Review of a Critical Evaluation of the Complex Ptsd Literature Implications for Dsm-5
World J Psychiatry. 2018 Mar 22; 8(1): 12–19.
Circuitous posttraumatic stress disorder: The demand to consolidate a distinct clinical syndrome or to reevaluate features of psychiatric disorders following interpersonal trauma?
Evangelia Giourou
Section of Psychiatry, School of Medicine, University of Patras, Rio Patras 26500, Greece
Department of Public Health, Schoolhouse of Medicine, University of Patras, Rio Patras 26500, Hellenic republic
Maria Skokou
Department of Psychiatry, Schoolhouse of Medicine, Academy of Patras, Rio Patras 26500, Greece
Stuart P Andrew
Specialist Intendance Team Limited, Lancashire LA4 4AY, United kingdom of great britain and northern ireland
Konstantina Alexopoulou
School of Medicine, Academy of Patras, Rio Patras 26500, Greece
Philippos Gourzis
Department of Psychiatry, School of Medicine, University of Patras, Rio Patras 26500, Greece
Eleni Jelastopulu
Section of Public Wellness, School of Medicine, Academy of Patras, Rio Patras 26500, Greece
Received 2017 Nov xiv; Revised 2017 Dec 29; Accepted 2018 Feb 4.
Abstruse
Complex posttraumatic stress disorder (Complex PTSD) has been recently proposed as a singled-out clinical entity in the WHO International Classification of Diseases, xith version, due to exist published, two decades subsequently its get-go initiation. It is described as an enhanced version of the current definition of PTSD, with clinical features of PTSD plus three additional clusters of symptoms namely emotional dysregulation, negative self-cognitions and interpersonal hardship, thus resembling the clinical features commonly encountered in borderline personality disorder (BPD). Complex PTSD is related to circuitous trauma which is defined by its threatening and entrapping context, mostly interpersonal in nature. In this manuscript, we review the current findings related to traumatic events predisposing the in a higher place-mentioned disorders as well equally the biological correlates surrounding them, forth with their clinical features. Furthermore, we suggest that besides the present distinct clinical diagnoses (PTSD; Complex PTSD; BPD), in that location is a cluster of these comorbid disorders, that follow a continuum of trauma and biological severity on a spectrum of common or similar clinical features and should be treated as such. More studies are needed to confirm or reject this hypothesis, particularly in clinical terms and how they correlate to clinical entities' biological groundwork, endorsing a shift from the phenomenologically but classification of psychiatric disorders towards a more biologically validated classification.
Keywords: Circuitous posttraumatic stress disorder, Posttraumatic stress disorder, Borderline personality disorder, Trauma, Complex trauma
Core tip: A cluster of complex posttraumatic stress disorder (PTSD), PTSD and deadline personality disorder that have in mutual a history of trauma, is proposed, as a clinical and biological continuum of symptom severity, to exist classified together under trauma-related disorders instead of simply singled-out clinical diagnoses. Trauma depending on biological vulnerability and other precipitating risk factors is suggested that it can pb to either what we commonly diagnose as PTSD or to profound and permanent personality changes, with complex PTSD being an intermediate in terms of its clinical presentation and biological findings so far.
INTRODUCTION
Complex posttraumatic stress disorder (Complex PTSD), has been originally proposed past Herman[1], as a clinical syndrome post-obit precipitating traumatic events that are usually prolonged in elapsing and mainly of early life onset, peculiarly of an interpersonal nature and more specifically consisting of traumatic events taking place during early life stages (i.eastward., child abuse and neglect)[1].
In order to develop a new psychiatric diagnosis, it requires carrying a certain extent of validity every bit a singled-out entity with a clinical utility[2], providing essential additions to already established diagnoses especially regarding biological aetiology, course and treatment options.
Several psychiatric disorders overlap in terms of symptomatology and there is a loftier comorbidity present to most, if non all, especially when precipitating factors are common or similar. Furthermore, until now, psychiatric diagnoses accept been traditionally described as theoretical constructs, mostly to facilitate communication of professionals working in the field, with the exact psychopathological processes and biological background research only currently blooming. This also carries the question whether already established psychiatric diagnoses need to exist re-evaluated and re-grouped following newly suggested research findings, aiming to offering more efficient treatment plans to patients in question.
Information technology has been questioned[2,iii] whether complex PTSD can form a singled-out diagnosis, since its symptomatology often overlaps with several mental disorders following trauma, mainly with PTSD which is usually correlated to single effect trauma as well as Axis II disorders, mainly deadline personality disorder (BPD). The latter besides the high comorbidity with complex PTSD[4], likewise shares some of the cadre symptoms described in complex PTSD peculiarly related to impaired relationships with others, dissociative symptoms, impulsive or reckless behaviours, irritability and self-destructive behaviours.
