Episode 52 – The “Complex” in CPTSD (Part 1)

As I said in Episode 51, Complex Post-Traumatic Stress Disorder, or CPTSD, is not actually a diagnosis in the DSM-5, the latest and most commonly used Diagnostic and Statistical Manual for Mental Disorders. There are discussions of adding it to future DSMs, but even there there is debate as to whether it should be its own separate condition or if it should simply be a subtype of PTSD. Today I’m just going to disregard all of this and discuss the distinctions between CPTSD and the more well-known PTSD.

A lot of symptoms are shared between the unofficial CPTSD and the classic PTSD. For example: flashbacks; anxiety; avoiding situations, places, or other things related to the trauma; negative changes in thinking or mood; and hypervigilance. CPTSD includes an entirely different subset of symptoms relating more to mood and identity, including: emotion regulation; identity and sense of self; and relationships.

PTSD is thought to arise from one particular traumatic event. A car crash, a natural disaster, war events, sexual abuse. CPTSD is distinguished from that by length of trauma and symptoms, with the main differences already listed up above. CPTSD could arise from community violence, repeated sexual or domestic abuse – any long-term repeated trauma.

CPTSD also sounds very similar to borderline personality disorder, or BPD, which I have discussed before. It’s debated as to whether these are two separate conditions or not. From what I can tell, the main differences are that CPTSD can be developed at any age, whereas BPD typically is present by young adulthood, and that BPD does not require “trauma” to develop in the first place (though BPD is strongly associated with childhood abuse or neglect).

My PTSD is probably more accurately a case of CPTSD; I believe my psychiatrist only settled on PTSD instead because CPTSD is not technically in the DSM-5, which is what most mental health professionals use for diagnosing patients. The DSM-5 does include a subtype of PTSD called dissociative PTSD, which seems to include the symptoms.

However, it is a diagnosis listed in the ICD-11, or the International Classification of Diseases, which the WHO (World Health Organization) uses. In the ICD-11, CPTSD results from “exposure to a traumatic event or series of events of an extremely threatening nature.” These events are also “usually prolonged or repetitive and escape from the situation is impossible or dangerous.” Examples could include:

• prolonged domestic violence;
• childhood sexual or physical abuse;
• torture;
• genocide;
• or slavery.

To be continued…