I had an interesting conversation over on Twitter the other day. Some folks might say I was feeding a troll, but the questions they/he/it were asking had some heft to them. Basically, the troll was denying that CPTSD even existed. So I did what I tend to do, which is bombard them with scientific evidence. As a troll, of course, no amount of science was going to persuade them to change their mind.
However, it did cause me to dive back into the literature. So, I owe the troll one. One of the first articles I found was this one from the European Journal of Psychotraumatology. The full citation and the link the to paper are below.
The paper titled Complex PTSD: what is the clinical utility of the diagnosis? was written by Åshild Nestgaard Rød and Casper Schmidt. Both authors are associated with the Department of Communication and Psychology at Aalborg University, Aalborg, Denmark.
With the upcoming implementation of the International Classification of Diseases, version 11 (ICD-11) the researchers sought to assess the clinical utility of the diagnosis of CPTSD.
The Introduction gives a detailed history of the evolution of the CPTSD diagnosis. I will give a brief timeline to sum up the steps cited in this article. (Please remember these researchers are based in Denmark. If a favorite practitioner is not mentioned, it is not a denial or a slight of their work, just a different pool of resources.)
1992: J.L. Herman puts forth the initial idea of ‘Complex PTSD’.
2000: The DSM-IV issues an appendix that covers ‘disorders of extreme stress not otherwise specified’ (DESNOS)
20??: The ICD-10 used the term ‘enduring personality change after catastrophic experience’ (EPCACE) but the term was not widely used.
2018: With the publication of the ICD-11 the diagnosis EPCACE was replaced with the diagnosis of CPTSD.
What the ICD-11 classifies as CPTSD is described as follows.
“There is a distinct post-traumatic stress disorder which, in addition to core symptoms of PTSD, is characterized by disorders in three domains of self-organization:
1) affective dysregulation,
2) negative self-concept and
3) relational difficulties.
The disorder is initially triggered by persistent and invasive stress, without symptoms necessarily arising from trauma-related stimuli at their onset (Maercker et al., 2013).”
Through review of the empirical research and an analysis of the measuring tools (International Trauma Questionnaire (ITQ) and International Trauma Interview (ITI)) the researchers draw a convincing conclusion for the successful implementation of the diagnosis of CPTSD in clinical settings.
A significant amount of evidence supports the discriminant validity of CPTSD when compared with PTSD (Brewin et al., 2017), but CPTSD’s utility for clinical practice is still unclear (Cloitre, 2020). This article intends to uncover this based on the empirical research literature that has led to CPTSD’s inclusion in ICD-11, and an account is given of relevant measuring tools that have been developed in connection with the establishment of CPTSD as a clinical construct. The clinical utility of the diagnosis is evaluated considering past conditions, differential diagnostics, implications for treatment, and future needs in clinical practice.
They sum up their findings with “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.”
As of 2022 the ICD-11 was implemented in clinical practice in Europe.
Complex PTSD: what is the clinical utility of the diagnosis?
Eur J Psychotraumatol. 2021; 12(1): 2002028.
Published online 2021 Dec 9. doi: 10.1080/20008198.2021.2002028