What is complex post-traumatic stress disorder (CPTSD)?

Although there have been descriptions of complex post-traumatic stress disorder (CPTSD) in the literature for many years, CPTSD was first included in the ICD-11 in 2022. As a new diagnosis, research into evidence-based treatment specifically for CPTSD is still in its infancy.

There is significant overlap in symptoms between borderline personality disorder (BPD) and CPTSD, with 50% of people diagnosed with BPD also meeting criteria for CPTSD.

According to ICD-11, symptoms of CPTSD may emerge in people who have experienced prolonged and repeated trauma such as childhood sexual abuse, childhood physical abuse, torture and domestic violence. People living with CPTSD can experience unstable emotions, difficulty feeling close to others and sustaining relationships, and a negative sense of self. People with CPTSD also suffer from PTSD symptoms: re-experiencing traumatic events through nightmares, flashbacks or intrusive memories, avoidance of trauma reminders, and hypervigilance.

People with both BPD and CPTSD experience difficulties with emotion regulation, self-concept and interpersonal relationships. The main differences between CPTSD and BPD include:

1. People living with BPD experience an unstable sense of self. Their sense of identity may change depending on who they are with and the context. In CPTSD, the sense of self is stable but characterised by feelings of worthlessness, shame, guilt and failure in relation to traumatic events.
2. People with BPD usually experience intense and unstable relationships. People living with CPTSD can find it difficult to feel close to others and thus tend to avoid relationships and distance themselves from others.
3. Impulsivity, non-suicidal self-injury and suicidal behaviours are more common in BPD.

The current evidence for treatment of CPTSD recommends a period of stabilisation through psychotherapy, prior to embarking on trauma-specific exposure therapy or processing of trauma memories. The stabilisation period may include building skills in emotion regulation and interpersonal relationships. This approach to CPTSD differs from therapy approaches for single-event trauma (i.e. post-traumatic stress disorder (PTSD)). In the absence of stabilisation, exposure-based treatment may lead to deterioration and destabilisation in some people with CPTSD.