Complex post-traumatic stress disorder recognised by the World Health Organisation

After decades of discussion in the psychological and psychiatric community, the diagnosis of complex post-traumatic stress disorder (CPTSD) has been recognised by the World Health Organization’s International Classification of Diseases (ICD). The inclusion of the diagnosis comes with an updated list of symptoms as well as guidelines for professionals on clinical assessment and treatment.

Written by Bryony Porteous-Sebouhian

A sister diagnosis to PTSD

An international team of experts have come together under the guidance of the University of Zurich to put together a summary of the ‘new’ diagnosis and a list of symptoms, the inclusion of CPTSD in the ICD-11 is being referred to as ‘long-awaited’ after decades of psychologists specialising in trauma fighting for the diagnosis to be recognised.

PTSD has been widely understood as one of the most common responses to trauma for decades, since research after World War II and the Vietnam War indicated that exposure to distressing or traumatic events can result in people experiencing intrusive memories, flashbacks and other behaviours such as avoiding anything that might trigger a memory of the trauma.

However, experts in the field of trauma have known for decades that victims of more prolonged trauma such as abuse, present a much broader range of symptoms. Researchers such as Bessel Van Der Kolk - who wrote the impactful, The Body Keeps The Score - have been campaigning since the late 1980s for a wider understanding of trauma to be acknowledged in internationally impactful publications such as the DSM or ICD.

What does the new expanded criteria include?

The updated ICD-11 now includes the ‘new’ diagnosis of CPTSD as well as a list of expanded symptoms including those that fall under ‘self-organisation disturbances’. These newer symptoms include:

• ‘Excessive or heightened emotional responses
• Feelings of worthlessness
• Difficulties in sustaining relationships and feeling close to others.’

The team behind a study at the University of Zurich have added to this step forwarded by putting together a resource that described how to diagnose CPTSD in detail, based on a patient’s presentation and cluster of symptoms.

The study also helps professionals to identify the distinct features of the condition in children and adolescents as well as distinguishing CPTSD from other mental health conditions such as depression, bipolar disorder, psychosis and personality disorders.

Speaking to Science Daily , fist author, Adreas Maercker from the University of Zurich spoke about how their research will hopefully go on to inform professionals:

“We elaborate how the CPTSD diagnosis can be made in routine situations in emergency medical facilities and in regions with underdeveloped health care systems, for example.”

Maercker then spoke about how the study looks into the evidence base for possible therapeutic approaches:

“This is particularly important, since not all countries use the WHO's disease classification. Some have adopted the DSM-5 classification published by the American Psychiatric Association, which currently doesn't list a diagnosis for complex PTSD.”

Maercker and the research team working on the study were asked by the World Health Organization to inform the WHO’s updated specification in the ICD-11.

This recognition from the ICD and WHO hopefully points toward a shift in the international attitude toward the trauma and the wide variety of experiences that fall along the spectrum of trauma. Which will hopefully result in the diagnosis being included in the DSM, and acknowledged across mental health services from assessment and treatment services, to primary care and GPs.?