1.1 Frequently asked topics on childhood trauma – PTSD or Complex PTSD?

The human approach to understanding and addressing trauma is evolving; honestly, we haven’t yet figured out all the implications of trauma.   There are some important considerations:

  1. There is a difference between PTSD and Complex PTSD (The video explains this further)
  2. The Diagnostic and Statistical Manual of Mental Disorders, 5th edition(DSM-5), a handbook often used by psychiatrists and psychologists, does not currently acknowledge complex PTSD as a separate condition.
  3. PTSD (Post Traumatic Stress Disorder), a condition covered under DSM-IV in anxiety disorders, is covered in DSM-V. However, in DSM-5 it was called out as a separate disorder.  ICD-10 also only covers PTSD (not Complex PTSD)
  4. However, the World Health Organization’s International Classification of Diseases, 11th Revision (ICD-11), acknowledges the condition, and some clinicians diagnose it.

There are several components to differentiate Complex PTSD from simple PTSD.  Specifically, the contributors or risk factors highlight the repeated nature of trauma as the main differentiator that could increase the risk of Complex PTSD.  When repeated traumatic events happen to a child (with a developing brain that may not comprehend or process the trauma), the outcome is far more complex than a one-off trauma-related event.  The outcome differentiator between the two includes (a) functional impairment that is more significant in Complex PTSD, and (b) several other components such as self-concept, relationship with self and relationship with others could be enhanced.

1.2 Key Terms:

PTSD-Post Traumatic Stress Disorder


ACE-Adverse Childhood Experiences

TIC-Trauma Informed Care

BPD-Borderline Personality Disorder

ICD-International Classification of Disease

DSM- Diagnostic and Statistical Manual of Mental Disorders

DESNOS-Disorders of Extreme Stress Not Otherwise Specified

ADHD- Attention-Deficit / Hyperactivity Disorder

1.3 Excerpts from Module 6 – Life Coaching & Advanced Integration Techniques of Integrated Regression Therapy & Life Coaching Certification.

The text below is extracted from the Module 6 manual for awareness since it covers extensive insights from >1500 subjects’ ACE assessments and >200 subjects’ trauma assessments.

1.3.1  Learning Module – Complex PTSD and Adverse Childhood Experience

all six modules regression therapy and life coachingImportant note for the students: This section provides a practical framework only after regular clinical work.  It is included in this manual to encourage participants to understand the challenges involved with CPTSD and possible outcomes. For individuals who have not worked on clients with CPTSD profiles they should seek guidance from an experienced practitioner to get maximum value and not just pursue this as self-study.

CPTSD (Complex Post Traumatic Stress Disorder), not included in DSM-V but covered in ICD-11, consists of the core symptoms of PTSD (re-experiencing, avoidance/numbing, and hyperarousal) and additional symptoms such as a range of functional impairment, i.e., disturbances in self-organizing capacities. (Cloitre et al., 2013; Gray et al., 2019; Maercker, 2021, 2021; Maercker et al., 2022; Palic et al., 2016).

Adverse Childhood Experiences (ACEs) have emerged as a significant risk factor for CPTSD.  In India, there is limited research on ACEs, PTSD, and CPTSD. With >400 million young children and adolescents and limited research on ACE, India needs broad-based awareness, especially among mental health practitioners and students.

The team at Wellness Space has worked with over 1500 assessments of ACEs in past two years and successfully implemented hundreds of interventions based on the evaluations. This team is equipped and willing to share their insights, understanding, and interventions related to ACEs with students and mental health practitioners. The research at Wellness Space using all the data and qualitative information would add a unique perspective to the module on CPTSD. One example is the results obtained from the analysis of data pre (before) intervention and post (after) intervention.

1.3.2  Learning Goals:

The module will introduce the concept of Complex PTSD (Post Traumatic Stress Disorder) and review evidence on the role of repeated exposure to ACEs and adult CPTSD. The practitioner will clarify the assessment of ACEs, highlight the markers to differentiate between PTSD and CPTSD and discuss the intervention using Trauma Informed Care (or TIC) approach. Finally, there will be a focus on integrating the process and tools related to ACEs, CPTSD, and TIC.

1.3.3  Learning Objectives:

The objectives of the module are.

  1. An understanding of the ACEs and their role/impact on long-term adult mental health
  2. Practical learning of how to assess for ACEs and be able to narrow the risk areas using TIC approach.
  3. Learning how to assess CPTSD and differentiate it from PTSD.
  4. Review evidence on the role of ACEs in long-term health, CPTSD, and internalizing/externalizing behaviours

Glimpse of some “Discussion topics:

1.3.4  History of PTSD Classification

Workshop discussions:

  • PTSD in DSM-IV and DSM-V
  • CPTSD in ICD-11 and not explicitly captured in DSM-V
  • DESNOS (Disorders of Extreme Stress Not Otherwise Specified) in DSM-V
  • Disorders Specifically associated with stress in ICD-11

1.3.5  Some visuals


Functional impairment and CPTSD

Video highlighting how to incorporate the insights of childhood trauma and PTSD into therapeutic intervention

1.4  References:

Cloitre, M., Garvert, D. W., Brewin, C. R., Bryant, R. A., & Maercker, A. (2013). Evidence for proposed ICD-11 PTSD and complex PTSD: A latent profile analysis. European Journal of Psychotraumatology, 4(1), 20706. https://doi.org/10.3402/ejpt.v4i0.20706

Gray, R., Budden-Potts, D., & Bourke, F. (2019). Reconsolidation of Traumatic Memories for PTSD: A randomized controlled trial of 74 male veterans. Psychotherapy Research: Journal of the Society for Psychotherapy Research, 29(5), 621–639. https://doi.org/10.1080/10503307.2017.1408973

Maercker, A. (2021). Development of the new CPTSD diagnosis for ICD-11. Borderline Personality Disorder and Emotion Dysregulation, 8(1), 7. https://doi.org/10.1186/s40479-021-00148-8

Maercker, A., Cloitre, M., Bachem, R., Schlumpf, Y. R., Khoury, B., Hitchcock, C., & Bohus, M. (2022). Complex post-traumatic stress disorder. The Lancet, 400(10345), 60–72. https://doi.org/10.1016/S0140-6736(22)00821-2

Palic, S., Zerach, G., Shevlin, M., Zeligman, Z., Elklit, A., & Solomon, Z. (2016). Evidence of complex posttraumatic stress disorder (CPTSD) across populations with prolonged trauma of varying interpersonal intensity and ages of exposure. Psychiatry Research, 246, 692–699. https://doi.org/10.1016/j.psychres.2016.10.062