Circuitous PTSD is divers by symptom clusters mainly resembling an enhanced PTSD, with symptoms such as shame, feeling permanently damaged and ineffective, feelings of threat, social withdrawal, despair, hostility, somatisation and a variety from the previous personality. It also regularly presents with serious disturbances in self-organisation in the form of affective dysregulation, consciousness, cocky-perception with a negative self-concept and perception of the penetrator(s), often causing dysfunctional relations with others leading to interpersonal bug[1,five-vii].
The aim of this paper is to review the until now inquiry on complex PTSD and its correlation to other trauma-related mental disorders mainly PTSD and BPD, primarily regarding the diagnostic frame and biological correlates, in order to examine whether in that location is sufficient information to approve the demand of establishing a distinct clinical mental syndrome or to address the need to reassess and expand the diagnostic criteria of trauma-related disorders to include clinical features of complex PTSD currently missing from the already confirmed clinical entities.
CLINICAL DESCRIPTIONS AND BIOLOGICAL CORRELATES OF Circuitous PTSD, PRECIPITATING TRAUMATIC EVENTS AND CLINICAL DIVERGENCE FROM PTSD
Complex PTSD is already suggested as a distinct diagnostic entity, in the World Health Organisation (WHO) International Classification of Diseases, 11th version, (ICD-11)[five], which is due to be published in 2018 and currently under review, classified under disorders specifically associated with stress. It is grouped together along with PTSD, prolonged grief disorder, aligning disorder, reactive attachment disorder, disinhibited social engagement disorder and others. The disorders mentioned higher up are all associated with stress and exposure to distressing traumatic events. The clinical features following the stressful experience result in serious functional impairment regardless whether the traumatic event precipitating the disorder, falls under the normal range of life experiences (such equally grief) or encompasses events of a menacing nature (i.e., torture or abuse).
Co-ordinate to ICD-11[5], complex PTSD follows exposure to a traumatic event or a series of events of an extremely threatening nature most usually prolonged, or repetitive and from which escape is usually incommunicable or strenuous[6].
Two decades ago when information technology was first proposed, precipitating traumatic events were described strictly every bit beingness prolonged in time usually taking identify during early on developmental stages (i.e., childhood)[1]. The literature describing complex PTSD always since, post-obit its first initiation equally a cluster of symptoms beyond archetype PTSD, began to also include entrapping events taking place during adulthood[8] and argued against their prolonged nature per se, referring to single event traumas besides equally repeated series of single complex trauma that could exist and so astringent and catastrophic in nature leading to profound personal effects, such every bit personality modification, even later on the decision of major developmental stages[ix]. A recent study of Palic et al[10], argues of the complex PTSD association, not only with babyhood trauma but with exposure to all forms of adulthood trauma, predominately having in mutual the interpersonal intensity of the stress induced and the severity of prolonged trauma exposure. Some other study of va Dijke et al[eleven], correlated the presence of complex trauma in adulthood to complex PTSD symptomatology, specifically dissociation, suggesting a potential link to the dissociative subtype of PTSD.
Complex trauma, which summates a total of precipitating traumatic events to circuitous PTSD, is currently beingness described as a horrific, threatening, entrapping, deleterious and generally interpersonal traumatic event, such equally prolonged domestic violence, babyhood sexual or concrete corruption, torture, genocide campaigns, slavery etc. forth with the victim's inability to escape due to multiple constraints whether these are social, physical, psychological, ecology or other[12,13].
Circuitous PTSD includes almost of the core symptoms of PTSD, specifically flashbacks (i.east., re-experiencing the traumatic outcome), numbness and blunt emotion, avoidance and disengagement from people, events and environmental triggers of the predisposing trauma likewise as autonomic hyperarousal. Furthermore, due to the nature of the circuitous trauma experienced, it also includes affective dysregulation, adversely disrupted belief systems most oneself as being diminished and worthless, severe hardship in forming and maintaining meaningful relationships forth with deep-rooted feelings of shame and guilt or failure[7]. Its distinct characteristics added upon PTSD symptomatology, often interfere to separate it from BPD (i.e., affective dysregulation) and PTSD alone, which in cases with a chronic course will somewhen transit to a lasting personality change[xiv].
Therefore it is speculated that prolonged exposure to circuitous trauma and/or chronic PTSD, would, therefore, lead to personality alterations that are oftentimes also seen clinically in complex PTSD patients (such as feelings of being permanently damaged and alienation), even when the traumatic experiences are taking place during adulthood[14]. It is speculated that complex trauma has to be present for a sufficient amount of time to cause a clinically axiomatic diversion from the already established personality traits, towards traits that seem to either aid the victim cope with trauma or as an expression of disintegration which might express as the dysregulation of emotion processing and self-organization, two of the core symptoms added to the already established PTSD diagnostic criteria[10,fifteen]. Complex trauma, especially childhood cumulative trauma and exposure to multiple or repeated forms of maltreatment, has been shown to affect multiple melancholia and interpersonal domains[12]. Also, chronic trauma is more strongly predictive of complex PTSD than PTSD lonely, while complex PTSD is associated with a greater impairment in functioning[xvi].
