Examining the Evidence for Complex Posttraumatic Stress Disorder as a Clinical Diagnosis

Landy, Meredith S. H.; Wagner, Anne Catherine; Brown-Bowers, Amy; Monson, Candice M.

doi:10.1080/10926771.2015.1002649

Cited by 16 publications

(9 citation statements)

References 54 publications

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“…The validity of cPTSD as a disorder or subtype distinct from PTSD has been a topic of considerable debate . The internal consistency and validity of cPTSD has been questioned based on inconsistent research findings on the symptoms comprising the diagnosis, the nature and the type of events that give rise to the diagnosis, and the relationship of cPTSD to other established diagnoses such as major depressive disorder and borderline personality disorder …”

Section: Validity Of the Cptsd Constructmentioning

confidence: 99%

Critical Analysis of the Current Treatment Guidelines for Complex PTSD in Adults

et al. 2016

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According to current treatment guidelines for Complex PTSD (cPTSD), psychotherapy for adults with cPTSD should start with a "stabilization phase." This phase, focusing on teaching self-regulation strategies, was designed to ensure that an individual would be better able to tolerate trauma-focused treatment. The purpose of this paper is to critically evaluate the research underlying these treatment guidelines for cPTSD, and to specifically address the question as to whether a phase-based approach is needed. As reviewed in this paper, the research supporting the need for phase-based treatment for individuals with cPTSD is methodologically limited. Further, there is no rigorous research to support the views that: (1) a phase-based approach is necessary for positive treatment outcomes for adults with cPTSD, (2) front-line trauma-focused treatments have unacceptable risks or that adults with cPTSD do not respond to them, and (3) adults with cPTSD profit significantly more from trauma-focused treatments when preceded by a stabilization phase. The current treatment guidelines for cPTSD may therefore be too conservative, risking that patients are denied or delayed in receiving conventional evidence-based treatments from which they might profit.

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Section: Validity Of the Cptsd Constructmentioning

confidence: 99%

Critical Analysis of the Current Treatment Guidelines for Complex PTSD in Adults

et al. 2016

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“…Finally, treatment outcome research of complex PTSD has been criticised for insufficiently distinguishing between complex traumatic events and complex posttraumatic sequelae. In-depth evaluations of the complex PTSD literature may be found in Resick et al ( 2012 ) and Landy, Wagner, Brown-Bowers, and Monson ( 2015 ). We now turn to the two central theses of this paper.…”

Section: Appraisalmentioning

confidence: 99%

Complex PTSD and phased treatment in refugees: a debate piece

Heide

Mooren

Kleber

2016

European Journal of Psychotraumatology

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BackgroundAsylum seekers and refugees have been claimed to be at increased risk of developing complex posttraumatic stress disorder (complex PTSD). Consequently, it has been recommended that refugees be treated with present-centred or phased treatment rather than stand-alone trauma-focused treatment. This recommendation has contributed to a clinical practice of delaying or waiving trauma-focused treatment in refugees with PTSD.ObjectiveThe aim of this debate piece is to defend two theses: (1) that complex trauma leads to complex PTSD in a minority of refugees only and (2) that trauma-focused treatment should be offered to all refugees who seek treatment for PTSD.MethodsThe first thesis is defended by comparing data on the prevalence of complex PTSD in refugees to those in other trauma-exposed populations, using studies derived from a systematic review. The second thesis is defended using conclusions of systematic reviews and a meta-analysis of the efficacy of psychotherapeutic treatment in refugees.ResultsResearch shows that refugees are more likely to meet a regular PTSD diagnosis or no diagnosis than a complex PTSD diagnosis and that prevalence of complex PTSD in refugees is relatively low compared to that in survivors of childhood trauma. Effect sizes for trauma-focused treatment in refugees, especially narrative exposure therapy (NET) and culturally adapted cognitive-behaviour therapy (CA-CBT), have consistently been found to be high.ConclusionsComplex PTSD in refugees should not be assumed to be present on the basis of complex traumatic experiences but should be carefully diagnosed using a validated interview. In line with treatment guidelines for PTSD, a course of trauma-focused treatment should be offered to all refugees seeking treatment for PTSD, including asylum seekers.

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“…For example, it has been argued that the construct validity requires more evidence than can be provided by results from latent class and profile analyses alone (Achterhof, Huntjens, Meewisse, & Kiers, 2019 ; Ford, 2020 ; but see Cloitre et al, 2020 ). Arguments against incorporating CPTSD as a psychiatric diagnosis focus on the conflicting definitions of CPTSD (De Jongh et al, 2016 ; Resick et al, 2012 ), evidence regarding different symptom severities rather than distinct symptom sets (Wolf et al, 2015 ), and the absence of standardized measurement tools for the CPTSD diagnosis (De Jongh et al, 2016 ; Landy, Wagner, Brown-bowers, & Candice, 2015 ). However, recent attempts have been made to validate self-report measures to assess CPTSD (Hyland et al, 2017 ; Karatzias et al, 2017 ; Shevlin et al, 2018 ) of which the 12-item version of the International Trauma Questionnaire (ITQ) has been proven to be a valid measure to diagnose CPTSD based on the ICD-11 (Cloitre et al, 2018 ).…”

Section: Introductionmentioning

confidence: 99%

Trauma-focused treatment outcome for complex PTSD patients: results of an intensive treatment programme

Voorendonk

Jongh

Rozendaal³

et al. 2020

European Journal of Psychotraumatology

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Background: Complex PTSD (CPTSD) has been incorporated in the 11th edition of the International Classification of Diseases (ICD-11) as a mental health condition distinct from PTSD. Objective: The objective of the current study is to determine whether individuals classified as having CPTSD can benefit from an intensive trauma-focused treatment, resulting in decreased PTSD and CPTSD symptoms, and loss of diagnoses. Method: Patients diagnosed with PTSD (N = 308) took part in an intensive 8-day treatment programme combining prolonged exposure, EMDR therapy, psycho-education, and physical activity. The treatment was not phase-based in that it did not contain a stabilization phase or skill training prior to therapy. CPTSD diagnosis was assessed by means of the International Trauma Questionnaire (ITQ) and PTSD diagnosis was assessed with both the ITQ and CAPS-5. Treatment response was measured with the CAPS-5, PCL-5, and ITQ. Results: Symptoms of both PTSD and CPTSD significantly decreased from pre-to posttreatment resulting in a significant loss of CAPS-5 based PTSD (74.0%) and ITQ-based PTSD and CPTSD diagnoses (85.0% and 87.7%, respectively). No adverse events occurred in terms of suicides, suicide attempts, or hospital admissions. Conclusions: The results are supportive of the notion that the majority of patients classified as having CPTSD strongly benefit from an intensive trauma-focused treatment for their PTSD.

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Examining the Evidence for Complex Posttraumatic Stress Disorder as a Clinical Diagnosis

Cited by 16 publications

References 54 publications

Critical Analysis of the Current Treatment Guidelines for Complex PTSD in Adults

Critical Analysis of the Current Treatment Guidelines for Complex PTSD in Adults

Complex PTSD and phased treatment in refugees: a debate piece

Trauma-focused treatment outcome for complex PTSD patients: results of an intensive treatment programme

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