Dissertations, Theses, and Capstone Projects

Date of Degree

9-2026

Document Type

Doctoral Dissertation

Degree Name

Doctor of Philosophy

Program

Psychology

Advisor

Cathy Spatz Widom

Committee Members

Peggilee Wupperman

Elizabeth Jeglic

William Gottdiener

Valentina Nikulina

Subject Categories

Clinical Psychology

Keywords

Complex posttraumatic stress disorder (CPTSD), childhood maltreatment, childhood abuse and neglect, interpersonal trauma, ICD-11, prospective longitudinal study

Abstract

The current study examined whether court-substantiated childhood maltreatment may be associated with increased risk for Complex PTSD (CPTSD) and whether individuals with CPTSD and individuals with PTSD could be distinguished in terms of complex trauma exposure. Children with documented cases of abuse and neglect prior to age 11 were matched on age, race, sex, and approximate family socioeconomic status with children without documented histories of maltreatment (controls) and both groups were followed prospectively into adulthood. Participants (N = 1,196) were assessed using a DSM-III-R based structured interview of PTSD symptoms and other self-report measures of psychiatric symptoms at mean age 29. A subset of participants also reported on their lifetime victimization histories at mean age 39.5. The prevalence of CPTSD in the overall sample was 9.2%. The odds of developing CPTSD were 3.6 times higher for maltreated individuals than for comparison subjects, controlling for age, sex, and race. Increased risk for CPTSD was also observed across maltreatment subtypes, including sexual abuse (OR = 5.11), physical abuse (OR = 4.24), and neglect (OR = 3.63). Theoretical distinctions between CPTSD and PTSD in terms of complex trauma exposure were largely supported. The two disorders were best differentiated by traumas that were interpersonal in nature, and which involved cumulative exposure. Similar results were observed when using subjective (self-report) indicators of index trauma exposures and objective (court-substantiated) indicators of maltreatment. Self-reported characteristics related to age, developmental timing, and recency of trauma exposure did not distinguish between the disorders, although there was some evidence of specific age effects in early childhood. Findings suggest that symptom constellations reflecting disturbances in self-organization—including affect dysregulation, negative self-concept, and disturbances in interpersonal relationships—may more accurately capture the enduring psychological effects of complex trauma among adult survivors of childhood maltreatment than typical conceptualizations of PTSD.

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