Complex trauma and the unseen: who gets to be a victim?

Abstract

The inclusion of complex post-traumatic stress disorder (cPTSD) in the International Classification of Diseases 11th Revision in January 2022 marks a significant advancement in trauma recognition. However, while cPTSD offers a more inclusive framework, it risks perpetuating trauma hierarchies by reinforcing a division where some trauma responses are attributed to personality disorders (such as borderline personality disorder) and others to external factors (cPTSD). This division echoes one of the oldest themes in victimology-the separation of 'deserving' and 'undeserving' victims-raising broader questions about what is recognised as complex trauma. Survivors often face the danger of being 'unvictimed', where their experiences are dismissed or invalidated either internally or by families, society and institutions. Unvictiming results from trauma ideals that establish an elusive standard of what trauma should look like. While cPTSD broadens psychiatry's role in shaping these ideals, it merely moves the goalposts rather than changing the rules of the game. To prevent the reproduction of a two-tier system, we should adopt transdiagnostic and transmodality approaches, ensuring that complex trauma recognition is accessible to all who find it validating. While systemic changes are essential, we can immediately focus on small acts of trauma recognition within clinical settings, which validate survivors and help expand our collective understanding of trauma.