Question 1

What is the difference between PTSD and Complex PTSD?

Accepted Answer

PTSD (ICD-11 6B40, DSM-5-TR 309.81) follows discrete traumatic events and presents with three symptom clusters: re-experiencing, avoidance, and persistent threat sensing. Complex PTSD (ICD-11 6B41) includes those three clusters PLUS three Disturbances in Self-Organization: affect dysregulation, persistent negative self-concept, and persistent interpersonal disturbance. C-PTSD typically follows prolonged or repeated trauma from which escape was difficult — captivity, sustained abuse, war zones, prolonged neglect. The clinical work is phase-based and longer-arc; standard exposure-based PTSD protocols can destabilize C-PTSD without prior stabilization.

Question 2

Is Complex PTSD in the DSM-5-TR?

Accepted Answer

Not as a separate diagnosis. The DSM-5-TR includes a dissociative subtype of PTSD that captures some C-PTSD features but does not separate the disorder. The ICD-11 (used internationally and increasingly in US clinical research) includes 6B41 Complex PTSD as a distinct diagnosis. The American Psychological Association acknowledges C-PTSD clinically. Treatment planning typically uses the ICD-11 framework even when billing requires DSM-5-TR codes.

Question 3

What is phase-based treatment for Complex PTSD?

Accepted Answer

Phase-based treatment is the consensus clinical approach for C-PTSD, articulated in the ISTSS Expert Consensus Treatment Guidelines. Phase 1 — Stabilization — establishes safety, distress tolerance, affect regulation skills, and interpersonal stability before any trauma processing. Phase 2 — Trauma Processing — uses evidence-based modalities (Trauma-Focused CBT, EMDR, somatic approaches) to process traumatic memories once stabilization is sufficient. Phase 3 — Integration — rebuilds identity, relationships, and meaning. Skipping Phase 1 destabilizes patients; standard PTSD exposure protocols applied without stabilization can worsen C-PTSD.

Question 4

How long does Complex PTSD treatment take?

Accepted Answer

C-PTSD treatment is longer-arc than single-incident PTSD treatment. Phase 1 stabilization alone often takes 6–12 months. Full phase-based treatment typically runs 18–36 months for moderate-to-severe presentations, though significant symptom reduction usually occurs earlier. The trajectory is non-linear; periods of acute work alternate with consolidation. Pacing is determined by stabilization status, not by external timelines.

Question 5

Can Complex PTSD be treated through telehealth?

Accepted Answer

Yes, with informed pacing. Telehealth is well-supported for trauma treatment in adults, including C-PTSD, when the clinical relationship is established and stabilization is sufficient. Telehealth removes barriers — no exposure to triggering shared physical spaces, no commute that extends activation, scheduling flexibility — which can make sustained treatment more feasible. The clinical work translates without loss to a virtual format. Acute crisis stabilization and severe dissociation may require in-person care or higher level-of-care referral.