Complex PTSD and personality disorder in ICD-11: when to assign one or two diagnoses?

OBJECTIVE: To outline overlap and boundaries between ICD-11 definitions of complex post-traumatic stress disorder (C-PTSD) and personality disorder (PD) and propose guiding principles that may assist practitioners in assigning one or both of the two diagnoses. CONCLUSIONS: The ICD-11 definitions for C-PTSD and PD are substantially comparable in terms of self- and interpersonal problems, and childhood trauma may be at the root of both disorders. The ICD-11 formally recognizes this overlap and allows the assignment of both diagnoses at the same time. The C-PTSD diagnosis essentially differs from a PD diagnosis by requiring a history of trauma and PTSD symptoms. Moreover, C-PTSD typically involves stable and persistent patterns of negative self-perception while emphasizing avoidant interpersonal patterns. In comparison, the PD diagnosis may differ from C-PTSD by allowing an unstable or internally contradictory sense of self, which may involve both overly negative and overly positive self-views. When the diagnostic requirements for both C-PTSD and PD are met, only the C-PTSD diagnosis should be assigned, unless the PD diagnosis may contribute with clinically useful information that is not sufficiently covered by the C-PTSD diagnosis. The outlined similarities and boundaries must be further corroborated by future empirical studies.

[Overlap and boundaries between complex PTSD and personality disorders].

ICD-11 introduces a new diagnosis of complex PTSD and a fundamentally new approach to personality disorders. The two diagnoses share substantial features including impairment of self and interpersonal functioning and emotional dysregulation. This review outlines the overlap and boundaries between ICD-11 definitions of Complex PTSD and Personality Disorder. A set of principles related to trauma, onset, emotion dysregulation, self and interpersonal functioning, and dissociative and psychotic-like states are put forward to guide practitioners.