Complex PTSD as a Distinct Diagnostic Construct

Brewin, C. R., Lanius, R. A., Novac, A., Schnyder, U., Galea, S. (2009). Reformulating PTSD for DSM-V: Life after criterion A. Journal of Traumatic Stress, 22, 366–373.

Brewin, C. R., Cloitre, M., Hyland, P., Shevlin, M., Maercker, A., Bryant, R., ...Reed, G. M. (2017). Evidence regarding the ICD-11 proposals for diagnosing PTSD and complex PTSD. Clinical Psychology Review, 58, 1-15.

Bryant, R. A. (2012). Simplifying Complex PTSD: Comment on Resick et al. Journal of Traumatic Stress, 25(3), 252-253. doi:10.1002/jts.21696

Cloitre, M., Garvert, D., Brewin, C., Bryant, R., & Maercker, A. (2013). Evidence for proposed ICD-11 PTSD and complex PTSD: a latent profile analysis. European Journal of Psychotraumatology, 4.

Fuss, J. et al. (2019). Public stakeholders’ comments on ICD-11 chapters related to mental and sexual health. World Psychiatry, 18(2), 233-35.

Giourou E. et al. (2018). Complex posttraumatic stress disorder: The need to consolidate a distinct clinical syndrome or to reevaluate features of psychiatric disorders following interpersonal trauma? World J Psychiatry, 8(1), 12-19. Available:  Not available online.

Goodman, M. (2012). Complex PTSD is on the trauma spectrum: Comment on Resick et al. Journal of Traumatic Stress, 25(3), 254-255.

Herman, J. (1992). Complex PTSD: A syndrome in survivors of prolonged and repeated trauma. Journal of Traumatic Stress, 5(3).

Herman, J. (2012). CPTSD is a distinct entity: Comment on Resick et al. (2012). Journal of Traumatic Stress, 25(3), 256-257.

Hyland, P., et al. (2017). An assessment of the construct validity of the ICD-11 proposal for Complex Post Traumatic Stress Disorder. Psychological Trauma: Theory, Research, Practice, And Policy.

ISTSS Guidelines Position Paper on Complex PTSD in Adults (n.d.)

ISTSS Guidelines Position Paper on Complex PTSD in Children and Adolescents (n.d.)

Karatzias, T,, et al. (2017). Evidence of distinct profiles of Posttraumatic Stress Disorder (PTSD) and Complex Posttraumatic Stress Disorder (CPTSD) based on the new ICD-11 Trauma Questionnaire (ICD-TQ), Journal of Affective Disorders, 207, 181-187. 

Karatzias, T., et al., (2017). PTSD and Complex PTSD: ICD-11 updates on concept and measurement in the UK, USA, Germany and Lithuania. European Journal of Psychotraumatology, 8 (sup7), 1418103. doi:10.1080/20008198.2017.1418103 

Knefel, M., Garvert, D. W., Cloitre, M., & Lueger-Schuster, B. (2015). Update to an evaluation of ICD-11 PTSD and Complex PTSD criteria in a sample of adult survivors of childhood institutional abuse by Knefel & Lueger-Schuster (2013): A latent profile analysis. European Journal of Psychotraumatology, 61-6.

Knefel, M., et al., (2019). A cross-cultural comparison of ICD-11 Complex Posttraumatic Stress Disorder symptom networks in Austria, the United Kingdom, and Lithuania, Journal of Traumatic Stress, DOI: 10.1002/jts.22361

Knefel, M., et al., (2019). The replicability of ICD-11 complex post-traumatic stress disorder symptom networks in adults. The British Journal of Psychiatry . DOI: 10.1192/bjp.2018.286

Landy, M. J. H., Wagner, A.C., Brown-Bowers, A., Monson, C. M. (2015). Examining the evidence for complex posttraumatic stress disorder as a clinical diagnosis. Journal of Aggression, Maltreatment and Trauma, 24, 215-236.

Resick, P. et al. (2012). A critical evaluation of the Complex PTSD literature: Implications for DSM-5. Journal of Traumatic Stress, 25(3), 241-251.

Resick, P. et al. (2012). Advocacy through science: Reply to comments on Resick et al. (2012). Journal of Traumatic Stress, 25(3), 260-263. doi:10.1002/jts.21702

Rosenthal, M., Reinhardt, K. & Birrell, P.  (2016) Guest editorial: Deconstructing disorder: An ordered reaction to a disordered environment, Journal of Trauma & Dissociation, 17(2), 131-137.

van der Kolk, B. A., Roth, S. & Pelcovitz, D. (2005). Disorders of extreme stress: The empirical foundation of a complex adaptation to trauma. Journal of Traumatic Stress, 18(5), 389-399. 

