Clinicians’ experiences in diagnosing and treating complex post-traumatic stress disorder in adults: a reflexive thematic analysis

AI Summary

C-PTSD extends beyond a simple diagnosis, complicating trauma histories and differential diagnosis in routine adult mental health services.
Establishing trust is essential before trauma processing; clinicians must balance safety, pacing, and choice of treatment modalities.
Adequate resources, evidence based pathways, regular supervision, multidisciplinary training, and trauma informed services are needed to enable effective C-PTSD care.

AI Summary

Background: Complex post-traumatic stress disorder (C-PTSD) has been included in the International Classification of Diseases, 11th revision (ICD-11) to recognize the impact of significant trauma(s) on an affected individual.

While the ICD-11 has been in use globally since 2022, research is limited on how clinicians working in routine adult mental health (AMH) services adapt to diagnosing and treating C-PTSD.Objective: To investigate the experiences of clinicians in applying and treating C-PTSD with adults in a public AMH setting.Method: A reflexive thematic analysis approach was used to code and analyse results from semi-structured interviews conducted with 20 psychologists and psychiatrists.Results: Three key themes were identified from clinicians' experiences: (1) 'C-PTSD is beyond a simple diagnosis', reflecting challenges regarding understanding trauma history and differential diagnosis; (2) 'Balancing treatment on a tightrope', highlighting trust as a foundation required in the therapeutic relationship before attempting trauma processing through various treatment modalities; and (3) 'Resourcing for C-PTSD treatment success', emphasizing how adequate resources, regular supervision, training, and attuned trauma services are needed to overcome barriers to treatment of C-PTSD in public AMH settings.Conclusions: Clinicians reported key challenges in working with C-PTSD diagnosis in AMH settings.

The need for adequate access to resources, such as evidence-based treatment pathways, further training on C-PTSD across multidisciplinary teams, regular supervision, and trauma-informed services that are attuned to individuals' needs, is a key issue for clinicians that requires addressing in public AMH services.

Basic summary

Eur J Psychotraumatol. 2026 Dec;17(1):2685933. doi: 10.1080/20008066.2026.2685933. Epub 2026 Jul 17.

ABSTRACT

Background: Complex post-traumatic stress disorder (C-PTSD) has been included in the International Classification of Diseases, 11th revision (ICD-11) to recognize the impact of significant trauma(s) on an affected individual. C-PTSD has the core symptoms of post-traumatic stress disorder (PTSD) with additional symptoms of disturbances of self-organization. While the ICD-11 has been in use globally since 2022, research is limited on how clinicians working in routine adult mental health (AMH) services adapt to diagnosing and treating C-PTSD.Objective: To investigate the experiences of clinicians in applying and treating C-PTSD with adults in a public AMH setting.Method: A reflexive thematic analysis approach was used to code and analyse results from semi-structured interviews conducted with 20 psychologists and psychiatrists.Results: Three key themes were identified from clinicians’ experiences: (1) ‘C-PTSD is beyond a simple diagnosis’, reflecting challenges regarding understanding trauma history and differential diagnosis; (2) ‘Balancing treatment on a tightrope’, highlighting trust as a foundation required in the therapeutic relationship before attempting trauma processing through various treatment modalities; and (3) ‘Resourcing for C-PTSD treatment success’, emphasizing how adequate resources, regular supervision, training, and attuned trauma services are needed to overcome barriers to treatment of C-PTSD in public AMH settings.Conclusions: Clinicians reported key challenges in working with C-PTSD diagnosis in AMH settings. While clinicians are aware of the diagnostic criteria, building a therapeutic relationship with C-PTSD clients remains a challenge before engaging in effective interventions. The need for adequate access to resources, such as evidence-based treatment pathways, further training on C-PTSD across multidisciplinary teams, regular supervision, and trauma-informed services that are attuned to individuals’ needs, is a key issue for clinicians that requires addressing in public AMH services.

PMID:42464788 | DOI:10.1080/20008066.2026.2685933

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