Women interpersonal chronic trauma survivors are frequently misdiagnosed with borderline personality disorder (BPD) or post traumatic stress disorder (PTSD), which often results in mistreatment. Neither PTSD nor BPD adequately describes the unique character alterations observed among those exposed to prolonged early childhood trauma.  Researchers suggest survivors of interpersonal and chronic trauma should be subsumed under complex PTSD (CPTSD)(MacLean & Gallop, 2003).  The primary purpose of this study was to test the validity of complex PTSD as a construct. MANOVA, ANOVA, chi- Square, and independent samples t- Tests were utilized to test hypotheses. Results revealed that women who experienced higher frequencies of trauma met more CPTSD criteria and had higher mean base rate scores on the Major Depression, Depressive, Avoidant, Masochistic, Anxiety, PTSD, and Borderline scales of the MCMI- III than women who experienced fewer traumas. Additionally, findings suggest that the Major Depression, Depressive, Anxiety, PTSD, and Borderline scales may highlight differences among women interpersonal trauma survivors who meet five of six CPTSD criteria versus those who meet full CPTSD diagnostic criteria. Lastly, the mean Borderline scale score for women who met full CPTSD diagnostic criteria was below the cutoff for personality traits. Overall, these findings provide evidence and validation for the distinction of CPTSD from BPD and PTSD.

Complex posttraumatic stress disorder (CPTSD) integrates symptoms common to victims of "complex" traumas, like childhood physical or sexual abuse, with the diagnostic criteria of posttraumatic stress disorder (PTSD). It was hypothesized that a history of witnessing interparental violence would be related to adulthood CPTSD symptoms. Results from hierarchical multiple regressions with 287 college students showed that witnessing interparental violence and experiencing child physical abuse predicted higher levels of CPTSD, PTSD, and depression symptoms. After controlling for child abuse, witnessing interparental violence predicted higher levels of traditional PTSD symptoms, but it did not predict an increase in overall CPTSD symptom severity or depression. Results suggest that the traditional PTSD construct, rather than CPTSD, best accounts for the symptoms of those who witnessed interparental violence in childhood.

The work group in charge of editing the trauma disorders in the upcoming edition of the International Classification of Diseases (ICD-11) made several changes to the trauma criteria. Specifically, they simplified the criteria for posttraumatic stress disorder (PTSD) and added a new trauma disorder called complex PTSD (CPTSD). To assess the new and newly defined trauma disorders, Litvin, Kaminski and Riggs developed a self-report trauma measure called the Complex Trauma Inventory (CTI). Although the reliability and validity of the CTI has been supported, no empirically-derived cutoff scores exist. We determined the optimal CTI cutoff scores using receiver operating characteristic (ROC) analyses in a diverse sample of 82 participants who experienced trauma and were recruited from an inpatient trauma unit, student veteran organizations, and university classrooms. We used the Clinician-Administered Interview for Trauma Disorders (CAIT) to diagnose the presence of an ICD-11 trauma disorder, and we correlated the results of the CAIT with the Clinician-Administered PTSD Scale for the DSM-5 to establish the convergent validity of the CAIT, r = .945, p < .001. For the ROC analyses, the CTI was used as the index test and the CAIT was used as the criterion test. The area under the curve (AUC) analyses indicated good to excellent effect sizes, AUC = .879 to .904. We identified two sets of cutoff scores for the CTI: the first set prioritized the sensitivity of the CTI scores and ranged from .884 to .962; the second set prioritized the specificity of the CTI scores and the false-positive scores (1-specificity) ranged from .054 to .143. Our study enhanced the utility of the CTI and addressed another need in the trauma field by developing a structured clinical interview (CAIT) that can be used to diagnose the ICD-11 trauma disorders.