 Weiss, D. S. (2012). Introduction to the special feature on Complex PTSD. Journal of Traumatic Stress, 25(3), 239-240. doi:10.1002/jts.21711


Cloitre, M., et al. (2009). A developmental approach to complex PTSD: Childhood and adult cumulative trauma as predictors of symptom complexity. Journal of Traumatic Stress, 22(5), 399-408. 

Cloitre, M., et al. (2014). Distinguishing PTSD, Complex PTSD, and Borderline Personality Disorder: A latent class analysis. European Journal of Psychotraumatology, 5(1), 25097

Cloitre, M., et al. (2018). The International Trauma Questionnaire: Development of a self-report measure of ICD-11 PTSD and complex PTSD. Acta Psychiatrica Scandinavica, 1-11.  

Danese, A. & van Harmelen, A. (2017). The hidden wounds of childhood trauma, European Journal of Psychotraumatology, 8(7).

Elklit, A., Hyland, P., & Shevlin, M. (2014). Evidence of symptom profiles consistent with Post Traumatic Stress Disorder and Complex Post Traumatic Stress Disorder in different trauma samples. European Journal of Psychotraumatology, 51(10). doi:10.3402/ejpt.v5.24221

Ford, J. D. & Courtois, C. A. (2014). Complex PTSD, affect dysregulation, and borderline personality disorder. Borderline Personality Disorder and Emotion Dysregulation, 1(1), 9.

Jowett, S., et al. (2019). Differentiating symptom profiles of ICD-11 PTSD, complex PTSD, and borderline personality disorder: A latent class analysis in a multiply traumatized sample. Personality Disorders: Theory, Research, and Treatment. DOI:  10.1037/per0000346

Karatzias, T. et al. (2019). Risk factors and comorbidity of ICD‐11 PTSD and complex PTSD: Findings from a trauma‐exposed population based sample of adults in the United Kingdom. Depression and Anxiety.  DOI: 10.1002/da.22934

Knefel, M., et al., (2018). From child maltreatment to ICD-11 complex post-traumatic stress symptoms: The role of emotion regulation and re-victimisation. Journal of Clinical Psychology 75(2). DOI: 10.1002/jclp.22655.

Terpou, B., et al. (2019). The effects of trauma on brain and body: A unifying role for the midbrain periaqueductal gray. Journal of Neuroscience Research. DOI: 10.1002/jnr.24447

van der Hart, O., Nijenhuis, E. R., & Steele, K. (2005). Dissociation: An insufficiently recognized major feature of complex posttraumatic stress disorder. Journal of Traumatic Stress, 18(5), 413-423.

Physical & Psychological Co-Morbidities


Anda, R.  et al. (2006). The enduring effects of abuse and related adverse experiences in childhood: A convergence of evidence from neurobiology and epidemiology. European Archives of Psychiatry and Clinical Neuroscience, 256(3), 174–186.

Boscarina, J. (2006). Post Traumatic Stress Disorder and physical illness: Results from clinical and epidemiologic studies, Annals of the New York Academy of Sciences.

Brown, D., et al. (2009). Adverse childhood experiences and the risk of premature mortality, American Journal of Preventative Medicine, 37(5), 389-396.

Danese, A. & Harmelen, A. (2017).   The hidden wounds of childhood trauma. European Journal of Psychotraumatology, 8.

Frost, R., al. (2019). The distribution of psychosis, ICD-11 PTSD and complex PTSD symptoms among a trauma-exposed UK general population sample. Psychological, Social and Integrative Approaches. DOI: 10.1080/17522439.2019.1626472

Hansen, M. & Olff, M. (2017). Child maltreatment across the lifespan. European Journal of Psychotraumatology, 8 (7).

Kelly-Irving, M. et al. (2013). Adverse childhood experiences and premature all-cause mortality, European Journal of Epidemiology, 28.

Lanius, R., Vermetten, E. & Pain, C. (Eds).  (2010).  The Impact of Early Life Trauma on Health and Disease: The Hidden Epidemic.

