Complex Post Traumatic Stress Disorder (Complex PTSD) was first proposed as a distinct diagnosis from PTSD by Dr. Judith Herman in her 1992 book "Trauma and Recovery: The Aftermath of Violence - From Domestic Abuse to Political Terror”. In the 30 years since then, however, the diagnosis has been the subject of ongoing debate among mental health clinicians and researchers. It was only 2018 that the World Health Organization (WHO) announced it would be included in the eleventh edition of its International Classification of Diseases (ICD-11). The ICD-11 descriptor of Complex PTSD reads as follows:
Complex post traumatic stress disorder (Complex PTSD) is a disorder that may develop following exposure to an event or series of events of an extremely threatening or horrific nature, most commonly prolonged or repetitive events from which escape is difficult or impossible (e.g. torture, slavery, genocide campaigns, prolonged domestic violence, repeated childhood sexual or physical abuse).
All diagnostic requirements for PTSD are met. In addition, Complex PTSD is characterised by severe and persistent 1) problems in affect regulation; 2) beliefs about oneself as diminished, defeated or worthless, accompanied by feelings of shame, guilt or failure related to the traumatic event; and 3) difficulties in sustaining relationships and in feeling close to others. These symptoms cause significant impairment in personal, family, social, educational, occupational or other important areas of functioning.
Bibliography of Research into the WHO ICD-11 Diagnosis of Complex PTSD - Updated 27 March 2022
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Barbieri, A., Visco-Comandini, F., Alunni Fegatelli, D., Schepisi, C., Russo, V., Calò, F., Dessì, A., Cannella, G., & Stellacci, A. (2019). Complex trauma, PTSD and complex PTSD in African refugees. European Journal of Psychotraumatology, 10(1), 1700621. https://doi.org/10.1080/20008198.2019.1700621
Ben‐Ezra M., Karatzias T., Hyland P., Brewin C., Cloitre M., Bisson J., Roberts, N., . . . & Shevlin M. (2018). Posttraumatic stress disorder (PTSD) and complex PTSD (CPTSD) as per ICD‐11 proposals: A population study in Israel. Depression and Anxiety, 35(3), 264–274. https://doi.org/10.1002/da.22723
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Campodonico, C., Berry, K., Haddock, G., & Varese, F. (2021). Protective Factors Associated With Post-traumatic Outcomes in Individuals With Experiences of Psychosis. Frontiers in psychiatry, 12, 735870. https://doi.org/10.3389/fpsyt.2021.735870
Charak, R., Cano-Gonzalez, I., Shevlin, M., Ben-Ezra, M., Karatzias, T., & Hyland, P. (2021). Dimensional latent structure of ICD-11 posttraumatic stress disorder, complex PTSD, and adjustment disorder: Evidence from ghana, kenya, and nigeria. Traumatology. https://doi.org/10.1037/trm0000311
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Choi, H., Lee, W., & Hyland, P. (2021). Factor structure and symptom classes of ICD-11 complex posttraumatic stress disorder in a south korean general population sample with adverse childhood experiences. Child Abuse & Neglect, 114, 104982-104982. https://doi.org/10.1016/j.chiabu.2021.104982
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Cloitre, M. (2020). ICD-11 complex post-traumatic stress disorder: Simplifying diagnosis in trauma populations. The British Journal of Psychiatry, 216(3), 129-131. doi:10.1192/bjp.2020.43
Cloitre, M., Brewin, C. R., Kazlauskas, E., Lueger‐Schuster, B., Karatzias, T., Hyland, P., & Shevlin, M. (2021). Commentary: The need for research on PTSD in children and adolescents—A commentary on Elliot et al. (2020). Journal of Child Psychology and Psychiatry, 62(3), 277–279. https://doi.org/10.1111/jcpp.13361
