Clinicians' experiences in diagnosing and treating complex post-traumatic stress disorder in adults: a reflexive thematic analysis

Background: Complex post-traumatic stress disorder (C-PTSD) has been included in the International Classification of Diseases, 11th revision (ICD-11) to recognize the impact of significant trauma(s) on an affected individual. C-PTSD has the core symptoms of post-traumatic stress disorder (PTSD) with additional symptoms of disturbances of self-organization. While the ICD-11 has been in use globally since 2022, research is limited on how clinicians working in routine adult mental health (AMH) services adapt to diagnosing and treating C-PTSD.Objective: To investigate the experiences of clinicians in applying and treating C-PTSD with adults in a public AMH setting.Method: A reflexive thematic analysis approach was used to code and analyse results from semi-structured interviews conducted with 20 psychologists and psychiatrists.Results: Three key themes were identified from clinicians’ experiences: (1) ‘C-PTSD is beyond a simple diagnosis’, reflecting challenges regarding understanding trauma history and differential diagnosis; (2) ‘Balancing treatment on a tightrope’, highlighting trust as a foundation required in the therapeutic relationship before attempting trauma processing through various treatment modalities; and (3) ‘Resourcing for C-PTSD treatment success’, emphasizing how adequate resources, regular supervision, training, and attuned trauma services are needed to overcome barriers to treatment of C-PTSD in public AMH settings.Conclusions: Clinicians reported key challenges in working with C-PTSD diagnosis in AMH settings. While clinicians are aware of the diagnostic criteria, building a therapeutic relationship with C-PTSD clients remains a challenge before engaging in effective interventions. The need for adequate access to resources, such as evidence-based treatment pathways, further training on C-PTSD across multidisciplinary teams, regular supervision, and trauma-informed services that are attuned to individuals’ needs, is a key issue for clinicians that requires addressing in public AMH services.