Complex PTSD Research Articles

The memory and identity theory of ICD-11 complex posttraumatic stress disorder.

The 11th version of the International Classification of Diseases (ICD-11) includes complex posttraumatic stress disorder (CPTSD) as a separate diagnostic entity alongside posttraumatic stress disorder (PTSD). ICD-11 CPTSD is defined by six sets of symptoms, three that are shared with PTSD (reexperiencing in the here and now, avoidance, and sense of current threat) and three (affective dysregulation, negative self-concept, and disturbances in relationships) representing pervasive "disturbances in self-organization" (DSO). There is considerable evidence supporting the construct validity of ICD-11 CPTSD, but no theoretical account of its development has thus far been presented. A theory is needed to explain several phenomena that are especially relevant to ICD-11 CPTSD such as the role played by prolonged and repeated trauma exposure, the functional independence between PTSD and DSO symptoms, and diagnostic heterogeneity following trauma exposure. The memory and identity theory of ICD-11 CPTSD states that single and multiple trauma exposure occur in a context of individual vulnerability which interact to give rise to intrusive, sensation-based traumatic memories and negative identities which, together, produce the PTSD and DSO symptoms that define ICD-11 CPTSD. The model emphasizes that the two major and related causal processes of intrusive memories and negative identities exist on a continuum from prereflective experience to full self-awareness. Theoretically derived implications for the assessment and treatment of ICD-11 CPTSD are discussed, as well as areas for future research and model testing. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

The Phenomenology of Complex PTSD in Adolescence

Posttraumatic stress disorder and complex posttraumatic stress disorder (PTSD and C-PTSD) can present at any age. Compared to younger children and adults, adolescents who are undergoing critical developmental changes in self-concept and socio-emotional abilities have heightened vulnerabilities to the impact of traumatic life events. C-PTSD may be often missed in adolescence, for depressive, anxiety, and even personality disorders and this deprives the adolescent of specific trauma and attachment focused psychotherapeutic interventions that are primary and essential for management. In this article, we present three case summaries to illustrate the phenomenology of C-PTSD in adolescence. The implication is for clinicians to be aware of, and hone their skills in the identification of this disorder in young people.

The phenomenology of nightmares in post-traumatic stress disorder and complex post-traumatic stress disorder

IntroductionNightmares are a re-experiencing symptom of Post-Traumatic Stress Disorder (PTSD) and Complex PTSD (CPTSD). They are intrusive, involuntary and have a significant impact on wellbeing, suggesting they have substantial clinical relevance. However, little is known about the phenomenological features of post-traumatic nightmares and how they are associated with the severity of PTSD and CPTSD symptoms. MethodParticipants (N = 398) who identified that they had experienced a lifetime trauma completed various self-report questionnaires related to PTSD symptoms, CPTSD symptoms and nightmare characteristics. Participants also described their sensory experiences and rated the emotional intensity and vividness of their post-traumatic nightmares. ResultsWe found that elevated scores on various characteristics of nightmares including frequency of awakenings, nightmare severity, impact on wellbeing and the perceived realism of the nightmare were linked to more severe PTSD and CPTSD symptoms. Further, increased frequency, vividness, and emotional intensity of nightmares significantly predicted more severe PTSD symptoms but not CPTSD symptoms. ConclusionsOur study was largely exploratory and was the first to identify that specific nightmare features are related to PTSD and CPTSD symptom severity. However, although nightmare features of frequency, vividness and intensity appear to be related to CPTSD symptom severity, other variables may better predict CPTSD symptoms. Possible explanations for our findings, implications for treatment and directions for future research are discussed.

Distinguishing between ICD-11 complex post-traumatic stress disorder and borderline personality disorder: clinical guide and recommendations for future research.

Although complex post-traumatic stress disorder and borderline personality disorder are distinct disorders, there is confusion in clinical practice regarding the similarities between the diagnostic profiles of these conditions. We summarise the differences in the diagnostic criteria that are clinically informative and we illustrate these with case studies to enable diagnostic accuracy in clinical practice.

