Complex PTSD Test: How To Identify And Diagnose C-PTSD

Complex post-traumatic stress disorder (also referred to as complex PTSD or C-PTSD) usually results from chronic traumatic experiences. This disorder can involve traditional PTSD symptoms like re-experiencing, avoidance, and hyperarousal, as well as emotional regulation difficulties, negative self-beliefs, and relationship challenges. You can take C-PTSD self-report questionnaires to evaluate your symptoms, but for an official diagnosis, a licensed mental health professional must administer official screening tools. Many types of therapy can be effective in treating C-PTSD, including cognitive processing therapy and prolonged exposure.

Identifying complex PTSD (C-PTSD)

Complex PTSD or complex post-traumatic stress disorder can develop in response to prolonged or repeated trauma. 

While post-traumatic stress disorder (PTSD) may occur in the aftermath of a single traumatic experience, C-PTSD is typically seen in those who have endured traumatic life circumstances, particularly those in which a person was unable to escape. These can include the following:

• Childhood abuse or neglect
• Domestic violence
• Repeated physical or sexual abuse
• Torture or slavery
• War and genocide campaigns

Diagnostic criteria for complex PTSD

C-PTSD usually differs from PTSD in several key ways due to the nature of the trauma and the wide-ranging effects it can have on an individual's mental, emotional, and social function. Here are the criteria for a diagnosis of complex PTSD:

1. Exposure to extreme traumatic events

C-PTSD typically involves uniquely threatening or disturbing circumstances, such as those involving prolonged or repeated violence or abuse. 

While each person may have a different level of tolerance for distressing situations, the types of trauma that trigger C-PTSD are generally more extreme and sustained. These traumatic experiences may involve not only direct threats to safety or integrity, but also prolonged or repeated exposure, which can result in a deep-seated impact on an individual's psychological and emotional well-being.

2. Core symptoms of PTSD

C-PTSD normally involves the core symptoms of PTSD:

• Re-experiencing: Intrusive thoughts, nightmares, or flashbacks
• Avoidance: Avoiding thoughts, conversations, people, places, or activities that may trigger traumatic memories
• Hyperarousal: Irritability, difficulty sleeping, difficulty concentrating, feeling jumpy

3. Additional symptoms specific to C-PTSD

Beyond the core symptoms of PTSD, C-PTSD usually involves additional symptoms that strain the way a person relates to themselves and others. 

Sometimes, these symptoms may be described as changes in personality, and they can significantly alter the way an individual perceives the world around them. 

Symptoms specific to C-PTSD can include the following:

• Severe and pervasive emotional regulation issues: Anger, frustration, persistent sadness, or suicidal thoughts
• Persistent negative self-beliefs: Helplessness, shame, guilt, stigma, or worthlessness
• Persistent interpersonal difficulties: Social withdrawal, trust issues, or problems sustaining healthy relationships

In general, to be diagnosed with C-PTSD, a person must meet all of these diagnostic criteria. In situations where an individual exhibits only some of these symptoms, but not enough to meet the full diagnostic criteria, they may be considered to have PTSD or subthreshold PTSD. 

Common C-PTSD tests

Researchers and clinical psychologists have developed several screening tools and questionnaires to help individuals and their clinicians assess and identify symptoms associated with C-PTSD. 

Self-report questionnaires for C-PTSD

Some C-PTSD tests are designed to be taken by the individual. These self-report measures can provide a convenient way to assess your symptoms so you can make an informed decision about how to approach treatment.

• The International Trauma Questionnaire (ITQ): This questionnaire is based on the 11th edition of the World Health Organization’s International Classification of Diseases (ICD-11). The ITQ is usually considered a reliable and valid measure for assessing and diagnosing both PTSD and C-PTSD.
• Complex Trauma Questionnaire (ComplexTQ): Specifically designed to assess complex trauma, the ComplexTQ evaluates symptoms across emotional regulation, interpersonal difficulties, and identity disturbances. Preliminary research indicates that the Complex TQ test is valid and reliable.
• Developmental Trauma Inventory (DTI): This inventory is primarily geared toward identifying exposure to trauma during childhood and its long-term effects. It can pinpoint developmental disruptions linked to trauma, which tend to be crucial in diagnosing C-PTSD. While not as well-studied as other tests, preliminary research indicates that the DTI may be promising for assessing PTSD and C-PTSD.

Note that these tools are generally meant to help you understand how closely your symptoms may align with a C-PTSD diagnosis. However, they are not intended to diagnose the disorder. For an official diagnosis, you will typically need to undergo a clinical evaluation with a licensed mental health professional.

Clinician-administered screening tools

Other C-PTSD tests are meant to be used in clinical interviews with licensed mental health professionals. These may be used to gain a deeper understanding of an individual’s trauma history and symptomatology, as well as to provide a comprehensive diagnostic assessment. 