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Daniunaite, I., Cloitre, M., Karatzias, T., Shevlin, M., Thoresen, S., Zelviene, P., & Kazlauskas, E. (2021). PTSD and complex PTSD in adolescence: Discriminating factors in a population-based cross-sectional study. European Journal of Psychotraumatology, 12(1), 1890937-1890937. https://doi.org/10.1080/20008198.2021.1890937
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Dokkedahl, S., Kristensen, T. R., & Elklit, A. (2022). Can Women Shelters Help Reduce Symptoms of PTSD and C-PTSD? Trajectories of PTSD Symptom Development Following Partner- and Family-Related Violence. Journal of Interpersonal Violence. https://doi.org/10.1177/08862605211066568
Dokkedahl, S., Kristensen, T. R., Murphy, S., & Elklit, A. (2021). The complex trauma of psychological violence: Cross-sectional findings from a cohort of four danish women shelters. European of Psychotraumatology, 12(1), 1863580. https://doi.org/10.1080/20008198.2020.1863580
Dumarkaite, A., Truskauskaite-Kuneviciene, I., Andersson, G., Mingaudaite, J., & Kazlauskas, E. (2021). Effects of mindfulness-based internet intervention on ICD-11 posttraumatic stress disorder and complex posttraumatic stress disorder symptoms: A pilot randomized controlled trial. Mindfulness, 12(11), 2754-2766. https://doi.org/10.1007/s12671-021-01739-w
Dyer, K. F. W., & Corrigan, J.-P. (2021). Psychological treatments for complex PTSD: A commentary on the clinical and empirical impasse dividing unimodal and phase-oriented therapy positions. Psychological Trauma: Theory, Research, Practice, and Policy, 13(8), 869-876. http://dx.doi.org.libproxy.uccs.edu/10.1037/tra0001080
Elliott, R., McKinnon, A., Dixon, C., Boyle, A., Murphy, F., Dahm, T., Travers‐Hill, E., Mul, C., Archibald, S., Smith, P., Dalgleish, T., Meiser‐Stedman, R., & Hitchcock, C. (2021). Prevalence and predictive value of ICD‐11 post‐traumatic stress disorder and complex PTSD diagnoses in children and adolescents exposed to a single‐event trauma. Journal of Child Psychology and Psychiatry, 62(3), 270-276. https://doi.org/10.1111/jcpp.13240
Facer-Irwin, E., Karatzias, T., Bird, A., Blackwood, N., & MacManus, D. (2021). PTSD and complex PTSD in male prisoners in the UK: Prevalence, trauma antecedents, and psychiatric comorbidities. Psychological Medicine, 1-11. doi:10.1017/S003329172004936
Felding, S. U., Mikkelsen, L. B., & Bach, B. (2021). Complex PTSD and personality disorder in ICD-11: When to assign one or two diagnoses? Australasian Psychiatry : Bulletin of the Royal Australian and New Zealand College of Psychiatrists, 10398562211014212-10398562211014212. https://doi.org/10.1177/10398562211014212
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Gelezelyte, O., Roberts, N. P., Kvedaraite, M., Bisson, J. I., Brewin, C. R., Cloitre, M., Kairyte, A., Karatzias, T., Shevlin, M., & Kazlauskas, E. (2022). Validation of the International Trauma Interview (ITI) for the Clinical Assessment of ICD-11 Posttraumatic Stress Disorder (PTSD) and Complex PTSD (CPTSD) in a Lithuanian Sample. European journal of psychotraumatology, 13(1), 2037905. https://doi.org/10.1080/20008198.2022.2037905
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Ho, G., Hyland, P., Shevlin, M., Inoue, S., Yang, P., Chen, F., Chan, A., & Karatzias, T. (2020). The validity of ICD-11 PTSD and Complex PTSD in East Asian cultures: Findings with young adults from China, Hong Kong, Japan, and Taiwan. European Journal of Psychotraumatology, 11, 1717826. https://doi.org/10.1080/20008198.2020.1717826
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