Triadic Therapy Based on Somatic Eye Movement Desensitization and Reprocessing for Complex Posttraumatic Stress Disorder: A Pilot Randomized Controlled Study

The triadic therapy based on somatic eye movement desensitization and reprocessing (EMDR) for complex posttraumatic stress disorder (TSP) is a combination therapy, which comprises simplified EMDR, a triplet of micro-dose medicines, and a pair of Chinese medicines. The EMDR procedure is a tactile bilateral stimulation on the body surface with minimum verbal intervention within 15 minutes every two weeks in a period of 2–3 months. In this study, 22 adult patients were treated with TSP. The Impact of Event Scale—Revised, Beck Depression Inventory (second edition), and Global Assessment of Functioning scores of the patients were significantly improved. Moreover, TSP is a safe treatment procedure in terms of titration, cost-effectiveness, and time-effectiveness. It could also treat multiple difficulties in patients with cPTSD from medical problems to socioeconomic problems.

Supplemental Material for Exposure to Potentially Morally Injurious Events in U.K. Health and Social Care Workers During COVID-19: Associations With PTSD and Complex PTSD

Supplemental Material for Exposure to Potentially Morally Injurious Events in U.K. Health and Social Care Workers During COVID-19: Associations With PTSD and Complex PTSD

Investigating the latent structure of the International Trauma Questionnaire to assess ICD-11 posttraumatic stress disorder (PTSD) and complex PTSD in an adult civilian sample during the Ukraine war.

The symptom structure of ICD-11 posttraumatic stress disorder (PTSD) and complex PTSD (CPTSD) and the validity of the International Trauma Questionnaire (ITQ) are yet to be tested among civilians in an active war zone. The present investigation examined the factor structure of the ITQ, the internal consistency of observed scores, and their associations with demographic characteristics and war-related experiences using a nationwide sample of 2,004 adults from the general population of Ukraine approximately 6 months after the full-scale Russian invasion in 2022. Overall, rates of endorsement across all symptom clusters were high. The mean total number of war-related stressors reported was 9.07 (SD = 4.35, range: 1-26). Internal reliability was good for all six ITQ subscales, Cronbach's αs = .73-.88, and the correlated six-factor model was found to provide the best representation of the latent structure of the ITQ in the present sample based on fit indices. There was evidence of a dose-response relationship, with increasing scores on all symptom clusters associated with higher total reported war-related stressors.

ICD-11 complex post-traumatic stress disorder and psychiatric comorbidity among UK Armed Forces veterans in Northern Ireland: a latent class analysis

ABSTRACT Background: There is evidence to suggest that the experience of complex post-traumatic stress disorder (C-PTSD) may be commonly associated with elevated risk for several mental ill-health comorbidities. Objective: The current study seeks to contribute to the growing literature on C-PTSD comorbidity by examining the relationship between C-PTSD and other mental health disorders in a UK Armed Forces veteran sample. Method: This study used data from the Northern Ireland Veterans’ Health and Wellbeing Study (NIVHWS). The effective sample consisted of 638 veterans (90.0% male). Tetrachoric correlations examined the relationship between C-PTSD caseness and other mental health outcomes. Latent class analysis was then conducted, determining the optimal number and nature of classes in the sample in relation to C-PTSD, depression, anxiety, and suicidality. Results: C-PTSD caseness (i.e. probable diagnosis) was found to be significantly associated with positive caseness of depression, anxiety, and suicidality. Overall, four latent classes emerged, with each of these classes characterized by varying degrees of comorbidity: a ‘Resilient/Low Comorbidity’ class, a ‘Lifetime Suicidal’ class, a ‘PTSD Polymorbid’ class, and a ‘C-PTSD Polymorbid’ class. Conclusions These findings support and extend previous results indicating the highly comorbid nature of C-PTSD. C-PTSD may be considered a highly polymorbid condition, increasing the risk for multiple mental health pathologies concurrently.

Long-term follow-up of a multimodal day clinic, group-based treatment program for patients with very high risk for complex posttraumatic stress disorder, and for patients with non-complex trauma-related disorders.