Up to now, at that place is a lack of investigation of biological correlates to complex PTSD, referring to neuroimaging studies, autonomic and neurochemical measures and genetic predisposition[17]. The only data so far, consist of neuroimaging studies mainly in groups of kid abuse-related subjects that mostly fence for the hippocampal dysfunction and decreased gray matter density observed, activation disturbances in the prefrontal cortex[xviii-20], besides equally findings suggesting of more a severe neural imaging correlate in circuitous PTSD than those observed in PTSD patient studies, primarily involving brain areas related to emotional regulation and cerebral defects, symptoms that have been additionally added in circuitous PTSD symptomatology vs PTSD[17]. Structural brain abnormalities in complex PTSD seem to be more extensive with brain activity subsequently circuitous trauma beingness distinctive than the 1 seen in PTSD patients who had experienced just single trauma[21] with higher functional clinical impairment in complex PTSD independently described simply confirming the biological results mentioned above[22,23].
The three additional clusters of symptoms beyond cadre PTSD symptoms refer to emotional regulation, negative self-concept and interpersonal relational dysfunction[24].
PTSD has been re-evaluated in DSM-5[15], adding a cluster D of PTSD symptoms including altering in mood and knowledge following the traumatic experience, also as the dissociative PTSD subtype (i.due east., depersonalisation and/or derealisation), a subtype that clinically resembles the cluster of symptoms that are usually encountered in the complex PTSD[25]. A recent written report of Powers et al[26] though, ended that the ICD-eleven Complex PTSD diagnosis is different than the DSM-5 PTSD diagnosis, in all clinical domains, showing more than severe emotion regulation and dissociation, and more severe impairment in relational attachment, suggesting that they present ii distinct constructs. More studies are needed to investigate the biological basis of circuitous PTSD every bit a clinical entity and its differences from trauma-induced disorders such as PTSD.
RE-CONCEPTUALISING BPD AS A COMPLEX TRAUMA SPECTRUM DISORDER
BPD is characterized by emotional dysregulation, oscillating between emotional inhibition and farthermost emotional lability which has been often associated with prolonged childhood trauma[27], such as child abuse and neglect as well as adverse childhood experiences, present in a range within 30 to 90% of BPD patients[28-xxx]. Emotional dysregulation, an unstable sense of identity, difficulties in interpersonal relationships equally core features of BPD[15] and precipitating circuitous interpersonal traumatic victimisation, a cluster of symptoms that overlaps with symptomatology described in complex PTSD, has led into a series of arguments whether BPD represents a comorbidity of trauma-related disorders or it really duplicates complex PTSD, a clinical entity already introduced every bit a split trauma-related diagnosis in ICD-11[31].
The WHO International Classification of Diseases, 11th version, (ICD-xi), includes a slightly different spectrum of personality disorders classification, including BPD into a wider spectrum of the Emotionally Unstable Personality Disorder, conveying all of the characteristics that BPD has been known by, so far, just distinguishing ii types; the impulsive type, defined by emotional instability and impulsiveness and the borderline type with an unstable sense of self and the environment, self-subversive tendencies and intense and unstable relations. Still again, while traumatic stress exposure is fundamental in Complex PTSD and has been added to its diagnostic criteria, it is not included in the definition of BPD, albeit the multiple references that trauma, especially during early life stages, plays a crucial role in the development of the borderline personality even if epigenetically added upon a temperamental vulnerability[32]. Particularly childhood trauma such as, sexual and concrete abuse, maladaptive parenting, neglect, and parental disharmonize has been correlated to BPD multiple times in literature as hazard if not etiological factors[33].
The long-term stress response machinery activation, mediated by the hypothalamic-pituitary-adrenal (HPA) centrality, due to chronic stress exposure, can predispose to multiple stress-related psychiatric entities, including PTSD[34]. Stress early in life due to childhood trauma has been reported to upshot in an adjustment dysfunction of the HPA centrality responsiveness upon stress states encountered, with patients with BPD. At that place seems to exist an increased activation of the HPA axis[35,36], suggesting the clan of the main stress regulating machinery to childhood trauma and a biological correlation to the development of the borderline personality. Furthermore, several interacting neurotransmitter systems are shown to be afflicted in BPD[37,38], resulting to a disruption of emotional regulation and social interaction also as cognitive impairments evident mainly in spatial memory, modulation of vigilance and negative emotional states mediated through the hippocampus and amygdala[39], symptomatology that is present in circuitous PTSD even in the lack of like biological studies to support this, at to the lowest degree in terms of neuromodulation alterations in circuitous PTSD.
Additionally, neuroimaging studies on BPD, confirm the reduction in hippocampus and amygdala volumes as well as in the temporal lobes[39-42], while a recent study of Kreiser et al[43], constitute that BPD patients with a comorbid lifetime history of PTSD had smaller hippocampal volumes compared to the ones that didn't. Additionally, a study of Kuhlmann et al[44], correlated the history of trauma to BPD, showing a modification of grey matter at stress regulating centers, including the hippocampus, the amygdala, the anterior cingulate cortex and the hypothalamus.
