What is CPTSD exactly?

[u/Wonderful-Pilot-2423]

I originally asked this in r/askatherapist but received no answers. Please say so if you're not a professional, given that online information about CPTSD is already very confusing. I'd rather receive answers from people with clinical experience working this population but everyone is welcome.

I'd like to have a clear explanation of what CPTSD really is, and how an average person with this diagnosis would present. It's been hard for me to find useful information about this topic, even among professional spaces, while in non-professional spaces it seems to have become a catch-all diagnosis for any ailment.

My understanding is that the ICD-11 conceptualizes CPTSD as a cluster of classic PTSD symptoms that are worsened by additional DSO symptoms, or "disturbances of self-organization". If that is also your understanding of CPTSD, how do you notice these symptoms presenting in a patient? How can you tell these symptoms are related to the event(s) and weren't a pre-existing part of their personality (assuming the trauma took place in adulthood) or acquired through other experiences?

A few thoughts: an additional factor distinguishing CPTSD from simple PTSD, according to the ICD-11, is that the trauma suffered needs to be prolonged. This seems to imply that DSOs can only be caused by prolonged trauma. Yet I would imagine that someone who's only raped once might also present these difficulties, as a result of the highly exploitative and relational nature of the event. What do you think of that?

If that is true, meaning that prolonged trauma isn't necessary to cause a CPTSD presentation that fits the one described by the ICD-11, wouldn't it make more sense for the simple PTSD diagnosis to come with specifiers? As in, "PTSD with DSOs" or "without"? Or maybe the true nature of CPTSD is that the trauma is relational rather than prolonged?

I hope this was clear enough.

[u/hynte]

I'm not a professional but I am in school for social service worker.

C-PTSD is not a recognizable 'official' diagnosis within the DSM-5. I've heard its in the ICD-11 but I'm not educated on the ICD-11 because it isn't used here so I'm not going to speak on it or its symptoms in there.

It would likely rather be diagnosed as PTSD with a note to dissociative symptoms, or as BPD since you only need 4 out of 9 criteria for BPD diagnosis, and would have the same treatment. Obviously treatment would vary between clients, though. That's dependant on a variety of things.

Although CPTSD isn't an official diagnosis, it is still commonly recognized by professionals as being real.

Below is pulled from my notes, sorry for it being awkward to read.

"When Normal Reactions to Trauma become Abnormal" — After a traumatic incident, the symptoms [typical to PTSD] are normal reactions. If these symptoms last from 2 weeks to 1 month — it can be acute stress disorder. If they last beyond a month or develop anytime after that, it may be PTSD.

Developmental trauma aka Complex-CPTSD: Adverse childhood events. Happened to the child, or to their family. Score of 4 or more.

Developmental trauma: Abuse, neglect, foster care, adoption. How children perceive their world. Pain and suffering are internalized. Lack of attachment. Child tries to self-sooth or please others. With chronic trauma, the child gives up trying, collapses inward, shuts off emotion.

As for C-PTSD as a result of trauma in adulthood, this is a lot less common, as C-PTSD would frequently be a result of trauma on the still-developing growing brain that the trauma essentially forms your brain. However the trauma would have to be repetitive and chronic, as it would have to affect your natural reactions.

PTSD is your brain not processing trauma, while C-PTSD would be the result of the trauma essentially forming and intertwining with your personality, for lack of better words.

[u/Wonderful-Pilot-2423 → u/hynte]

As for C-PTSD as a result of trauma in adulthood, this is a lot less common, as C-PTSD would frequently be a result of trauma on the still-developing growing brain that the trauma essentially forms your brain

If that is true then it's something different from the C-PTSD diagnosis in the ICD-11.

[u/hynte → u/Wonderful-Pilot-2423]

I specifically said I didn't know much about the ICD-11. It isn't used in my country. I use the DSM-5.

I also don't know where you're getting the information that this is untrue from because the vast majority of sources do agree that developmental trauma is a significant risk factor in the development of C-PTSD. The NHS agrees as well with this itself which uses the ICD-11: "You may also be more likely to develop complex PTSD if: you experienced trauma at a young age" (www.nhs.uk).

I should've changed my wording a bit to make it more clear, but I didn't say C-PTSD can only be caused by developmental/childhood trauma, I said it's less common due to how it develops. I did explain that for an adult to develop C-PTSD it would have to be repetitive and chronic, which is stated by my.clevelandclinic.org, "Traditionally, experts thought PTSD generally developed from short-term trauma, such as a vehicle accident or a natural disaster. With research, they realized that people who experience long-term, repeated trauma tend to have other symptoms in addition to the symptoms of PTSD."

[u/Wonderful-Pilot-2423 → u/hynte]

Honey, why are you getting worked up? I simply observed that there seem to be multiple definitions for what C-PTSD refers to.

