A critical evaluation of the complex PTSD literature: Implications for DSM‐5

Abstract

Complex posttraumatic stress disorder (CPTSD) has been proposed as a diagnosis for capturing the diverse clusters of symptoms observed in survivors of prolonged trauma that are outside the current definition of PTSD. Introducing a new diagnosis requires a high standard of evidence, including a clear definition of the disorder, reliable and valid assessment measures, support for convergent and discriminant validity, and incremental validity with respect to implications for treatment planning and outcome. In this article, the extant literature on CPTSD is reviewed within the framework of construct validity to evaluate the proposed diagnosis on these criteria. Although the efforts in support of CPTSD have brought much needed attention to limitations in the trauma literature, we conclude that available evidence does not support a new diagnostic category at this time. Some directions for future research are suggested.

Testing the ICD-11 proposal for complex PTSD in trauma-exposed adults: factor structure and symptom profiles

“…Resick et al, 2012). One study therefore included BPD symptoms in a latent class analysis (Cloitre et al, 2014) and identified four classes, namely PTSD, cPTSD, low symptom level, and BPD.…”

“…In line with this idea, the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) introduced the concept of Disorders of Extreme Stress Not Otherwise Specified (DESNOS; American Psychiatric Association [APA], 2000), although not as an official diagnosis. The current DSM-5, however, moved further away from cPTSD as a distinct disorder (American Psychiatric Association, 2013), mainly due to the lack of a consistent definition and therefore a lack of valid and reliable assessments (Resick et al, 2012) in combination with this edition’s very strict criteria for including additional diagnoses (Friedman, 2013). …”

Affect dysregulation, psychoform dissociation, and adult relational fears mediate the relationship between childhood trauma and complex posttraumatic stress disorder independent of the symptoms of borderline personality disorder

“…Whether these sequelae are best understood as a complex variant of PTSD (CPTSD) or a complicated array of overlapping psychiatric and personality disorders is controversial (Landy, Wagner, Brown-Bowers, & Monson, 2015; Resick et al, 2012). However, there is mounting evidence that a Disorders of Extreme Stress Not Otherwise Specified (DESNOS) formulation of CPTSD constitutes a distinct syndrome of potential clinical utility (e.g.…”

Intervenções em terapia cognitivo-comportamental para trauma complexo: uma revisão sistemática

“…Para aqueles que são desfavoráveis a proposição de um diagnóstico complexo, o DESNOS representaria uma sobreposição entre sintomas pertencentes a diferentes trasntornos de eixo I e II, como TEPT, Transtorno Depressivo Maior (TDM) e Transtorno de Personalidade Borderline (TPB) (Resick et al, 2012). Por outro lado, os que defendem a proposta diagnóstica argumentam que o mesmo representa uma extensão ao diagnóstico de TEPT e poderia auxiliar os clí-nicos na elaboração de estratégias de intervenção psicoterápicas e farmacológicas efetivas, uma vez que o foco do tratamento seria sobre os sintomas de TC e não apenas sobre os sintomas pós-traumáticos subjacentes ao TEPT (revivên-cia, evitação e alterações no humor e hiperexcitabilidade; Bryant, 2012;Cloitre et al, 2011;Cloitre et al, 2010;Herman, 2012;van der Kolk et al, 2005).…”