Right, which makes sense, of course, because the whole problem is that we don't have a diagnostic category or specifier for "bad childhood and consequent dysfunctional relationships". So these people get dumped into other categories. For classic adult-onset PTSD, an MDD-like picture can also be part of the presentation ("pervasive alterations in mood"), but because of the "better explained by" criterion, we rightly don't diagnose both together. For "complex PTSD," since the appropriate category is not in the DSM, they get called lots of other things and pile up a string of partially-applicable diagnoses that could be more perspicuously dealt with if we had a real name for the syndrome.
OK but my point is that we need a name for the thing that people are calling "complex PTSD." I am in full agreement that it bears little relationship to classic PTSD, although the parallel diagnostic structure of exposure+clinical syndrome makes sense to me. But the criterion A would be different, the clinical symptoms are different, and most importantly, the age and chronicity of exposure would be relevant.
But usually people who go into these other/NOS categories go there because they are oddballs, are missing a criterion or whatever. It doesn't make sense to me that a very common syndrome with obvious prognostic importance wouldn't have its own DSM label.
Really, there's no empirical support for the assertion that people with messed up childhoods have messed up adult relationships and relatively intractable mood/anxiety symptoms compared to people with loving, supportive childhoods? For real?
I don't think it makes a lot of sense to apply, for example, exposure-based interventions to people who had messed up childhoods, and expect that to fix their dysfunctional interpersonal schemas. Do you?
This study does not appear to have examined age or chronicity of exposure at all, just symptom clusters. (Also it included only 58 individuals with self-reported CPTSD sx and examined only the possibility of PTSD vs PTSD+CPTSD, not the possibility that someone could have CPTSD without PTSD.)
As I am certain you are aware, other studies, some of them cited by the one you linked, which doesn't appear to be an improvement upon them, have found support for the CPTSD diagnosis.
Preliminary data support the proposed ICD-11 distinction between PTSD and complex PTSD and support the value of testing the clinical utility of this distinction in field trials. Replication of results is necessary.
pubmed.ncbi.nlm.nih.gov
As part of the development of the Eleventh Revision of International Classification of Diseases and Related Health Problems (ICD-11), the World Health…
www.sciencedirect.com
Sure, I think the best way to approach the chronic-childhood-adversity/adult-relational-dysfunction presentation is absolutely a question that requires further active investigation. As we know, this is a difficult-to-treat group, and the phased approach you mention may not be the answer. Like WisNeuro above, I usually send them to DBT, which is often helpful (as it is often helpful for many people with emotional dysregulation/poor coping skills who don't fit classic BPD criteria). Although I kind of think DBT does a better job of addressing the immediate issue of coping skills but maybe not such a great job of addressing the larger problem of interpersonal dysfunction. DBT is so focused on putting out emotional-lability fires that there's not a lot of space to work on the relational piece.
But I think ignoring the existence of the syndrome and pretending that it is equivalent to adult-onset PTSD will preclude us from being able to do the research that is necessary to answer this question.
