This is a controversial question, and the answer is that there is not currently a plan for including C-PTSD in the DSM-6 as a separate diagnosis from PTSD. While many neuroscience researchers have shown that there are distinguishing symptoms of C-PTSD, others view C-PTSD as a symptom cluster which exists within the diagnostic criteria for PTSD. In 2019, the World Health Organization (WHO) listed C-PTSD in the 11th revision of the International Classification of Diseases (ICD-11), with the primary rationale that C-PTSD is more severe and is more likely than PTSD to have long-term disturbances in multiple areas of functioning, such as interpersonal, emotional, behavioral, cognitive, physical, academic, and career. Compared to PTSD, C-PTSD is conceptualized as a form of chronic trauma which has the following distinguishing features: (1) severe distortions in self-perception, (2) severe attachment deficits, (3) minimal emotional regulation skills, (4) a chronic sense of worthlessness, and (5) dissociation as a defense mechanism when triggered by stress or trauma-related memories. Other identified C-PTSD symptoms include habitual self-harming behaviors (substance abuse, abusive romantic partners), verbal and/or physical aggression toward others, and negative cognitive filtering of others’ intentions. Furthermore, C-PTSD has been differentiated from PTSD in its greater frequency of comorbidity with other disorders, particularly Borderline Personality Disorder, Generalized Anxiety Disorder, and Major Depressive Disorder.
The United States Substance Abuse and Mental Health Services Administration (SAMHSA) defines trauma as an event, series of events, or set of circumstances which inflict physical and emotional harm or pose a serious threat to one’s life. This exposure can occur through directly experiencing traumatic events, witnessing them firsthand, learning about trauma experienced by family or friends, or repeatedly being exposed to distressing details of traumatic events. Chronic trauma beginning in childhood can significantly alter an individual’s emotional and psychological development.
Exposure to more frequent or intense trauma, such as being sexually abused during several years of one’s childhood, has been correlated with more dramatic amygdala responses (fear or anger) to environmental stimuli which are perceived as threatening to one’s safety. Emotional neglect IS also a form of trauma and, if this occurs throughout one’s childhood, can decrease brain chemicals responsible for emotional expression and regulation. When a child is emotionally neglected, the development of trust and healthy communication patterns is greatly disrupted.
Trauma-focused therapeutic approaches share the main purpose of empowering trauma survivors in clarifying their own goals and managing their progress from session to session. C-PTSD requires a more comprehensive form of therapy with the shift in focus from “What’s wrong with you?” to “What happened to you?” This approach provides a framework for understanding and responding to the effects of trauma and integrating this awareness into all aspects of the therapeutic process.
C-PTSD requires a holistic approach that addresses the broader effects of trauma on the individual’s life. For those with C-PTSD, trauma-focused therapy must encompass a diverse range of modalities aimed at healing and resilience. Effective trauma therapy focuses upon cognitive reprocessing, which can be frightening but which is integral to creating real change in your behaviors, thought patterns, and emotions.
Trauma-focused therapy for C-PTSD is targeted at improving the distinguishing symptoms of emotional regulation, interpersonal effectiveness, distress tolerance, and the reframing of dysfunctional beliefs. Those with C-PTSD are also in need of guidance with understanding dissociative patterns and with reprocessing trauma memories. The main types of C-PTSD therapeutic treatments for adults are Trauma Affect Regulation Therapy, Anxious Attachment Therapy, Trauma-Focused Cognitive Behavioral Therapy, and Dialectical Behavior Therapy (DBT). All of these therapies help the client to calmly recognize situations and memories which trigger one’s self-defeating thoughts. The therapist assists the client in not becoming overwhelmed or avoiding these thoughts and related disturbing emotions.
More recently, research has shown that Dialectical Behavior Therapy (DBT) is effective in treating comorbid (co-existing) disorders, such as substance dependence, depression, Post-Traumatic Stress Disorder (PTSD), anxiety disorders, and eating disorders. The primary “dialectical” focus of DBT is to collaborate with the client in developing more effective strategies for achieving two seemingly opposite goals: acceptance and change. DBT therapists teach acceptance-oriented skills, such as distress tolerance, which is the ability to tolerate painful emotions during difficult situations, not to change them. Distress tolerance skills include the practice of mindfulness to accept, in a non-evaluative and non-judgmental manner, all types of emotional responses and to work toward changing the behavioral reactions to triggering situations.