Middlebrooks, J. & Audage, M. (2008). The effects of childhood stress on health across the lifespan: Project report. National Center for Injury Prevention and Control of the Centers for Disease Control and Prevention

Najavits, L. et al. (2017).  The science of childhood trauma as a driver of chronic illnesses, CTIPP Science Notes (1), 1-4. 

Pace, T. & Heim, C. (2011). A short review on the psychoneuroimmunology of posttraumatic stress disorder: From risk factors to medical comorbidities, Brain, Behavior & Immunity, 25(1), 6-13.

Schonkoff, J., Boyce, T. & McEwen, B. (2009). Neuroscience, molecular biology, and the childhood roots of health disparities: Building a new framework for health promotion and disease prevention, Psychiatry.

Schonkoff, J. et al. (2012). The lifelong effects of early childhood adversity and toxic stress, Pediatrics, 129(1).


Dube, S. et al. (2002). Adverse childhood experiences and personal alcohol abuse as an adult, Addictive Behaviors, 27, 713-725.

Sessa, B. (2017). Why MDMA therapy for alcohol use disorder? And why now? ]Neuropharmacology, 142.

 Strine, T. et al. (2012). Associations between adverse childhood experiences, psychological distress, and adult alcohol problems, American Journal of Health Behavior, 36(3), 408-423.


Brown, M., Thacker, L. & Cohen, S. (2014). Association between adverse childhood experiences and diagnosis of cancer. PLOS ONE 9(1).  

Danese, A. Moffitt, T. & Harringtion, H. (2009). Adverse childhood experiences and adult risk factors for age-related disease, depression, inflammation, and clustering of metabolic risk markers, JAMA Pediatrics. 

Danese, A. & McEwen, B. (2012). Adverse childhood experiences, allostasis, allostatic load, and age-related disease, Physiology & Behaviour, 106(1), 29-39.

Dube, S. et al. (2009). Cumulative childhood stress and autoimmune diseases in adults, Psychosomatic Medicine, 71(2), 243-250. 

Kelly-Irving, M. et al. (2013). The embodiment of adverse childhood experiences and cancer development: potential biological mechanisms and pathways across the life course, International Journal of Public Health, 58(1), 3-11.

Michopoulos, V., et al. (2016). Inflammation in Fear- and Anxiety-Based Disorders: PTSD, GAD, and Beyond, Neuropsychopharmacology. Available:

Plantinga, M., et al. (2013). Association between posttraumatic stress disorder and inflammation: A twin study, BMC Medicine, 30, 125-130. 

Eating Disorders

Bacon, L & Aphramor, L. (2011).  Weight science: evaluating the evidence for a paradigm shift, Nutrition Journal, 10(9). Available here.

Brewerton, T.  (2007). Eating disorders, trauma, and comorbidity: Focus on PTSD, Eating Disorders: The Journal of Treatment & Prevention, 15:4, 285-304. Available here.

Briere, J. & Scott, C. (2007). Assessment of trauma symptoms in eating-disordered populations, The Journal of Treatment & Prevention, 15:4, 347-358.  Available:

Farr, O., Sloane, D., Keane, T. & Mantozoros, C. (2014). Stress- and PTSD-associated obesity and metabolic dysfunction: A growing problem requiring further research and novel treatments, Metabolism, 63(12), 1463–1468. Available here.

Masodkar, K., Johnson, J. & Peterson, M. (2016). Review of Posttraumatic Stress Disorder and Obesity: Exploring the Link, The Primary Care Companion for CNS Disorders, 18(1).  Available here.

Mason, S. et al., (2015). Child maltreatment’s heavy toll: The need for trauma-informed obesity prevention, American Journal of Preventive Medicine. Available here.

Michopoulos, V. et al. (2015). The mediating role of emotion dysregulation and depression on the relationship between childhood trauma exposure and emotional eating, Appetite, 91, 129-136. Available here.

Palmisano, G., Innamorati, M. & Vanderlinden, J. (2016). Life adverse experiences in relation with obesity and binge eating disorder: A systematic review, Journal of Behavioral Addictions 5(1), 11-31. Available here

Palmisano, G., et al. (2018) Childhood traumatic experiences and dissociative phenomena in eating disorders: Level and association with the severity of binge eating symptoms, Journal of Trauma & Dissociation, 19(1), 88-107, Available here.

Tagay, S., Schlottbohm, E., Reyes-Rodriguez, M., Repic, N. & Senf, W. (2014). Eating disorders, trauma, PTSD, and psychosocial resources, Eating Disorders: The Journal of Treatment & Prevention, 22:1, 33-49. Available here.

