While advocates within mental health have been campaigning for an official complex-PTSD (CPTSD) or developmental trauma diagnosis within the DSM, this important diagnosis is still missing. Fortunately, the [ICD-11] includes an official diagnosis. Screening for CPTSD without DSM criteria has been challenging. However, with the release of the criteria International Trauma Questionnaire (ITQ), clinicians can screen for CPTSD using a simple screening tool.
What is Complex PTSD?
Complex PTSD, or developmental trauma, is a stress disorder. Complex PTSD consists of the same symptoms as PTSD: intrusive memories, flashbacks, nightmares, physical and emotional distress, and many others; along with changes to personality including negativity, distrust of others and chronic shame. While PTSD is mainly associated with single events of a traumatic nature, complex trauma is associated with many traumatic events occurring over a long period of time, typically during childhood.
The ICD-11 defines CPTSD as:
Complex post-traumatic stress disorder (Complex PTSD) is a disorder that may develop following exposure to an event or series of events of an extremely threatening or horrific nature, most commonly prolonged or repetitive events from which escape is difficult or impossible (e.g., torture, slavery, genocide campaigns, prolonged domestic violence, repeated childhood sexual or physical abuse).
The ICD-11 criteria for CPTSD:
All diagnostic requirements for PTSD are met. In addition, Complex PTSD is characterized by severe and persistent 1) problems in affect regulation; 2) beliefs about oneself as diminished, defeated or worthless, accompanied by feelings of shame, guilt or failure related to the traumatic event; and 3) difficulties in sustaining relationships and in feeling close to others. These symptoms cause significant impairment in personal, family, social, educational, occupational or other important areas of functioning.
How does the ITQ screen for CPTSD?
The International Trauma Questionnaire (ITQ) screens for CPTSD by assessing both for PTSD and Disturbance of Self Organization (DSO). If someone is assessed positively for both PTSD and DSO, then a diagnosis of CPTSD is supported.
This screening tool is a brief, simply-worded measure, focusing only on the core features of PTSD and CPTSD, and employs straightforward diagnostic rules. The ITQ was developed to be consistent with the organizing principles of the ICD-11, as set forth by the World Health Organization, which are to maximize clinical utility and ensure international applicability through a focus on the core symptoms of a given disorder.
The ITQ asks the client to briefly describe the experience or experiences associated with the trauma as well as the timeframe of how long ago it happened. Then it asks four sets of Likert scale questions to assess for dimensions of PTSD and DSO. The dimensions of PTSD assessed are: re-experiencing in the here and now, avoidance, sense of current threat, and indicators of functional impairment associated with these symptoms. The dimensions of DSO that are assessed are: affective dysregulation, negative self-concept, disturbances in relationships, and functional impairment.
Scoring is simple and based upon a common threshold of severity for each dimension. Any response above a 2 (“quite a bit,” or “extremely”) registers as significant toward a positive diagnosis. At least one response from each dimension must be above the threshold to result in a positive diagnosis.
Using the ITQ in Sessions Health
It’s simple to screen for CPTSD using Sessions Health. We’ve created a system form that you can import and use with all of your clients. From any client record, just select the International Trauma Questionnaire to screen them for CPTSD. Once you’ve administered the tool, it becomes a part of the client’s record so you can reference it in the future. You may also administer it again later on in treatment to compare responses for signs of progress.
While you can’t diagnose CPTSD with the DSM, most practitioners now know that it’s very important to understand the true nature of their clients’ distress even if it can’t be assigned to their record officially. Having the results of this screening tool will give you extra confidence that you are treating your clients for the actual underlying problems and not a constellation of varying diagnoses that less accurately reflect the condition your clients are presenting with.
What do I do if a client tests positive for CPTSD?
If you’re trained in treating trauma, you can begin treating your client for complex post-traumatic stress disorder using your trauma-informed approach. If you aren’t trained in treating someone with PTSD, or CPTSD, you should refer your client to another clinician. CPTSD is a serious disorder. Without the proper training in grounding, emotional regulation, and other necessary trauma skills, a client could become retraumatized.
Conclusion
CPTSD is an important diagnosis to understand and screen for, but it doesn’t yet exist within the DSM. The ICD-11, however, lists Complex PTSD as a diagnosis. The International Trauma Questionnaire is designed to screen for the existence of CPTSD according to ICD-11 criteria. Sessions Health makes it easy to screen your clients for CPTSD using the ITR so that you can better help your clients.