Likewise, studies indicate that epigenetic changes upon the brain derived neurotrophic factor[45], which is a key mediator in brain plasticity, are associated to prolonged early stage trauma, contributing to the cognitive dysfunction which is often described in BPD patients[46,47].
Altogether, the similarities between studies concerning BPD and complex PTSD[17-20], in terms of the common underlying systems affected along with the clinical analogy in both disorders, both associated to prolonged stress and trauma exposure, suggest the need to re-allocate subgroups of patients with BPD, especially the ones that evidence comorbidity with PTSD, as possible cases of circuitous PTSD or, as it will exist discussed below, added on a spectrum of trauma-related clinical entities carrying a like biological background with complementary clinical expression.
CONCLUSION
The new proposed diagnosis of circuitous PTSD in ICD-11, re-conceptualises a previous ICD-ten diagnosis namely "enduring personality modify afterwards catastrophic experience", which carries characteristic clinical features of self-organisation dysfunction and exposure to multiple and chronic or repeated and entrapping, for the private, traumatic events (e.thousand., child abuse, domestic violence, imprisonment, torture). The ICD-11 complex PTSD shares three core symptom clusters of PTSD (re-experiencing, avoidance and sense of threat), adding three additional clusters of symptoms, specifically emotional dysregulation, negative self-concept and relational disturbances. Even if a articulate personality modify is non required for the diagnosis of complex PTSD, the sustainable and pervasive amending in self-arrangement, especially within the group of patients who have experienced long-lasting early life circuitous trauma, according to the authors, suggesting that a personality change is unavoidable, essentially while even chronic PTSD alone tin pb to the change of personality somewhen as information technology has been noted in the literature[fourteen]. Therefore, complex PTSD, often clinically resembles a subtype of BPD.
At that place lies the question whether circuitous PTSD is a clearly defined singled-out entity or a PTSD comorbid with BPD. The contend focuses mainly on the fact that fifty-fifty if both conditions share core symptoms, such as bear on dysregulation and cocky-organization disturbances, BPD has been traditionally described by an unstable sense of cocky oscillating between highly positive and highly negative self-evaluation and a relational zipper style vacillating between idealizing and denigrating perceptions of others when complex PTSD on the other hand, is divers by a deeply negative sense of self and an avoidant attachment style that are stable in nature and follow complex trauma, something that is not described in the diagnostic criteria of BPD.
Yet, BPD seems to be a heterogeneous diagnostic category, which can include many subtypes of patients, such as patients with bipolar disorder, low or other personality disorders such as egotistic personality disorder, with an accurate clinical diagnosis being difficult nether applied pressures posed upon physicians and the comorbidity present amid the above mentioned disorders[48]. BPD clinical features exercise not seem to be stable over fourth dimension, and this is suggested to exist influenced by the underlying biological temperament[49,fifty], while the comorbidity with PTSD is mutual merely not nowadays in all of the BPD cases[51], therefore arguing for conceptualizing some of the BPD cases belonging to a trauma spectrum disorder instead[52].
Since the etiological background for well-nigh if not all psychiatric disorders, is not linear but instead information technology consists of many biological, psychological and social factors, interacting between each other and continuously adjusting, shifting and variating among individuals on top of brain plasticity and ever-changing circumstances, the authors suggest that the biological correlates of disorders appearing with similar phenomenology should exist better investigated.
The different clinical profiles described in the most recent nomenclature systems (Tabular array 1) even if sharing many mutual clinical features, that surround PTSD, complex PTSD and BPD, are all associated with unlike levels of harm and dissimilar risk factors mainly in the trauma history precipitating the phenomenology that finally occurs, which is evident in the neuroimaging findings of each disorder (Effigy 1).