To give you an official diagnosis, your mental health provider may use one of the following tools:

• Symptoms of Trauma Scale (SOTS): The SOTS can measure the frequency and intensity of trauma-related symptoms across various domains, including emotional, psychological, and physical responses to trauma. 
• Cameron Complex Trauma Interview (CCTI): The Cameron Complex Trauma Interview (CCTI) is a specialized diagnostic tool normally used to assess complex trauma in children ages five to 11. 
• Complex PTSD Item Set additional to the Clinician Administered PTSD Scale (COPISAC): This is an extension of a common PTSD screening tool used by mental health professionals. It is designed specifically to screen for complex PTSD.

How to get tested for complex PTSD

If you are concerned that you may be experiencing C-PTSD, you may benefit from taking self-report measures and formal assessments. Here’s how the testing process might look:

1. Take a self-report measure

You can start by completing a recognized self-report tool like the ones mentioned above. These tests can provide clarity and awareness surrounding your symptoms, and your results can help guide the conversation during your initial consultation with a mental health professional.

2. Seek professional help

If your results indicate that you may be experiencing PTSD or C-PTSD, it may be advisable to connect with a mental health professional for further evaluation. A licensed provider can assess your symptoms and work with you to develop a treatment plan. 

Note that, for an official diagnosis, state licensing boards typically require that providers meet with clients face-to-face for a clinical interview. This may be necessary in situations where you need prescription medication, disability accommodations, or insurance coverage for treatment.

3. Undergo a formal assessment

If you need an official diagnosis, your mental health provider will likely ask you to take a formal C-PTSD test. This generally involves a clinical interview in which they will ask you detailed questions about your personal history, symptoms, and experiences. 

The goal is usually to establish a comprehensive understanding of your trauma history and its impact on your life. The interview may also assess how your symptoms meet the diagnostic criteria for C-PTSD and differ from other common concerns, such as PTSD or borderline personality disorder. 

4. Develop a treatment plan

With a detailed understanding of your condition, you and your mental health provider can work together to develop a comprehensive treatment plan. Treatment for C-PTSD may include psychotherapy, lifestyle adjustments, and, in some cases, medication. 

Understanding therapy options for complex PTSD

Experts recommend a few types of trauma therapy for the treatment of complex PTSD. Though the treatment process may differ slightly depending on the type, each tends to target the parts of the brain responsible for memory and emotional regulation. 

These therapies usually aim to help individuals process and integrate traumatic memories, reduce the intensity of emotional responses to trauma cues, and improve overall emotional and behavioral control. Here are the treatments most commonly recommended for trauma disorders:

• Eye movement desensitization and reprocessing (EMDR):EMDR is primarily designed to help individuals process and integrate traumatic memories in a way that reduces their lingering effects. This therapy typically uses guided eye movements to help the brain work through traumatic memories, aiming to alter the emotional response associated with those memories.
• Cognitive processing therapy:CPT usually focuses on helping individuals understand and modify their distressing thoughts related to the trauma, aiming to change how they think about the trauma and reduce its ongoing negative effects on their emotions and behavior. 
• Prolonged exposure: This therapy normally involves repeated, detailed imagining of the trauma or progressive exposures to trauma reminders. The goal is typically to reduce the distress and avoidance behavior that can come with traumatic memories.

Sometimes, time isn’t enough to heal the wounds of the past

Work toward recovery in trauma therapy

You can find clinicians who specialize in trauma-informed care through your local mental health clinic or online. If you require an official diagnosis, you may need to attend an in-person appointment with a licensed mental health professional. If you have taken a self-report assessment and are ready to begin treatment without a formal diagnosis, online therapy may be an option worth exploring.

Online trauma therapy for complex PTSD

Online therapy platforms like BetterHelp generally allow you to attend weekly therapy sessions with a licensed therapist who specializes in treating complex trauma. Through BetterHelp, you can find a mental health provider offering the type of treatment you are seeking, plus attend weekly sessions by phone, video call, or live chat. 

While research is still in its early stages, preliminary studies suggest that online therapy sessions can be an effective way to deliver trauma-focused cognitive therapy, EMDR, and prolonged exposure. In traditional face-to-face settings, these therapies are among the most well-founded trauma interventions, having been backed by decades of research.

Takeaway

If you are concerned that you or a loved one may be living with C-PTSD, you can use a self-report tool such as the ITQ, ComplexTQ, or DTI to help you understand your symptoms. For a formal diagnosis, you will need to be clinically assessed by a mental health provider. They may use a C-PTSD test like the SOTS or COPISAC to evaluate and diagnose you. With a thorough understanding of how your trauma has affected you, you may be ready to begin treatment in your local area or online.