The present study examined the follow-up of a multimodal day clinic group-based therapy program for patients with trauma-related disorders and investigated potential differences for patients with classic PTSD versus cPTSD. Sixty-six patients were contacted 6 and 12 months after discharge of our 8-week program and completed various questionnaires (Essen Trauma Inventory (ETI), Beck Depression Inventory-Revised (BDI-II), Screening scale of complex PTSD (SkPTBS), Patient Health Questionnaire (PHQ)-Somatization, as well as single items to therapy utilization and life events in the interim period). Due to organizational reasons a control group could not be included. Statistical analyses included repeated-measures ANOVA with cPTSD as between-subject factor. The reduction of depressive symptoms at discharge was persistent at 6 and 12 months follow-up. Somatization symptoms were increased at discharge, but were leveled out at 6 months follow-up. The same effect was found for cPTSD symptoms in those patients with non-complex trauma-related disorders: Their increase of cPTSD symptoms was flattened at 6 months follow-up. Patients with a very high risk for cPTSD showed a strong linear reduction of cPTSD symptoms from admission to discharge and 6 months follow-up. cPTSD patients had a higher symptom load compared to patients without cPTSD on all time points and scales. Multimodal, day clinic trauma-focused treatment is associated with positive changes even after 6 and 12 months. Positive therapy outcomes (reduced depression, reduced cPTSD symptoms for patients with a very high risk for cPTSD) could be maintained. However, PTSD symptomatology was not significantly reduced. Increases in somatoform symptoms were leveled out and can therefore be regarded as side effects of treatment, which may be connected with actualization of trauma in the intensive psychotherapeutic treatment. Further analyses should be applied in larger samples and a control group.

Neurofeedback Effect on Symptoms of Posttraumatic Stress Disorder: A Systematic Review and Meta-Analysis.

Posttraumatic stress disorder (PTSD) encompasses various psychological symptoms and a high early dropout rate due to treatment unresponsiveness. In recent years, neurofeedback has been implemented to control PTSD's psychological symptoms through physiological brain regulation. However, a comprehensive analysis concerning its efficacy is lacking. Therefore, we conducted a systematic review and meta-analysis to determine neurofeedback's effect on reducing PTSD symptoms. We analyzed randomized and non-randomized controlled trials (RCTs) from 1990 to July 2020, evaluating neurofeedback treatments for those diagnosed with PTSD and their symptoms. In addition, we calculated the standardized mean difference (SMD)using random-effects models to estimate effect sizes. We assessed ten articles comprising 276 participants, with a - 0.74 SMD (95% confidence interval = - 0.9230, - 0.5567), 42% I2, moderate effect size, and - 1.40 to -0.08 prediction intervals (PI). Neurofeedback was more effective for complex trauma PTSD patients than single trauma. Increasing and lengthening sessions are more effective than fewer, condensed ones. Neurofeedback positively affected arousal, anxiety, depression, and intrusive, numbing, and suicidal thoughts. Therefore, neurofeedback is a promising and effective treatment for complex PTSD.

Le sentiment de compétence parentale des mères victimes d’abus sexuel(s) infantile(s) : un modèle structural

ObjectivesThe aim of this study was to investigate the impact of childhood sexual abuse on the parental sense of competence and to propose a structural model, taking into account the cumulative effect of the different types of abuse. Participants and methodThe participants were 1904 mothers of children aged 3 to 8. They were asked to complete an online form that included a sociodemographic questionnaire, the Childhood Trauma Questionnaire - Short Form (CTQ-SF), and the Questionnaire d’Auto-Évaluation de la Compétence Éducative Parentale (QAECEP). ResultsOur results confirm the link between sexual abuse and intrafamilial abuse. They suggest that the experience of childhood sexual abuse impacts mothers' parental sense of competence when it occurs in situations of multiple and severe abuses. Furthermore, our statistical analyses indicate that maternal psychological well-being and the presence of child disorders mediate the association between the mother's childhood experience and her parental sense of competence. DiscussionIt seems that the parental sense of competence is impacted by sexual abuse when it is part of multiple traumas leading to symptoms of complex post-traumatic stress disorder. Psychological well-being of the mother and the absence of disorders in the child demonstrates a protective role in the parental sense of competence of mothers with histories of childhood abuse. These findings have implications for interventions for mothers experiencing parenting difficulties. Our results suggest that taking into account the parental sense of competence and the childhood experiences is essential for providing appropriate interventions. ConclusionsThis study confirms the importance of integrating the mother's childhood experiences to better understand her parenting difficulties and to be able to intervene on her difficulties of traumatic origin.

Post-traumatic Stress Disorder, Complex Post-traumatic Stress Disorder, and Coping Styles among Internally Displaced Ukrainians

This study examined the relationship between coping styles and ICD-11 PTSD and Complex PTSD in a large sample of Ukrainian Internally Displaced Persons. Data were collected in 2016 using self-report measures from all Ukrainian oblasts not occupied by Russian forces. In total, 13.1% of people met diagnostic requirements for Complex PTSD, and 7.8% for PTSD. Higher levels of avoidant coping were evident in those meeting diagnostic requirements for PTSD and Complex PTSD compared to those not meeting requirements for either. Mental health interventions targeting avoidant coping might be particularly useful in reducing the burden of traumatic stress among war-affected Ukrainians.