Komplex PTSD har tidigare gått under samma kriterier och riktlinjer för behandling som PTSD, men togs 2018 in som en egen diagnos efter att WHO gjort revideringar inför utgåvan ICD-11. I Sverige finns ännu inga specifika riktlinjer för behandling av komplex PTSD. Syftet med denna studie var att undersöka hur psykoterapeuter uppfattar patienter med komplex PTSD, om och i så fall hur de anpassar behandlingsinterventioner till patientgruppen. Sju erfarna psykoterapeuter intervjuades. Rekrytering av deltagare skedde via egna arbetsrelaterade kontakter, som i sin tur kunde ge förslag om kvalificerade deltagare. Psykoterapeuterna intervjuades utifrån en semistrukturerad intervjuguide. Tematisk analys applicerades på intervjumaterialet, vilket mynnade ut i sju huvudteman. Resultaten visade att psykoterapeuterna såg tydlig skillnad mellan patienter med PTSD och patienter med komplex PTSD, i enlighet med differentieringen i ICD-11. Dissociation beskrevs också som ett framträdande symtom och som behandlingen behöver inriktas mot. Psykoterapeuterna beskrev att de i terapiprocessen anpassade och modifierade interventioner och var följsamma inför patienternas behov. Psykoterapiprocessen beskrevs i termer av “pendling” och “spiraler” snarare än sekventiellt med stabiliseringsfas, exponeringsfas och integreringsfas i en följd. Studiens resultat stämmer överens med förslag från ny forskning som rekommenderar en flexibel patientcentrerad multi-komponentbehandling som inriktas på de specifika symtomklustren vid komplex PTSD. Att arbeta i team beskrevs av psykoterapeuterna som en viktig bidragande faktor till kompetensutveckling samt ökade deras förmåga att använda verksamma metoder i arbetet med patienter med komplex PTSD. / The diagnosis complex PTSD has previously been subject to the same criteria and guidelinesfor treatment as PTSD. Complex PTSD was introduced in 2018 as its own diagnosis, when theWHO made revisions for the release of ICD-11. In Sweden, there are no specific guidelines forthe treatment of complex PTSD. The purpose of this study was to investigate howpsychotherapists perceive patients with complex PTSD and how they adapt treatmentinterventions to the patient group. Seven experienced psychotherapists were interviewed.Recruitment of participants was done via strategic selection. The psychotherapists wereinterviewed from a semi-structured interview guide. Thematic analysis was applied to theinterview material, which resulted in seven main themes. The results showed thatpsychotherapists saw a clear difference between PTSD and complex PTSD, as described in ICD-11. They also described dissociation as a prominent symptom. The psychotherapistsdescribed that they adapted and modified interventions and were keen to be compliant with theneeds of patients. The therapeutic process was described in terms "spirals" rather thansequentially. The study's findings are consistent with suggestions from new researchrecommending a flexible patient-centered multi-component treatment that targets the specificsymptom clusters of complex PTSD. Working in teams was described as an important contributing factor to competence development and increased the potential to use active methods with patients with complex PTSD.

The World Health Organization has proposed for the ICD-11 a differentiation of symptoms to distinguish separate disorders of PTSD and complex PTSD (CPTSD), rather than one disorder of PTSD as in the current DSM-5. In addition, the accuracy and usefulness of the borderline personality disorder (BPD) diagnosis has been debated for years due to this history of trauma often associated with the diagnosis. New instruments have been developed to assess CPTSD, allowing needed research to expand our understanding of CPTSD and how it may differ from PTSD. The present study explored the relationships between the three different patterns of symptom expression associated with these disorders and various coping strategies in a sample of trauma survivors. A canonical correlation analysis (CCA) showed a significant relationship between trauma symptoms and coping strategies and suggested that individuals with higher borderline personality disorder symptoms, and subsequently complex PTSD and PTSD symptoms, were more likely to cope using avoidant coping strategies- behavioral disengagement, denial, and substance use. This finding was similar to previous research findings that suggested high rates of negative psychological outcomes for adults cognitive and behavioral avoidant coping strategies. Contributions from other coping techniques, such as restraint and venting, also showed significant, but not as strong relationships to higher psychological symptoms.

