Complex post-traumatic stress disorder
Also known as Complex PTSD, complex PTSD, C-PTSD, CPTSD, complex post-traumatic stress disorder
PTSD plus lasting trouble with emotions, self-worth and relationships.
At a glance
In plain words
What it adds to PTSD, Why it develops, Not a weakness
See all 3What the extra symptoms sound like
Affective dysregulation: slow to calm, Affective dysregulation: shutting down, Negative self-concept: failure …
See all 7How therapists treat it
Herman's three stages, Phase-based treatment, Standard PTSD therapies …
See all 4Where it comes from
1988 and 1992, DESNOS and DTD
See all 2Connections
Judith Herman, Post-traumatic stress disorder and 12 others
See all 14
Also on this page: Key facts · Links · Sources · Related pages
- Complex PTSD usually follows prolonged or repeated trauma with little chance of escape.
- It has PTSD's core symptoms plus three more: emotional dysregulation, negative self-beliefs and relationship difficulties.
- Judith Herman first described it in 1992.
- The WHO's ICD-11 has included it since 2018; the American DSM does not.
Why it matters
- It describes many people abused or neglected as children better than PTSD alone, and it shapes how phase-based and relational therapies are used.
Key facts
- In short
- PTSD plus disturbances in self-organization: emotional dysregulation, negative self-concept, interpersonal problems1
- Developed by
- Judith Herman, in Trauma and Recovery (1992)1
- Recognized
- ICD-11 (published 2018, in effect 2022); not in the DSM-IV or DSM-51
- How common
- About 4% of adults in non-war, richer countries; 15% in war-exposed, poorer regions1
- Measured with
- The International Trauma Questionnaire (ITQ)1
- Criticism
- The DSM committee found too little validity research; 95% of those with the proposed diagnosis also met PTSD criteria1
In plain words
-
What it adds to PTSD1
Severe trouble regulating emotions, beliefs like being worthless with deep shame, and difficulty staying close to people.
-
Why it develops1
When harm comes from caregivers, people may come to feel fundamentally flawed and that others cannot be relied on.
-
Not a weakness1
Herman warned that survivors are often misread as dependent or self-defeating, when their reactions are learned survival responses.
What the extra symptoms sound like
-
Affective dysregulation: slow to calm2
One of the questionnaire statements used to assess ICD-11 complex PTSD reads "When I am upset, it takes me a long time to calm down".
-
Affective dysregulation: shutting down2
The same cluster includes the opposite pole: "I feel numb or emotionally shut down".
-
Negative self-concept: failure2
"I feel like a failure" is one of the two statements measuring negative self-concept.
-
Negative self-concept: worthlessness2
"I feel worthless" is the other.
-
Disturbed relationships: cut off2
"I feel distant or cut off from people" measures the relationship cluster.
-
Disturbed relationships: closeness2
"I find it hard to stay emotionally close to people" is its second item. In one sample of sexual violence survivors, 73.7% endorsed it.
-
Plus the PTSD core2
The same questionnaire asks about PTSD's core too, such as "Being 'super-alert', watchful, or on guard?", endorsed by 92.1% of that sample.
How therapists treat it
-
Herman's three stages1
Establish safety; remembrance and mourning; reconnection with community and society.
-
Phase-based treatment1
Build coping skills and safety first, then reduce avoidance and rework trauma beliefs, then consolidate.
-
Standard PTSD therapies1
Early studies find standard and phase-based PTSD treatment work about equally well for PTSD and complex PTSD.
-
No single answer1
There is no consensus on the best treatment; complex cases are often excluded from studies.
Where it comes from
-
1988 and 19921
Herman suggested the diagnosis in 1988 and set it out in Trauma and Recovery in 1992.
-
DESNOS and DTD1
Proposed for DSM-IV as DESNOS and later for children as developmental trauma disorder; both were rejected.
Connections
Related
- Judith HermanPersonFirst conceptualised it, in Trauma and Recovery (1992)
- Post-traumatic stress disorderTopicDiagnosis requires meeting PTSD criteria first
- Psychological traumaTopicUsually follows prolonged, repeated trauma
- Bessel van der KolkPersonProposed developmental trauma disorder as the childhood counterpart
- Schema therapyTopicProposed to complement trauma-focused work when relational or identity issues remain
- Dialectical behavior therapyTopicListed among evidence-based treatments for PTSD
- ShameTopicPervasive shame and worthlessness are part of the diagnosis
- Attachment theoryTopicOften caused by attachment figures, disrupting trust in others
- EMDR (Eye movement desensitization and reprocessing)TopicUsed by some practitioners for complex PTSD
- Internal Family SystemsTopicOne of its most common uses
- The Mosaic Mind: Empowering the Tormented Selves of Child Abuse SurvivorsBookLong-term effects of childhood abuse
- Trauma and Recovery: The Aftermath of Violence—From Domestic Abuse to Political TerrorBookThe book that first set out the diagnosis
- Undoing Aloneness and the Transformation of Suffering Into Flourishing: AEDP 2.0BookApplies AEDP to complex trauma
- Window of toleranceTopicLinked to narrowed or unstable windows
Links
Sources
- Complex post-traumatic stress disorder (Wikipedia) (opens en.wikipedia.org)
- Frost R et al. Assessing the factorial validity and the internal reliability of the International Trauma Questionnaire (ITQ) among survivors of sexual violence in Ireland. Epidemiol Psychiatr Sci 2022;31:e42 (opens pmc.ncbi.nlm.nih.gov)
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