Abstract
Purpose of review
This review describes treatments that have been developed (or adapted from treatment models for posttraumatic stress disorder [PTSD]) for Complex PTSD (cPTSD) in adulthood and developmental trauma disorder (DTD) in childhood. The nascent research evidence-base is reviewed and future directions are discussed.
Recent findings
Numerous psychotherapy treatments are in the early stages of clinical testing and dissemination for symptoms of cPTSD (emotion dysregulation, interpersonal detachment, altered self-perception) and the additional symptoms of DTD (interpersonal, somatic, and behavioral dysregulation and dissociation). There is indirect evidence, primarily based on reductions in depression and anxiety symptoms (but not cPTSD or DTD symptoms specifically), of efficacy for varied approaches to trauma-focused cognitive behavior therapy (CBT) in randomized controlled trials with adults and children with histories of developmentally adverse traumatic childhood experiences (e.g., abuse, violence). No approaches to pharmacotherapy have been systematically developed or tested for adult cPTSD or childhood DTD.
Summary
Despite a rapidly growing array of promising approaches to psychotherapy for cPTSD and DTD, the absence of formal diagnostic criteria for cPTSD and DTD has limited efforts to conduct scientific evaluations of the efficacy of these treatments. As treatment models continue to be created, refined, and disseminated, the recent development and validation of psychometric assessment measures for cPTSD (the International Trauma Questionnaire; ITQ) and DTD (the Developmental Trauma Disorder Semi-structured Interview; DTD-SI) is a crucial catalyst for rigorous outcome research that can lead to a robust cPTSD and DTD treatment outcome evidence-base and a precision health approach to treatment.
Similar content being viewed by others
Change history
27 October 2021
A Correction to this paper has been published: https://doi.org/10.1007/s40501-021-00254-y
References and Recommended Reading
Papers of particular interest, published recently, have been highlighted as: • Of importance
Ford JD. Complex adult sequelae of early life exposure to psychological trauma. In: Lanius RA, Vermetten E, Pain C, editors. The hidden epidemic: The impact of early life trauma on health and disease. New York: Cambridge University Press; 2010. p. 69–76.
D'Andrea W, Ford JD, Stolbach B, Spinazzola J, van der Kolk BA. Understanding interpersonal trauma in children: why we need a developmentally appropriate trauma diagnosis. Am J Orthopsychiatry. 2012;82(2):187–200. https://doi.org/10.1111/j.1939-0025.2012.01154.x.
Herman JL. Complex PTSD: A syndrome in survivors of prolonged and repeated trauma. J Trauma Stress 1992;5(3):377–391.
• van der Kolk BA, Pelcovitz D, Roth S, Mandel FS, McFarlane A, Herman JL. Dissociation, somatization, and affect dysregulation: the complexity of adaptation of trauma. Am J Psychiatry. 1996;153(7 Suppl):83–93 Describes an early formulation of complex PTSD—Disorders of Extreme Stress Not Otherwise Specified (DESNOS) and empirical evidence of its construct validity from the DSM-IV Field Trial study.
• Brewin CR, Cloitre M, Hyland P, Shevlin M, Maercker A, Bryant RA, et al. A review of current evidence regarding the ICD-11 proposals for diagnosing PTSD and complex PTSD. Clin Psychol Rev. 2017;58:1–15. https://doi.org/10.1016/j.cpr.2017.09.001Describes the formulation of complex PTSD that will be included in the World Health Organization’s ICD-11 and empirical evidence of its construct validity.
American Psychiatric Association. Diagnostic and statistical manual of mental disorders (5th Ed.). Arlington, VA: American Psychiatric Association; 2013.
Cloitre M, Hyland P, Bisson JI, Brewin CR, Roberts NP, Karatzias T, et al. ICD-11 Posttraumatic stress disorder and complex posttraumatic stress disorder in the United States: a population-based study. J Trauma Stress. 2019;32(6):833–42. https://doi.org/10.1002/jts.22454.
Cloitre M, Garvert DW, Brewin CR, Bryant RA, Maercker A. Evidence for proposed ICD-11 PTSD and complex PTSD: a latent profile analysis. Eur J Psychotraumatol. 2013;4. https://doi.org/10.3402/ejpt.v4i0.20706.
van der Kolk B, Ford JD, Spinazzola J. Comorbidity of developmental trauma disorder (DTD) and post-traumatic stress disorder: findings from the DTD field trial. Eur J Psychotraumatol. 2019;10(1):1562841. https://doi.org/10.1080/20008198.2018.1562841.