Table 1
Phenomenology of posttraumatic stress disorder, complex posttraumatic stress disorder and borderline personality disorder; DSM-5 clinical features and proposed criteria of ICD-11
| DSM - five | ICD - 11 | |
| PTSD | Exposure to traumatic events; Intrusion symptoms; Persistent abstention of stimuli; Negative alterations in cognitions and mood (dissociation, persistent negative beliefs of oneself, others or the globe, distorted cognitions about the traumatic event, persistent negative emotional state, disengagement from others, macerated interest or participation in previously enjoyed activities etc.); Alterations in arousal and reactivity; aggressive verbal and/or concrete behaviour, reckless or self-destructive behaviour; depersonalisation or derealisation; Significant impairment in all areas of operation | Exposure to an extremely threatening or horrific effect or series of events; vivid intrusive memories, flashbacks, or nightmares, which are typically accompanied past strong and overwhelming emotions; avoidance of thoughts and memories, events, people, activities, situations reminiscent of the event(s); persistent perceptions of heightened current threat, hypervigilance or an enhanced startle reaction. Meaning impairment in personal, family, social, educational, occupational or other important areas of performance |
| Complex PTSD | Non included equally a diagnostic entity | Exposure to an event(s) of an extremely threatening or horrific nature, most commonly prolonged or repetitive, from which escape is difficult or impossible; All diagnostic requirements for PTSD are and additionally: severe and pervasive affect dysregulation; persistent negative beliefs about oneself; deep-rooted feelings of shame, guilt or failure; persistent difficulties in sustaining relationships and in feeling close to others. Significant impairment in all areas of operation |
| BPD | Pervasive pattern of instability of interpersonal relationships, self-image and affects and impulsivity; frantic efforts to avoid abandonment, unstable and intense interpersonal relations oscillating between idealisation and devaluation, unstable self-paradigm or sense of cocky, self-harming behaviour, affective instability and marked reactivity of mood, chronic feelings of emptiness, poor anger management, transient paranoid ideation or astringent dissociation | Emotionally unstable personality disorder, Borderline type: Maladaptive self and interpersonal functioning, affective instability, and maladaptive regulation strategies: Frantic efforts to avoid abandonment; unstable interpersonal relations (idealisation/devaluation); unstable self-image; impulsivity; self-damaging behaviours; marked reactivity of mood; chronic feelings of emptiness; anger management issues; dissociative symptoms |
Proposed development of the clinical phenomenology based on trauma history and biological correlates. PTSD: Posttraumatic stress disorder; BPD: Borderline personality disorder.
Since fifty-fifty chronic PTSD will eventually lead to personality modification, it is suggested that complex trauma exposure, even during adulthood, is a predisposing factor for circuitous PTSD occurring, which will, eventually, if relatively prolonged in time, lead to more severe personality changes often clinically similar to BPD. We suggest that the time of the traumatic events occurrence (i.e., early on developmental stages vs adulthood), their severity and context, their duration in fourth dimension and whether they are of an entrapping and interpersonal nature, posed upon a genetically predisposed groundwork will somewhen progress into enduring or permanent personality modifications. Therefore, we propose that within the heterogeneous group of cases classified every bit BPD, there is a subgroup that could be possibly classified under trauma-related disorders and exist therapeutically treated as such.
Final, the authors suggest a continuum of clinical severity and symptoms' development in trauma-related disorders, within a spectrum of clinical features, biological background and precipitating trauma, from classic PTSD towards a subtype of BPD; specially concerning cases supposing a comorbidity with PTSD. We also advise of complex PTSD being an "intermediate" in its phenomenological manifestation, with biological analogies seemingly supporting these hypotheses.
More studies are needed focusing on the biological background of circuitous PTSD and how this relates to its newly proposed clinical entity and how it correlates to the extended findings in the literature effectually the biological science of PTSD and BPD. This is essential for examining the validity of it as a singled-out and separated entity altogether or to confirm the hypothesis of a spectrum surrounding the disorders discussed above, at to the lowest degree within the range of cases having a history of trauma present.
Footnotes
Conflict-of-interest argument: The authors accept no competing interests to disclose.
Manuscript source: Invited manuscript
Peer-review started: Nov 14, 2017
Offset decision: December eight, 2017
Article in press: February 4, 2018
Specialty type: Psychiatry
Country of origin: Greece
Peer-review report classification
Grade A (Excellent): A, A
Form B (Very good): B
Grade C (Good): 0
Grade D (Off-white): 0
Form Due east (Poor): 0
P- Reviewer: Celikel FC, Liu L, Tcheremissine OV S- Editor: Wang JL Fifty- Editor: A E- Editor: Wang CH
Contributor Data
Evangelia Giourou, Department of Psychiatry, School of Medicine, University of Patras, Rio Patras 26500, Greece. Section of Public Health, Schoolhouse of Medicine, Academy of Patras, Rio Patras 26500, Greece.
Maria Skokou, Department of Psychiatry, School of Medicine, University of Patras, Rio Patras 26500, Greece.
Stuart P Andrew, Specialist Care Team Limited, Lancashire LA4 4AY, United kingdom of great britain and northern ireland.
Konstantina Alexopoulou, School of Medicine, University of Patras, Rio Patras 26500, Greece.
Philippos Gourzis, Department of Psychiatry, School of Medicine, University of Patras, Rio Patras 26500, Hellenic republic.
Eleni Jelastopulu, Section of Public Health, School of Medicine, University of Patras, Rio Patras 26500, Greece.
