From the Guidelines
The treatment approach for Complex Post-Traumatic Stress Disorder (C-PTSD) should prioritize trauma-focused psychotherapy, such as Eye Movement Desensitization and Reprocessing (EMDR), Cognitive Processing Therapy (CPT), or phase-oriented trauma therapy, without necessarily requiring a stabilization phase prior to processing traumatic memories, as supported by recent guidelines and studies 1. The definition of C-PTSD, as outlined in the guidelines, includes the occurrence of core DSM-IV symptoms of PTSD, in conjunction with a range of self-regulation problems, such as emotion regulation difficulties, disturbances in relational capacities, alterations in attention and consciousness, adversely affected belief systems, and somatic distress or disorganization 1. Key aspects of treatment include:
- Trauma-focused psychotherapy as the first-line treatment
- Use of specific manualized psychotherapies, such as EMDR, CPT, or phase-oriented trauma therapy
- Medication, including SSRIs like sertraline or paroxetine, and prazosin for trauma-related nightmares
- Secure video teleconferencing for delivering recommended psychotherapy when validated or when other options are unavailable
- Avoidance of benzodiazepines, cannabis, or cannabis-derived products The treatment duration for C-PTSD is typically longer than for standard PTSD, often lasting 1-2 years or more, due to the more pervasive symptoms stemming from prolonged trauma, which affect core aspects of identity, emotional regulation, and relationship patterns 1. Recent guidelines, such as the 2023 U.S. Department of Veterans Affairs and U.S. Department of Defense Clinical Practice Guideline, recommend a comprehensive approach to managing PTSD and acute stress disorder, including assessment, diagnosis, prevention, treatment, and treatment of co-occurring conditions 1. Overall, the treatment of C-PTSD requires a patient-centered approach, incorporating evidence-based therapies and medications, while avoiding potentially harmful treatments, to optimize health outcomes and quality of life.
From the Research
Definition of Complex PTSD
- Complex Post-Traumatic Stress Disorder (C-PTSD) is a severe mental disorder that emerges in response to traumatic life events 2.
- It is characterized by three core post-traumatic symptom clusters, along with chronic and pervasive disturbances in emotion regulation, identity, and relationships.
Treatment Approach for C-PTSD
- The treatment approach for C-PTSD typically involves multicomponent therapies starting with a focus on safety, psychoeducation, and patient-provider collaboration 2.
- Treatment components may include self-regulatory strategies and trauma-focused interventions.
- Dialectical Behavioral Therapy for Complex Post-Traumatic Stress Disorders (DBT-PTSD) is a modular treatment program that combines evidence-based therapeutic strategies, including principles, rules, and skills of DBT, trauma-specific cognitive and exposure-based techniques, imaginative interventions, and procedures for behavioral change 3.
- Eye Movement Desensitization and Reprocessing (EMDR) and Cognitive Behavior Therapy (CBT) are also effective treatments for reducing PTSD symptoms, with EMDR showing better results in reducing depression and anxiety symptoms in some studies 4.
- DBT-PTSD and DBT Prolonged Exposure (PE) have been shown to be effective in reducing PTSD symptom severity and comorbid depressive symptoms, as well as borderline personality disorder (BPD) symptoms and non-suicidal self-injury (NSSI) frequency 5.
Key Considerations
- Individuals with C-PTSD typically have sustained or multiple exposures to trauma, such as childhood abuse and domestic or community violence 2.
- The disorder has a significant population prevalence, ranging from 1-8% in the general population and up to 50% in mental health facilities 2.
- Progress in diagnostics, assessment, and differentiation from post-traumatic stress disorder and borderline personality disorder is crucial for effective treatment 2.