Complex PTSD

What is Complex PTSD?

Complex Post-traumatic Stress Disorder is a not a diagnosis in the DSM-5 psychiatric manual, released in 2013, but is proposed to be included in the ICD-11 diagnostic manual, due for release in 2017.

Complex Post-traumatic Stress Disorder, also known as “complex trauma”, is the result of multiple traumatic events occuring over a period of time, for example caused by multiple incidents of child abuse.

Differences between PTSD and Complex PTSD 

PTSD_CPTSD_ICD11

Differences between PTSD and Complex PTSD

Interpersonal problems includes social and interpersonal avoidance (avoiding relationships), feeling distance or cut off from others, and never feeling close to another person. The term negative self-concept includes a feeling of worthlessness and feelings of guilt. While survivors of PTSD may feel “not myself”, a survivor of Complex PTSD may feel no sense of self at all or… a few may feel as if they are no longer human at all (Lovelace and McGrady, 1980; Timerman, 1981).[1]:385-386.

Believing yourself to be “contaminated, guilty, and evil” is commonly reported by survivors of Complex PTSD. A fragmented identity is common, with Dissociative Identity Disorder occurring in some people. [1]:386

Interpersonal sensitivity includes having feelings which are easily hurt, anger/temper outbursts. Complex PTSD is normally the result of interpersonal trauma, the long duration of the trauma and the control of the perpetrator(s) prevents people from expressing anger or rape at the perpetrator(s) during the trauma; anger and rage both at perpetrators and the self can only be expressed after the trauma ends. Prolonged abuse normally leads to a loss of previously-held beliefs, with feelings of “being forsaken by both and God”. [1]:382,386

Being unable to manage your own emotions is known as affect dysregulation, and often referred to as difficulties with emotion regulation. The unexpressed anger and internalized rage may lead to self-harm, a sense of self-hatred, and/or suicide attempts. [1]:382 Survivors of prolonged child abuse have an increased risk of self-injury, and the risk “repeated victimization” (e.g., relationships with abusive people, sexual harassment and rape) is significantly higher. [1]:387

Complex PTSD, BPD and Personality Disorders

Recent research has produced detailed analysis of the symptoms of Complex PTSD, PTSD and Borderline Personality Disorder (BPD). Many people with BPD have either PTSD, or meet the proposed criteria for Complex PTSD, but Complex PTSD was shown to be a separate diagnosis because a significant number did not meet the BPD criteria (and vice versa).

In 1992, when first proposing Complex PTSD, Judith Lewis-Herman stated: Concepts of personality developed in ordinary circumstances are frequently applied to survivors, without an understanding of the deformations of personality which occur under conditions of coercive control. Thus, patients who suffer from the complex sequelae of chronic trauma commonly risk being misdiagnosed as having personality disorders. They may be described as “dependent,” “masochistic,” or “self−defeating.”

Earlier concepts of masochism or repetition compulsion might be more use− fully supplanted by the concept of a complex traumatic syndrome.[1]:388

Complex PTSD was considered to be included within “associated features of PTSD” for the DSM-IV under the name Disorders of Extreme Stress Not Otherwise Specified (DESNOS), but this was not included in either the DSM-IV or DSM-V.[8]:23

ICD 11 draft – Complex Post-traumatic Stress disorder

The ICD-11, which is currently a draft document, includes the diagnosis of Complex Post-traumatic Stress Disorder in the Disorders specifically associated with stress section, immediately after Post-traumatic Stress Disorder. [3]

Code 7B21 “Complex PTSD is a disorder that arises after exposure to a stressor typically of an extreme or prolonged nature and from which escape is difficult or impossible.

The disorder is characterized by the core symptoms of PTSD as well as the development of persistent and pervasive impairments in affective, self and relational functioning, including difficulties in emotion regulation, beliefs about oneself as diminished, defeated or worthless, and difficulties in sustaining relationships.”

The current ICD-10 includes a diagnosis of Enduring Personality Change After Catastrophic Experience (EPCACE) in the Disorders of adult personality and behavior section. This is regarded as similar to Complex PTSD.

Code F62.0 “Enduring personality change may follow the experience of catastrophic stress. The stress must be so extreme that it is unnecessary to consider personal vulnerability in order to explain its profound effect on the personality…

ICD-10 Diagnostic guidelines

The personality change should be enduring and manifest as inflexible and maladaptive features leading to an impairment in interpersonal, social, and occupational functioning. Usually the personality change has to be confirmed by a key informant.

In order to make the diagnosis, it is essential to establish the presence of features not previously seen, such as: a hostile or mistrustful attitude towards the world; social withdrawal; feelings of emptiness or hopelessness; a chronic feeling of being “on edge”, as if constantly threatened estrangement.

This personality change must have been present for at least 2 years, and should not be attributable to a pre-existing personality disorder or to a mental disorder other than post-traumatic stress disorder (F43.1).

See also

International Society for Traumatic Stress Studies (ISTSS) Treatment Guidelines for Complex PTSD in Adults 

and Evidence for proposed ICD-11 PTSD and complex PTSD: a latent profile analysis

 

 

 

 

 

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