Understanding Complex PTSD: Using ICD-11
Introduction
Complex Post-Traumatic Stress Disorder (C-PTSD) is a condition that arises from prolonged exposure to traumatic events or abusive situations. While there is growing recognition of the long-term effects of trauma and its potential contribution to mental health issues, estimating the exact prevalence of C-PTSD in the U.S. population remains unclear. Although C-PTSD is not formally recognized as a diagnosis in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), which is the primary diagnostic manual used by mental health professionals in the US, the World Health Organization (WHO) in the International Classification of Diseases, 11th Revision (ICD-11) recognized it, and the diagnosis criteria for C-PTSD delineate its unique features and complexities. Let's delve into what these criteria entail.
** As of March 2024, the US is still primarily using the ICD-10 for medical coding and classification. The diagnosis of C-PTSD is not included in ICD-10. **
Exposure to Prolonged Trauma: One of the hallmark features of C-PTSD is exposure to prolonged trauma. This trauma may stem from various sources such as ongoing abuse, neglect, captivity, or situations where escape is difficult. Unlike PTSD, which typically arises from a single traumatic event, C-PTSD results from chronic stressors over an extended period.
Disturbances in Self-Organization: Individuals with C-PTSD often exhibit disturbances in their sense of self and identity. This can manifest as feelings of worthlessness, shame, guilt, or a pervasive sense of being fundamentally flawed. These disturbances may also extend to issues with emotional regulation, leading to intense emotional experiences and difficulty managing one's feelings.
Persistent Alterations in Consciousness: Another criterion involves persistent alterations in consciousness, including dissociative symptoms. Individuals with C-PTSD may experience dissociation, where they feel disconnected from themselves or their surroundings as a way to cope with overwhelming stress. These dissociative experiences can range from mild detachment to more severe episodes of dissociation, such as dissociative amnesia or depersonalization.
Disturbances in Relationships: Relationships can be significantly impacted by C-PTSD, leading to difficulties in forming and maintaining connections with others. Trust issues, difficulty in establishing boundaries, and patterns of unhealthy interpersonal dynamics are common features. These disturbances in relationships may stem from past experiences of betrayal, exploitation, or abuse.
Negative Self-Concept: Individuals with C-PTSD often harbor a negative self-concept, characterized by feelings of worthlessness, shame, or self-blame. These negative beliefs about oneself can be deeply ingrained and pervasive, impacting various aspects of life, including self-esteem, self-confidence, and the ability to pursue personal goals and aspirations.
Emotional Dysregulation: Emotional dysregulation is a key feature of C-PTSD, marked by intense emotional responses that are difficult to manage or control. Individuals may experience heightened levels of anxiety, anger, or sadness, which can lead to impulsive behavior, mood swings, and difficulty in coping with everyday stressors.
Somatic Symptoms: Physical symptoms often accompany C-PTSD, reflecting the profound impact of trauma on the body. These somatic symptoms may include chronic pain, gastrointestinal issues, headaches, or other psychosomatic complaints. These physical manifestations serve as a somatic reminder of the trauma endured and can further exacerbate distress and impairment.
Conclusion
The diagnostic criteria for C-PTSD outlined in the ICD-11 capture the multifaceted nature of this condition, encompassing disturbances in self-organization, alterations in consciousness, difficulties in relationships, negative self-concept, emotional dysregulation, and somatic symptoms. Understanding these criteria is crucial for clinicians to accurately identify and provide appropriate support for individuals struggling with the long-lasting effects of complex trauma. If you feel the symptoms mentioned resonate with you, we encourage you to seek a safe place to process the complex trauma history you may have experienced.
