Complex PTSD has entered the vernacular of clinicians, yet there is no clear outline in any of the current diagnostic manuals, International Statistical Classification of Diseases and Related Health Problems version 10 (ICD 10) , Diagnostic and Statistical Manual of Mental Disorders version 5 ( DSM 5 ) and The Psychodynamic Diagnostic Manual (PDM). The new ICD 11 proposes to include a new diagnosis of Complex PTSD diagnosis, and there is much debate about this. However, currently their is no Complex PTSD diagnosis.
So when a clinician says their client has complex PTSD, what do they mean? Some things to consider if you are using complex PTSD as a diagnosis.
- During the trials for the DSM IV Roth, S., Newman, E., Pelcovitz, D., van der Kolk, B., & Mandel, F. S. (1997) found that 92% of individuals who had the proposed Complex PTSD diagnosis met the criteria for the PTSD. This was why it was not included in the DSM5.
- Resick et al., (2012) Reviewed the Complex PTSD (CPTSD) literature and concluded that there is not enough empirical support for a distinct disorder. They outlined that there is a lack of definitional consensus amongst professionals; a lack of reliable, valid measures; and it was not yet clear if CPTSD depicts a separate disorder to PTSD or a more severe form.
- There is overlap of many disorders and PTSD is no different. The intersection between PTSD, depression, BPD and anxiety means clients can present with considerable distress.
- Complex posttraumatic stress disorder (CPTSD) is proposed for inclusion in the ICD-11 as a diagnosis distinct from posttraumatic stress disorder (PTSD), reflecting deficits in affective, self-concept, and relational domains. DSM 5 includes a number of these domains already. At this stage ICD-11 will require a diagnosis of PTSD before CPTSD can be diagnosed.
- The concept of “clinically meaningful” is often put forward as a reason for the use of CPTSD. However, if there is no consensus on definition of the meaning then this is not meaningful. Is your use of this term meaningful or helpful for clients?
- Complexity, does this mean multi-diagnostic? Does co-morbidity exist? Most clinicians would agree that it does, and yes, it is messy.
- Complexity, does this mean I find it hard to treat, “be with this client”? Does it mean I am not sure what to do?
- Resick et al., (2012) outlined that clinical trials have included people who would potentially meet the definition of CPTSD in terms of symptoms and complex trauma histories, and these people have responded to treatments that are effective for PTSD.
Roth, S., Newman, E., Pelcovitz, D., van der Kolk, B., & Mandel, F. S. (1997). Complex PTSD in victims exposed to sexual and physical abuse: Results from the DSM-IV field trial for Posttraumatic Stress Disorder. Journal of Traumatic Stress, 10, 539-555.
Resick, P. A., Bovin, M. J., Calloway, A. L., Dick, A. M., King, M. W., Mitchell, K. S., et al. (2012). A critical evaluation of the complex PTSD literature: Implications for DSM-5. Journal of Traumatic Stress, 25, 241-251.