Complex PTSD as a Diagnosis
There has been ongoing debate among mental health clinicians and researchers regarding the diagnosis of Complex PTSD. Although there were many who wished to see it included as a separate category in the 2015 edition of American Psychological Association Diagnostic & Statistical Manual of Mental Disorders, there were many who disagreed (Bryant, 2012; Herman, 2012; Resnick et al., 2012a, 2012b; Weiss, 2012). As well known traumatologist Bessel van der Kolk writes in a 2019 article entitled “The Politics of Mental Health,” despite the fact that the American Psychological Association’s “PTSD committee voted 19 to 2 to create a new diagnosis in the DSM…. [the] diagnosis was eventually left out of the DSM-IV, despite overwhelming research evidence for a much more complex developmental response to trauma” [than PTSD].
AS Hyland et al (2016) points out, research does provide evidence of the validity of Complex PTSD as distinct from PTSD:
In addition to the numerous other findings regarding the validity of a unique and distinguishable class of trauma survivors who exhibit the symptom profile of CPTSD (Cloitre et al., 2013; Cloitre et al., 2014; Elklit et al., 2014; Knefel et al., 2015; Knefel & LuegerSchuster, 2013), researchers and clinicians now have a growing body of evidence, drawn from a multitude of distinct trauma populations, to support the construct validity of CPTSD as a distinct diagnostic entity (Hyland et al., 2016, p. 7).
For relational trauma survivors the good news is in 2018 the World Health Organization announced it would include Complex PTSD in the 11th edition of its International Classification of Diseases (ICD-11), the other main diagnostic manual used around the world. It is not known whether or when it might be included in the next edition of the APA DSM.
It should be noted that Complex PTSD is referred to alternately in the literature as Complex Trauma, Disorder of Extreme Stress Not Otherwise Specified (DESNOS), and Developmental Trauma (relating to children). Although we use Complex PTSD here at OOTS, many of us prefer the term Relational Trauma Response because it is less pathologizing. That is, it puts the focus on those who perpetrated our trauma and the fact that we responded in a normal way to abnormal stress, rather than on us as ‘disordered’.
Bryant, R. A. (2012). Simplifying complex PTSD: Comment on Resick et al. (2012). Journal of Traumatic Stress, 25(3), 252-253. doi:10.1002/jts.21696
Cloitre, M., Courtois, C., Ford, J. Green, B., Alexander, P., Briere, J., Herman, J. Lanius, R., Pearlman, L., Stolbach, B., Spinazzola, J. & van der Hart, O. (2012). ISTSS expert consensus treatment guidelines for Complex PTSD in adults. International Society for Traumatic Stress Studies.
Elklit, A., Hyland, P., & Shevlin, M. (2014). Evidence of symptom profiles consistent with posttraumatic stress disorder and complex posttraumatic stress disorder in different trauma samples. European Journal of Psychotraumatology, 51-10. doi:10.3402/ejpt.v5.24221
Herman, J. (2012). CPTSD is a distinct entity: Comment on Resick et al. (2012). Journal of Traumatic Stress, 25(3), 256-257. doi:10.1002/jts.21697
Hyland, P., Shevlin, M., Elklit, A., Murphy, J., Vallières, F., Garvert, D. W., & Cloitre, M. (2016). An Assessment of the Construct Validity of the ICD-11 Proposal for Complex Posttraumatic Stress Disorder. Psychological Trauma: Theory, Research, Practice, And Policy, doi:10.1037/tra0000114
Kezelman, C., Hossack, N., Stavroupoulos, P. & Burley, P. (2015). The cost of unresolved childhood trauma and abuse in adults in Australia. Retrieved from: http://www.blueknot.org.au/WHO-WE-ARE/Our-Documents/Publications
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. doi:10.3402/ejpt.v6.25290
Resick, P. A., Bovin, M. J., Calloway, A. L., Dick, A. M., King, M. W., Mitchell, K. S., & ... Wolf, E. J. (2012). A critical evaluation of the complex PTSD literature: Implications for DSM-5. Journal of Traumatic Stress, 25(3), 241-251. doi:10.1002/jts.21699
Resick, P. A., Wolf, E. J., Stirman, S. W., Wells, S. Y., Suvak, M. K., Mitchell, K. S., & ... Bovin, M. J. (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
Walker, P. (2013). Complex PTSD: From surviving to thriving. USA: Azure Coyote.
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
World Service Organization of Adult Children of Alcoholics. http://www.adultchildren.org/member-GlobalFellowship