Is emotional neglect the first psychological threat? Differentiating ICD-11 PTSD and complex PTSD with comorbid anxiety and depression.

BACKGROUND: ICD-11 introduced PTSD and Complex PTSD (CPTSD) as distinct diagnoses, highlighting the role of trauma type in their development. Emotional neglect, a subtle yet pervasive form of relational trauma, may represent an early psychological threat with long-lasting effects on self-regulation and identity. Its role in differentiating PTSD from CPTSD remains underexplored. A clearer understanding of these associations is essential for accurate diagnosis and the implementation of targeted therapeutic interventions.

OBJECTIVE: This study examined the impact of specific trauma types - particularly emotional neglect and abuse - on ICD-11 PTSD and CPTSD diagnoses, as well as their comorbidity with depression and anxiety. Additional objectives included comparing the prevalence rates of PTSD and CPTSD based on ICD-11 and DSM-5 criteria, and exploring the sociodemographic and clinical correlates of these disorders.

METHOD: A convenience-based, nonclinical sample of Polish adults (N = 794) completed online standardized set self-report questionnaires. Trauma exposure was assessed using the Traumatic Experience Checklist (TEC). ICD-11 PTSD and CPTSD with the International Trauma Questionnaire (ITQ), DSM-5 PTSD with the PTSD Checklist for DSM-5 (PCL-5). Comorbid symptoms of depression and anxiety were measured with the Center for Epidemiologic Studies Depression Scale - Revised (CESD-R) and the Penn State Worry Questionnaire (PSWQ). Structural equation modeling (SEM) and logistic regression analyses were conducted to identify differential predictors of ICD-11 PTSD and CPTSD.

RESULTS: Emotional neglect emerged as the strongest and most consistent predictor of CPTSD and also significantly predicted PTSD symptom severity. In contrast, threat to life/pain/bizarre punishment was the most robust predictor of PTSD diagnosis. CPTSD was associated with higher comorbidity with depression and anxiety compared to PTSD.

CONCLUSION: Although the ICD-11 diagnostic framework emphasizes symptom-based classification rather than the type of traumatic event, our findings underscore the clinical importance of differentiating trauma types - particularly emotional neglect - as relevant risk factors. Emotional neglect appears to function as a foundational psychological threat, playing a pivotal role in the development of CPTSD. Recognizing the distinct impact of specific trauma types may enhance diagnostic precision, guide treatment planning, and support early intervention strategies for individuals with relational trauma histories.