References
ane. Herman JL. Circuitous PTSD: A syndrome in survivors of prolonged and repeated trauma. J Trauma Stress. 1992;5:377–391. [Google Scholar]
2. Resick PA, Bovin MJ, Calloway AL, Dick AM, King MW, Mitchell KS, Suvak MK, Wells SY, Stirman SW, Wolf EJ. A critical evaluation of the complex PTSD literature: implications for DSM-five. J Trauma Stress. 2012;25:241–251. [PubMed] [Google Scholar]
3. Herman J. CPTSD is a singled-out entity: comment on Resick et al. (2012) J Trauma Stress. 2012;25:256–257; discussion on 260-263. [PubMed] [Google Scholar]
4. McLean LM, Gallop R. Implications of childhood sexual corruption for adult deadline personality disorder and complex posttraumatic stress disorder. Am J Psychiatry. 2003;160:369–371. [PubMed] [Google Scholar]
5. Reed GM, First MB, Elena Medina-Mora M, Gureje O, Pike KM, Saxena S. Draft diagnostic guidelines for ICD-11 mental and behavioural disorders available for review and comment. World Psychiatry. 2016;15:112–113. [PMC complimentary article] [PubMed] [Google Scholar]
6. Bryant RA. The complexity of circuitous PTSD. Am J Psychiatry. 2010;167:879–881. [PubMed] [Google Scholar]
seven. Cloitre Chiliad, Courtois CA, Charuvastra A, Carapezza R, Stolbach BC, Dark-green BL. Treatment of complex PTSD: results of the ISTSS practiced clinician survey on best practices. J Trauma Stress. 2011;24:615–627. [PubMed] [Google Scholar]
8. McDonnell M, Robjant K, Katona C. Complex posttraumatic stress disorder and survivors of human being rights violations. Curr Opin Psychiatry. 2013;26:1–6. [PubMed] [Google Scholar]
ix. Courtois CA. Circuitous trauma, circuitous reactions: Assessment and treatment. Psychol Trauma. 2008;Southward:86–100. [Google Scholar]
10. Palic S, Zerach Chiliad, Shevlin M, Zeligman Z, Elklit A, Solomon Z. Show of complex posttraumatic stress disorder (CPTSD) across populations with prolonged trauma of varying interpersonal intensity and ages of exposure. Psychiatry Res. 2016;246:692–699. [PubMed] [Google Scholar]
eleven. van Dijke A, Ford JD, Frank LE, van der Hart O. Clan of Babyhood Complex Trauma and Dissociation With Circuitous Posttraumatic Stress Disorder Symptoms in Adulthood. J Trauma Dissociation. 2015;16:428–441. [PubMed] [Google Scholar]
12. Cloitre One thousand, Stolbach BC, Herman JL, van der Kolk B, Pynoos R, Wang J, Petkova E. A developmental approach to complex PTSD: childhood and adult cumulative trauma equally predictors of symptom complexity. J Trauma Stress. 2009;22:399–408. [PubMed] [Google Scholar]
13. Cloitre M, Petkova E, Wang J, Lu Lassell F. An examination of the influence of a sequential treatment on the course and impact of dissociation amid women with PTSD related to babyhood corruption. Depress Anxiety. 2012;29:709–717. [PubMed] [Google Scholar]
xiv. Ehlers A, Maercker A, Boos A. Posttraumatic stress disorder post-obit political imprisonment: the role of mental defeat, alienation, and perceived permanent modify. J Abnorm Psychol. 2000;109:45–55. [PubMed] [Google Scholar]
fifteen. Regier DA, Kuhl EA, Kupfer DJ. The DSM-5: Nomenclature and criteria changes. World Psychiatry. 2013;12:92–98. [PMC free article] [PubMed] [Google Scholar]
16. Cloitre M, Garvert DW, Brewin CR, Bryant RA, Maercker A. Testify for proposed ICD-11 PTSD and complex PTSD: a latent contour analysis. Eur J Psychotraumatol. 2013;iv [PMC free article] [PubMed] [Google Scholar]
17. Marinova Z, Maercker A. Biological correlates of complex posttraumatic stress disorder-state of enquiry and future directions. Eur J Psychotraumatol. 2015;6:25913. [PMC free commodity] [PubMed] [Google Scholar]
18. Thomaes Thou, Dorrepaal East, Draijer NP, de Ruiter MB, Elzinga BM, van Balkom AJ, Smoor PL, Smit J, Veltman DJ. Increased activation of the left hippocampus region in Complex PTSD during encoding and recognition of emotional words: a pilot study. Psychiatry Res. 2009;171:44–53. [PubMed] [Google Scholar]
19. Thomaes K, Dorrepaal Eastward, Draijer N, de Ruiter MB, Elzinga BM, Sjoerds Z, van Balkom AJ, Smit JH, Veltman DJ. Increased anterior cingulate cortex and hippocampus activation in Circuitous PTSD during encoding of negative words. Soc Cogn Affect Neurosci. 2013;eight:190–200. [PMC free article] [PubMed] [Google Scholar]
