Complex PTSD
Complex PTSD (C-PTSD) is a diagnosis proposed by Judith Herman (1992) to describe the psychological impact of prolonged, repeated trauma, particularly that which occurs during childhood. While not included in the DSM-5, it was recognized by the World Health Organization in the ICD-11 (2018).
The DSM-5 does include a dissociative subtype of PTSD (PTSD with dissociative symptoms), which recognizes depersonalization and derealization as additional symptoms. However, this dissociative subtype is a narrow addition that doesn’t capture the full range of complex trauma symptoms, such as disturbances in self-organization, affective dysregulation, and negative self-concept that characterize Complex PTSD.
Characteristics
Section titled “Characteristics”Complex PTSD encompasses not only the core symptoms of PTSD but also disturbances in self-organization, such as:
- Affective dysregulation
- Negative self-concept
- Interpersonal difficulties
- Hypervigilance
- Emotional dysregulation
- Dissociation
Misdiagnosis
Section titled “Misdiagnosis”Many survivors of prolonged abuse are misdiagnosed as having Borderline Personality Disorder, Narcissistic Personality Disorder, or Bipolar Disorder when they are actually suffering from Complex PTSD (Walker, 2013). The symptoms of trauma—hypervigilance, emotional dysregulation, dissociation, difficulty with relationships—were historically treated as intrinsic personality disorders rather than adaptive responses to chronic harm.
References
Section titled “References”Herman, J. L. (2015). Trauma and recovery: The aftermath of violence—from domestic abuse to political terror. Basic Books.
Walker, P. (2013). Complex PTSD: From surviving to thriving. Azure Coyote.