Complex PTSD: what is the clinical utility of the diagnosis?

Abstract

Background The diagnosis of complex posttraumatic stress disorder (CPTSD) was included in the 11th revised edition of the International Classification of Diseases (ICD-11). CPTSD shares trauma-specific symptoms with its sibling disorder PTSD but is additionally characterized by disturbances of the individual’s self-organization (DSO). The clinical utility of the CPTSD diagnosis has yet to be thoroughly investigated. Objective The current study aimed to examine the clinical utility of the CPTSD diagnosis, considering the upcoming implementation of ICD-11 in clinical practice. Method International field studies, construct- and validity analyses leading up to the inclusion in ICD-11 are reviewed, and the diagnostic measures; International Trauma Questionnaire (ITQ) and International Trauma Interview (ITI) are presented. Also, the relationship between CPTSD and borderline personality disorder (BPD) is elaborated in an independent analysis, to clarify their differences in clinical relevance to treatment. Treatment implications for CPTSD are discussed with reference to existing guidelines and clinical needs. Results The validation of ITQ and ITI contributes to the cementation of CPTSD in further clinical practice, providing qualified assessment of the construct, with intended informative value for both clinical communication and facilitation of treatment. CPTSD is found distinguishable from both PTSD and BPD in empirical studies, while the possibility of comorbid BPD/PTSD cases being better described as CPTSD is acknowledged. Practitioners need to employ well-established methods developed for PTSD, while considering additional DSO-symptoms in treatment of CPTSD. Conclusions The inclusion of CPTSD in ICD-11 may potentially facilitate access to more tailored treatment interventions, as well as contribute to increased research focus on disorders specifically associated with stress. The clinical utility value of this additional diagnosis is expected to reveal itself further after ICD-11 is implemented in clinical practice in 2022 and onwards. Yet, CPTSD’s diagnostic inclusion gives future optimism to assessing and treating complex posttraumatic stress symptoms.

Patterns and correlates of patient‐reported helpfulness of treatment for common mental and substance use disorders in the WHO World Mental Health Surveys

“…Both types of childhood adversities considered here were found to be associated with significantly reduced RR of patient‐level helpfulness, but only for PTSD and largely because of reduced RR of individual professionals being helpful. This might reflect a special difficulty in treating PTSD associated with childhood traumas, a possibility consistent with the rationale underlying the inclusion of a special diagnostic category for complex PTSD in the ICD‐11 diagnostic system 30,31 .…”

Complex Trauma, Psychosis and COVID-19: A Case Report

“…This report presents a case recounting the history of an ongoing episode of abuse in early life. After experiencing a stressor, anxious symptoms were triggered, progressing to re-experiencing and delusional ideas, dissociative reaction and cognitive alteration, a clinical picture that suggests a direct relationship with the trauma 30 . Among the prominent symptoms in this case, we find paranoid delusion (closely related to abuse), misidentification phenomenon and disorganized behavior, which can be consistent with a subtype of Post-Traumatic Stress Disorder; it is unfortunate no to have a clear history of symptoms in the recent period after the abuse that help to determine the presence of traditional Post-Traumatic Stress Disorder symptoms 31 .…”

“…Among the prominent symptoms in this case, we find paranoid delusion (closely related to abuse), misidentification phenomenon and disorganized behavior, which can be consistent with a subtype of Post-Traumatic Stress Disorder; it is unfortunate no to have a clear history of symptoms in the recent period after the abuse that help to determine the presence of traditional Post-Traumatic Stress Disorder symptoms 31 . Complex trauma is integrated as a suspicion into the hospital evolution record, since it has been described that certain social interactions can trigger traumatic reactions, and the experience with the current partner during the crisis has likely been interpreted as a new condition of abuse 30 . COVID-19 infection should be considered, being known that approximately a third of these patients develop neuropsychiatric symptoms, including mood disturbances, anxiety and psychosis.…”

Psychometric evaluation of the Dutch International Trauma Questionnaire for the 11th revision of the International Classification of Diseases posttraumatic stress disorder and complex posttraumatic stress disorder.

“…To reach a diagnosis, PTSD and CPTSD require exposure to a threatening or horrific event, symptoms persisting for several weeks, and impairment in functioning (WHO, 2019). Differentiating between the two disorders could have implications for mental health policy, research, and clinical practice; it could help to determine risk factors and develop targeted interventions for PTSD and CPTSD (Nestgaard Rød & Schmidt, 2021). The availability of validated assessment tools to measure these constructs is a prerequisite for this use.…”