ICD–11 Complex PTSD in U.S. National and Veteran Samples: Prevalence and Structural Associations With PTSD

Erika J. Wolf, Mark W. Miller, Dean Kilpatrick, Heidi S. Resnick, Christal L. Badour, Brian P. Marx, Terence M. Keane, Raymond C. Rosen, Matthew J. Friedman

Research output: Contribution to journalArticlepeer-review

91 Scopus citations


The 11th edition of the International Classification of Diseases (ICD–11) is under development, and current proposals include major changes to trauma-related psychiatric diagnoses, including a heavily restricted definition of posttraumatic stress disorder (PTSD) and the addition of complex PTSD (CPTSD). We aimed to test the postulates of CPTSD in samples of 2,695 community participants and 323 trauma-exposed military veterans. CPTSD prevalence estimates were 0.6% and 13% in the community and veteran samples, respectively; one quarter to one half of those with PTSD met criteria for CPTSD. There were no differences in trauma exposure across diagnoses. A factor mixture model with two latent dimensional variables and four latent classes provided the best fit in both samples: Classes differed by their level of symptom severity but did not differ as a function of the proposed PTSD versus CPTSD diagnoses. These findings should raise concerns about the distinctions between CPTSD and PTSD proposed for ICD–11.

Original languageEnglish
Pages (from-to)215-229
Number of pages15
JournalClinical Psychological Science
Issue number2
StatePublished - Mar 1 2015

Bibliographical note

Funding Information:
This research was funded by an American Psychiatric Association DSM Research Program grant to Dean Kilpatrick, a U.S. Department of Veterans Affairs Mental Health Services grant to Mark Miller, a U.S. Department of Veterans Affairs Merit Review Award (5I01CX000431-02) to Mark Miller, a U.S. Department of Veterans Affairs Clinical Science & Research Career Development Award to Erika Wolf, and a U.S. Department of Defense grant (W81XWH-07-PTSD-IIRA) to Raymond C. Rosen and Terence M. Keane. This work was also supported in part by the South Carolina Clinical & Translational Research Institute, with an academic home at the Medical University of South Carolina, National Institutes of Health Grants UL1 RR029882 and UL1 TR000062. Manuscript preparation was supported by NIMH Grant T32 MH018869 (principal investigator: Dean G. Kilpatrick). Contents are solely the responsibility of the authors, and views expressed do not necessarily represent those of the APA or other agencies supporting this research. The contents of this manuscript do not represent the views of the U.S. Department of Veterans Affairs or the United States Government.

Publisher Copyright:
© 2014, © The Author(s) 2014.


  • ICD
  • complex posttraumatic stress disorder
  • factor mixture model
  • taxonomy

ASJC Scopus subject areas

  • Clinical Psychology


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