ICD-11 posttraumatic stress disorder (PTSD) and complex PTSD (CPTSD) in treatment seeking veterans: risk factors and comorbidity



Emerging evidence suggests that ICD-11 CPTSD is a more common condition than PTSD in treatment seeking samples although no study has explored risk factors and comorbidities of PTSD and CPTSD in veteran populations. In this study, risk factors and comorbidity between veterans meeting criteria for PTSD or CPTSD using the ICD-11 International Trauma Questionnaire (ITQ) were explored.


A sample of help-seeking veterans who had been diagnosed with a mental health difficulty (n = 177) was recruited. Participants completed a range of mental health and functioning measures. Multinomial logistic regression analysis was conducted to explore differences in the above factors between participants meeting case criteria for PTSD, CPTSD or another mental health disorder.


Those with CPTSD appeared to have taken longer to seek help, reported higher rates of childhood adversity and more experiences of emotional or physical bullying during their military careers. Further, participants with CPTSD reported a greater burden of comorbid mental health difficulties including high levels of dissociation, anger, difficulties related to moral injury and common mental health difficulties and greater degree of impairment including social isolation, sleep difficulties and impaired functioning.


Considering that CPTSD is a more debilitating condition than PTSD, there is now an urgent need to test the effectiveness of new and existing interventions in veterans with CPTSD.

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We would like to thank the participants who took part in this study and Combat Stress staff who supported data collection.


This study was funded by a grant award by the Forces in Mind Trust.

Author information




All authors made substantial contributions to the design of this research project, drafting and editing the manuscript, approving the final version and agreeing to the integrity of the work presented. DM was responsible for producing the first draft of the manuscript and MS for conducting the statistical analysis.

Corresponding author

Correspondence to Dominic Murphy.

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Murphy, D., Karatzias, T., Busuttil, W. et al. ICD-11 posttraumatic stress disorder (PTSD) and complex PTSD (CPTSD) in treatment seeking veterans: risk factors and comorbidity. Soc Psychiatry Psychiatr Epidemiol (2021). https://doi.org/10.1007/s00127-021-02028-6

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  • PTSD
  • Complex PTSD
  • ICD-11
  • Veterans
  • Military
  • Trauma