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Variation in post-traumatic response: the role of trauma type in predicting ICD-11 PTSD and CPTSD symptoms



The World Health Organization’s 11th revision to the International Classification of Diseases manual (ICD-11) will differentiate between two stress-related disorders: PTSD and Complex PTSD (CPTSD). ICD-11 proposals suggest that trauma exposure which is prolonged and/or repeated, or consists of multiple forms, that also occurs under circumstances where escape from the trauma is difficult or impossible (e.g., childhood abuse) will confer greater risk for CPTSD as compared to PTSD. The primary objective of the current study was to provide an empirical assessment of this proposal.


A stratified, random probability sample of a Danish birth cohort (aged 24) was interviewed by the Danish National Centre for Social Research (N = 2980) in 2008–2009. Data from this interview were used to generate an ICD-11 symptom-based classification of PTSD and CPTSD.


The majority of the sample (87.1%) experienced at least one of eight traumatic events spanning childhood and early adulthood. There was some indication that being female increased the risk for both PTSD and CPTSD classification. Multinomial logistic regression results found that childhood sexual abuse (OR = 4.98) and unemployment status (OR = 4.20) significantly increased risk of CPTSD classification as compared to PTSD. A dose–response relationship was observed between exposure to multiple forms of childhood interpersonal trauma and risk of CPTSD classification, as compared to PTSD.


Results provide empirical support for the ICD-11 proposals that childhood interpersonal traumatic exposure increases risk of CPTSD symptom development.

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    Note that no person is in both classes. In line with the taxonomic structure of the ICD, CPTSD is not a subtype of PTSD and therefore a person can only be diagnosed with one of the two disorders.


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Correspondence to Philip Hyland.

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Conflict of interest

Marylène Cloitre participated as a member of the World Health Organization Working Group on the Classification of Disorders Specifically Associated with Stress, reporting to the International Advisory Group for the Revision of ICD-10 Mental and Behavioural Disorders. However, the views expressed reflect the opinions of the author and not necessarily the Working Group or Advisory Group and the content of this article does not represent WHO policy. No conflict of interest associated with other authors.

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Hyland, P., Murphy, J., Shevlin, M. et al. Variation in post-traumatic response: the role of trauma type in predicting ICD-11 PTSD and CPTSD symptoms. Soc Psychiatry Psychiatr Epidemiol 52, 727–736 (2017).

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  • Posttraumatic stress disorder (PTSD)
  • Complex-PTSD (CPTSD)
  • ICD-11
  • Childhood trauma
  • Childhood sexual abuse