It may be very difficult for autistic adults to secure and maintain employment

Autism is viewed as a risk factor for complex post-traumatic stress disorder (CPTSD). Throughout life, autistic people may experience discrimination and marginalization. Many autistic children have been bullied and excluded at school. It may be very difficult for autistic adults to secure and maintain employment. Up to approximately 85 percent of autistic people are unemployed. When they are employed, they often are overqualified or work part-time and are more likely to be bullied.

An autistic person may also face unfair discipline at work. They may have had a strong performance early on at work, getting positive feedback. However, bosses may grow tired of autism-related behavior and then become overly harsh with an autistic worker. According to the Gold Law Firm, “Some supervisors unjustly criticize an employee’s work performance to create documentation for termination. Employers know they cannot terminate an employee because of a disability, so they create reasons for termination, which may include poor work performance.” This unjust critique of performance may cause self-esteem problems, even causing an autistic person to doubt whether they can do high-quality work. The individual could recall that their old boss may have said that the real reason why the supervisor did not assign certain work to the person is fear of autism-related communication problems. Thus, the real issue at work was autism-related problems, not poor performance. This fact could help improve self-esteem, but at the same time, cause the person to be even angrier with their former supervisor.

It may be difficult for an autistic person to bounce back from a termination

It may be difficult for an autistic person to bounce back from a termination because they may struggle to find work. While it takes unemployed members of the general population an average of 22.4 weeks to get a new job, it takes autistic individuals an average of a year to become employed. Longer periods of unemployment may make any person less employable. The unemployed person loses job skills and may get discouraged from applying for jobs. In addition, some employers may think that prolonged unemployment shows poor work performance.

It is possible that an autistic individual may be underemployed. They may find low-paying part-time work that they are overqualified for. Underemployment affects finances, harms self-esteem, decreases career growth, and does not allow an autistic person to reach their full potential.

CPTSD symptoms may include lower self-esteem and little belief in one’s skills and strengths. People with CPTSD can also have decreased self-worth and may lose hope.

It is not surprising that an autistic person could develop self-esteem/self-worth issues. In their lived experience, potential employers, romantic interests, friends, and even relatives may not all want them.

To properly treat an autistic client, the mental health provider should know that the client is autistic. As some people are diagnosed with autism later in life, an individual may be autistic but not know it. If a clinician suspects that a client’s autism is a contributing factor to the client’s problems, the mental health professional should talk with the client about their speculation.

Affirmative conversations using a strengths-based approach, which many social workers utilize, could temporarily improve the client’s decreased self-esteem. However, after feeling better about themselves, the client may be reminded that no one wants their skills. Thus, they may get angry. Continuing to suffer, they may revert to declining levels of self-esteem, thus experiencing a cycle of emotions.

Clinicians could try to prevent the setbacks by letting their clients know that they are thinking about their clients and by complimenting their clients via periodic e-mails. Clinicians may not feel that they have the capacity to send such e-mails due to a large caseload and may not know what to write every time. They may also feel that contact between sessions should mainly be about billing and scheduling, and/or they may not want to write e-mails outside those topics. In addition, clients may not want to hear from their therapist so much.  However, these e-mails may benefit their clients, who would be reminded that they have strengths and who might appreciate that at least someone is thinking of them. Before sending such e-mails, the clinicians should ask their clients about receiving e-mails and then follow the clients’ lead.

Mental health professionals could also try to break the vicious cycle by encouraging their clients to use their academic and/or professional skills in a volunteer capacity. Volunteering can develop skills, transferable professional experiences, and professional contacts, which might help them get new employment. Volunteering also enables autistic people to make meaningful contributions, increases their self-confidence and self-esteem, and distracts them from focusing on their negative employment experience.

However, mental health professionals should also recognize that volunteering could be a double-edged sword, causing even more pain for their clients. The positive results of volunteering may not help a client who is focused on employment and remains unemployed. Given the especially high unemployment rates of autistic people, the client may continue to be unemployed. In addition, although the client could derive pleasure and benefit others by using their skills, they could get frustrated and angry by their continued, prolonged unemployment. Their self-esteem could continue to decline.