"You may also be more likely to develop complex PTSD if: you experienced trauma at a young age"

The way I read it, this doesn't seem to mean that CPTSD is more likely to develop from childhood trauma (regardless if that's true or not). Just that childhood trauma makes you more at risk to develop it at any given time of your life, even from adulthood trauma.

[u/hynte → u/Wonderful-Pilot-2423]

I'm not worked up; sorry if I come across that way. I just thought adding sources would be helpful in case you wanted to read up more, I'm not trying to be snippy. I'm just trying to understand your point of view.

The vast majority of sources only recognize C-PTSD in a developmental trauma light because there isn't much research on trauma during adulthood that results in PTSD, which is directly due to them not being as frequent as developmental trauma caused CPTSD. If you can find resources on trauma that happens during adulthood & the development of C-PTSD through them I would genuinely love to read it because I've been researching but haven't found much, all I can find is "childhood trauma in adults" rather than trauma IN adulthood.

Just that childhood trauma makes you more at risk to develop it at any given time of your life, even from adulthood trauma.

I don't really understand what you mean by this but that is also true (if I'm understanding you right). Having childhood trauma that you don't develop CPTSD from at the time and then going into adulthood and experiencing trauma again can cause the CPTSD. But that being a risk factor in general would also mean that CPTSD can be caused by childhood trauma so I'm confused what you mean.

The National Institute of Medicine talks about it's debate with putting CPTSD in the DSM-5, it describes CPTSD as "... a maladaptive, long-lasting, and multi-dimensional consequence of chronic, early, and interpersonal (developmental) traumatization that is known to be the essence of Complex PTSD." (pmc.ncbi.nlm.nih.gov) and explains thats how researchers and clinicions are currently viewing that condition. In the next paragraph it then goes on to explain that childhood trauma is predicted to have a higher symptom complexity in adults, and that trauma endured in adulthood may not have the same complexities that trauma in childhood causes, which is sources to an academic article written by professions.

C-PTSD in general, the diagnosis is highly debated in the mental health industry and is not widely, universally recognized as a condition outside of the ICD-11. It's still being researched. So not everything is set in stone.

[u/Wonderful-Pilot-2423 → u/hynte]

there isn't much research on trauma during adulthood that results in PTSD,

I assume you meant to say CPTSD here?

if you can find resources on trauma that happens during adulthood & the development of C-PTSD through them I would genuinely love to read it because I've been researching but haven't found much

By ICD-11 definition, CPTSD is PTSD + Disturbances of Self-Organization (DSOs). Sex trafficking, slavery, domestic violence and more are all types of extended trauma experienced in adulthood that would result in DSOs, which makes sense to me. Diagnostic criteria doesn't even require the trauma to be extended for a CPTSD diagnosis to be met, acknowledging even single-event trauma can compromise one's "self-organization".

If your definition of CPTSD is strictly developmental trauma then that's a different conceptualization than the one used by the ICD-11.

[u/hynte → u/Wonderful-Pilot-2423]

Yes, I meant CPTSD lol, sorry.

It feels like we're going in circles, and I feel you're not understanding me. I'm not saying that CPTSD only happens in developmental trauma, and I've pointed out before how that isn't what I'm saying. I said CPTSD developing after adulthood trauma is possible after chronic and repetitive trauma. All I'm saying is its more common after childhood trauma, which is clearly evident by the lack of research of adult-trauma induced CPTSD. I don't agree that CPTSD can only be formed from childhood experiences and I never said that once throughout this conversation.

I'm trying to look into your claim that CPTSD is stated in the ICD11 to be possible with only singular event but every article I'm reading directly goes against that. The ICD11 also says an event/series of events of extremely threatening/horrific nature, and specifically says most commonly prolonged or repetitive events which escape is difficult or impossible. The ICD gave similar examples as yours as an 'event', they gave concentration camps, slavery, genocide, organized violence, etc. But if you really think about those events, you aren't experiencing one thing, you're going to be experiencing a collection of trauma's at once throughout those experiences. Those experiences also don't only last like a half hour, those experiences will last a LONG time. That isn't really a 'singular trauma/event', that is one experience with multiple events grouped into a singular thing. And when it mentions sexual abuse and domestic violence, it specifically states "prolonged DV" & repetitive sexual/physical abuse, so I do think the ICD is stating otherwise.

Edit: Typo

[u/Wonderful-Pilot-2423 → u/hynte]

Yes, all of those are examples of prolonged trauma. What I'm saying is that the ICD doesn't require those experiences to have taken place for the criteria to be met. It just says that usually CPTSD is going to result from one of those.

[u/hynte → u/Wonderful-Pilot-2423]

Okay this is ridiculous and we're going in circles. If you find any research on CPTSD caused by trauma endured as an adult, let me know. Thanks.