Complex PTSD and trauma-informed care — structured clinical viva

This maps to ICD-11 complex PTSD if PTSD core plus DSO (affect dysregulation, negative self-concept, relational disturbance) are confirmed after prolonged trauma. Name the manual: DSM-5-TR has no formal CPTSD category.^[1]

Differential. Compare with PTSD alone and BPD using discriminators (trauma-linked re-experiencing/avoidance vs abandonment-centred personality pattern). Dual diagnosis is allowed.^[5]

Treatment stance. Validate fear of therapy. Skills-supported trauma-focused care (STAIR sequencing; PE/CPT/TF-CBT/EMDR; DBT-PTSD in complex childhood-abuse populations) has evidence. Reject both reckless flooding and indefinite "stabilisation forever" when she is safe enough to process (de Jongh critique).^[2][3][4]

Medication. Sertraline can be offered as adjunct for PTSD symptoms with clear start dose and monitoring; it is not a full substitute for trauma processing if she wants recovery from trauma memory grip.^[6]

Engagement. Trauma-informed principles: safety, trust, choice, collaboration, empowerment, cultural humility; interpreter and asylum/legal stressors as ongoing threat modifiers.^[1]