Psych · General adult psychiatry — trauma and stressor-related disorders
Complex PTSD and trauma-informed care
Also known as Complex PTSD · cPTSD · CPTSD · Disorders of extreme stress not otherwise specified · DESNOS · Disturbances of self-organisation · DSO · Trauma-informed care · STAIR Narrative Therapy · DBT-PTSD · Phase-based trauma treatment
Exam-exhaustive fellowship reference on ICD-11 complex PTSD — PTSD core plus DSO triad, differential from PTSD and BPD, ITQ assessment, phase-based STAIR evidence and de Jongh critique, DBT-PTSD, trauma-focused therapies, adjunct pharmacotherapy doses, and trauma-informed care principles. FRANZCP-primary, globally tagged.
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10 MCQs with explanations
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Red flags
Meet the patient
A 34-year-old woman sits in your clinic twisting a tissue. Her childhood was a decade of abuse by a stepfather; her adulthood has been a series of relationships that end the same way. She has nightmares of being back in that house, flinches at raised voices, and says — quietly, and with total conviction — "I am still there. I destroy every relationship. I am worthless."[2][5]
The examiner's questions write themselves: PTSD or complex PTSD? BPD or both? And when her therapist proposes two years of "stabilisation" before any trauma work — do you agree?[6][10]
You have read the opening of this topic. The complete unit — every section and its primary-source references — is part of the Psychiatry Fellowship fellowship atlas.
References22Show ledgerHide ledger
- [1]Maercker A, Brewin CR, Bryant RA, Cloitre M, et al. Diagnosis and classification of disorders specifically associated with stress: proposals for ICD-11 World Psychiatry, 2013.PMID 24096776
- [2]Brewin CR, Cloitre M, Hyland P, Shevlin M, et al. A review of current evidence regarding the ICD-11 proposals for diagnosing PTSD and complex PTSD Clin Psychol Rev, 2017.PMID 29029837
- [3]Cloitre M, Garvert DW, Brewin CR, Bryant RA, et al. Evidence for proposed ICD-11 PTSD and complex PTSD: a latent profile analysis Eur J Psychotraumatol, 2013.PMID 23687563
- [4]Hyland P, Shevlin M, Brewin CR, Cloitre M, et al. Validation of post-traumatic stress disorder (PTSD) and complex PTSD using the International Trauma Questionnaire Acta Psychiatr Scand, 2017.PMID 28696531
- [5]Cloitre M, Garvert DW, Weiss B, Carlson EB, et al. Distinguishing PTSD, Complex PTSD, and Borderline Personality Disorder: A latent class analysis Eur J Psychotraumatol, 2014.PMID 25279111
- [6]Karatzias T, Bohus M, Shevlin M, Hyland P, et al. Distinguishing between ICD-11 complex post-traumatic stress disorder and borderline personality disorder: clinical guide and recommendations for future research Br J Psychiatry, 2023.PMID 37381070
- [7]Ford JD, Courtois CA Complex PTSD, affect dysregulation, and borderline personality disorder Borderline Personal Disord Emot Dysregul, 2014.PMID 26401293
- [8]Cloitre M, Koenen KC, Cohen LR, Han H Skills training in affective and interpersonal regulation followed by exposure: a phase-based treatment for PTSD related to childhood abuse J Consult Clin Psychol, 2002.PMID 12362957
- [9]Cloitre M, Stovall-McClough KC, Nooner K, Zorbas P, et al. Treatment for PTSD related to childhood abuse: a randomized controlled trial Am J Psychiatry, 2010.PMID 20595411
- [10]De Jongh A, Resick PA, Zoellner LA, van Minnen A, et al. CRITICAL ANALYSIS OF THE CURRENT TREATMENT GUIDELINES FOR COMPLEX PTSD IN ADULTS Depress Anxiety, 2016.PMID 26840244
- [11]Karatzias T, Murphy P, Cloitre M, Bisson J, et al. Psychological interventions for ICD-11 complex PTSD symptoms: systematic review and meta-analysis Psychol Med, 2019.PMID 30857567
- [12]Bohus M, Kleindienst N, Hahn C, Müller-Engelmann M, et al. Dialectical Behavior Therapy for Posttraumatic Stress Disorder (DBT-PTSD) Compared With Cognitive Processing Therapy (CPT) in Complex Presentations of PTSD in Women Survivors of Childhood Abuse: A Randomized Clinical Trial JAMA Psychiatry, 2020.PMID 32697288
- [13]Coventry PA, Meader N, Melton H, Temple M, et al. Psychological and pharmacological interventions for posttraumatic stress disorder and comorbid mental health problems following complex traumatic events: Systematic review and component network meta-analysis PLoS Med, 2020.PMID 32813696
- [14]Oprel DAC, Hoeboer CM, Schoorl M, de Kleine RA, et al. Effect of Prolonged Exposure, intensified Prolonged Exposure and STAIR+Prolonged Exposure in patients with PTSD related to childhood abuse: a randomized controlled trial Eur J Psychotraumatol, 2021.PMID 34630934
- [15]Bisson JI, Roberts NP, Andrew M, Cooper R, Lewis C Psychological therapies for chronic post-traumatic stress disorder (PTSD) in adults Cochrane Database Syst Rev, 2013.PMID 24338345
- [16]Bisson JI, Berliner L, Cloitre M, Forbes D, et al. The International Society for Traumatic Stress Studies New Guidelines for the Prevention and Treatment of Posttraumatic Stress Disorder: Methodology and Development Process J Trauma Stress, 2019.PMID 31283056
- [17]Yehuda R, Hoge CW, McFarlane AC, Vermetten E, et al. Post-traumatic stress disorder Nat Rev Dis Primers, 2015.PMID 27189040
- [18]Brady K, Pearlstein T, Asnis GM, Baker D, et al. Efficacy and safety of sertraline treatment of posttraumatic stress disorder: a randomized controlled trial JAMA, 2000.PMID 10770145
- [19]Davidson J, Baldwin D, Stein DJ, Kuper E, et al. Treatment of posttraumatic stress disorder with venlafaxine extended release: a 6-month randomized controlled trial Arch Gen Psychiatry, 2006.PMID 17015818
- [20]Harris M, Fallot RD Designing trauma-informed addictions services New Dir Ment Health Serv, 2001.PMID 11291263
- [21]Blevins CA, Weathers FW, Davis MT, Witte TK, Domino JL The Posttraumatic Stress Disorder Checklist for DSM-5 (PCL-5): Development and Initial Psychometric Evaluation J Trauma Stress, 2015.PMID 26606250
- [22]Foa EB, Hembree EA, Cahill SP, Rauch SA, et al. Randomized trial of prolonged exposure for posttraumatic stress disorder with and without cognitive restructuring: outcome at academic and community clinics J Consult Clin Psychol, 2005.PMID 16287395