Background The effects of prolonged, interpersonal trauma have long been recognised. Such traumatic events can lead to the development of post-traumatic stress disorder (PTSD), but are also associated with a range of other psychological difficulties. The forthcoming ICD-11 has proposed the inclusion of a new diagnostic category to cover such trauma reactions, named complex-PTSD (CPTSD). CPTSD is conceptualised as including the core elements of PTSD with additional difficulties with affect regulation, self-concept, interpersonal relationships. This thesis presents a systematic review of the research into the proposed CPTSD diagnosis. In addition, this thesis investigates the association between difficulties with emotional regulation, interpersonal problems and PTSD symptoms in a group of male prisoners, and a male community sample. Aims This project aims to investigate whether the proposed CPTSD diagnosis accurately describes the difficulties seen following complex trauma, and examines whether it is best to view CPTSD is different from exiting disorders, including PTSD and borderline personality disorder (BPD). In addition, it aims to investigate the association between difficulties with emotional regulation, interpersonal problems and PTSD among men in prison. Methods We systematically assessed and synthesised the available research regarding the proposed ICD-11 CPTSD diagnosis. In the second paper, data regarding PTSD, emotional regulation, and interpersonal problems were collected from HMP Glenochil, a male-only prison in Scotland (n=51), and matched to an existing community data set (n=46). Results The results of the systematic review provide partial support for the factorial validity of CPTSD. In addition, they indicate that CPTSD can be conceptualised as distinct from both PTSD and BPD, and that CPTSD is more closely related to prolonged interpersonal trauma than PTSD. However, there is overlap between PTSD and CPTSD in terms of both symptomology and aetiology. The results also indicate high levels of PTSD among male prisoners. In addition, PTSD was found to be strongly associated difficulties with emotional regulation, but not interpersonal problems, in the forensic sample. In the community sample emotional regulation was a less strong predictor of PTSD symptoms, and both emotional regulation, and interpersonal problems were associated with the severity of PTSD. Conclusions This thesis supports the inclusion of CPTSD as a distinct diagnostic entity. Inclusion of CPTSD may allow survivors a better understanding of the aetiology of their difficulties, and may initiate research into effective ways of working with individuals who have experienced complex-trauma. I addition, they demonstrate the need for trauma-informed prison services, which prioritise the development of emotional regulation strategies in recovery and rehabilitation.

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An understanding of factors that contribute to Complex Post Traumatic Stress Disorder (CPTSD) is of considerable importance to inform the prevention and treatment of the disorder. Moreover, gaining a better understanding of the factors that contribute to the etiology of CPTSD is of interest since most research to date focuses on the etiology of PTSD. Therefore, the purpose of the current study is to test the hypothesized prediction between childhood exposure to violence, childhood attachment, current interpersonal factors, and CPTSD symptoms. Using data from a community clinic and shelter serving victims of domestic violence and sexual assault, a partial least squares path analysis approach was employed to test the model’s strength in predicting contributing factors of CPTSD. Results support the proposed model, however, an alternative and more parsimonious model was found to be superior and revealed relationships between interpersonal variables and CPTSD. Specifically, women who reported child abuse and poor attachment with either parent, a perceived lack of current emotional and tangible support, and recent intimate partner violence (IPV) also reported symptoms of CPTSD. However, other variables, such as adult attachment avoidance and anxiety did not influence IPV or CPTSD as expected. Ultimately, the current findings lend support for Herman’s (1992) original conceptualization of CPTSD symptoms observed in survivors of prolonged and repeated trauma. Implications of these findings are discussed and results highlight the importance of assessing the contextual factors (e.g., social support, family environment) when a victim of prolonged trauma comes for treatment. Lastly, treatment implications and specific points of intervention are presented.

Female survivors of multiple forms of trauma are increasingly found to be a significant portion of the university population (Briere, Kaltman, & Green 2008). While there is a strong literature base for understanding the effects of individual trauma on psychological functioning (e.g., Briere, 1992; Kaltman, Krumnick, Stockton, Hooper, & Green, 2005), little is known about specific symptom constellations for those who have experienced multiple traumas (Rich, Gingerich, & Roseìn, 1997). Using a clinical population of 500 female university students, this study explored the rates of multiple interpersonal traumatic experiences, the connection between multiple traumas and symptom severity, and the association of specific constellations of multiple types of traumas with specific constellations of trauma symptoms. The Trauma Symptom Inventory-Alternate (Briere, 1995) and self-report measures of demographic data and abuse histories were used to collect data, which was analyzed with frequencies, Multivariate Analysis of Variance, and a Canonical Correlation to explore the interrelationships of abuse and trauma symptoms. Multiple abuse was common, with 81% of participants experiencing two or more types of abuse. Multiple trauma generally predicted more severe trauma-related symptoms than those with no trauma or single traumas. A Canonical Correlation revealed a moderately significant relationship between participants with aggressive types of abuse (e.g., childhood physical, adult physical, and adult sexual abuse) with higher symptoms of intrusive experiences, defensive-avoidance, and dissociation. These findings suggest a differential model of trauma effects, particularly for trauma types characterized by aggression. Implications for future research and clinical practice are addressed.