Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Psychiatr. Mar 22, 2018; 8(1): 12-19
Published online Mar 22, 2018. doi: 10.5498/wjp.v8.i1.12
Complex posttraumatic stress disorder: The need to consolidate a distinct clinical syndrome or to reevaluate features of psychiatric disorders following interpersonal trauma?
Evangelia Giourou, Maria Skokou, Stuart P Andrew, Konstantina Alexopoulou, Philippos Gourzis, Eleni Jelastopulu
Evangelia Giourou, Maria Skokou, Philippos Gourzis, Department of Psychiatry, School of Medicine, University of Patras, Rio Patras 26500, Greece
Evangelia Giourou, Eleni Jelastopulu, Department of Public Health, School of Medicine, University of Patras, Rio Patras 26500, Greece
Stuart P Andrew, Specialist Care Team Limited, Lancashire LA4 4AY, United Kingdom
Konstantina Alexopoulou, School of Medicine, University of Patras, Rio Patras 26500, Greece
Author contributions: Giourou E contributed to the conception and designed this manuscript, conducted the literature review and was the lead author; Skokou M made critical revisions of the article’s draft and edited sections of the manuscript; Andrew SP contributed to conception of the article, edited sections of the article and performed the language editing as a native English speaker; Alexopoulou K contributed in conducting the literature review and to drafting sections of the manuscript; Gourzis P made critical revisions related to the intellectual content of the manuscript and edited sections of the manuscript; Jelastopulu E contributed to the conception and design of this manuscript, drafting the article and made critical revisions to the intellectual content of it; all authors have approved the final version of this manuscript.
Conflict-of-interest statement: The authors have no competing interests to disclose.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: Eleni Jelastopulu, MD, PhD, Professor, Department of Public Health, School of Medicine, University of Patras, University Campus, Rio Patras 26504, Greece.
Telephone: +30-2610-969878 Fax: +30-2610-991606
Received: November 14, 2017
Peer-review started: November 14, 2017
First decision: December 8, 2017
Revised: December 29, 2017
Accepted: February 4, 2018
Article in press: February 4, 2018
Published online: March 22, 2018

Complex posttraumatic stress disorder (Complex PTSD) has been recently proposed as a distinct clinical entity in the WHO International Classification of Diseases, 11th version, due to be published, two decades after its first 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 complex trauma which is defined by its threatening and entrapping context, generally interpersonal in nature. In this manuscript, we review the current findings related to traumatic events predisposing the above-mentioned disorders as well as the biological correlates surrounding them, along with their clinical features. Furthermore, we suggest that besides the present distinct clinical diagnoses (PTSD; Complex PTSD; BPD), there 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 background, endorsing a shift from the phenomenologically only classification of psychiatric disorders towards a more biologically validated classification.

Keywords: Complex posttraumatic stress disorder, Posttraumatic stress disorder, Borderline personality disorder, Trauma, Complex trauma

Core tip: A cluster of complex posttraumatic stress disorder (PTSD), PTSD and borderline personality disorder that have in common a history of trauma, is proposed, as a clinical and biological continuum of symptom severity, to be classified together under trauma-related disorders instead of just distinct clinical diagnoses. Trauma depending on biological vulnerability and other precipitating risk factors is suggested that it can lead 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.