a disorder that describes the more complex reactions that are often seen in individuals exposed to chronic trauma, such as child abuse or domestic violence. Complex PTSD is a relatively new diagnosis, having been added to the WHO’s International Classification of Diseases (ICD-11) in 2019. It was first proposed by Judith Herman in 1992:
CPTSD is thought to develop when a person is exposed to prolonged periods of what are termed potentially traumatic events (PTEs), usually of an extremely threatening or horrific nature. Many of the criteria are similar to PTSD but include additional features characterized as “disorders of self organization” (DSO) symptoms. These disturbances are thought to be pervasive and occur across various contexts. They are typically (Cloitre 2020) divided into
While there is overlap between PTSD and CPTSD, there are also similarities between CPTSD and other psychiatric diagnoses, for example, the concept of emotionally unstable or borderline personality disorder (BPD). This has led to debate over whether CPTSD is actually PTSD with comorbid BPD. However, recent studies have suggested that CPTSD is distinct from BPD in at least three ways:
Many of the therapies used for PTSD can be adapted to treat CPTSD. These include Cognitive Behavioral Therapy (CBT), such as Prolonged Exposure Therapy (PE), Cognitive Processing Therapy (CPT), and Eye Movement Desensitization and Reprocessing (EMDR). Other therapies shown to be helpful for some patients with CPTSD include Brief Eclectic Therapy (BET), Dialectical Behavioral Therapy (DBT) for PTSD, Narrative Exposure Therapy (NET), and Psychodynamic Therapy. Though the ‘gold standard’ for PTSD treatment is sometimes said to be PE, this may not be appropriate in some cases of CPTSD.
Thinking about how to structure therapy, independently of the modality the therapist pursues, the International Society for Traumatic Stress Studies (ISTSS) (2012) recommends three phases of treatment for cPTSD:
|Phase 1||Ensuring safety, reducing symptoms, increasing emotional and social competencies.|
|Phase 2||Processing the unresolved aspects of the memories of traumatic experiences so that these are integrated into a representation of self, relationships, and the world. (This can be achieved through using standard or adapted methods taken from conventional trauma-focused CBT.)|
|Phase 3||Consolidations of treatment gains to facilitate the transition from treatment into a greater engagement with the outside world.|
This three stage model has goals of decreasing biological activation, improving boundaries with others, learning to live in the presence of constant or frequent suicidality, and shame reduction.
Cloitre, M. (2020). ICD-11 complex post-traumatic stress disorder: Simplifying diagnosis in trauma populations. British Journal of Psychiatry, 216(3), 129–131. doi:10.1192/bjp.2020.43.
Herman J. L. (1992). Complex PTSD: A syndrome in survivors of prolonged and repeated trauma.Journal of Traumatic Stress, 5(3), 377–391. 10.1002/jts.2490050305
ICD-11 Complex post-traumatic stress disorder.
ISTSS Expert Consensus Guidelines for the treatment of Complex PTSD