0672 Nightmare Disorder & Insomnia Severity in Complex Posttraumatic Stress Disorder

Abstract Introduction Most adults experience a traumatic event at some point in their lifetime, and some also go on to develop posttraumatic stress disorder (PTSD). Sleep disorders such as insomnia and nightmares are common in PTSD, which may be due to hyperarousal and distressing memories that disrupt the sleep-wake cycle. Complex PTSD (C-PTSD) is a new distinct diagnosis of PTSD that includes three new symptom domains: emotional dysregulation, negative self-cognitions, and interpersonal hardships. Despite evidence linking PTSD and sleep disturbances, this work has yet to be extended to C-PTSD. To address this gap, the current study examined the association between nightmares, insomnia, and C-PTSD symptoms, as well as explored gender and the time elapsed since the traumatic event as moderating variables. Methods Data were obtained from a sample of 243 trauma-exposed participants recruited online. Most participants identified as White (n = 207; 85%), non-Hispanic (n = 219; 90%), and female (n = 135; 56%), with an average age of 37.26 years (SD = 11.39). The Complex Trauma Inventory (CTI) and International Trauma Questionnaire (ITQ) were utilized to measure C-PTSD symptoms. Results Greater C-PTSD symptoms measured via the CTI were associated with greater insomnia symptoms (b = 3.22, 95% CI [2.46, 3.97]) and nightmare disorder symptoms (b = 2.14, 95% CI [1.57, 2.72]). Similarly, greater C-PTSD symptoms measured via the ITQ were also associated with greater insomnia symptoms (b = 0.28, 95% CI [0.22, 0.34]) and nightmare disorder symptoms (b = 0.18, 95% CI [0.13, 0.23]). No moderating effects of gender or time elapsed since trauma were found. Conclusion Results underscore that C-PTSD symptoms are strongly linked to nightmares and problems falling asleep, staying asleep, and waking up too early—regardless of a person’s gender identity or how long ago they experienced a traumatic event. Findings may inform more targeted, sleep-focused cognitive-behavioral treatments for C-PTSD. Support (if any)

Individuals with and without child maltreatment experiences are evaluated similarly and do not differ in facial affect display at zero- and first-acquaintance

BackgroundIndividuals with a history of child maltreatment (CM) are more often disliked, rejected and victimized compared to individuals without such experiences. However, contributing factors for these negative evaluations are so far unknown.ObjectiveBased on previous research on adults with borderline personality disorder (BPD), this preregistered study assessed whether negative evaluations of adults with CM experiences, in comparison to unexposed controls, are mediated by more negative and less positive facial affect display. Additionally, it was explored whether level of depression, severity of CM, social anxiety, social support, and rejection sensitivity have an influence on ratings.MethodsForty adults with CM experiences (CM +) and 40 non-maltreated (CM-) adults were filmed for measurement of affect display and rated in likeability, trustworthiness, and cooperativeness by 100 independent raters after zero-acquaintance (no interaction) and 17 raters after first-acquaintance (short conversation).ResultsThe CM + and the CM- group were neither evaluated significantly different, nor showed significant differences in affect display. Contrasting previous research, higher levels of BPD symptoms predicted higher likeability ratings (p = .046), while complex post-traumatic stress disorder symptoms had no influence on ratings.ConclusionsThe non-significant effects could be attributed to an insufficient number of participants, as our sample size allowed us to detect effects with medium effect sizes (f2 = .16 for evaluation; f2 = .17 for affect display) with a power of .95. Moreover, aspects such as the presence of mental disorders (e.g., BPD or post-traumatic stress disorder), might have a stronger impact than CM per se. Future research should thus further explore conditions (e.g., presence of specific mental disorders) under which individuals with CM are affected by negative evaluations as well as factors that contribute to negative evaluations and problems in social relationships.

Open Trial of Trauma-Focused Psychodynamic Psychotherapy for Posttraumatic Stress Disorder Among LGBTQ Individuals.