twenty. Thomaes Chiliad, Dorrepaal E, Draijer N, de Ruiter MB, Elzinga BM, van Balkom AJ, Smit JH, Veltman DJ. Treatment effects on insular and inductive cingulate cortex activation during classic and emotional Stroop interference in kid abuse-related circuitous mail service-traumatic stress disorder. Psychol Med. 2012;42:2337–2349. [PubMed] [Google Scholar]
21. Thomaes K, Dorrepaal E, van Balkom AJ, Veltman DJ, Smit JH, Hoogendoorn AW, Draijer North. [Complex PTSD following early on-childhood trauma: emotion-regulation training every bit add-on to the PTSD guideline] Tijdschr Psychiatr. 2015;57:171–182. [PubMed] [Google Scholar]
22. Karatzias T, Shevlin M, Fyvie C, Hyland P, Efthymiadou Due east, Wilson D, Roberts Due north, Bisson JI, Brewin CR, Cloitre M. Evidence of distinct profiles of Posttraumatic Stress Disorder (PTSD) and Complex Posttraumatic Stress Disorder (CPTSD) based on the new ICD-xi Trauma Questionnaire (ICD-TQ) J Bear upon Disord. 2017;207:181–187. [PubMed] [Google Scholar]
23. Perkonigg A, Höfler Grand, Cloitre M, Wittchen HU, Trautmann Due south, Maercker A. Evidence for two dissimilar ICD-11 posttraumatic stress disorders in a community sample of adolescents and young adults. Eur Arch Psychiatry Clin Neurosci. 2016;266:317–328. [PubMed] [Google Scholar]
24. Ford JD, Courtois CA. Complex PTSD, touch dysregulation, and deadline personality disorder. Borderline Personal Disord Emot Dysregul. 2014;1:9. [PMC free article] [PubMed] [Google Scholar]
25. Battle DE. Diagnostic and Statistical Manual of Mental Disorders (DSM) Codas. 2013;25:191–192. [PubMed] [Google Scholar]
26. Powers A, Fani N, Carter S, Cross D, Cloitre M, Bradley B. Differential predictors of DSM-5 PTSD and ICD-11 circuitous PTSD amongst African American women. Eur J Psychotraumatol. 2017;viii:1338914. [PMC gratis commodity] [PubMed] [Google Scholar]
27. van Dijke A, Ford JD, van der Hart O, van Son M, van der Heijden P, Bühring M. Affect dysregulation in borderline personality disorder and somatoform disorder: differentiating nether- and over-regulation. J Pers Disord. 2010;24:296–311. [PubMed] [Google Scholar]
28. Battle CL, Shea MT, Johnson DM, Yen Southward, Zlotnick C, Zanarini MC, Sanislow CA, Skodol AE, Gunderson JG, Grilo CM, et al. Babyhood maltreatment associated with adult personality disorders: findings from the Collaborative Longitudinal Personality Disorders Written report. J Pers Disord. 2004;18:193–211. [PubMed] [Google Scholar]
29. Yen Southward, Shea MT, Boxing CL, Johnson DM, Zlotnick C, Dolan-Sewell R, Skodol AE, Grilo CM, Gunderson JG, Sanislow CA, et al. Traumatic exposure and posttraumatic stress disorder in deadline, schizotypal, avoidant, and obsessive-compulsive personality disorders: findings from the collaborative longitudinal personality disorders study. J Nerv Ment Dis. 2002;190:510–518. [PubMed] [Google Scholar]
30. Zanarini MC, Frankenburg FR, Hennen J, Reich DB, Silk KR. Prediction of the 10-twelvemonth course of borderline personality disorder. Am J Psychiatry. 2006;163:827–832. [PubMed] [Google Scholar]
31. Cloitre G, Garvert DW, Weiss B, Carlson EB, Bryant RA. Distinguishing PTSD, Complex PTSD, and Borderline Personality Disorder: A latent form analysis. Eur J Psychotraumatol. 2014;v [PMC gratuitous article] [PubMed] [Google Scholar]
32. Leichsenring F, Leibing E, Kruse J, New Equally, Leweke F. Deadline personality disorder. Lancet. 2011;377:74–84. [PubMed] [Google Scholar]
33. Winsper C, Lereya ST, Marwaha South, Thompson A, Eyden J, Singh SP. The aetiological and psychopathological validity of borderline personality disorder in youth: A systematic review and meta-assay. Clin Psychol Rev. 2016;44:13–24. [PubMed] [Google Scholar]
34. Mehta D, Binder EB. Gene × environment vulnerability factors for PTSD: the HPA-axis. Neuropharmacology. 2012;62:654–662. [PubMed] [Google Scholar]
35. Southwick SM, Axelrod SR, Wang S, Yehuda R, Morgan CA tertiary, Charney D, Rosenheck R, Mason JW. Xx-four-hr urine cortisol in combat veterans with PTSD and comorbid borderline personality disorder. J Nerv Ment Dis. 2003;191:261–262. [PubMed] [Google Scholar]
36. Wingenfeld K, Driessen Chiliad, Adam B, Hill A. Overnight urinary cortisol release in women with borderline personality disorder depends on comorbid PTSD and depressive psychopathology. Eur Psychiatry. 2007;22:309–312. [PubMed] [Google Scholar]