To improve the self-esteem of their autistic clients, mental health professionals could also:

• Recognize the clients’ achievements and strengths – However, such actions can cause an autistic client to feel discouraged because they may feel that their experiences and abilities have gotten them nowhere.
• Encourage them to develop new skills (i.e., learn a new language, musical instrument, food recipe).
• Recommend that they challenge themselves to do activities that they do not usually do
• Recommend that they say yes to opportunities.
• Encourage them to find a niche for themselves (i.e., be the only one in their family who can make certain food).
• Encourage them to use their skills to make people happy (i.e. – Play music for people, cook for individuals) .
• Suggest to them that they find communities (i.e., around their special interests).
• Recommend confidence-building films and books.

Proven methods of treating and coping with CPTSD among non-autistic people may not work for autistic people. Those tactics include:

• Trauma-focused cognitive behavioral therapy.
• Strengths-based approach – Highlighting the client’s strengths may not work as a permanent solution.
• Support network – As many autistic people are socially isolated and lonely, they may have a limited or no support network.

Autistic people need to be assisted. They can be valuable if they are given a chance and respected.

Photo by Alexandr Podvalny on Unsplash

Guest Post Disclaimer: Any and all information shared in this guest blog post is intended for educational and informational purposes only. Nothing in this blog post, nor any content on CPTSDfoundation.org, is a supplement for or supersedes the relationship and direction of your medical or mental health providers. Thoughts, ideas, or opinions expressed by the writer of this guest blog post do not necessarily reflect those of CPTSD Foundation. For more information, see our Privacy Policy and Full Disclaimer.

Miriam Edelman

This vignette may not be all that unique. Autistic people are often marginalized and excluded, not allowed to fully participate in society and live to their potential, because of the ableist world. All too often, they are not fully accepted and included. Instead, they very well may be subjected to neuroableism, “the specific type of ableism experienced by neurodivergent people due to systemic oppression in a supremacist-based society that values neurotypicalness as the ‘right’ way to be, think, and act.” Examples of neuroableism are “[a]ssuming all humans must conform to a specific way of being,” “[e]xpecting all humans to communicate in the same way,” “[j]udging and labeling neurodivergent people according to their ability to assimilate and hide their neurodivergence,” and “[r]efusing to learn to communicate with neurodivergent people in the way they need.”

Throughout their lives, autistic individuals often are expected to act like everyone else.

As autistic autism advocate Scott Frasard wrote, “[s]chools punish autistic children for stimming or not making eye contact,” “[w]orkplaces value ‘good communication skills’ over actual competence,” and “[s]ocial circles reward compliance and shun authenticity.”

Neurodiversity expert Bridgette Hebert Hamstead wrote about how inclusion often means autistic people conforming, not being accepted as their authentic selves:

Too often, inclusion does not mean changing systems to accommodate the needs of neurodivergent individuals. It means asking neurodivergent people to adapt to systems that remain rigid and unchanged. The message is not “we will meet you where you are” but rather “we will let you be here as long as you learn to act like us.” From classrooms to offices, inclusion is frequently contingent on compliance. You can be part of the group, but only if you do not rock the boat. You can join the team, but only if you keep your differences quiet. You can speak up, but only in ways that do not make others uncomfortable.

Hamstead addressed employment, which is key, as autistic people have challenges securing and maintaining employment:

In workplaces, inclusion is often performative. Employers promote diversity initiatives, host awareness events, or celebrate Neurodiversity Week, but they rarely examine the structural barriers that make the workplace inaccessible in the first place. Autistic employees are encouraged to disclose their diagnoses, but once they do, they are expected to work harder to “fit in.” Accommodations are grudgingly granted, if at all. Feedback is filtered through neurotypical standards of professionalism. There is little room for different communication styles, sensory needs, or pacing. The underlying expectation remains the same: adapt or be excluded.