Lesbian, gay, bisexual, transgender, and queer (LGBTQ) individuals report higher rates of exposure to traumatic events and posttraumatic stress disorder (PTSD) compared with heterosexual and cisgender individuals. No treatment outcomes research has focused on PTSD in the LGBTQ population. Trauma-focused psychodynamic psychotherapy (TFPP) is a brief, manualized, attachment- and affect-focused psychotherapy for PTSD. TFPP explicitly incorporates broad identity-related and societal factors into its conceptualization of trauma and its consequences, which may be especially helpful for LGBTQ patients with minority stress who seek affirmative care. Fourteen LGBTQ patients with PTSD, assessed with the Clinician-Administered PTSD Scale for DSM-5 (CAPS-5), received 24 sessions of twice-weekly (12 weeks) TFPP via teletherapy provided by supervised early-career therapists inexperienced in the modality. Sessions were videotaped to monitor therapists' treatment adherence. Patients were assessed at baseline, week 5, termination (week 12), and 3 months posttreatment for PTSD symptoms (assessed with the CAPS-5) and secondary outcomes. TFPP was well tolerated by patients, with 12 (86%) completing the intervention. CAPS-5-measured PTSD symptoms, including dissociation, significantly improved during treatment (mean decrease=-21.8, d=-1.98), and treatment gains were maintained at follow-up. Most patients experienced PTSD clinical response (N=10, 71%) or diagnostic remission (N=7, 50%). Patients generally experienced significant, concomitant improvements in complex PTSD symptoms, general anxiety, depression, and psychosocial functioning. Adherence to the intervention among therapists was high, with 93% of rated sessions meeting adherence standards. TFPP shows promise in the treatment of PTSD among sexual and gender minority patients seeking LGBTQ-affirmative PTSD care.

Post-Traumatic Stress Disorder and Complex-Post-Traumatic Stress Disorder Caused by Childhood Experience

A distressing incident can lead to PTSD, a mental health condition. However, most trauma starts at home, where parents account for most child abuse (approximately 80% of all cases). There is another trauma called CPTSD. Complex post-traumatic stress disorder (C-PTSD) is a psychological impairment caused by long-term exposure to social and interpersonal trauma in the setting of reliance, confinement, or entrapment (where the sufferer is unable to escape), leading to a loss of control, powerlessness, and a warped sense of self. Of these, the most typical examples include people who have suffered chronic abuse, neglect, or abuse by caregivers. This article focuses on PTSD and CPTSD caused by childhood experiences. It shows the etiology and the effect on childrens lives and futures from psychological, sociological, and biological perspectives. Also, it provides some childhood experiences of people living with PTSD to show the significant impact. The article includes the treatment of PTSD and CPTSD. The recommendation, in the end, makes some suggestions to improve these mental illnesses. In conclusion, people can learn more about the impact of childhood experiences on PTSD and CPTSD from this article.

Risk factors, comorbidity and social impairment of ICD-11 PTSD and complex PTSD in Danish treatment-seeking military veterans

PurposeWhile a number of studies have investigated risk factors and comorbidities of ICD-11 post-traumatic stress disorder (PTSD) and complex PTSD (CPTSD) in various trauma exposed samples, few studies have been conducted in military samples. Existing studies with military samples have included rather small samples. The aim of the present study was to identify risk factors and comorbidities of ICD-11 PTSD and CPTSD in a large sample of previously deployed, treatment-seeking soldiers and veterans. Methods: Previously deployed, treatment-seeking Danish soldiers and veterans (N = 599), recruited from the Military Psychology Department of the Danish Defense, completed the International Trauma Questionnaire (ITQ), as well as questionnaires of common mental health difficulties, trauma exposure, functioning and demographics. Multivariate multinomial logistic regression analysis explored differences in self-reported exposure to adversity and health outcomes between those meeting ICD-11 criteria for probable PTSD, CPTSD and no trauma disorder. Results: A total of 13.0% met probable ICD-11 criteria for PTSD and 31.4% for CPTSD. Risk factors for CPTSD (compared to those with no trauma disorder) included exposure to warfare or combat, longer duration since the traumatic event and being single. Those with CPTSD were more likely than those with PTSD or no trauma disorder to endorse symptoms of depression, anxiety, stress, use of psychotropic medication, and suicide attempts. Conclusion: CPTSD is a more common and debilitating condition compared to PTSD in treatment-seeking soldiers and veterans. Further research should focus on testing existing and novel interventions for CPTSD in the military.