Waller, G., Corstorphine, E. & Mountford, V. (2007). The role of emotional abuse in the eating disorders: Implications for treatment, Eating Disorders: The Journal of Treatment & Prevention, 15:4, 317-331.

Suicidality & Self-Harm

Dube, S. et al. (2001). Childhood abuse, household dysfunction, and the risk of attempted suicide throughout the life span: Findings from the Adverse Childhood Experiences Study, JAMA Network. Available:

Ford J. D. & Gómez, J. (2015) The relationship of psychological trauma and dissociative and posttraumatic stress disorders to nonsuicidal self-Injury and suicidality: A review. Journal of Trauma & Dissociation, 16(3), 232-271

Assessment and Treatment

Bisson, J., et al. (2019). The International Society for Traumatic Stress Studies New Guidelines for the Prevention and Treatment of Posttraumatic Stress Disorder: Methodology and Development Process. Journal of Traumatic Stress.  DOI: 10.1002/jts.22421

Chouliara, Z. et al., (2017). Therapeutic change in group therapy for interpersonal trauma: A relational framework for research and clinical practice. Journal of Interpersonal Violence, 1-20.

Cloitre, M. (2015). The ‘‘one size fits all’’ approach to trauma treatment: Should we be satisfied? European Journal of Psychotraumatology, 6, 27344  

Cloitre, M., et al. (2012). ISTSS expert consensus treatment guidelines for Complex PTSD in adults. International Society for Traumatic Stress Studies.

Cloitre, M., et al. (2018). The International Trauma Questionnaire: Development of a self-report measure of ICD-11 PTSD and complex PTSD. Acta Psychiatrica Scandinavica, 1-11.

Courtois, C. A. (2008). Complex trauma, complex reactions: Assessment and treatment. Psychological Trauma: Theory, Research, Practice, and Policy, S(1), 86–100.

de Arellano, M. A., Ko, S. J., Danielson, C. K. & Sprague, C. M. (2008). Trauma-informed interventions: Clinical and research evidence and culture-specific information project. Los Angeles, CA & Durham, NC: National Center for Child Traumatic Stress.

De Jongh, A., et al. (2016). Critical analysis of the current treatment guidelines for complex PTSD in adults. Depression and Anxiety, 33, 359–369.

Ford, J. D. (2015). Complex PTSD: Research directions for nosology/assessment, treatment, and public health. European Journal of Psychotraumatology, 6(1), 27584.

Gómez, J., Lewis, J., Noll, L., Smidt, A. & Birrell, P. (2015) Shifting the focus: Nonpathologizing approaches to healing from betrayal trauma through an emphasis on relational care, Journal of Trauma & Dissociation, 17(2), 165-185.

Grossman, F., Spinazzola, J., Zucker, M. & Hopper, E. (2017). Treating adult survivors of childhood emotional abuse and neglect: A new framework. American Journal of Orthopsychiatry, 87(1), 86–93.

Heide, F. J. J. T., Mooren, T. M., & Kleber, R. J. (2016). Complex PTSD and phased treatment in refugees: A debate piece. European Journal of Psychotraumatology, 7(1), 28687

Jongh, A., Resick, P. A., Zoellner, L. A., Minnen, A., Lee, C. W., Monson, C. M., ... & Rauch, S. A. (2016). Critical analysis of the current treatment guidelines for complex PTSD in adults. Depression and Anxiety, 33(5), 359-369.

Ho, G., et al. (2019). Translation and validation of the Chinese ICD-11 International Trauma Questionnaire (ITQ) for the Assessment of Posttraumatic Stress Disorder (PTSD) and Complex PTSD (CPTSD). European Journal of Psychotraumatology. DOI:  10.1080/20008198.2019.1608718

Karatzias, T., et al., (2018). Is Self-Compassion a Worthwhile Therapeutic Target for ICD-11 Complex PTSD (CPTSD)? Behavioural and Cognitive Psychotherapy, 1–13. doi:10.1017/s1352465818000577.

Karatzias, T., et al (2019). Psychological interventions for ICD-11 Complex PTSD: Systematic review and meta-analysis. Psychological Medicine. DOI: 10.1017/S0033291719000436

Krammer, S., Kleim, B., Simmen-Janevska, K., & Maercker, A. (2016). Childhood trauma and complex posttraumatic stress disorder symptoms in older adults: a study of direct effects and social-interpersonal factors as potential mediators. Journal of Trauma & Dissociation, 17(5), 593-607.

