ICD-11 PTSD, complex PTSD, and substance use disorder: Associations and clinical correlates.

Abstract

Objective: Trauma- and substance-related disorders are highly comorbid. The co-occurrence of these conditions is associated with a more severe clinical profile in patients, and this remains a significant challenge for treatment providers. Previous research examining this comorbidity has focused on Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, posttraumatic stress disorder (PTSD), resulting in a significant lack of research examining other formulations of trauma-related disorders, in particular complex posttraumatic stress disorder (CPTSD). It remains unclear whether CPTSD requires additional treatment approaches in substance use treatment settings. The present study sought to expand previous research by examining the International Classification of Diseases 11th revision PTSD and Complex PTSD (CPTSD) diagnoses in a substance use treatment setting, and to explore the associations between symptoms of PTSD/CPTSD and characteristics of substance use disorder.

Method: The study utilized data collected from individuals commencing substance use treatment (n = 72). Assessments included trauma exposure, trauma-related symptoms, primary substance of concern, psychological dependence, and recent substance use.

Results: Forty percent of the sample screened positive for a trauma-related disorder, with CPTSD more prevalent (34.8%) than PTSD (5.8%). There was limited evidence of associations between trauma-related symptoms and substance use characteristics. Severity of each CPTSD symptom cluster (affect dysregulation, negative self-concept, disturbances in relationships) was significantly, positively associated with psychological dependence, a pattern not found for PTSD symptoms.

Conclusions: Given that CPTSD is more prevalent and demonstrates differential relationships to substance use characteristics, future research should examine whether individuals with comorbid CPTSD would benefit from adjusted treatment approaches. (PsycInfo Database Record (c) 2025 APA, all rights reserved).