Cultural concepts of distress and complex PTSD: Future directions for research and treatment

Complex post-traumatic stress disorder (CPTSD) was introduced as a new diagnostic category in ICD-11. It encompasses PTSD symptoms along with disturbances in self-organization (DSO), i.e., affect dysregulation, negative self-concept, and disturbances in relationships. Quantitative, etic research, which applies the same constructs and measures across cultural groups from an “outsider” perspective, supports the cross-cultural validity of CPTSD. At the same time, evidence from qualitative, emic research, which takes the viewpoint of the “insider,” reveals cultural variation in the phenomenology of PTSD, which most likely translates into cultural variation regarding DSO. This theoretical review aims to set the ground for future research on such cultural aspects in the DSO, by proposing a balanced, complementary use of etic and emic research. Evidence from etic and emic research related to PTSD and DSO suggests that the way that DSO symptoms manifest, and the underlying etiological processes, are closely intertwined with cultural notions of the self. We argue that it is important to consider potential variations in normative cultural scripts related to the self, emotion regulation and interpersonal relationships across cultures to better understand how DSO symptomatology deviates from such normative scripts. We propose directions for future research and implications for culturally sensitive clinical practice