Date of Award

Fall 12-9-2023

Degree Type

Project

Degree Name

Doctor of Nursing Practice (DNP)

Department

School of Nursing

First Advisor

Jennifer Stewart-Glenn

Abstract

Conflicting models of how trauma manifests into identifiable symptoms have been a source of controversy and perplexity among practicing mental health clinicians and diagnosticians. Complex post-traumatic stress disorder (CPTSD) is now an internationally recognized diagnosis since its inclusion in the 11th version of the World Health Organization’s (WHO) International Classification of Diseases (ICD-11) in 2018. The American Psychological Association (APA) does not share this recognition of CPTSD as an individual diagnosis and instead opted to update the diagnostic criteria for PTSD to include DSO and a 4th category of dissociative features rather than include CPTSD as a separate diagnosis in the most recent edition of the Diagnostic & Statistical Manual 5th edition (DSM-5) released in 2013.

The presence of disturbances of self-organization (DSO) in Post Traumatic Stress Disorder (PTSD) and/or the misinterpretation of DSO often result in the diagnosis of common comorbidities of PTSD. The misinterpretation of the clinical manifestations of DSO can also lead to a frequently missed diagnosis of CPTSD. Misdiagnosis could change the course of treatment and result in ineffective care leading to significant negative effects on functional impairment.

This project seeks to clarify the conceptualization of the clinical manifestations of the distinct diagnostic criteria of DSO in CPTSD within general outpatient mental health care settings and, more specifically, in women with comorbid substance use and addiction. This is achieved through a concept analysis of CPTSD using the evolutionary concept analysis method in the context of clinical practice. Through this careful concept analysis of CPTSD, combined with relevant clinical practice experience and current evidence, emerging practical clinical implications are determined and evaluated.

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