Spinazzola J, van der Kolk B, Ford JD. When nowhere is safe: trauma history antecedents of posttraumatic stress disorder and developmental trauma disorder in childhood. Journal of traumatic stress. 2018;31(5):631–42. https://doi.org/10.1002/jts.22320.
• Ford JD, Spinazzola J, van der Kolk B, Grasso D. Toward an empirically-based developmental trauma disorder diagnosis for children: factor structure, item characteristics, reliability, and validity of the Developmental Trauma Disorder Semi-Structured Interview (DTD-SI). Journal of Clinical Psychiatry. 2018;79(5):e1–9. https://doi.org/10.4088/JCP.17m11675Describes a developmentally based formulation of complex PTSD in childhood and adolescence—developmental trauma disorder (DTD) and the semi-structured interview developed to assess DTD—and empirical evidence of the interview's psychometrics and DTD’s construct validity from the DTD Field Trial study.
Cloitre M, Courtois CA, Charuvastra A, Carapezza R, Stolbach BC, Green BL. Treatment of complex PTSD: results of the ISTSS expert clinician survey on best practices. J Trauma Stress. 2011;24(6):615–27. https://doi.org/10.1002/jts.20697.
Courtois CA, Ford JD. Treating complex trauma: a sequenced relationship-based approach. New York: Guilford; 2013.
Litt L. Clinical decision making in the treatment of complex PTSD and substance misuse. J Clin Psychol. 2013;69(5):534–42. https://doi.org/10.1002/jclp.21989.
Dorrepaal E, Thomaes K, Hoogendoorn AW, Veltman DJ, Draijer N, van Balkom AJ. Evidence-based treatment for adult women with child abuse-related Complex PTSD: a quantitative review. Eur J Psychotraumatol. 2014;5:23613. https://doi.org/10.3402/ejpt.v5.23613.
• Ford JD, Courtois CA. Treating complex traumatic stress disorders in children and adolescents: Scientific foundations and therapeutic models. New York: Guilford; 2013. Provides detailed descriptions of treatment models for complex PTSD symptoms or DTD with children and adolescents.
Ford JD, Cloitre M. Best practices in psychotherapy for children and adolescents. In: Courtois CA, Ford JD, editors. Treating complex traumatic stress disorders: an evidence-based guide. New York: Guilford; 2009. p. 59–81.
Shevlin M, Hyland P, Roberts NP, Bisson JI, Brewin CR, Cloitre M. A psychometric assessment of Disturbances in Self-Organization symptom indicators for ICD-11 Complex PTSD using the International Trauma Questionnaire. Eur J Psychotraumatol. 2018;9(1):1419749. https://doi.org/10.1080/20008198.2017.1419749.
• Hyland P, Shevlin M, Brewin CR, Cloitre M, Downes AJ, Jumbe S, et al. Validation of post-traumatic stress disorder (PTSD) and complex PTSD using the International Trauma Questionnaire. Acta psychiatrica Scandinavica. 2017;136(3):313–22. https://doi.org/10.1111/acps.12771Describes the questionnaire used to assess ICD-11 cPTSD with adults and evidence of its psychometrics.
• Karatzias T, Murphy P, Cloitre M, Bisson J, Roberts N, Shevlin M, et al. Psychological interventions for ICD-11 complex PTSD symptoms: systematic review and meta-analysis. Psychol Med. 2019;49(11):1761–75. https://doi.org/10.1017/S0033291719000436A good review of treatment outcome research for adults with PTSD and associated problems potentially related to complex PTSD (depression, anxiety, and distress.
• Gutermann J, Schreiber F, Matulis S, Schwartzkopff L, Deppe J, Steil R. Psychological Treatments for Symptoms of Posttraumatic Stress Disorder in Children, Adolescents, and Young Adults: A Meta-Analysis. Clinical Child Famiily Psychol Rev. 2016;19(2):77–93. https://doi.org/10.1007/s10567-016-0202-5A good review of treatment outcome research for children with PTSD and associated problems with depression, anxiety, and insomnia.
