Psychological interventions for ICD-11 complex PTSD symptoms: systematic review and meta-analysis

Author for correspondence: Thanos Karatzias, E-mail: [email protected]

Introduction

The 11th revision to the World Health Organization's International Classification of Diseases (ICD-11) (WHO, 2018) includes two distinct sibling conditions, post-traumatic stress disorder (PTSD) (code 6B40) and complex PTSD (CPTSD) (code 6B41), under a general parent category of ‘Disorders specifically associated with stress’. PTSD is comprised of three symptom clusters including (1) re-experiencing of the trauma in the here and now, (2) avoidance of traumatic reminders and (3) a persistent sense of current threat that is manifested by exaggerated startle and hypervigilance. ICD-11 CPTSD includes the three PTSD clusters and three additional clusters that reflect ‘disturbances in self-organisation’ (DSO); (1) affect dysregulation, (2) negative self-concept and (3) disturbances in relationships (Maercker et al., 2013). These disturbances are proposed to be typically associated with sustained, repeated or multiple forms of traumatic exposure (e.g. genocide campaigns, childhood sexual abuse, child soldiering, severe domestic violence, torture or slavery) (Karatzias et al., 2017), reflecting loss of emotional, psychological and social resources under conditions of prolonged adversity (Cloitre et al., 2013).

The qualitative distinction between PTSD and CPTSD symptomatology has been supported in different trauma samples (see Brewin et al., 2017) including those experiencing interpersonal violence (Cloitre et al., 2013), rape, domestic violence, traumatic bereavement (Elklit et al., 2014), survivors of institutional abuse such as that occurring within foster care and religious organisations (Knefel et al., 2015) and refugees (Hyland et al., 2018). The distinction between PTSD and CPTSD has also been confirmed in samples of young adults (Perkonigg et al., 2016) and children (Sachser et al., 2016). The second-order factorial structure of CPTSD in which the disorder is comprised of both PTSD and DSO has also been supported in previous research (e.g. Karatzias et al., 2016; Hyland et al., 2017a, 2017b; Shevlin et al., 2017).

To date a number of meta-analyses and systematic reviews have investigated the effectiveness of PTSD treatments in general (Callahan et al., 2004; Pelekis and Dahl, 2005; Bisson and Andrews, 2007; Bisson et al., 2007; Taylor and Harvey, 2009, 2010; Barrera et al., 2013; Bisson et al., 2013; Sloan et al., 2013; Watts et al