Post-Traumatic Stress Disorder

Lore & Background

The diagnosis of PTSD was originally given to adults who had suffered a trauma, such as during a war or rape. For children, chronic trauma such as maltreatment, family violence, or disruption in attachment to a primary caregiver can lead to different symptoms. The term developmental trauma disorder (DTD) has been proposed as the childhood equivalent of complex PTSD (C-PTSD), which is a related disorder with additional symptom clusters. Bessel van der Kolk explains DTD as numerous encounters with interpersonal trauma such as physical assault, sexual assault, violence, or death, and it can also be brought on by subjective events such as abandonment, betrayal, defeat, or shame.

Repeated traumatization during childhood leads to symptoms in seven domains including attachment problems, biomedical symptoms, affect or emotional regulation difficulties, elements of dissociation, behavioral control issues, cognition problems, and self-concept disturbances.

Reader's Guide

In the ICD-11, there are two paired diagnoses: PTSD and C-PTSD. To be diagnosed with C-PTSD, a person must also meet the diagnostic criteria for PTSD. Aside from the traumatic event itself, PTSD has three core elements: re-experiencing the event in the form of intrusive memories, nightmares, or flashbacks; deliberate avoidance of memories, thoughts, or other reminders of the event; and persistent perceptions of heightened current threat such as hypervigilance or enhanced startle reaction.

Functionality that can only be obtained with significant additional effort is considered to be impaired. C-PTSD has the same core elements as PTSD, but there are three additional symptoms that must be present: severe and pervasive difficulties in regulating emotions; changes in beliefs about oneself such as feeling worthless with significant shame; and difficulties in maintaining close relationships with important people. Again, these symptoms must cause significant impairment to be considered C-PTSD.

Did You Know?

• The World Health Organization's ICD-11 has included C-PTSD since its initial publication in 2018, which came into effect in 2022.
• The American Psychiatric Association has not included C-PTSD in the Diagnostic and Statistical Manual of Mental Disorders.
• A validated self-report measure called the International Trauma Questionnaire (ITQ) exists for assessing ICD-11 C-PTSD.
• The previous edition (ICD-10) proposed a diagnosis of Enduring Personality Change after Catastrophic Event (EPCACE), which was an ancestor of C-PTSD.
• In the ICD-11, there is no requirement of a specific trauma type for C-PTSD, unlike early descriptions that specified prolonged and repetitive trauma.