Anger is natural. According to an article published by Harvard Medical School, “[in] psychological terms, anger is a normal emotional response to a person or situation you believe has treated you unfairly or has otherwise been hurtful or harmful.” Anger can be connected to “bullying, trauma, neglect, abuse, rejection, discrimination, or other struggles that may date back to childhood.” Anger can result from unfair treatment by one’s employer and denial of equal access based on illegitimate reasons, including gender and disability.

It is completely understandable that autistic people may have intense rage. They may have been constantly told that how they communicate and even how they exist is unacceptable. As Hamstead wrote:

The truth is, rage is a deeply valid and appropriate response to ableism. It is a valid response to being told your entire life that your way of being in the world is wrong. It is a valid response to being punished for sensory differences, isolated for communication styles, or gaslit by systems that refuse to accommodate your needs. It is a valid response to being infantilized, pathologized, and talked over in conversations about your own identity. It is a valid response to being denied employment, excluded from education, or subjected to harmful therapies because your brain does not function the way others expect it to.

Other sources of anger for autistic people may include sensory stimulation, others’ behavior, disturbance of routine and order, work-related and relationship-related challenges, imperfections of others, stress, and being ignored.

It may be challenging for autistic people to recognize and comprehend their feelings. Autistic people may express anger by yelling, name-calling, hitting, kicking, hurting themselves, biting, scratching, banging their heads, breaking items, and more. However, some of these actions, in modified form, may be used by autistic people to regulate their emotions. For example, some scratching could refocus an autistic person’s thoughts from anger and other negative feelings.

It is vital to address anger. Untreated anger may lead to adverse physical health consequences, including headaches, insomnia, depression, high blood pressure, heart attack, stroke, and more. It may also worsen mental health conditions, including complex PTSD and depression. In addition, as a result of rage, people may develop substance abuse disorder.

When treating an extremely angry autistic client, mental health professionals need to address their thoughts and behavior in order to make the best recommendations to the client.

• Address your thoughts and behavior:
  • Create a safe neuro-affirming space, where you accept your client’s autism-related behavior.
  • Understand their anger – The world was not built for autistic people. Instead, it was built by allistic (non-autistic) people for allistic people.
  • Realize that an autistic client may have trouble getting through the following five stages of anger: denial, depression, anger, bargaining, and acceptance. It may be extremely difficult for them to accept their situation. They were born autistic and may have major problems because of how unaccepting and ableist the world is.
  • See what could help them when they get angry. – If/when they get angry while meeting with you, you could assist them with their preferred method(s).
  • Realize that you may be one of the few people who are available to talk with them. Many autistic people are socially isolated and lonely.
  • If meeting in person, lend your client fidget toys, which may help your client filter out potentially distracting information, decrease anxiety, and sooth themselves. Do not get distracted and/or thrown off if your client uses a fidget toy.
  • Do not:
    • Get exasperated regarding their intense anger. It is much more difficult to experience their life than to hear about it for a small period of time a week.
    • Get irritated with their autistic-related behavior (i.e., liking to e-mail). If you criticize them, you could trigger them, reminding them of others who have made similar remarks.
    • Trigger them – Triggering them could make them angry. For example, do not use certain words that upset them.
    • Be afraid of your client. Your client may be angry with how the world has treated them, not with you.
    • Get taken aback if your client has trouble with emotional regulation and yells and/or cries. Autistic people often have trouble controlling their emotions.
  • Make recommendations to your client (Be flexible with your recommendations. They may work for your client some days, but not others. Be sensitive to what is happening with your client in the moment.):
    • Encourage them to channel their anger into productive actions. – For example, working on autistic advocacy could help improve the world so others would not have to go through the same experiences as an autistic client. An autistic client can advocate for autism acceptance through various means, including writing, creating videos, speaking, and more.
    • Recommend a stop-think technique, which is similar to cognitive behavioral therapy (CBT). Under the stop-think approach, a person stops and speculates whether their thoughts are correct or beneficial, challenges incorrect or non-beneficial thoughts, and develops alternative thoughts.
    • Encourage the creation of an action plan that your client can use regarding anger. The plan could involve methods to distract themselves from situations, remove themselves from situations, avoid incidents that could upset them, and adjust their routines.
    • Suggest that your client practice radical acceptance. Radical acceptance, which is from Dialectic Behavior Therapy, is completely accepting reality instead of fighting it (even if the situation is unfair). Accepting does not mean approval or agreement. Instead, it means acknowledging that something happened. Radical acceptance prevents pain from turning into suffering, and it prevents such thoughts as “This is unfair?” As Hamstead wrote:

 “Radical acceptance is not about giving up or resigning ourselves to suffering. It is about recognizing that who we are is valid, even if we do not fit into the boxes society expects us to occupy. It means accepting our brains, our bodies, our patterns, and our needs as they are, without needing to justify or explain them. It means allowing ourselves to stop performing, stop apologizing, and stop trying to become someone we are not. When we accept ourselves as we are in this moment, with all of our complexities and contradictions, we create space for real change to happen. Not change that comes from pressure or shame, but change that comes from growth, care, and curiosity.”

She also wrote about practicing radical acceptance:

 “We become more present in our lives, less focused on proving our worth and more attuned to what we actually need and want. We begin to create lives where we can thrive—not in spite of our neurodivergence, but because we are finally living in alignment with it.”

Her suggestions on how neurodivergent adults can practice radical acceptance are:

1. “Notice your internal dialogue.”
2. “Allow yourself to rest without earning it.”
3. “Unlearn harmful definitions of success.”
4. “Practice saying no.”
5. “Create rituals of self-affirmation.”
6. “Surround yourself with people who affirm your neurodivergence.”
7. “Let your body and brain lead.”
8. “Accept that some days will be harder than others.”
9. “Release the idea of a ‘perfect version’ of you.”
10. “Return to acceptance again and again.”

You can educate your client about and help them with radical acceptance. For example, you can use a worksheet and help your client determine what self-affirmation moments would most help them.

However, recognize that your client may have a difficult time with radical acceptance, as in their lived experience, many may not want them and their skills. In addition, realize that your client’s immense anger can motivate them to try to have the world be more accepting of autistic people.

• Suggest exercise to your client, as physical activity can assist with emotional regulation and stress. However, as autistic people are more likely to be overweight or obese than others, recommendations to exercise could irritate your client. They may know about their weight issues and feel they are going to a therapist for mental health issues, not to be told to exercise.
• Encourage your client to relax. Ways to relax include deep breathing, tai chi, and other techniques.
• Encourage your client to attend a support group, as it may be beneficial.

Autistic people have every right to be angry, as they live in a world that was not constructed for them. However, they can be extremely valuable if they are respected, not marginalized. Have empathy for them, as you should for anybody.

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Guest Post Disclaimer: Any and all information shared in this guest blog post is intended for educational and informational purposes only. Nothing in this blog post, nor any content on CPTSDfoundation.org, is a supplement for or supersedes the relationship and direction of your medical or mental health providers. Thoughts, ideas, or opinions expressed by the writer of this guest blog post do not necessarily reflect those of CPTSD Foundation. For more information, see our Privacy Policy and Full Disclaimer.

Miriam Edelman

Misdiagnosis With Emotionally Unstable Personality Disorder

A frequent misdiagnosis of people with CPTSD is Emotionally Unstable Personality Disorder (EUPD), which was known as Borderline Personality Disorder. There is overlap between EUPD and CPTSD, both of which involve early trauma. Both diagnoses also entail dissociation; “anxiety, anger, or depression;” challenges with emotional regulation; self-destructive actions; and avoidance.