Norcross, J. C., & Wampold, B. E. (2019). Relationships and responsiveness in the psychological treatment of trauma: The tragedy of the APA Clinical Practice Guideline. Psychotherapy. Advance online publication.

Rosenthal, M., Reinhardt, K. & Birrell, P. (2016). Deconstructing disorder: An ordered reaction to a disordered environment, Journal of Trauma & Dissociation, 17(2), 131-137.

Stadtmann. M., Maercker, A., Binder, J. & Schnepp, W. (2018). Why do I have to suffer? Symptom management, views and experiences of patients with a cPTSD: a grounded theory. BMC Psychiatry.

Tarocchi, A., Aschieri, F., Fantini, F. & Smith, J. (2013). Therapeutic assessment of complex trauma: A single-case time-series study. Clinical Case Studies, 12(3).

van der Kolk, B. A. (2002). The assessment and treatment of complex PTSD. Treating trauma survivors with PTSD, 127-156.

Related Research

Christie, H. et al. (2017). The transition to parenthood following a history of childhood maltreatment: a review of the literature on prospective and new parents’ experiences. European Journal of Psychotraumatology, 8 (7).

Digitale, E. (2016). Traumatic stress changes brains of boys, girls differently. Stanford Medicine News Centre

Haskell, L. & Randall, M. (2009). Disrupted attachments: A social context complex trauma framework and the lives of Aboriginal Peoples in Canada. Journal of Aboriginal Health.

Magruder, K. et al. (2016). Prevention and public health approaches to trauma and traumatic stress: a rationale and a call to action. European Journal of Psychotraumatology, 7 (1).

Magruder, K. et al. (2017). Trauma is a public health issue. European Journal of Psychotraumatology, 8 (1).

Powers, A., Fani, N., Carter, S., Cross, D., Cloitre, M., & Bradley, B. (2017). Differential predictors of DSM-5 PTSD and ICD-11 complex PTSD among African American women. European Journal of Psychotraumatology, 8(1).

Schnyder, U. et al. (2017). The global collaboration on traumatic stress. European Journal of Psychotraumatology, 8 (7).

Söchting, I., Corrado, R., Cohen, I., Ley, R. & Brasfield, C. (2007).  Traumatic pasts in Canadian Aboriginal people: Further support for a Complex Trauma conceptualization? British Columbia Medical Journal, 49(6), 320-326.

Spence, H. (2019). Experiencing the death of a formerly abusive parent. Dissertations & Theses. 278.

Research Conducted at OOTS

  • September 2017 - Trauma Survivors and the Effects of Being Misdiagnosed, Lisa Henshaw, doctoral candidate in the School of Social Work, Adelphi University, Garden City, New York, USA. Delighted to report that the study researcher Lisa Henshaw will be presenting her findings Nov 2019 at the International Society for Traumatic Stress Studies (ISTSS) 35th Annual Meeting. Here is the abstract:

    The Complexity of Unrecognized Trauma: A Phenomenological Study to Reveal Survivors' Lived Experiences - This qualitative study explored the lived experience of nine women who self-reported that their reactions to trauma were not professionally recognized during experiences of seeking help. Three semi-structured interviews were conducted with each woman (Seidman, 2013) and data analyzed using thematic content analysis (Braun & Clarke, 2006) led to four key findings. Firstly, respondents survived persistent, early childhood trauma in the context of interpersonal relationships, and secondly, these experiences manifested in complex reactions. Thirdly, their manifested, complex reactions to trauma were not professionally recognized and the women experienced retraumatization through relationships with the professionals they sought help from, as well as incorrect diagnoses. Lastly, respondents were vulnerable to experience repetitive trauma during adulthood in the context of both professional and interpersonal relationships. Phenomena uncovered how respondents’ experiences of professionally unrecognized trauma interlaced with their lifelong trauma narratives, contributing to a developing identity of profound and ambiguous loss, as well as growth through survivors’ strength and determination to find meaning. Implications are offered for practice, policy and future research, highlighting the significance of recognizing complex trauma reactions in policy and practice.

  • June 2017 - Couples Therapy and Survivors of Traumatic Experiences. Eric Mortensen, University of Saint Thomas Graduate School of Professional Psychology, Minnesota, USA.

  • January 2017