• Gutermann J, Schwartzkopff L, Steil R. Meta-analysis of the long-term treatment effects of psychological interventions in youth with PTSD symptoms. Clinical Child and Famiily Psychology Review. 2017;20(4):422–4. https://doi.org/10.1007/s10567-017-0242-5A good review of long-term follow-up results from treatment outcome research for children with PTSD and associated problems with depression, anxiety, and insomnia.
• Ford JD, Courtois CA, editors. Treatment of complex traumatic stress disorders in adults (2nd Edition). New York: Guilford; 2020. Provides detailed descriptions of treatment models for complex PTSD symptoms with adults and transition-age youth.
Gerson B, Nijdam MJ, Smid GJ, Schnyder U. Brief eclectic pschotherapy. In: Ford JD, Courtois CA, editors. Treating complex rraumatic stress disorders in adults. 2nd ed. New York: Guilford Press; 2020. p. 267–85.
Ehlers A, Murray H. Cognitive therapy. In: Ford JD, Courtois CA, editors. Treating complex rraumatic stress disorders in adults. 2nd ed. New York: Guilford Press; 2020. p. 226–48.
Chard KM, Healy ET, Martin CE. Cognitive processing therapy. In: Ford JD, Courtois CA, editors. Treating complex rraumatic stress disorders in adults. 2nd ed. New York: Guilford Press; 2020. p. 249–66.
Korn D, Shapiro F. Eye Movement Desensitization and Reprocessing Therapy. In: Ford JD, Courtois CA, editors. Treating complex rraumatic stress disorders in adults. 2nd ed. New York: Guilford Press; 2020. p. 286–308.
Schauer M, Robjant K, Elbert T, Neuner F. Narrative exposure therapy. In: Ford JD, Courtois CA, editors. Treating complex rraumatic stress disorders in adults. 2nd ed. New York: Guilford Press; 2020. p. 309–32.
Hembree EA, Foa EB. Prolonged exposure therapy. In: Ford JD, Courtois CA, editors. Treating complex rraumatic stress disorders in adults. 2nd ed. New York: Guilford Press; 2020. p. 207–25.
Paivio SC, Angus LE. Emotion-Focused Therapy. In: Ford JD, Courtois CA, editors. Treating complex rraumatic stress disorders in adults. 2nd ed. New York: Guilford Press; 2020. p. 332–49.
Jackson C, Nissenson K, Cloitre M. Cognitive Behavioral Therapy. In: Ford JD, Courtois CA, editors. Treating complex rraumatic stress disorders in adults. 2nd ed. New York: Guilford Press; 2020. p. 370–89.
Ford JD. Trauma Affect Regulation: Guide for Education and Therapy (TARGET). In: Ford JD, Courtois CA, editors. Treatment of complex traumatic stress disorders in adults. 2nd ed. New York: Guilford Press; 2020. p. 390–412.
Niles BL, Williston SK, Mori DL. Mindfulness approaches. In: Ford JD, Courtois CA, editors. Treating complex rraumatic stress disorders in adults. 2nd ed. New York: Guilford Press; 2020. p. 550–68.
Hien D, Litt LC, Lopez-Castro T, Ruglass LM. Complex trauma and addiction treatment. In: Ford JD, Courtois CA, editors. Treating complex rraumatic stress disorders in adults. 2nd ed. New York: Guilford Press; 2020. p. 487–507.
Lowell A, Lopez-Yianilos A, Markowitz J. Intrerpersonal psychotherapy. In: Ford JD, Courtois CA, editors. Treating complex rraumatic stress disorders in adults. 2nd ed. New York: Guilford Press; 2020. p. 350–69.
Alexander PC. Dual trauma attachment-based couple therapy. In: Ford JD, Courtois CA, editors. Treating complex rraumatic stress disorders in adults. 2nd ed. New York: Guilford Press; 2020. p. 440–58.
Ford JD. Family therapy. In: Ford JD, Courtois CA, editors. Treatment of complex traumatic stress disorders in adults. 2nd ed. New York: Guilford; 2020. p. 459–86.
Smith SE, Ford JD. Complementarry healing therapies. In: Ford JD, Courtois CA, editors. Treating complex rraumatic stress disorders in adults. 2nd ed. New York: Guilford Press; 2020. p. 569–90.
Fisher J. Experiential approaches. In: Ford JD, Courtois CA, editors. Treating complex rraumatic stress disorders in adults. 2nd ed. New York: Guilford Press; 2020. p. 533–49.
