A Response to “C-PTSD does not stand up to scrutiny.”

Good diagnosis clarifies, while poor diagnosis can harm. When I read Mark L. Ruffalo, M.S.W., D.Psa.’s recent Psychology Today article, "The Trouble With Complex Trauma," I knew I wanted to contribute to the conversation from a clinician's standpoint. While the following response was not published by the magazine, the topic is too important to stay silent on. Here is my perspective on the essential, and distinct, roles of the Complex-Post Traumatic Stress Disorder and Borderline Personality Disorder diagnoses.

In Response to "The Trouble With Complex Trauma" By Bradford White, Ph.D.

Dear Dr. Ruffalo,

Thank you for taking the time to explore the evolving conversation around trauma and diagnosis in your recent article. As a clinical psychologist who has spent the past fifteen years working closely with individuals suffering from Complex PTSD (C-PTSD), Borderline Personality Disorder (BPD), and related conditions, I appreciate your willingness to raise difficult questions about the future of psychiatric classification.

What follows is offered not as a point-by-point rebuttal, but as one clinician’s perspective, informed by daily work with people navigating the aftermath of prolonged trauma. I believe that open dialogue, grounded in both clinical experience and empirical evidence, is the only path to a more accurate understanding of human suffering.

C-PTSD and BPD Are Distinct, Though Overlapping

You rightly point out that there is symptomatic overlap between C-PTSD and BPD. However, this overlap does not mean these diagnoses are functionally or developmentally equivalent. C-PTSD, as conceptualized in the ICD-11, reflects a specific adaptational profile to chronic, inescapable interpersonal trauma. It is defined by the core symptoms of PTSD plus persistent Disturbances in Self-Organization (DSO): affective dysregulation, negative self-concept, and relational difficulties.

While these domains can overlap with BPD, the presentation is often starkly different. Many of my patients with C-PTSD lead quiet, structured lives, their internal worlds characterized by shame, mistrust, and emotional numbing—without the frantic efforts to avoid abandonment, profound identity diffusion, or chronic feelings of emptiness that are hallmarks of BPD. For them, C-PTSD provides a crucial frame for understanding their pain and planning appropriate treatment.

The Function of Diagnosis: A Heuristic, Not an Absolute

You express concern that the C-PTSD label may oversimplify human complexity. I would argue the opposite: when used thoughtfully, the C-PTSD construct often expands the clinical conversation. It invites attention to early relational trauma, attachment disruptions, and dissociation—dynamics frequently missed in standard PTSD or mood disorder formulations. It also guides clinicians toward a phase-oriented treatment model, which is essential for this population.

No diagnostic label is perfect. But the right one, at the right time, can reduce shame, clarify treatment, and improve outcomes. For many trauma survivors, C-PTSD has done exactly that.

Stigma and the Language of Diagnosis

As you know BPD remains highly stigmatized, not just in popular culture but within our own field. This is not a matter of favoring one diagnosis over another, but of recognizing that diagnostic precision has a profound impact on a patient's sense of self. When a person's suffering is primarily an adaptive response to trauma, the C-PTSD framework offers a more accurate and etiologically sound explanation than a personality disorder construct. This accuracy reduces iatrogenic shame and validates their lived experience.

Toward a Trauma-Informed Future

Your article rightly cautions against jumping onto diagnostic bandwagons. I share that concern. But I believe the C-PTSD framework—far from being a fad—is a necessary evolution in our understanding of trauma’s long-term psychological impact. It has clear clinical utility, it offers a developmental lens on symptoms, and, most importantly, it validates the experiences of people whose suffering has often been invisible.

In closing, I appreciate your contribution to this vital dialogue. It is only through rigorous, respectful discourse—one grounded in both clinical work and scientific humility—that we move closer to the truth.

Respectfully,

Bradford White, Ph.D.