However, CPTSD and EUPD are different from one another. While EUPD relates to fear of abandonment, CPTSD involves fear of relationships. People with EUPD tend not to have a stable sense of identity. In contrast, individuals with CPSD have a distorted view of themselves. In addition, unlike EUPD, CPTSD entails challenges trusting individuals, “negative views of self or the world, nightmares or insomnia, and flashbacks.” Misdiagnosing CPTSD as EUPD could result in improper treatment, as some of the CPTSD-specific symptoms would not be addressed by treatment for EUPD.

Case Vignette

Let’s look at a case vignette, as individual cases can really show what may happen. In the United States, an individual (Let’s call her BC) with probable CPTSD received different, conflicting diagnoses and thus inadequate treatment from mental health professionals because CPTSD does not exist as a diagnosable condition in the United States. A little more than a year after traumatic job experiences (including a firing), BC began therapy.

BC’s initial therapist diagnosed BC with just depression. BC truly felt that she experienced more than just depression. BC truly thought that she had PTSD and CPTSD symptoms. Meanwhile, BC’s therapist refused to say that BC had PTSD symptoms. BC’s therapist often ended sessions by asking BC about BC’s upcoming week, a question that could be a helpful part of treatment for depression. BC stopped meeting with that therapist.

BC began to be treated by a new mental health professional, who diagnosed BC with adjustment disorder. Depression and adjustment disorder have overlapping symptoms, but are different. Unlike depression, adjustment disorder can often be connected to a specific incident. Adjustment disorders are temporary, resolving within six months. Depression can last from an episode of around two weeks to something long-term that cannot be resolved without medical treatment. BC stopped meeting with her second therapist.

Then, BC started to meet with a third, her current, therapist, who diagnosed BC with unspecified trauma and stressor-related disorder (UTSRD), depression, and anxiety. The new therapist does not believe that BC has adjustment disorder because it has been almost two years since BC’s termination. The therapist recognizes that BC has PTSD symptoms but is not eligible for a PTSD diagnosis because BC does not meet criterion A, the type of trauma that is required for a PTSD diagnosis. UTSRD makes sense as a diagnosis because BC does not meet full PTSD criteria. Even so, this mix of diagnoses may not truly get at the CPTSD symptoms that are not PTSD symptoms.

As a result of misdiagnoses/lack of CPTSD diagnosis and thus insufficient treatment, BC’s mental health continues to decline. BC is still overly fixated on her old office. She can easily turn any conversation to something about her old office. Her constant fixation and talking about that office cause major problems between BC  and BC’s loved ones. BC continues to have trouble sleeping and begins to have major self-esteem issues. Over time, it has gotten much more difficult for BC to do anything. On many days, BC cries because she is distraught about her old office and her life. She is irritated by the smallest things. More often, BC has suicidal thoughts and even developed plans to kill herself, something that she had not done until then. Frequently, BC does not see any point in her life. BC feels that BC and the world would be better off without her in it. If there were a CPTSD diagnosis in the DSM-V, BC could have improved at least somewhat instead of declining.

BC seems to have CPTSD. She has PTSD symptoms, including flashbacks, avoidance of triggers of trauma, and frequent negative sentiments and feelings. She also has additional CPTSD-specific symptoms, including negative self-views and major challenges with relationships.

Untreated CPTSD Symptoms Can Worsen

BC’s situation is not unique because if CPTSD is not treated, CPTSD symptoms may worsen. CPTSD can cause brains to change in such ways that cause people with CPTSD to struggle. Due to complex trauma, one’s amygdala, which helps with the processing of emotions, grows, potentially resulting in a person’s inability to tell the difference between real and fake dangers. Meanwhile, CPTSD makes the hippocampus smaller, decreasing a person’s capability of processing and keeping accurate memories. There is a greater chance of fragmented memories focusing on “anything negative or scary from the past.” Complex trauma harms the functioning of the prefrontal cortex, which helps people be organized, regulate their emotions, and make smart choices. Complex trauma can also harm the HPA axis, resulting in mood swings and more. Alterations of the brain lead to “intrusive memories, [n]ightmares, [f]lashbacks, [a]voidance of anything (people, places, sensations, etc.) that recalls the complex trauma you endured, [n]egative moods that involve dissociation, hopelessness, guilt, shame, and an inability to find pleasure in what you once enjoyed,” and “[b]eing at higher risk for depression which intensifies C-PTSD symptoms while introducing new physical signs” Untreated CPTSD is also linked with “[d]iabetes, [h]eart disease, [s]troke, [h]igh blood pressure,” and “[a]utoimmune diseases.”

