The inclusion of complex post-traumatic stress disorder (cPTSD) in the International Classification of Diseases 11th Revision in January 2022 marks a significant advancement in trauma recognition. However, while cPTSD offers a more inclusive framework, it risks perpetuating trauma hierarchies by reinforcing a division where some trauma responses are attributed to personality disorders (such as borderline personality disorder) and others to external factors (cPTSD). This division echoes one of the oldest themes in victimology-the separation of 'deserving' and 'undeserving' victims-raising broader questions about what is recognised as complex trauma. Survivors often face the danger of being 'unvictimed', where their experiences are dismissed or invalidated either internally or by families, society and institutions. Unvictiming results from trauma ideals that establish an elusive standard of what trauma should look like. While cPTSD broadens psychiatry's role in shaping these ideals, it merely moves the goalposts rather than changing the rules of the game. To prevent the reproduction of a two-tier system, we should adopt transdiagnostic and transmodality approaches, ensuring that complex trauma recognition is accessible to all who find it validating. While systemic changes are essential, we can immediately focus on small acts of trauma recognition within clinical settings, which validate survivors and help expand our collective understanding of trauma.

中文翻译：

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复杂的创伤和看不见的事物：谁会成为受害者？


2022 年 1 月，复杂创伤后应激障碍 （cPTSD） 被纳入国际疾病分类第 11 版修订版，标志着创伤识别的重大进步。然而，虽然 cPTSD 提供了一个更具包容性的框架，但它有可能强化一种划分，即一些创伤反应归因于人格障碍（如边缘型人格障碍），而另一些归因于外部因素 （cPTSD）。这种划分呼应了受害者学中最古老的主题之一——“应得的”和“不应得的”受害者的区分——提出了关于什么是公认的复杂创伤的更广泛的问题。幸存者往往面临“非受害者”的危险，他们的经历在内部或家庭、社会和机构中被忽视或无效。非受害者是创伤理想的结果，这些理想建立了一个难以捉摸的创伤应该是什么样子的标准。虽然 cPTSD 扩大了精神病学在塑造这些理想中的作用，但它只是移动了球门柱，而不是改变游戏规则。为了防止两级系统的复制，我们应该采用跨诊断和跨模式的方法，确保所有发现它验证的人都可以获得复杂的创伤识别。虽然系统性变化是必不可少的，但我们可以立即专注于临床环境中的创伤识别小行为，这些行为可以验证幸存者并帮助扩大我们对创伤的集体理解。