Complex post-traumatic stress disorder (CPTSD) is a stress-related mental disorder generally occurring in response to complex traumas, i.e. commonly prolonged or repetitive exposures to a series of traumatic events, within which individuals perceive little or no chance to escape.
In the ICD-11 classification, CPTSD is a category of post-traumatic stress disorder (PTSD) with three additional clusters of significant symptoms: emotional dysregulations, negative self-beliefs (e.g. feelings of shame, guilt, failure for wrong reasons), and interpersonal difficulties. Examples of CPTSD's symptoms are prolonged feelings of terror, worthlessness, helplessness, distortions in identity or sense of self, and hypervigilance. CPTSD's symptoms share some similarities with the observed symptoms in borderline personality disorder, dissociative identity disorder and somatization disorder.
There exist strong relationships between CPTSD and repetitive adverse childhood experiences, especially among survivors of harmful foster care. In fact, the trauma model of mental disorders associates CPTSD with chronic or repetitive: sexual, psychological, physical abuse or neglect, intimate partner violences, bullying, kidnapping and hostage situations, indentured servants, slavery or other human trafficking, sweatshop workers, prisoners of war, concentration camp survivors and solitary confinement. The undergone situations generally last for long periods of time. Besides these, any situations involving captivity or entrapment (i.e. perceived situations lacking of easy and viable escape routes) can lead to CPTSD.
History
Judith Lewis Herman was the first psychiatrist and scholar to propose Complex Post-Traumatic Stress Disorder (CPTSD) as a (new) mental disorder in 1992, within her book Trauma & Recovery and an accompanying article.
Classifications
The World Health Organization (WHO)'s International Statistical Classification of Diseases has included CPTSD since its eleventh revision that was published in 2018 and came into effect in 2022 (ICD-11). The previous edition (ICD-10) proposed a diagnosis of Enduring Personality Change after Catastrophic Event (EPCACE), which was an ancestor of CPTSD. Besides the United States Department of Veterans Affairs (VA), Healthdirect Australia (HDA) and the British National Health Service (NHS), have also acknowledged CPTSD as mental disorder. However, the American Psychiatric Association (APA) has not included CPTSD in the Diagnostic and Statistical Manual of Mental Disorders. It has nonetheless proposed: Disorders of Extreme Stress - not otherwise specified (DESNOS) since the DSM-IV, which is a mental disorder close to CPTSD.
Symptoms
Children and adolescents
The diagnosis of PTSD was originally developed for adults who had suffered from a single-event trauma, such as a traumatic experience during a war, or rape. However, the situation for many children is quite different. Children can suffer chronic trauma such as maltreatment, family violence, dysfunction, or a disruption in attachment to their primary caregiver. In many cases, it is the child's caregiver who causes the trauma. The diagnosis of PTSD does not take into account how the developmental stages of children may affect their symptoms and how trauma can affect a child's development.
The term developmental trauma disorder (DTD) has been proposed as the childhood equivalent of CPTSD. This developmental form of trauma places children at risk for developing psychiatric and medical disorders. Bessel van der Kolk explains DTD as numerous encounters with interpersonal trauma such as physical assault, sexual assault, violence or death. It can also be brought on by subjective events such as abandonment, betrayal, defeat or shame.