Complex PTSD (CPTSD)

Presenter: Dr. Donnelly Snipes

Differences in Diagnostic Manuals

• DSM-5-TR (used in the USA): Does not include CPTSD as a diagnosis.
• ICD-11 (used in many other countries): Includes CPTSD as a distinct diagnosis separate from PTSD and BPD.
• ICD-11 Code for CPTSD: 6B41

Criteria for CPTSD Diagnoses

1. Exposure to Prolonged or Repetitive Events

   • Events are extremely threatening or horrific.
   • Escape from these events is difficult or impossible.
   • Interpretation of 'horrific' is age-dependent.

2. Core Elements of PTSD Present for Several Weeks

   • Symptoms include: intense intrusive memories, flashbacks, nightmares, avoiding reminders, and hypervigilance.
   • Complex PTSD can result in a diminished startle response due to prolonged activation of the HPA axis.

3. Affective Dysregulation and Dissociative Symptoms

   • Problems with regulating affect.
   • Dissociation during stress and emotional numbing, particularly an inability to experience positive emotions.

4. Persistent Negative Self-Perception and Guilt

   • Beliefs of being diminished, defeated, or worthless.
   • Deep-seated feelings of shame, guilt, and failure linked to trauma.

5. Difficulty in Relationships

   • Struggle with sustaining relationships and feeling close to others due to trust issues and emotional dysregulation.
   • Can lead to either intense, unstable relationships or avoidant, withdrawn behaviors.

6. Impairment in Functioning

   • Significant impairment in personal, family, educational, or occupational functioning.
   • High-functioning individuals with CPTSD maintain functioning with significant additional effort.

Characteristics of CPTSD Symptoms

• Symptoms onset can occur at any age after exposure to chronic trauma.
• More severe and persistent symptoms than PTSD due to repetitive trauma.
• Neurological changes and damage due to prolonged trauma exposure.

Vulnerability in Children and Adolescents

• More vulnerable to developing CPTSD due to brain malleability.
• Prone to cognitive difficulties (attention, planning, organizing), which can be misdiagnosed as ADHD.
• May exhibit regression, reckless behavior, aggression, and difficulties in interpersonal relationships.
• Disorganized attachment when caregivers are sources of trauma, leading to unstable relationships.

Overlapping Diagnoses and Symptoms

• Overlap between CPTSD and personality disorders (especially Cluster B and borderline personality traits).
• Important to differentiate symptoms to avoid misdiagnosis.
• Co-occurring diagnoses (e.g., ADHD, depression) should only be made if symptoms are not fully explained by CPTSD alone.
• Trauma history is crucial for proper diagnosis.

Conclusion

• While CPTSD is not recognized in the DSM-5-TR, it is included in the ICD-11.
• Some insurance companies accept billing based on ICD-11 codes.
• Therapists should check with insurance companies and be aware of the ICD-11 criteria.

Key Takeaways

• CPTSD involves prolonged trauma, leading to severe symptoms and affect dysregulation.
• Important to recognize the differences between CPTSD and other disorders to provide accurate diagnosis and treatment.

CEUs available at AllCEUs.com.