Complex posttraumatic stress disorder (PTSD) is a prevalent, persistent, and disabling trauma disorder newly recognized in ICD-11. Some recent studies suggested that complex PTSD symptoms are negatively associated with self-compassion. This cross-regional study further examined whether low self-compassion would be characteristic of individuals with ICD-11 complex PTSD across cultures. An international sample of 995 female mental health service users completed validated measures of childhood trauma, complex PTSD, and self-compassion (22.7 % came from Western countries, 77.3 % from non-Western countries [mainly Asian countries, including Malaysia, Indonesia, Singapore, India, Philippines]). One-way ANCOVA showed that, compared with participants with and without PTSD, participants with complex PTSD reported the lowest levels of self-compassion, after controlling for the effects of childhood trauma. The results are consistent in both Western and non-Western samples. This study shows that individuals with probable ICD-11 complex PTSD are characterized by low levels of self-compassion across cultures. Interventions targeting self-compassion should be integrated into the prevention and treatment of ICD-11 complex PTSD.

Introduction

Complex post-traumatic stress disorder (CPTSD) was formally recognized as a distinct psychiatric diagnosis in ICD-11 following decades of empirical work and clinical advocacy (Herman, 1992; Van der Kolk et al., 2005). CPTSD is characterized by the core symptoms of PTSD alongside disturbances in self-organization (DSO), and is typically associated with prolonged or repeated traumatic exposure (World Health Organization, 2019). Despite its recent inclusion in ICD-11, findings on the factorial structure and validity of CPTSD remain mixed (Kazlauskas et al., 2020; Redican et al., 2021). Studies using factor analysis, latent profile analysis, and latent class analysis have produced different structural models, although the two-factor higher-order model continues to receive the strongest empirical support (Kindred et al., 2025).

Growing evidence suggests that CPTSD may be more common than PTSD in both Western and Asian populations (e.g., 8.8% vs. 2.4% in Ireland; 4.2% vs. 1.7% in Hong Kong) (Ho et al., 2024; McGinty et al., 2023). Two recent systematic reviews further demonstrate that ICD-11 CPTSD is prevalent across clinical and community samples (Fung et al., 2025b; Huynh et al., 2025). Longitudinal research also indicates that CPTSD is more persistent than PTSD and is linked to substantial functional impairment (Lam et al., 2023; Po et al., 2023) and high comorbidity (Koirala et al., 2021; Maercker et al., 2022). Given its prevalence, chronicity, and clinical severity, deeper examination of factors associated with CPTSD is essential for informing prevention and intervention efforts.

One such factor receiving increasing attention is self-compassion, defined as extending compassion toward oneself in moments of suffering, inadequacy, or perceived failure (Neff, 2016). Self-compassion is a robust multidimensional construct comprising self-kindness, self-judgment, common humanity, isolation, mindfulness, and over-identification (Neff, 2016). A meta-analysis has shown that low self-compassion is strongly associated with a broad range of psychological difficulties (MacBeth & Gumley, 2012). Trauma-related conditions—including CPTSD and dissociative disorders—commonly involve dissociative phobias (Steele et al., 2005), heightened shame (Pai & Vella, 2024), and self-blame, such as maladaptive shifts in perceived responsibility (Ross & Halpern, 2009). Clinically, survivors of complex trauma frequently endorse deeply negative self-beliefs, such as “It is my fault,” “I am unworthy of care,” or “I deserved the abuse” (Cloitre et al., 2020). Accordingly, post-trauma self-perception may be a crucial contributor to CPTSD symptomatology. Supporting this notion, Karatzias et al. (2019) found that self-compassion was negatively associated with DSO symptoms—but not core PTSD symptoms—in a clinical sample in Scotland. However, cultural differences in self-compassion (Tóth-Király & Neff, 2021) and trauma response (Nagulendran & Jobson, 2020) highlight the need for further cross-cultural replication. Moreover, because self-compassion is closely linked to trauma exposure itself (Zhang et al., 2023), analyses must account for trauma history.

In light of these gaps, the present study examined data from a large international survey of female mental health service users who completed validated assessments of childhood trauma, CPTSD, and self-compassion. We hypothesized that individuals meeting ICD-11 criteria for probable CPTSD would report lower levels of self-compassion compared to those without CPTSD, even after adjusting for childhood trauma exposure. To evaluate cross-cultural generalizability, analyses were conducted separately for Western and non-Western subsamples.

link of Study: https://www.sciencedirect.com/science/article/pii/S0022395625007022