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Complex PTSD — MRCPsych Paper B MCQ

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HardAnxiety & Stress-Related DisordersComplex PTSDMRCPsych Paper B

A 23-year-old woman has complex post-traumatic stress disorder following repeated childhood sexual abuse. In addition to re-experiencing, avoidance and a persistent sense of threat, she has affect dysregulation, dissociation, a negative self-concept and difficulty trusting therapists. She has stable accommodation, no current substance misuse or acute risk, and is willing to undertake psychological therapy. According to NICE NG116, which treatment plan is most appropriate?

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Correct answer: D — Offer trauma-focused CBT with additional sessions and work on engagement barriers

NICE recommends an individual trauma-focused intervention for adults with PTSD. Trauma-focused CBT is usually delivered over 8–12 sessions, but additional sessions may be required after multiple traumas. For complex PTSD, treatment should also allow extra time to develop trust and address barriers to engagement, including dissociation, emotional dysregulation, interpersonal difficulties and negative self-perception. EMDR is also an evidence-based option after non-combat trauma, but NICE does not support an inflexible 8-session course. Medication may be considered when preferred but should not automatically replace trauma-focused therapy. NICE does not require a universal, separate stabilisation-only programme before trauma processing; preparation should be individualised. Supportive approaches or DBT may address particular needs but are not recommended as sole substitutes for treatment of the core PTSD syndrome.

Reference: National Institute for Health and Care Excellence. Post-traumatic stress disorder (NG116), recommendations 1.6.16–1.6.20 and 1.7.3. 2018; last reviewed 2025. https://www.nice.org.uk/guidance/ng116/chapter/recommendations