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Did you know? The historical background of CPTSD and the important contribution of the first researcher!
Complex post-traumatic stress disorder (CPTSD) is a stress-related psychological behavioral disorder often triggered by exposure to complex trauma. These traumas typically refer to ongoing or repeated events that create a sense of inescapability for the victim. According to the International Classification of Diseases, 11th Revision (ICD-11), CPTSD is a category of post-traumatic stress disorder that, in addition to the symptoms of PTSD, has three important symptom clusters: affective regulation disorders, negative self-beliefs (such as shame, guilt, feelings of unwarranted failure), and interpersonal difficulties. Symptoms include persistent feelings of fear, worthlessness, helplessness, distorted identity or sense of self, and hypervigilance.
The history of CPTSD can be traced back to the 20th century, when many psychologists and psychiatrists began to notice that some people developed a unique set of psychological symptoms as a result of long-term psychological trauma.
Early descriptions of CPTSD not only emphasized the type of trauma (e.g., sustained, repeated), but in ICD-11, a specific type of trauma is not required for diagnosis. According to ICD-11 published by the World Health Organization (WHO), CPTSD has been officially included in the deficient health diagnosis since 2018 and will take effect in 2022.
Past versions of ICD-10 proposed a diagnosis called "Persistent Personality Changes Following Catastrophic Events" (EPCACE), which was the predecessor of CPTSD. It is worth noting that both Health Authority Australia (HDA) and the UK National Health Service (NHS) have recognized CPTSD as a mental illness. However, the American Psychiatric Association (APA) has not included CPTSD in the Diagnostic and Statistical Manual of Mental Disorders. In DSM-IV, the related "extreme stress disorder" (DESNOS) was included in the study, but was ultimately not included. Instead, DSM-IV and the subsequent DSM-5 expanded the symptoms of PTSD to better capture a variety of post-traumatic symptoms.
Symptoms of CPTSD
Children and Youth
In diagnosing PTSD in adults, the primary consideration is the pain they experience as a result of trauma, such as those suffered in war or rape. However, the situation is different for many children. Children may suffer from long-term trauma such as abuse, domestic violence, dysfunction, or disconnection from primary caregivers. Bessel van der Kolk explains that developmental trauma disorder (DTD) may be the childhood equivalent of CPTSD. This developmental trauma puts children at risk for mental illness and medical problems.
Persistent trauma during childhood can cause symptoms different from those described for PTSD. Symptoms include interpersonal boundaries, loss of trust, social isolation, and difficulty regulating emotions.
Adults
In adults, manifestations of CPTSD often begin with long-term interpersonal trauma in childhood. These early traumas interrupt their developing sense of self. Often the effects of emotional and physical pain or neglect in relationships with caregivers or siblings.
Diagnosis and Assessment
The diagnosis of CPTSD considers situations that have occurred, but was excluded in the 1994 DSM-IV, and PTSD is also listed in the DSM-5. ICD-11 has included CPTSD since it was first published in 2018. To assess ICD-11 CPTSD, a valid self-report scale exists, the International Trauma Questionnaire (ITQ).
Although complex PTSD has its own unique set of symptoms, the differences between it and PTSD are still worthy of attention. According to ICD-11, CPTSD can be diagnosed only if all conditions are met, including difficulty regulating emotions, changes in self-beliefs, and difficulty maintaining close relationships with significant others.
Treatment methods
Although standard evidence-based treatments are effective in treating PTSD, treatment of CPTSD often requires addressing interpersonal difficulties and other disparate symptoms. In her book Trauma and Memory, Judith Lewis Herman proposes a three-stage recovery model: establishing safety, remembering and mourning the loss, and reconnecting with community and wider society. She believes that recovery can only occur within a healing relationship.
The process of treating C-PTSD often involves prioritizing issues of functional impairment over PTSD symptoms.
As the understanding and research on CPTSD gradually deepens, experts are constantly exploring more effective treatment models and methods. This gives hope to many people who have been affected by complex trauma. But we also need to think about, in the face of this psychological dilemma, how can society provide support and understanding to promote everyone's recovery?
