With a group of mainly child and adolescent psychiatrists and psychologists, van der Kolk developed the concept of ‘Developmental Trauma Disorder’ (DTD) and proposed it for introduction into the to be developed DSM. At the same time, Herman described a therapeutic framework approach that distinguishes three phases: security, remembering and grieving, and reconnection. This diagnostic proposal had six symptom groups: Disturbance of affect regulation, alterations of consciousness, disturbed self-perception, disturbed perception of the offender, relationship problems, and changes in the value system. She proposed a new diagnosis, which she called complex post-traumatic stress disorder (CPTSD). In a milestone book, Judith Lewis Herman summarized her clinical research with (female) victims of domestic and sexualized violence, including child sexual abuse. This research-based and operationalized approach laid the scientific foundation for PTSD as a new disease entity. As core symptom groups, he depicted intrusions and avoidance, followed by negative cognitive and mood changes such as guilt and shame.

He described prototypically the psychological consequences of severe traffic accidents and applied this to wartime experiences, concentration camp imprisonment, rape, and life-threatening medical conditions. Horowitz had presented the concept of ‘stress response syndromes’, which turned out to gain wide attention through clinically precise descriptions and a psychodynamic-cognitive model and was accompanied by a large empirical research program. Just as important as the political advocacy was the further development of psychopathology or the investigation of psychological stress consequences at that time. The women’s rights movement could make its voice heard for traumatized women as victims of domestic or sexualized violence. The Vietnam War had ended in 1975, and American Veterans Administration Hospitals were faced with large numbers of traumatized veterans they had to care for. psychiatry, in which scientist-practitioners played an important role, with Vietnam veterans on the one hand and the women’s rights movement on the other hand as advocates. The introduction of the diagnosis followed a political negotiation process in U.S. An externally caused mental disorder was introduced into the state of the art of psychiatry and clinical psychology – a kind of scientific recognition, which has never been seen before in classification systems of mental disorders. The introduction of the diagnosis of posttraumatic stress disorder (PTSD) in the Diagnostic and Statistical Manual, Version III (American Psychiatric Association, 1980) was a major milestone for the mental health field.

The scholarly use of the new diagnosis has resulted in an increasing number of published studies on this topic in the diagnostic and therapeutic fields. The diagnosis is clinically easy to use in accordance with the WHO development goals for the ICD-11 and has shown good psychodiagnostic properties in various studies, including good discrimination from personality disorder with borderline pattern. The CPTSD diagnosis comprises the core symptoms of the – newly, narrowly defined – PTSD diagnosis, the three symptom groups of affective, relationship, and self-concept changes. This paper provides a review of the historical lines of development that led to the CPTSD diagnosis, as well as the results since the ICD-11 publication in 2018. Thus, in a multi-stage process of ICD-11 development, the diagnosis of CPTSD was developed. This diagnosis has not been clinically influential, nor has it been subjected to much research. In the previous International Classification of Diseases, version 10 (ICD-10) issued by the World Health Organization (WHO), this symptom constellation was termed ‘enduring personality change after catastrophic experience’. The diagnosis of complex post-traumatic stress disorder (CPTSD) was proposed several decades ago by scientist-practitioners, almost parallel to the first description of the diagnosis of post-traumatic stress disorder (PTSD).

Dsm 5 complex ptsd criteria