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Clinical Atlas Prestige · Evidence-first

Psych VivasGeneral adult psychiatry — trauma and stressor-related disorders

Psych Vivas · General adult psychiatry — trauma and stressor-related disorders

Complex PTSD and trauma-informed care — structured clinical viva

Fellowship viva covering ICD-11 CPTSD, DSO triad, BPD overlap, STAIR evidence, de Jongh critique, DBT-PTSD, SSRI dosing concepts, ITQ, and trauma-informed care.

clinical
On this page & tools

Target exams

FRANZCPMRCPsychABPNMD-DNB

Target exams

FRANZCPMRCPsychABPNMD-DNB
Prompt
You are the psychiatry registrar. A 36-year-old refugee with prolonged captivity and torture history presents with PTSD symptoms, chronic shame, affect dysregulation and difficulty trusting anyone. She asks whether she has complex PTSD, whether 'stabilisation forever' is required before any trauma therapy, and whether medication will fix her. Discuss nosology, differential from BPD, phase-based evidence and critique, trauma-informed engagement, risk, and shared decision-making.

Interpretation

Reveal interpretation

This maps to ICD-11 complex PTSD if PTSD core plus DSO (affect dysregulation, negative self-concept, relational disturbance) are confirmed after prolonged trauma. Name the manual: DSM-5-TR has no formal CPTSD category.[1]

Differential. Compare with PTSD alone and BPD using discriminators (trauma-linked re-experiencing/avoidance vs abandonment-centred personality pattern). Dual diagnosis is allowed.[5]

Treatment stance. Validate fear of therapy. Skills-supported trauma-focused care (STAIR sequencing; PE/CPT/TF-CBT/EMDR; DBT-PTSD in complex childhood-abuse populations) has evidence. Reject both reckless flooding and indefinite "stabilisation forever" when she is safe enough to process (de Jongh critique).[2][3][4]

Medication. Sertraline can be offered as adjunct for PTSD symptoms with clear start dose and monitoring; it is not a full substitute for trauma processing if she wants recovery from trauma memory grip.[6]

Engagement. Trauma-informed principles: safety, trust, choice, collaboration, empowerment, cultural humility; interpreter and asylum/legal stressors as ongoing threat modifiers.[1]

Key points

CPTSD formula

PTSD core + DSO triad under ICD-11.[1]

Bridge not home

Phase-based skills enable processing; they are not endless delay.[2][3]

DBT-PTSD signal

RCT support versus CPT in complex childhood-abuse presentations.[4]

References

  1. [1]Brewin CR, Cloitre M, Hyland P, et al. A review of current evidence regarding the ICD-11 proposals for diagnosing PTSD and complex PTSD Clin Psychol Rev, 2017.PMID 29029837
  2. [2]Cloitre M, Stovall-McClough KC, Nooner K, et al. Treatment for PTSD related to childhood abuse: a randomized controlled trial Am J Psychiatry, 2010.PMID 20595411
  3. [3]De Jongh A, Resick PA, Zoellner LA, et al. CRITICAL ANALYSIS OF THE CURRENT TREATMENT GUIDELINES FOR COMPLEX PTSD IN ADULTS Depress Anxiety, 2016.PMID 26840244
  4. [4]Bohus M, Kleindienst N, Hahn C, et al. Dialectical Behavior Therapy for Posttraumatic Stress Disorder (DBT-PTSD) Compared With Cognitive Processing Therapy (CPT) JAMA Psychiatry, 2020.PMID 32697288
  5. [5]Karatzias T, Bohus M, Shevlin M, et al. Distinguishing between ICD-11 complex post-traumatic stress disorder and borderline personality disorder Br J Psychiatry, 2023.PMID 37381070
  6. [6]Brady K, Pearlstein T, Asnis GM, et al. Efficacy and safety of sertraline treatment of posttraumatic stress disorder JAMA, 2000.PMID 10770145