Ogden P. Sensorimotor Psykchotherapy. In: Ford JD, Courtois CA, editors. Treating complex rraumatic stress disorders in adults. 2nd ed. New York: Guilford Press; 2020. p. 509–32.
Steele K, van der Hart O. Assessing and treating compkex dissociative disorders. In: Ford JD, Courtois CA, editors. Treating complex rraumatic stress disorders in adults 2nd Edition. New York: Guilford Press; 2020. p. 149–67.
Kliethermes M, Nanney RW, Cohen J, Mannarino A. Trauma focused cognitive behavior therapy. In: Ford JD, Courtois CA, editors. Treating complex traumatic stress disorders in children and adolescents: An evidence-based guide. New York: Guilford Press; 2013. p. 184–202.
Wesselman D, Shapiro F. Eye movement desensitization and reprocessing. In: Ford JD, Courtois CA, editors. Treatment of complex traumatic stress disorders in children and adolescents. New York: Guilford Press; 2013. p. 203–24.
Lanktree C, Briere JN. Integrative treatment of complex trauma. In: Ford JD, Courtois CA, editors. Treating complex traumatic stress disorders in children and adolescents: Scientific foundations and therapeutic models. New York: Guilford; 2013. p. 143–61.
Klatzkin A, Lieberman A, Van Horn P. Child-parent psychotherapy and historical trauma. In: Ford JD, Courtois CA, editors. Treating complex traumatic stress disorders in children and adolescents: Scientific foundations and therapeutic models. New York: Guilford; 2013. p. 295–314.
Urquiza AJ, Timmer S. Parent-child interaction therapy. In: Ford JD, Courtois CA, editors. Treating complex traumatic stress disorders in children and adolescents: Scientific foundations and therapeutic models. New York: Guilford; 2013. p. 315–28.
Ford JD, Blaustein M, Habib M, Kagan R. Developmental trauma-focused treatment models. In: Ford JD, Courtois CA, editors. Treating complex traumatic stress disorders in children and adolescents: Scientific foundations and therapeutic models. New York: Guilford; 2013. p. 261–76.
Navalta CP, Brown AD, Nisewaner A, Ellis BH, Saxe GN. Trauma systems therapy. In: Ford JD, Courtois CA, editors. Treating complex traumatic stress disorders in children and adolescents: Scientific foundations and therapeutic models. New York: Guilford; 2013. p. 329–48.
DeRosa RR, Rathus JH. Dialectical Behavior Therapy with adolescents. In: Ford JD, Courtois CA, editors. Treating complex traumatic stress disorders in children and adolescents. New York: Guilford; 2013. p. 225–47.
Wieland S, Silberg J. Dissociation-focused therapy. In: Ford JD, Courtois CA, editors. Treating complex traumatic stress disorders in children and adolescents: An evidence-based guide. New York: Guilford Press; 2013. p. 162–83.
Ford JD. Trauma memory processing in PTSD psychotherapy: A unifying framework. J Trauma Stress. 2018;31:933–42. https://doi.org/10.1002/jts.22344.
Brewin CR. Episodic memory, perceptual memory, and their interaction: foundations for a theory of posttraumatic stress disorder. Psychol Bull. 2014;140(1):69–97. https://doi.org/10.1037/a0033722.
Bartels L, Berliner L, Holt T, Jensen T, Jungbluth N, Plener P, et al. The importance of the DSM-5 posttraumatic stress disorder symptoms of cognitions and mood in traumatized children and adolescents: two network approaches. J Child Psychol Psychiatry. 2019;60(5):545–54. https://doi.org/10.1111/jcpp.13009.
Villalta L, Khadr S, Chua KC, Kramer T, Clarke V, Viner RM, et al. Complex post-traumatic stress symptoms in female adolescents: the role of emotion dysregulation in impairment and trauma exposure after an acute sexual assault. Eur J Psychotraumatol. 2020;11(1):1710400. https://doi.org/10.1080/20008198.2019.1710400.
Knefel M, Lueger-Schuster B, Karatzias T, Shevlin M, Hyland P. From child maltreatment to ICD-11 complex post-traumatic stress symptoms: the role of emotion regulation and re-victimisation. J Clin Psychol. 2019;75(3):392–403. https://doi.org/10.1002/jclp.22655.
