Differentiating Symptom Profiles of ICD-11 PTSD, Complex PTSD and Borderline Personality Disorder: A Latent Class Analysis in a Multiply Traumatised Sample

Background: Complex PTSD (CPTSD) has been included as a diagnostic category in the ICD-11 consisting of six symptom clusters; the three PTSD criteria of Re-experiencing, Avoidance, and Hypervigilance, in addition to three Disturbances of Self-Organisation (DSO) symptoms defined as Emotional Dysregulation, Interpersonal Difficulties, and Negative Self-Concept. As Borderline Personality Disorder (BPD) shares similar features to DSO presentations and is commonly associated with PTSD, there is debate as to whether and how CPTSD is distinct from PTSD comorbid with BPD.
Aim: To identify groups with distinct profiles of self-reported CPTSD and BPD symptoms and associated trauma history characteristics.
Method: A Latent Class Analysis (LCA) using CPTSD and BPD symptom variables was conducted on a sample of 195 treatment-seeking adults at a specialist trauma service. The classes were then compared on demographic and clinical characteristics using a series of ANOVA and chi-square tests.
Results: The LCA determined three distinct classes; a CPTSD/High BPD class characterised by high symptom endorsement across both conditions; a CPTSD/Moderate BPD class characterised by high PTSD and DSO symptom endorsement and moderate BPD; and a PTSD/Low BPD class characterised by PTSD symptoms and low DSO and BPD symptom endorsement. The two CPTSD classes were associated with greater exposure to multiple, interpersonal traumas earlier in life and exhibited higher functional impairment.
Conclusions: Findings support the construct of a CPTSD diagnosis as a separate entity although BPD features seem to overlap greatly with CPTSD symptoms in this highly traumatised clinical sample.