Final Thoughts

Many problems could be prevented by a CPTSD diagnosis or CPTSD specifier in the DSM. The new diagnosis/specifier would raise awareness, resulting in people getting the proper diagnosis and appropriate treatment. It can be very difficult for a person to receive sufficient treatment without the correct CPTSD diagnosis.

Photo by Jonas Jacobsson on Unsplash

Guest Post Disclaimer: Any and all information shared in this guest blog post is intended for educational and informational purposes only. Nothing in this blog post, nor any content on CPTSDfoundation.org, is a supplement for or supersedes the relationship and direction of your medical or mental health providers. Thoughts, ideas, or opinions expressed by the writer of this guest blog post do not necessarily reflect those of CPTSD Foundation. For more information, see our Privacy Policy and Full Disclaimer.

Miriam Edelman

CPTSD Basics

CPTSD, which is either similar to or a variation of Post-Traumatic Stress Disorder (PTSD), happens after people experience prolonged or repeated trauma. Like PTSD, CPTSD causes fear and anxiety. People with PTSD or CPTSD can have flashbacks, nightmares, or insomnia. They can also re-experience their trauma, be on guard, and avoid reminders of their particular traumas.

CPTSD is more challenging to address than PTSD. Individuals with CPTSD usually have extreme PTSD symptoms and other challenges, including difficulties with emotional regulation, negative self-views, and struggles with maintaining relationships. Their negative feelings, including helplessness, can persist long after the end of the trauma. People with CPTSD can also be extremely angry and distrust the world, feel empty, and have difficulty remaining calm.

People’s CPTSD symptoms can vary. Individuals with CPTSD can be depressed and then get angry or suicidal.

CPTSD and Autism 

Autistic people could be more likely to get CPTSD because they have a greater chance of experiencing major traumatic events, which compound in such ways that could cause CPTSD. Trauma can begin in childhood, as autistic children are at risk of being excluded and have a greater chance of being bullied. Schools can be toxic for these children because school staff often try to have autistic children conform. When autistic children are taught that what they feel and do is incorrect, their self-esteem, self-confidence, and self-advocacy can be harmed for the rest of their lives. Autistic people can also be traumatized as a result of being called names, bullied, taken advantage of, invalidated, and rejected.

As adults, autistic people are often unemployed or underemployed, although they may have the skills and expertise to succeed at work. At work, they are often judged to allistic (non-autistic) standards. Employers can get frustrated with autistic employees’ autism-related behavior and misjudge these workers. They also can discriminate against these workers in a variety of ways and provide negative performance reviews. Frequently, managers illegally fire these employees for autism-related behaviors, such as asking too many questions. It can be difficult for autistic people to get new jobs. Sustained unemployment can cause depression and negative thoughts, including “I am starting to question if I am unhirable.”

This repeated trauma can have devastating effects on autistic people. A lifetime of being rejected and ostracized could lead them to think that no one wants them. The thoughts can spiral and cause this population to become suicidal and ultimately end their lives. In fact, autistic people are at a much larger chance of suicide than the general population because of mental health problems, adverse life events, isolation, and more.

Autistic people are at greater risk of developing PTSD symptoms because they are more likely to experience trauma and because of their autistic traits and how they process information. They can also ruminate, not being able to stop negative thoughts and feelings.

