Complex posttraumatic stress disorder and emotion dysregulation: A better understanding of the literature through a systematic review.

Abstract

Objective: This Preferred Reporting Items for Systematic Reviews and Meta-Analyses systematic review aimed to clarify and summarize what is known about the role of emotion dysregulation (ED) in complex posttraumatic stress disorder (CPTSD) from both cross-sectional and longitudinal perspectives by (a) exploring the links between CPTSD and ED symptoms in trauma-exposed individuals; (b) comparing the intensity of ED phenomena between measures of CPTSD and posttraumatic stress disorder symptoms; (c) characterizing the underlying correlates, observable manifestations, and strategies of emotion regulation; and (d) identifying assessment tools that measure ED in CPTSD.

Method: Studies were selected from the Scopus, PubMed, and APA PsycInfo databases. These studies required the inclusion of at least one keyword from each category referring to ED, CPTSD, and the International Classification of Diseases, 11th Revision; used quantitative data to evaluate emotional regulation and CPTSD symptoms; employed cross-sectional or longitudinal designs; and utilized samples with significant trauma exposure.

Results: A total of 33 studies were included, demonstrating a significant link between ED and CPTSD symptoms and showing a greater frequency of ED symptoms in CPTSD compared to posttraumatic stress disorder. Avoidance responses such as emotion suppression, dissociation, and self-destructive behaviors were frequently reported, ranging from emotional hypoactivation to hyperactivation. Findings on underlying correlates and observable manifestations varied widely.

Conclusions: Despite the diversity of correlates, manifestations, and strategies, this systematic review shows that ED is a central feature of CPTSD and contributes to symptom severity. (PsycInfo Database Record (c) 2026 APA, all rights reserved).