Post-Traumatic Stress Disorder

Lore & Background

The source describes that the diagnosis of PTSD was originally given to adults who had suffered a trauma, such as during a war or rape. For children, chronic trauma such as maltreatment, family violence, or disruption in attachment to a primary caregiver can lead to different symptoms. The term developmental trauma disorder (DTD) has been proposed as the childhood equivalent of complex PTSD (C-PTSD), which is a related disorder with additional symptom clusters. Bessel van der Kolk explains DTD as numerous encounters with interpersonal trauma such as physical assault, sexual assault, violence, or death, and it can also be brought on by subjective events such as abandonment, betrayal, defeat, or shame. Repeated traumatization during childhood leads to symptoms in seven domains including attachment problems, biomedical symptoms, affect or emotional regulation difficulties, elements of dissociation, behavioral control issues, cognition problems, and self-concept disturbances.

In Their Own Story

The source notes that adults with C-PTSD have sometimes experienced prolonged interpersonal traumatization beginning in childhood, rather than, or as well as, in adulthood. These early injuries interrupt the development of a robust sense of self and of others. Because physical and emotional pain or neglect was often inflicted by attachment figures such as caregivers or siblings, these individuals may develop a sense that they are fundamentally flawed and that others cannot be relied upon. A 2025 systematic review and meta-analysis reported that the pooled prevalence for ICD-11 PTSD and C-PTSD were 2% and 4%, respectively, among adults in non-war-exposed/economically developed countries/regions. Prevalences increased to 16% and 15%, respectively, in war-exposed/less economically developed countries and regions.

Reader's Guide

In the ICD-11, there are two paired diagnoses: PTSD and C-PTSD. To be diagnosed with C-PTSD, a person must also meet the diagnostic criteria for PTSD. Aside from the traumatic event itself, PTSD has three core elements: re-experiencing the event in the form of intrusive memories, nightmares, or flashbacks; deliberate avoidance of memories, thoughts, or other reminders of the event; and persistent perceptions of heightened current threat such as hypervigilance or enhanced startle reaction. These symptoms must cause impairment in important areas of functioning. Functionality that can only be obtained with significant additional effort is considered to be impaired. C-PTSD has the same core elements as PTSD, but there are three additional symptoms that must be present: severe and pervasive difficulties in regulating emotions; changes in beliefs about oneself such as feeling worthless with significant shame; and difficulties in maintaining close relationships with important people. Again, these symptoms must cause significant impairment to be considered C-PTSD.

Did You Know?

• The World Health Organization's ICD-11 has included C-PTSD since its initial publication in 2018, which came into effect in 2022.
• The American Psychiatric Association has not included C-PTSD in the Diagnostic and Statistical Manual of Mental Disorders.
• A validated self-report measure called the International Trauma Questionnaire (ITQ) exists for assessing ICD-11 C-PTSD.
• The previous edition (ICD-10) proposed a diagnosis of Enduring Personality Change after Catastrophic Event (EPCACE), which was an ancestor of C-PTSD.
• In the ICD-11, there is no requirement of a specific trauma type for C-PTSD, unlike early descriptions that specified prolonged and repetitive trauma.