CPTSD in Diagnostic Criteria

CPTSD is an official diagnosis in the International Classification of Diseases (ICD) (which is used to diagnose people around the world), but not in the DSM (which is utilized for diagnoses in the United States). While the ICD-11 has separate CPTSD and PTSD diagnoses, the DSM has only the PTSD diagnosis with the dissociative PTSD subtype. However, according to Sabino Recovery, many health practitioners and organizations consider CPTSD to be a valid diagnosis.

Many would like CPTSD to be a separate DSM diagnosis. Within a decade of the inclusion of PTSD in the DSM-III in 1980, Judith Herman proposed a new CPTSD diagnosis. She felt that CPTSD can exist with PTSD but goes beyond it. Currently, over 12,000 people have signed onto a change.org petition, entitled “Add C-PTSD to the DSM-5.”

The DSM considers CPTSD as a part of PTSD partly because 92 percent of individuals with CPTSD have PTSD. However, PTSD and CPTSD are different from each other; they have different causes and somewhat different symptoms. The International Trauma Questionnaire, which has been used in 29 nations, can differentiate between PTSD and CPTSD. This questionnaire could lead to a diagnosis of PTSD or CPTSD, not both.

The DSM-IV and the DSM-5 addressed complex trauma/CPTSD in different ways. In the DSM-IV, complex trauma fell under disorders of extreme stress, not otherwise specific (DESNOS). DESNOS was based largely on Herman’s CPTSD idea.

People disagree about which DSM-5 diagnosis covers complex trauma and, thus, CPTSD. According to an opinion piece, the DSM-5 PTSD diagnostic criteria included many CPTSD symptoms in the DSM-5’s new PTSD dissociative subtype. This subtype involves the presence of depersonalization and derealization. The Cleveland Clinic reported that DSM-5’s dissociative PTSD subtype of Post-Traumatic Stress  Disorder (PTSD) appears to include CPTSD symptoms. However, according to PsychCentral, complex trauma is in the DSM’s Unspecified trauma- and stressor-related disorder diagnosis.

The ICD-11’s separate CPTSD diagnosis (Code: 6B4) is described in the following way:

“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). All diagnostic requirements for PTSD are met. In addition, Complex PTSD is characterised 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.”

The ICD-11 diagnostic criteria mention “Culture-Related Features” and state that females are more likely than males to get CPTSD.

Recommendations

CPTSD could be treated better in the DSM either via a more detailed CPTSD subtype of the PTSD diagnosis or a new diagnosis (similar to what the ICD-11 has). As the DSM-III added PTSD diagnosis and as the DSM-5 added dissociative symptoms to its PTSD diagnosis, there is precedent for the DSM to follow through with these suggestions.

Since the DSM never has included CPTSD as a separate diagnosis, it might be easier to have a more detailed CPTSD subtype of PTSD. A more detailed CPTSD subtype could be treated as a specifier, an extension that gives more specifics of a person’s condition. The new subtype could be called Complex Post-Traumatic Stress Disorder (CPTSD). Then, it could say a person would be diagnosed with the CPTSD subtype if he/she met certain criteria. However, it might be more accurate to have a separate diagnosis for CPTSD than for PTSD, as people get CPTSD and PTSD in different ways. A single event could cause PTSD, but not usually CPTSD.

Acknowledgement of and better addressing of CPTSD in the DSM would enable people, including many with autism, to be properly treated. It is difficult (if not impossible) to treat a condition that has not been labeled. Without a new classification (in terms of a CPTSD subtype or a new CPTSD diagnosis in the DSM), mental health professionals may continue to provide suboptimal treatment to their clients.

Photo by Annie Spratt on Unsplash

Guest Post Disclaimer: Any and all information shared in this guest blog post is intended for educational and informational purposes only. Nothing in this blog post, nor any content on CPTSDfoundation.org, is a supplement for or supersedes the relationship and direction of your medical or mental health providers. Thoughts, ideas, or opinions expressed by the writer of this guest blog post do not necessarily reflect those of CPTSD Foundation. For more information, see our Privacy Policy and Full Disclaimer.

Miriam Edelman