Research-based Recovery Information*
for Adult Survivors of Childhood Abuse and Adversity

COMPLEX PTSD -- Review of a Diagnosis

This site was set up in memory of friends and relatives who had died following years of suffering the longterm effects of childhood violence and abuse. Thus, the disorder, sometimes called "Complex Trauma Disorder" (Courtois & Ford, 2009*) or "Complex PTSD" (there is no one diagnosis specifically incorporated into diagostic manuals), was from the start a core focus of this site. Recently, The Journal of Traumatic Stress had a special feature (Volume 25(3)) on Complex PTSD (Posttraumatic Stress Disorder) [LINK]. I've noted the articles, included the Abstracts below (where available) and provided links to the PDFs I've received so far. I also direct your attention to my page discussing treatment options [LINK]

Courtois, C. A., & Ford, J. D. (Eds.). (2009). Treating Complex Traumatic Stress Disorders: An Evidence-Based Guide. New York, NY: Guilford Press.

CONTENTS -- Journal of Traumatic Stress 2012 25(3)    [LINK]

Introduction to the special feature on complex PTSD    [LINK]
(pages 239–240)
Daniel S. Weiss

A critical evaluation of the complex PTSD literature: Implications for DSM-5    [LINK]
(pages 241–251)
Patricia A. Resick, Michelle J. Bovin, Amber L. Calloway, Alexandra M. Dick, Matthew W. King, Karen S. Mitchell, Michael K. Suvak, Stephanie Y. Wells, Shannon Wiltsey Stirman and Erika J. Wolf
Complex posttraumatic stress disorder (CPTSD) has been proposed as a diagnosis for capturing the diverse clusters of symptoms observed in survivors of prolonged trauma that are outside the current definition of PTSD. Introducing a new diagnosis requires a high standard of evidence, including a clear definition of the disorder, reliable and valid assessment measures, support for convergent and discriminant validity, and incremental validity with respect to implications for treatment planning and outcome. In this article, the extant literature on CPTSD is reviewed within the framework of construct validity to evaluate the proposed diagnosis on these criteria. Although the efforts in support of CPTSD have brought much needed attention to limitations in the trauma literature, we conclude that available evidence does not support a new diagnostic category at this time. Some directions for future research are suggested.

Simplifying complex PTSD: Comment on Resick et al. (2012)    [LINK]
(pages 252–253)
Richard A. Bryant
Although constructs related to complex posttraumatic stress disorder (CPTSD) have been discussed for many years, the field still lacks reliable and standardized definitions to guide research in this field. This comment responds to the article by Resick et al. (2012), who conclude that CPTSD lacks sufficient support to be recognized as a diagnosis. Even though there is no doubt that research is lacking, this comment argues that the key to progressing the field is introducing a standardized definition that will allow researchers to understand CPTSD in relation to other trauma-related disorders, identify key mechanisms driving the condition, and further treatment programs specifically for patients with CPTSD.

Complex PTSD is on the trauma spectrum: Comment on Resick et al. (2012)   [LINK]
(pages 254–255)
Marianne Goodman
Conceptualizing posttraumatic stress disorder (PTSD) along a spectrum with complex and simple features is integrative and models an approach taken by disciplines in medicine outside of psychiatry. This perspective is offered in the Resick et al. (2012) review. To best delineate the nature and permeability of the border between Complex PTSD and PTSD, an emphasis on clarifying underlying biological processes is needed to move beyond our current reliance on symptomatic description.

CPTSD is a distinct entity: Comment on Resick et al. (2012)    [LINK]
(pages 256–257)
Judith Herman
The concept of complex posttraumatic stress disorder (CPTSD) is both conceptually and clinically useful. This distinct entity is highly prevalent, across different cultures, in survivors of prolonged, repeated trauma. Recognition of this entity as part of the spectrum of traumatic disorders would promote development of effective treatment.

Child maltreatment—Clinical PTSD diagnosis not enough?!: Comment on Resick et al. (2012)    [LINK]
(pages 258–259) Ramón J. L. Lindauer
Child maltreatment has a high prevalence. It can lead to severe psychological and physical problems from childhood to late adulthood. At present, the recognition and treatment of child abuse and its consequences is inadequate. Diagnostic criteria, such as those defined in the Diagnostic and Statistical Manual of Mental Disorders of the American Psychiatric Association, are vital for that purpose. Resick and colleagues (2012) conclude that insufficient scientific basis now exists for incorporating complex posttraumatic stress disorder (CPTSD) into DSM-5. Although they are right from a research point of view, what would be the clinical, political, and social consequences of not including it? This comment discusses those consequences from the standpoint that treating children with developmental trauma disorder at an early age will serve to prevent later sequelae. Also see recent material here by   Schmid et al  [LINK]   and   Wylie   [LINK].

Advocacy through science: Reply to comments on Resick et al. (2012)    [LINK]
(pages 260–263)
Patricia A. Resick, Erika J. Wolf, Shannon Wiltsey Stirman, Stephanie Y. Wells, Michael K. Suvak, Karen S. Mitchell, Matthew W. King and Michelle J. Bovin
The 4 comments on the review by Resick et al. (2012) of the complex posttraumatic stress disorder (CPTSD) literature highlight important theoretical and conceptual questions about the nature and utility of CPTSD and echo the very questions that motivated the review. We discuss the points raised in the comments, particularly with respect to the definition of CPTSD, its relationship to PTSD, and treatment implications. We suggest that setting high scientific standards for CPTSD research is an optimal way to advance the conceptualization of the construct and the treatment of this population.