Berzenski SR. Distinct emotion regulation skills explain psychopathology and problems in social relationships following childhood emotional abuse and neglect. Dev Psychopathol. 2019;31(2):483–96. https://doi.org/10.1017/S0954579418000020.
Jerud AB, Zoellner LA, Pruitt LD, Feeny NC. Changes in emotion regulation in adults with and without a history of childhood abuse following posttraumatic stress disorder treatment. J Consult Clin Psychol. 2014;82(4):721–30. https://doi.org/10.1037/a0036520.
Hayes AM, Yasinski C, Grasso D, Ready CB, Alpert E, McCauley T, et al. Constructive and unproductive processing of traumatic experiences in trauma-focused cognitive-behavioral therapy for youth. Behav Ther. 2017;48(2):166–81. https://doi.org/10.1016/j.beth.2016.06.004.
Ford JD. Emotion regulation and skills-based interventions. In: Cook J, Gold S, Dalenberg C, editors. Handbook of trauma psychology. Washington, DC: American Psychological Association; 2017. p. 227–52.
Fluckiger C, Del Re AC, Wampold BE, Horvath AO. The alliance in adult psychotherapy: a meta-analytic synthesis. Psychotherapy. 2018;55(4):316–40. https://doi.org/10.1037/pst0000172.
Berzenski SR, Yates TM. The differential influences of parenting and child narrative coherence on the development of emotion recognition. Dev Psychol. 2017;53(10):1912–23. https://doi.org/10.1037/dev0000395.
Berzenski SR, Yates TM. Preschoolers' emotion knowledge and the differential effects of harsh punishment. J Fam Psychol. 2013;27(3):463–72. https://doi.org/10.1037/a0032910.
Ford JD. Complex trauma and developmental trauma disorder in adolescence. Adolesc Psychiatry. 2017;7(4):220–35. https://doi.org/10.2174/2210676608666180112160419.
Hyland P, Karatzias T, Shevlin M, Cloitre M. Examining the discriminant validity of complex posttraumatic stress disorder and borderline personality disorder symptoms: results from a United Kingdom Population Sample. J Trauma Stress. 2019;32(6):855–63. https://doi.org/10.1002/jts.22444.
• Mahoney A, Karatzias T, Hutton P. A systematic review and meta-analysis of group treatments for adults with symptoms associated with complex post-traumatic stress disorder. Journal of affective disorders. 2019;243:305–21. https://doi.org/10.1016/j.jad.2018.09.059A good review of treatment outcome research with group therapy for adults with PTSD and associated problems potentially related to complex PTSD.
Karatzias T, Hyland P, Bradley A, Fyvie C, Logan K, Easton P, et al. Is Self-Compassion a Worthwhile Therapeutic Target for ICD-11 Complex PTSD (CPTSD)? Behav Cogn Psychother. 2018:1–13. https://doi.org/10.1017/S1352465818000577.
Hyland P, Shevlin M, Fyvie C, Cloitre M, Karatzias T. The relationship between ICD-11 PTSD, complex PTSD and dissociative experiences. Journal of trauma & dissociation : the official journal of the International Society for the Study of Dissociation. 2020;21(1):62–72. https://doi.org/10.1080/15299732.2019.1675113.
Van Dijke A, Hopman JAB, Ford JD. Affect dysregulation, psychoform dissociation, and adult relational fears mediate the relationship between childhood trauma and complex posttraumatic stress disorder independent of the symptoms of borderline personality disorder. Eur J Psychotraumatol. 2018;9(1):1400878. https://doi.org/10.1080/20008198.2017.1400878.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
Julian Ford is the developer of the Trauma Affect Regulation: Guide for Education and Therapy (TARGET©) therapy curriculum copyrighted by the University of Connecticut and a consultant to ATSPro, Inc. the sole licensed distributor of the curriculum by the copyright holder.
Additional information
Publisher’s Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
This article is part of the Topical Collection on Early Life Trauma
The original online version of this article was revised due to a retrospective Open Access cancellation.
Rights and permissions
About this article
Cite this article
Ford, J.D. Progress and Limitations in the Treatment of Complex PTSD and Developmental Trauma Disorder. Curr Treat Options Psych 8, 1–17 (2021). https://doi.org/10.1007/s40501-020-00236-6
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s40501-020-00236-6