Complex posttraumatic stress disorder: The need to consolidate a distinct clinical syndrome or to reevaluate features of psychiatric disorders following interpersonal trauma?

Table 1 Phenomenology of posttraumatic stress disorder, complex posttraumatic stress disorder and borderline personality disorder; DSM-5 clinical features and proposed criteria of ICD-11

	DSM - 5	ICD - 11
PTSD	Exposure to traumatic events; Intrusion symptoms; Persistent avoidance of stimuli; Negative alterations in cognitions and mood (dissociation, persistent negative beliefs of oneself, others or the world, distorted cognitions about the traumatic event, persistent negative emotional state, detachment from others, diminished interest or participation in previously enjoyed activities etc.); Alterations in arousal and reactivity; aggressive verbal and/or physical behaviour, reckless or self-destructive behaviour; depersonalisation or derealisation; Significant impairment in all areas of functioning	Exposure to an extremely threatening or horrific event or series of events; vivid intrusive memories, flashbacks, or nightmares, which are typically accompanied by strong and overwhelming emotions; avoidance of thoughts and memories, events, people, activities, situations reminiscent of the event(s); persistent perceptions of heightened current threat, hypervigilance or an enhanced startle reaction. Significant impairment in personal, family, social, educational, occupational or other important areas of functioning
Complex PTSD	Not included as a diagnostic entity	Exposure to an event(s) of an extremely threatening or horrific nature, most commonly prolonged or repetitive, from which escape is difficult or impossible; All diagnostic requirements for PTSD are and additionally: severe and pervasive affect dysregulation; persistent negative beliefs about oneself; deep-rooted feelings of shame, guilt or failure; persistent difficulties in sustaining relationships and in feeling close to others. Significant impairment in all areas of functioning
BPD	Pervasive pattern of instability of interpersonal relationships, self-image and affects and impulsivity; frantic efforts to avoid abandonment, unstable and intense interpersonal relations oscillating between idealisation and devaluation, unstable self-image or sense of self, self-harming behaviour, affective instability and marked reactivity of mood, chronic feelings of emptiness, poor anger management, transient paranoid ideation or severe dissociation	Emotionally unstable personality disorder, Borderline type: Maladaptive self and interpersonal functioning, affective instability, and maladaptive regulation strategies: Frantic efforts to avoid abandonment; unstable interpersonal relations (idealisation/devaluation); unstable self-image; impulsivity; self-damaging behaviours; marked reactivity of mood; chronic feelings of emptiness; anger management issues; dissociative symptoms

PTSD: Posttraumatic stress disorder; BPD: Borderline personality disorder.