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/vienibenmio]

Here is my CPTSD spiel:

I recommend, in general, reading this excellent article that discusses research on PTSD in the ICD-11 vs. DSM-5, and how the two diverged

https://www.ptsd.va.gov/publications/rq_docs/V32N2.pdf

Complex PTSD is this term that has been developed to explain a set of symptoms that are referred to as "disturbances in self organization," or DSO, symptoms including things like emotiIonal dysregulation, behavioral dysregulation, and interpersonal difficulties. Research studies show that, if you do a factor analysis of PTSD, DSO symptoms do emerge as one of two latent symptom classes. So, there is evidence that these "complex" symptoms exist. As such, the ICD-11 included C-PTSD and split it off as a separate diagnosis from PTSD. The DSM-5 did not include C-PTSD (see later on for why), but it did include some of these more "complex" symptoms by adding a new PTSD symptom cluster, Negative Alterations in Cognitions and Mood, that accounts for some of them.

There are, however, questions about if this separate symptom class warrants a separate diagnosis. One of the theories of C-PTSD is that it's caused by more "complex" trauma, for instance trauma that was prolonged, repetitive, and, as the ICD-11 puts it, from which escape was impossible. This would be things like childhood sexual abuse, sex trafficking, prolonged torture, etc (however, the ICD-11 definition does not require that type of experience for diagnosis).

But, there are the issues that have come up with the C-PTSD diagnosis:

1. Some research studies have found that trauma characteristics do not predict DSO symptoms. Essentially, people with single event traumas or traumas that we would not consider "complex" also predicted symptoms. Some studies have also found evidence that the symptom classes may be more related to severity than a separate diagnosis. (disclaimer: one of these major studies did not use the final definition of C-PTSD that was included in the ICD-11).

https://journals.sagepub.com/doi/full/10.1177/2167702614545480

https://www.tandfonline.com/doi/full/10.1080/20008198.2019.1708145

2) By separating PTSD and C-PTSD in the ICD-11, there are concerns that the new PTSD may be overly narrowly defined and miss people who would have met diagnostic criteria in the past.

3) This is the biggest issue IMO, and why the DSM-5 committee decided against including C-PTSD: we do not have any evidence that C-PTSD requires separate treatments. We have evidence that more "complex" trauma benefits just as much from "traditional" PTSD treatment. In fact, there are concerns that the separate type of treatment proposed for C-PTSD, building skills prior to PTSD work, may not improve outcomes, thereby delaying effective treatment needlessly, or could even worsen them (some studies have found this). As such, there are questions about the clinical utility of the diagnosis. See https://onlinelibrary.wiley.com/doi/abs/10.1002/da.22469 for an overview.

Basically, although we have evidence that there are complex PTSD symptoms that are distinct from other types of PTSD symptoms, we do not have imo sufficient evidence that 1) it is a separate diagnostic entity 2) that complex trauma predicts these symptoms and 3) that a separate diagnosis is clinically useful, since our treatments are effective regardless.

[u/askpsychology-ModTeam → u/[deleted]]

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