Posttraumatic Stress Disorder and Complex Posttraumatic Stress Disorder in DSM‐5 and ICD‐11: Clinical and Behavioral Correlates

Abstract

The American Psychiatric Association and the World Health Organization provide distinct trauma-based diagnoses in the fifth edition of the Diagnostic and Statistical Manual (DSM-5), and the forthcoming 11th version of the International Classification of Diseases (ICD-11), respectively. The DSM-5 conceptualizes posttraumatic stress disorder (PTSD) as a single, broad diagnosis, whereas the ICD-11 proposes two "sibling" disorders: PTSD and complex PTSD (CPTSD). The objectives of the current study were to: (a) compare prevalence rates of PTSD/CPTSD based on each diagnostic system; (b) identify clinical and behavioral variables that distinguish ICD-11 CPTSD and PTSD diagnoses; and (c) examine the diagnostic associations for ICD-11 CPTSD and DSM-5 PTSD. Participants in a predominately female clinical sample (N = 106) completed self-report scales to measure ICD-11 PTSD and CPTSD, DSM-5 PTSD, and depression, anxiety, borderline personality disorder, dissociation, destructive behaviors, and suicidal ideation and self-harm. Significantly more people were diagnosed with PTSD according to the DSM-5 criteria (90.4%) compared to those diagnosed with PTSD and CPTSD according to the ICD-11 guidelines (79.8%). An ICD-11 CPTSD diagnosis was distinguished from an ICD-11 PTSD diagnosis by higher levels of dissociation (d = 1.01), depression (d = 0.63), and borderline personality disorder (d = 0.55). Diagnostic associations with depression, anxiety, and suicidal ideation and self-harm were higher for ICD-11 CPTSD compared to DSM-5 PTSD (by 10.7%, 4.0%, and 7.0%, respectively). These results have implications for differential diagnosis and for the development of targeted treatments for CPTSD.

Risk factors and comorbidity of ICD‐11 PTSD and complex PTSD: Findings from a trauma‐exposed population based sample of adults in the United Kingdom

“…Consistent with theoretical models of CPTSD (Cloitre, Garvert, Brewin, Bryant, & Maercker, ), and findings from clinical (Hyland et al, ; Karatzias et al, ) and general population (Cloitre et al, in press) samples, we showed that interpersonal trauma is an independent risk factor for CPTSD. Interpersonal trauma exposure, particularly in childhood, tends to be more toxic with regard to its effects on health and well‐being predominantly because it compromises a child's ability to successfully master certain developmental tasks (e.g., affect regulation, secure attachments; Cicchetti & Toth, ).…”

“…Although not yet examined in relation to ICD‐11 PTSD and CPTSD, urban residence has been shown to increase the risk for multiple psychiatric disorders including mood and anxiety disorders independent of other covariates (Peen, Schoevers, Beekam, & Dekker, ), therefore, we expected that growing up in an urban area would be associated with an increased risk for both PTSD and CPTSD. Finally, based on data from clinical (Hyland et al, ) and internally displaced (Shevlin et al, ) samples, we expected that PTSD and CPTSD would be highly comorbid with the other psychiatric disorders measured in this study.…”

“…Little is currently known about the risk factors that differentiate PTSD and CPTSD after traumatic exposure, or, how frequently other mental and physical health disorders co‐occur with PTSD and CPTSD. Emerging evidence, primarily drawn from clinical samples, suggests that childhood sexual abuse, negative trauma‐related cognitions, distress intolerance, and unemployment status are associated with an increased risk of CPTSD (Hyland et al, ; Hyland, Shevlin, Fyvie, & Karatzias, ). Furthermore, CPTSD is more strongly associated with symptoms of depression, anxiety, borderline personality disorder, and suicidality than PTSD (Hyland et al, ).…”

“…Emerging evidence, primarily drawn from clinical samples, suggests that childhood sexual abuse, negative trauma‐related cognitions, distress intolerance, and unemployment status are associated with an increased risk of CPTSD (Hyland et al, ; Hyland, Shevlin, Fyvie, & Karatzias, ). Furthermore, CPTSD is more strongly associated with symptoms of depression, anxiety, borderline personality disorder, and suicidality than PTSD (Hyland et al, ). Identifying risk factors and comorbidities associated with these disorders has important implications for diagnosis and subsequent treatment, as well as for the prevention and early intervention.…”

Nonsuicidal Self‐Injury and Borderline Personality Features as Risk Factors for Suicidal Ideation Among Male Veterans With Posttraumatic Stress Disorder

“…Because PTSD is associated with emotion dysregulation and increased negative emotions, male veterans with PTSD may use NSSI as a coping strategy for regulating intense negative emotions. A recent study found that the criteria for complex PTSD in the 11th revision of the International Classification of Diseases ( ICD‐11 ) appears more strongly associated with BPD, self‐harm, and SI than DSM‐5 PTSD (Hyland, Shevlin, Fyvie, & Karatzias, ). Research using DSM‐5 and ICD‐11 is needed to replicate and expand the present findings.…”