Intended for healthcare professionals

  1. Education
  2. Diagnosis and...
  3. Diagnosis and management of complex post-traumatic stress disorder (C-PTSD)
Practice Practice Pointer

Diagnosis and management of complex post-traumatic stress disorder (C-PTSD)

BMJ 2025; 388 doi: https://doi.org/10.1136/bmj-2024-079458 (Published 30 January 2025) Cite this as: BMJ 2025;388:e079458
  1. Joanne Stubley, consultant medical psychotherapist1,
  2. Beverley Chipp, expert by experience2,
  3. Marta Buszewicz, retired GP, honorary associate professor34
  1. 1Tavistock Trauma Service, Tavistock and Portman NHS Trust, London, UK
  2. 2Patient author
  3. 3Camden, London
  4. 4University College London
  1. Correspondence to J Stubley jstubley{at}tavi-port.nhs.uk

What you need to know

  • Complex PTSD is a new diagnosis in ICD-11. It combines the symptoms of PTSD with difficulties in self-organisation

  • Complex PTSD usually arises from repeated, prolonged, or chronic exposure to trauma, whereas PTSD is often caused by a single episode of trauma

  • Best practice guidelines advise phase based and multi component therapy, personalised to individual needs

Complex post-traumatic stress disorder (C-PTSD) is a new diagnosis in the International Classification of Diseases (ICD) 11.1 It is not currently recognised in the Diagnostic and Statistical Manual of Mental Disorders (DSM) 5.2 Caused by recurrent, chronic, or sustained trauma, C-PTSD has the clinical features of PTSD and symptoms that reflect the prolonged impact of sustained trauma on self-organisation, encompassing affect regulation, negative self-concept, and difficulties sustaining interpersonal relationships. Here we explain what C-PTSD is, how to recognise it, and the fundamentals of management, acknowledging that the evidence base continues to grow and evolve.

What is complex PTSD?

Complex PTSD may occur following exposure to events that are traumatic (box 1). Typically, this means chronic, repetitive, or prolonged trauma but may also arise from a single event or experience.1

Box 1

What is trauma?

ICD-11 defines trauma as “exposure to an extremely threatening or horrific event or series of events in which escape is difficult or impossible”1 . Such events include, but are not limited to torture, concentration camps, slavery, genocide campaigns, and other forms of organised violence, prolonged domestic violence, and repeated childhood sexual or physical abuse).”1

RETURN TO TEXT

Complex PTSD comprises two sets of symptoms: PTSD symptoms and disturbances of self-organisation (box 2), with diagnostic criteria requiring the presence of both. The essential features of PTSD include re-experiencing symptoms (nightmares, flashbacks, intrusive images); hyperarousal (anxiety, irritability, exaggerated startle, insomnia); and avoidance. The DSM-5 classification of PTSD included a fourth category of symptoms that describes changes in cognition and mood, …

View Full Text

Log in

Log in through your institution

Subscribe

* For online subscription

Buy this article

Back to top