As post-traumatic stress disorder (PTSD) was developed to account for the psychological impact of traumatic events in soldiers returning from war, complex post-traumatic stress disorder (CPTSD) is developed to describe more complex responses to trauma, of often multiple, prolonged and relational character. CPTSD shares trauma-specific symptoms with its sibling disorder PTSD but is additionally characterized by disturbances of the individual’s self- organization, observed by emotional dysregulation, a negative self-concept and relational difficulties. Following longitudinal clinical observations and empirical analyses, CPTSD has earned its status as an independent diagnosis in the latest revision of International Classification of Diseases (ICD-11).
The aim of this master thesis was to examine and explicate the clinical utility of the CPTSD diagnosis, considering the upcoming implementation of ICD-11 in clinical practice. The main research question was directly derived from the ICD-revision, and further questions have been postulated, and examined, using existing literature, in independent chapters of the dissertation. The development and constitution of the CPTSD diagnosis has its basis in international field studies and further construct- and validity analyses, which show strong evidence for the diagnostic differentiation of CPTSD and PTSD. In addition, comprehensive and cross-cultural analyses of the diagnosis and its complex nature, has been made possible by the development of the International Trauma Questionnaire (ITQ) and International Trauma Interview (ITI). The validation of these test instruments is seen as a contributing factor in the cementation of the diagnosis in further clinical practice. The instruments permit the mapping of core symptoms from ICD-11, which consequently provide qualified assessment of the concepts, with informative value for both clinical communication and facilitation of treatment. Furthermore, the present thesis has elaborated the relationship between CPTSD and borderline personality disorder, due to their overlapping symptom criteria. In an independent analysis the two disorders were found distinguishable by their phenomenological presentation, although the possibility of CPTSD masking as comorbid BPD/PTSD in a diagnostic context is discussed.
The thesis discusses the aid in which research on differential diagnostics can provide in the construction of symptom-specific interventions, and what further implications the diagnosis might have for clinical practice. The research on CPTSD is still in its infancy, and there remains to be established consensus on treatment directions in the absence of adequate intervention
studies on the disorder. It is concluded that practicing professionals need to note the available evidence and make use of well-established methods developed for treatment of PTSD, as well as make efforts to integrate accommodating techniques for disturbances of self-organization in the treatment of CPTSD. The introduction of CPTSD in the ICD-11 may facilitate access to more tailored treatment options, as well as contribute to increased research focus on disorders specifically associated with stress. The clinical value of this additional diagnosis is expected to reveal itself after the newly revised ICD-11 is implemented in clinical practice. It is however concluded by this master thesis that there exists a multitude of reasons for optimism regarding the diagnosis’ clinical impact on a heavily traumatized and vulnerable group of people.