PTSD and CPTSD in ICD-11

On 3. July 2018

On June 18th, 2018, WHO released their 11th version of their International Classification of Diseases (ICD-11). I have previously taken a look at the ADHD diagnoses, and this time I take a quick look at PTSD and Complex PTSD.

This article provides a quick look at the new diagnosis CPTSD (and PTSD) to give you a quick overview of what it mean and I enclose some additional reading references, for in-depth research, if you are so inclined.

6B40 Post traumatic stress disorder

Description

Post-traumatic stress disorder (PTSD) is a syndrome that develops following exposure to an extremely threatening or horrific event or series of events that is characterized by all of the following: 1) re-experiencing the traumatic event or events in the present in the form of vivid intrusive memories, flashbacks, or nightmares, which are typically accompanied by strong and overwhelming emotions such as fear or horror and strong physical sensations, or feelings of being overwhelmed or immersed in the same intense emotions that were experienced during the traumatic event; 2) avoidance of thoughts and memories of the event or events, or avoidance of activities, situations, or people reminiscent of the event or events; and 3) persistent perceptions of heightened current threat, for example as indicated by hypervigilance or an enhanced startle reaction to stimuli such as unexpected noises. The symptoms must persist for at least several weeks and cause significant impairment in personal, family, social, educational, occupational or other important areas of functioning.

Inclusions

  • Traumatic neurosis

Exclusions

  • Acute stress reaction (QE84)
  • Complex post traumatic stress disorder (6B41)

6B41 Complex post traumatic stress disorder

Description

Complex post-traumatic stress disorder (Complex PTSD) is a disorder that may develop following exposure to an event or series of events of an extremely threatening or horrific nature, most commonly prolonged or repetitive events from which escape is difficult or impossible (e.g., torture, slavery, genocide campaigns, prolonged domestic violence, repeated childhood sexual or physical abuse). The disorder is characterized by the core symptoms of PTSD; that is, all diagnostic requirements for PTSD have been met at some point during the course of the disorder. In addition, Complex PTSD is characterized by 1) severe and pervasive problems in affect regulation; 2) persistent beliefs about oneself as diminished, defeated or worthless, accompanied by deep and pervasive feelings of shame, guilt or failure related to the traumatic event; and 3) persistent difficulties in sustaining relationships and in feeling close to others. The disturbance causes significant impairment in personal, family, social, educational, occupational or other important areas of functioning.

Exclusions

  • Post traumatic stress disorder (6B40)

Scientific Studies of PTSD and CPTSD

I’ve found this study that give some more details, and should shed some light on the background for the ICD-11 criteria.

PTSD and Complex PTSD:
ICD-11 updates on concept and measurement in the UK, USA, Germany and Lithuania

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5774423/
https://pdfs.semanticscholar.org/4c55/1adaa64fed206371db89feea7ddb8366d567.pdf

The qualitative distinction between PTSD and CPTSD symptomatology has been supported in different trauma samples including those experiencing interpersonal violence (Cloitre et al., 2013), rape, domestic violence, traumatic bereavement (Elklit, Hyland, & Shevlin, 2014), and victims of institutional abuse such as that occurring within foster care and religious organizations (Knefel, Garvert, Cloitre, & Lueger-Schuster, 2015). Samples have also included young adults (Perkonigg, Hoffler, Wittchen, Trautmann, & Maercker, 2014) and children (Sachser, Keller, & Goldbeck, 2016). The proposed three-factor structure of ICD-11 PTSD (Re, Av, Th) has been supported in a number of studies (e.g. Gluck, Knefel, Tran, & Lueger-Schuster, 2016; Hansen, Hyland, Armour, Shevlin, & Elklit, 2015; Tay et al., 2016). In addition, the second-order factorial structure of CPTSD in which the disorder is comprised of both PTSD and DSO has also been supported (e.g. Hyland et al., 2017b2017c; Shevlin et al., 2017).

Preliminary findings suggest that CPTSD is common in clinical and general population samples although there may be variations across countries in prevalence rates. In clinical samples of trauma victims, preliminary evidence suggests that CPTSD is a more common condition than PTSD. Preliminary findings also suggest that CPTSD is a more debilitating condition compared to PTSD with regard to survivors’ functioning. Childhood, multiple, and interpersonal trauma are all most likely associated with CPTSD as opposed to PTSD in both clinical and population samples.

A diagnosis of PTSD requires that:

(i) an individual has experienced a traumatic event,

(ii) indicates the presence of at least one symptom in each of its three clusters (as indicated by a score of ≥ 2 on the Likert scale – ‘Moderately’), and 

(iii) indicates functional impairment associated with these symptoms.

A probable diagnosis of CPTSD requires that the PTSD criteria are met and the following scores for each of the three DSO clusters: AD scores ≥ 10 on items C1–C5 (Affective Dysregulation-hyperactivation) or a score of ≥ 8 on items C6–C9 (Affective Dysregulation-hypoactivation); NSC requires a score ≥ 8 on items C10–C13, and DR requires a score ≥ 6 on items C14–C16.

In the World Health Organization’s International Classification of Diseases (ICD-11), published in June 2018, two distinct sibling conditions, Posttraumatic Stress Disorder (PTSD) and Complex PTSD (CPTSD), are to be found under a general parent category of ‘Disorders specifically associated with stress’.

ICD-11 PTSD (6B40) is comprised of three symptom clusters including:

(1) re-experiencing of the trauma in the here and now (Re),

(2) avoidance of traumatic reminders (Av), and

(3) a persistent sense of current threat that is manifested by exaggerated startle and hypervigilance (Th).

ICD-11 CPTSD (6B41) includes the three PTSD clusters and three additional clusters that reflect ‘disturbances in self-organization’ (DSO):

(1) affective dysregulation (AD),

(2) negative self-concept (NSC), and

(3) disturbances in relationships (DR)

These disturbances are typically associated with sustained, repeated, or multiple forms of traumatic exposure (e.g. genocide campaigns, childhood sexual abuse, child soldiering, severe domestic violence, torture, or slavery), reflecting loss of emotional, psychological, and social resources under conditions of prolonged adversity.

I hope that this short introduction to PTSD/CPTSD have had value for you and I thank you for your time!

/ADDspeaker

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