A Transdiagnostic Understanding of C-PTSD

As with PTSD, complex PTSD often co-occurs with a range of other mental health conditions, including anxiety, depression, and substance use disorders (Ford et al., 2014; Karatzias et al., 2017).

It is important for health professionals to assess for comorbid conditions when working with individuals with complex PTSD to ensure comprehensive treatment, with an understanding that while these are classified under separate diagnostic labels, they are most likely linked with the person’s trauma history.

Misdiagnosis

From a categorical diagnostic perspective, Complex PTSD, borderline personality disorder (BPD), somatic symptom disorders, and dissociative disorders share overlapping symptoms, making it difficult for health professionals to differentiate between them. In some cases, clients with C-PTSD may be misdiagnosed. The key difference between these conditions is the specific types of symptoms that clients present with (as with any condition that is defined categorically by symptom clusters). The main categorical symptom differences are outlined below.

Please ensure that you read through all items before proceeding by selecting each title.

Borderline Personality Disorders

Borderline Personality Disorder is characterized by symptoms such as intense fear of abandonment, impulsivity, unstable relationships, and an unstable sense of self (Cloitre et al., 2014).

Somatic Symptom Disorder

Somatic symptom disorder is characterized by physical symptoms without an identifiable medical cause, such as chronic pain, gastrointestinal distress, or sexual dysfunction (APA, 2021).

Dissociative Disorders

Dissociative disorders, on the other hand, are characterized by disruptions or breakdowns in memory, awareness, identity, and perception. The DSM-5 includes 3 dissociative disorders: dissociative amnesia, dissociative identity disorder, and depersonalization-derealization disorder. Although dissociation can be a feature of C-PTSD, it is not the central feature as it is in dissociative disorders (van der Kolk et al., 2005).

Applying a Transdiagnostic Lens

Given the overlapping symptoms between these conditions, it is not uncommon for clients to receive an incorrect diagnosis or to be misdiagnosed with multiple disorders. For example, clients with complex PTSD may be diagnosed with BPD due to their emotional dysregulation, impulsivity, and unstable sense of self. Misdiagnosis can lead to inappropriate treatment or reduced access to treatment, worsening symptoms, stigmatization, and decreased quality of life for clients.

When we think trans-diagnostically about a person’s presentation, we orient to what common experiences and coping strategies might cross diagnostic categories. This enables us to better relate to the person from a bio-psycho-social perspective, rather than relating to just their symptom clusters. The DSM makes no reference to traumatic stress as a risk factor or common etiology, yet it is likely to underlie all three conditions listed below.

Life Course Theory

Life course theory is an empirical framework that can help us to better understand how individual lives are shaped by historical events, social structures, and personal choices made over time. It emphasizes the importance of studying the entire course of people's lives, from childhood through adulthood, and how different experiences across time and generations can affect health and well-being and also contribute to health disparities. The theory also recognizes that individuals are not passive recipients of their environment but instead are active agents who can shape their own lives through the choices they make. This theory has been used to examine a wide range of topics, including health disparities, educational attainment, family formation, and work-life balance. (Elder, 1998; Dannefer, 2003).

Required Reading

We have included an article outlining life course theory, since an understanding of this framework helps us to maintain a perspective that is aligned with the Numinus Care Model principles of trauma- and violence-informed care, cultural safety and humility, and justice, equity, dignity and inclusion when thinking about the person in front of us who is seeking care. This approach considers how socially patterned physical, environmental, and socioeconomic exposures at different stages of human development shape health within and across generations, in alignment with a transdiagnostic approach.. Please read this article before attending live session 6.

Jones, N. L., Gilman, S. E., Cheng, T. L., Drury, S. S., Hill, C. V., & Geronimus, A. T. (2019). Life course approaches to the causes of health disparities. American Journal of Public Health, 109(Suppl 1), S48-S55.

Learn More

There are many areas of emerging research within the psychedelic-assisted therapy space, below are a few emerging areas to keep an eye out for:

Eating disorders (Borgland & Neyens, 2022)
Behavioural addictions (Wizła et al., 2022)
Couples therapy (Wagner, 2021)
Migraines (Schindler, 2022)
Social anxiety among adults with autism (Danforth, 2022)
Obsessive-compulsive disorder (Rodriguez et al., 2013; Kelmendi et al., 2022)

References

American Psychiatric Association. (2021). What is somatic symptom disorder? Psychiatry.org.

Borgland, S. L., & Neyens, D. M. (2022). Serotonergic psychedelic treatment for obesity and eating disorders: potential expectations and caveats for emerging studies. Journal of psychiatry & neuroscience : JPN, 47(3), E218–E221.

Cloitre, M., Garvert, D. W., Weiss, B., Carlson, E. B., & Bryant, R. A. (2014). Distinguishing PTSD, complex PTSD, and borderline personality disorder: A latent class analysis. European Journal of Psychotraumatology, 5(1), 25097.

Danforth A. (2022). Psychedelic-Assisted Therapy for Social Adaptability in Autistic Adults. Current topics in behavioral neurosciences, 56, 71–92.

Dannefer, D. (2003). Cumulative advantage/disadvantage and the life course: Cross-fertilizing age and social science theory. Journals of Gerontology: Series B, Psychological Sciences and Social Sciences, 58(6), S327–S337.

Elder, G. H. (1998). The life course as developmental theory. Child Development, 69(1), 1-12.

Ford, J. D., Courtois, C. A., Steele, K., van der Hart, O., & Nijenhuis, E. R. (2014). Treatment of complex posttraumatic self-dysregulation. Journal of Traumatic Stress, 27(1), 1-8.

Kelmendi, B., Kichuk, S. A., DePalmer, G., Maloney, G., Ching, T. H. W., Belser, A., & Pittenger, C. (2022). Single-dose psilocybin for treatment-resistant obsessive-compulsive disorder: A case report. Heliyon, 8(12), e12135.

Karatzias, T., Shevlin, M., Fyvie, C., Hyland, P., Efthymiadou, E., Wilson, D., ... & Cloitre, M. (2017). An initial psychometric assessment of an ICD-11 based measure of PTSD and complex PTSD (ICD-TQ): Evidence of construct validity. Journal of Anxiety Disorders, 46, 35-42.

Rodriguez, C. I., Kegeles, L. S., Levinson, A., Feng, T., Marcus, S. M., Vermes, D., Flood, P., & Simpson, H. B. (2013). Randomized Controlled Crossover Trial of Ketamine in Obsessive-Compulsive Disorder: Proof-of-Concept. Neuropsychopharmacology, 38(12), 2475-2483.

Schindler E. A. D. (2022). Psychedelics in the Treatment of Headache and Chronic Pain Disorders. Current topics in behavioral neurosciences, 56, 261–285.

van der Kolk, B. A., Roth, S., Pelcovitz, D., Sunday, S., & Spinazzola, J. (2005). Disorders of extreme stress: The empirical foundation of a complex adaptation to trauma. Journal of traumatic stress, 18(5), 389–399.

Wagner, A. C. (2021). Couple Therapy With MDMA—Proposed Pathways of Action. Frontiers in Psychology, 12, 733456.

Wizła, M., Kraus, S. W., & Lewczuk, K. (2022). Perspective: Can psychedelic-assisted therapy be a promising aid in compulsive sexual behavior disorder treatment?. Comprehensive Psychiatry, 115, 152303.