What is the term for a 30-year-old female with Complex Post-Traumatic Stress Disorder (CPTSD) experiencing terror and lack of confidence in responsibilities involving others, resulting in career impairment?

From the Guidelines

The term that best describes these symptoms is "Complex PTSD" with prominent avoidance and developmental trauma features. This condition is characterized by severe and persistent disturbances in affect regulation, a negative self-concept, and difficulties in sustaining relationships, in addition to the three core features of PTSD, as described in the ICD-11 changes 1. The symptoms presented, such as feeling terrified of the workplace, driving, or any responsibility that affects others or involves others, feeling young and scared in jobs, having no confidence, and having to mask an adult self to be acceptable, are all consistent with the diagnosis of Complex PTSD, which develops following exposure to a threatening or horrific event (or series of events) 1. Key features of this condition include:

• Severe and persistent disturbances in affect regulation
• A negative self-concept
• Difficulties in sustaining relationships
• The three core features of PTSD: re-experiencing the traumatic event, avoidance of thoughts and memories of the event, and persistent perceptions of heightened current threat Treatment for Complex PTSD typically involves trauma-focused therapy, such as EMDR (Eye Movement Desensitization and Reprocessing) or CPT (Cognitive Processing Therapy), combined with medication management, as these approaches address the underlying trauma and associated symptoms 1. The brain's fear response becomes hyperactivated in situations perceived as threatening, leading to avoidance behaviors that ultimately reinforce the fear cycle and impair functioning, which is a key aspect of Complex PTSD, as described in the changes from ICD-10 to ICD-11 1. Recovery involves creating new neural pathways through consistent therapeutic work and gradual exposure to feared situations in a supported environment, which is critical for individuals with Complex PTSD to overcome their symptoms and improve their quality of life.

From the Research

Symptoms and Impairments

• Feeling terrified of the workplace, driving, or any responsibility that affects others or involves others can be related to symptoms of posttraumatic stress disorder (PTSD) and avoidant personality disorder (AVPD) 2, 3
• Feeling young and scared in jobs, having no confidence, and having to mask an adult self to be acceptable may be associated with negative self-concept, shame proneness, and interpersonal hypersensitivity characteristic of AVPD 2
• Career impairment and other impairments resulting from these symptoms can be linked to the avoidance and anxiety associated with PTSD and AVPD 4, 5

Possible Diagnoses

• Avoidant personality disorder (AVPD) may be a possible diagnosis, given the symptoms of social anxiety, avoidance, and negative self-concept 2, 5
• Posttraumatic stress disorder (PTSD) may also be a possible diagnosis, considering the symptoms of anxiety, avoidance, and hypervigilance 4, 3
• Complex posttraumatic stress disorder (CPTSD) may be another possible diagnosis, given the symptoms of anxiety, avoidance, and negative self-concept, as well as the presence of ongoing threat or trauma 4

Treatment and Intervention

• Trauma-focused cognitive-behavioral therapies (CBT) may be effective in treating PTSD and AVPD, although more research is needed to determine their safety and efficacy in individuals with ongoing threat or trauma 4
• Integrative treatments incorporating cognitive behavioral strategies, shame aversion, and avoidance may be helpful for AVPD 2
• Therapy adapted to anxious and avoidant attachment may be optimal for treating AVPD and PTSD, although more research is needed to test this approach 2, 3