37. Friedel RO. Dopamine dysfunction in borderline personality disorder: a hypothesis. Neuropsychopharmacology. 2004;29:1029–1039. [PubMed] [Google Scholar]
38. Grosjean B, Tsai GE. NMDA neurotransmission as a critical mediator of borderline personality disorder. J Psychiatry Neurosci. 2007;32:103–115. [PMC free article] [PubMed] [Google Scholar]
39. Driessen M, Herrmann J, Stahl 1000, Zwaan Thou, Meier S, Hill A, Osterheider M, Petersen D. Magnetic resonance imaging volumes of the hippocampus and the amygdala in women with borderline personality disorder and early on traumatization. Curvation Gen Psychiatry. 2000;57:1115–1122. [PubMed] [Google Scholar]
xl. Irle E, Lange C, Sachsse U. Reduced size and abnormal disproportion of parietal cortex in women with borderline personality disorder. Biol Psychiatry. 2005;57:173–182. [PubMed] [Google Scholar]
41. Tebartz van Elst L, Hesslinger B, Thiel T, Geiger E, Haegele K, Lemieux Fifty, Lieb Grand, Bohus M, Hennig J, Ebert D. Frontolimbic brain abnormalities in patients with deadline personality disorder: a volumetric magnetic resonance imaging study. Biol Psychiatry. 2003;54:163–171. [PubMed] [Google Scholar]
42. Rossi R, Lanfredi Thousand, Pievani M, Boccardi M, Beneduce R, Rillosi Fifty, Giannakopoulos P, Thompson PM, Rossi G, Frisoni GB. Volumetric and topographic differences in hippocampal subdivisions in borderline personality and bipolar disorders. Psychiatry Res. 2012;203:132–138. [PubMed] [Google Scholar]
43. Kreisel SH, Labudda K, Kurlandchikov O, Beblo T, Mertens 1000, Thomas C, Rullkötter N, Wingenfeld K, Mensebach C, Woermann FG, et al. Book of hippocampal substructures in borderline personality disorder. Psychiatry Res. 2015;231:218–226. [PubMed] [Google Scholar]
44. Kuhlmann A, Bertsch K, Schmidinger I, Thomann PA, Herpertz SC. Morphometric differences in key stress-regulating structures between women with and without borderline personality disorder. J Psychiatry Neurosci. 2013;38:129–137. [PMC costless article] [PubMed] [Google Scholar]
45. Duman RS, Monteggia LM. A neurotrophic model for stress-related mood disorders. Biol Psychiatry. 2006;59:1116–1127. [PubMed] [Google Scholar]
46. Perroud N, Salzmann A, Prada P, Nicastro R, Hoeppli ME, Furrer S, Ardu S, Krejci I, Karege F, Malafosse A. Response to psychotherapy in borderline personality disorder and methylation status of the BDNF cistron. Transl Psychiatry. 2013;three:e207. [PMC complimentary article] [PubMed] [Google Scholar]
47. Thaler L, Gauvin L, Joober R, Groleau P, de Guzman R, Ambalavanan A, Israel M, Wilson S, Steiger H. Methylation of BDNF in women with bulimic eating syndromes: associations with childhood corruption and borderline personality disorder. Prog Neuropsychopharmacol Biol Psychiatry. 2014;54:43–49. [PubMed] [Google Scholar]
48. Kernberg OF, Yeomans Fe. Borderline personality disorder, bipolar disorder, depression, attention deficit/hyperactivity disorder, and narcissistic personality disorder: Applied differential diagnosis. Bull Menninger Clin. 2013;77:1–22. [PubMed] [Google Scholar]
49. Zanarini MC, Frankenburg FR, Reich DB, Silk KR, Hudson JI, McSweeney LB. The subsyndromal phenomenology of deadline personality disorder: a 10-year follow-up study. Am J Psychiatry. 2007;164:929–935. [PubMed] [Google Scholar]
50. Hopwood CJ, Newman DA, Donnellan MB, Markowitz JC, Grilo CM, Sanislow CA, Ansell EB, McGlashan Th, Skodol AE, Shea MT, et al. The stability of personality traits in individuals with borderline personality disorder. J Abnorm Psychol. 2009;118:806–815. [PMC free article] [PubMed] [Google Scholar]
51. Grant BF, Chou SP, Goldstein RB, Huang B, Stinson FS, Saha TD, Smith SM, Dawson DA, Pulay AJ, Pickering RP, et al. Prevalence, correlates, disability, and comorbidity of DSM-Iv borderline personality disorder: results from the Moving ridge two National Epidemiologic Survey on Alcohol and Related Conditions. J Clin Psychiatry. 2008;69:533–545. [PMC gratuitous article] [PubMed] [Google Scholar]
52. Lewis KL, Grenyer BF. Borderline personality or complex posttraumatic stress disorder? An update on the controversy. Harv Rev Psychiatry. 2009;17:322–328. [PubMed] [Google Scholar]
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