Complex PTSD typically follows severe stressors which have been repeated, multiple (and varied) and prolonged in nature, and from which escape is not possible or very difﬁcult. It may also occur after a single traumatic stressor, and through childhood physical and/or sexual abuse and neglect are often the traumatic stressors, adult domestic violence, exposure to genocide or torture are consistent with the trauma criteria. In ICD-11 the stressor (i.e., trauma) acts as the “gate” to consideration of PTSD or Complex PTSD as a diagnosis, but which is determined by the symptom proﬁle regardless of the nature of the trauma (Cloitre et al., 2013); crucially, a trauma history is not determinative for the diagnosis.
The new ICD-11 diagnosis for Complex PTSD consists of the core features of PTSD, i.e., intrusion, avoidance of reminders and hyperarousal, in addition to disturbances in the following three domains:
1 Affect dysregulation, which may manifest as emotional sensitivity, heightened emotional reactivity, lack of emotions or dissociative states. Behavioural manifestations may include reckless or violent outbursts, or self-destructive behaviour;
2 Negative self-concept, with persistent negative beliefs about oneself, with pervasive feelings of shames, guilt or failure; and
3 Interpersonal disturbances, including affiliative problems, often avoiding social engagement or showing no interest in it.
The inclusion of Complex PTSD in ICD-11 is of substantial clinical importance but may also help the organisation of clinical services as the interventions and their duration, and the therapeutic skills required of the clinician are markedly different for Complex PTSD. It is to be hoped that the codiﬁ cation of Complex PTSD will facilitate psychotherapy outcome research, with funding streams more available.
(Extracted from) The Comprehensive Resource Model: Effective Therapeutic Techniques for the Healing of Complex Trauma, written by Lisa Schwarz, Frank Corrigan, Alastair Hull and Rajiv Raju, published by Routledge, 2017