As simple as possible, but not simpler: Revisiting the International Trauma Questionnaire (ITQ) complex PTSD items omitted in the shortened version

BackgroundThe risks of oversimplification of the symptomatology of Complex PTSD (CPTSD) have been highlighted in the literature. ObjectiveTo re-examine 10 items representing disturbances in self-organization (DSO) that were deleted from the original 28-item version of the International Trauma Questionnaire (ITQ) when creating the current 12-item version. Participants and settingAn online convenience sample of 1235 MTurk users. MethodsOnline survey comprising the fuller 28-item previous version of the ITQ, Adverse Childhood Experiences (ACEs) questionnaire, and PTSD Checklist for DSM-5 (PCL-5). ResultsFirst, averaged endorsement of the 10 omitted items was lower than the 6 retained DSO items (d’ = 0.34). Second, the 10 omitted DSO items accounted for incremental variance over and correlated equivalently to the 6 retained items with the PCL-5. Third, only the 10 omitted DSO items (r-part = 0.12) while not the 6 retained DSO items (r-part = −0.01) independently predicted ACE scores and, eight of these ten omitted DSO items differentiated higher ACE scores even among the subset of 266 participants who endorsed all 6 of the retained DSO items, most with medium effect sizes. Fourth, exploratory principal axis factor analysis differentiated two latent variables within the fuller set of 16 DSO symptoms, with the strongest indicators of the second factor, namely uncontrollable anger, recklessness, derealization, and depersonalization, being unmeasured within the 6 retained DSO items. Moreover, scores on both factors independently predicted both PCL-5 and ACE scores. ConclusionsThere are conceptual and pragmatic advantages to revisiting a more content-valid and comprehensive conceptualization of CPTSD and DSO, partially as may be measured by the recently deleted items from the original and fuller length ITQ.

Factor structure of the international trauma questionnaire in trauma exposed LGBTQ+ adults: Role of cumulative traumatic events and minority stress heterosexist experiences.

To examine the factor structure of the international trauma questionnaire (ITQ), a self-report measure of PTSD and CPTSD, and the associations of cumulative lifetime trauma exposure assessed via the life events checklist and minority stress assessed via the daily heterosexist experiences scale, with CPTSD (three PTSD symptom clusters, three clusters reflecting disturbances in self-organization [DSO]) among LGBTQ + adults. Participants comprised 225 LGBTQ + adults (including 74 transgender and gender diverse individuals; age range: 18-60 years; M/SD = 31.35/9.48) residing in Spain. Confirmatory factor analyses indicated that both a first-order six-factor model and a hierarchical two-factor model, comprising PTSD and DSO as second-order factors, fit the data best. Cumulative traumatic events score was associated with PTSD, and cumulative minority stress was associated with PTSD and DSO. Among the minority stress subscales, harassment based on gender expression was positively associated with all symptom clusters of PTSD and DSO. This is the first study to examine the role of minority stressors alongside exposure to psychological traumas in ICD-11 PTSD and CPTSD and emphasizes the inclusion of minority stressors in trauma-related assessments. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Exploring the health and well-being of a national sample of U.K. treatment-seeking veterans.

Military veterans experience a higher prevalence of mental health difficulties compared with the general population. Research has highlighted veterans who experience mental health difficulties have poorer treatment outcomes. Understanding veteran needs may help improve veteran mental health services and treatment outcomes. The aim of this study was to explore the complexity of health and well-being needs among a national clinical sample of veterans. In total, 989 veterans from a U.K. veterans mental health charity were invited to complete a questionnaire about their sociodemographic characteristics, military experiences, physical and mental health, and well-being. Of the invitees, 428 veterans (43.3%) completed the questionnaire. Common mental disorders, such as anxiety and depression, were the most frequently reported mental health difficulty (80.7%), followed by loneliness (79.1%) and perceived low social support (72.2%). Rates of PTSD were also high (68.7% any PTSD), with most participants experiencing complex PTSD (CPTSD; 62.5%) compared with PTSD (6.2%). Veterans with co-occurring CPTSD symptoms have poorer health due to a higher number of comorbidities, for instance between CPTSD and moral injury. Comorbidity appeared to be the norm rather than the exception within treatment-seeking veterans. As such, it seems important for veteran mental health services to take a holistic approach when supporting veterans. (PsycInfo Database Record (c) 2023 APA, all rights reserved).