Heterogeneity in patterns of DSM-5 posttraumatic stress disorder and depression symptoms: Latent profile analyses

Contractor, Ateka A.; Roley‐Roberts, Michelle E.; Lagdon, Susan; Armour, Chérie

doi:10.1016/j.jad.2017.01.029

Cited by 61 publications

(55 citation statements)

References 60 publications

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“…Participants with full or subthreshold PTSD also reported moderate levels of depression symptoms (PTSD group, mean BDI-II total score 14.5  9.6; resilient group, mean BDI-II total score 0.43  1.1). However, PTSD is highly heterogenous (Armour et al, 2015;Contractor et al, 2017), and PTSD symptom subscores showed continuous variation across our participants as a group (Table S1) -justifying the use of dimensional approach to PTSD symptomatology for our analysis.…”

Section: Participantsmentioning

confidence: 81%

Latent cause inference during extinction learning in trauma-exposed individuals with and without PTSD

Norbury¹,

Brinkman²,

Kowalchyk³

et al. 2020

Preprint

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Problems in learning that sights, sounds, or situations that were once associated with danger have become safe (extinction learning) may explain why some individuals suffer prolonged psychological distress following traumatic experiences. Although simple associative learning models have been unable to provide a convincing account of how and why this learning fails, it has recently been proposed that this may be explained by individual differences in beliefs about the causal structure of the environment. Here, we tested two competing hypotheses as to how differences in causal inference might be related to trauma-related psychopathology, using extinction learning data collected from clinically well-characterized individuals with varying degrees of post-traumatic stress (N=56). Latent cause modelling revealed that individuals with more severe PTSD were more likely to assign observations from conditioning and extinction stages to a single underlying cause. Specifically, multivariate analysis incorporating multiple PTSD and depression symptom dimensions revealed a negative relationship between tendency to infer multiple causes were active in the environment and re-experiencing symptom severity. We interpret these results as providing evidence of a primary deficit in discriminative learning in participants with more severe PTSD re-experiencing symptoms. Specifically, in these individuals, a greater tendency to attribute all stimulus configurations to the same underlying cause resulted in greater uncertainty about stimulus-outcome associations, and impeded learning both that certain stimuli were safe, and that certain stimuli were no longer dangerous. Better understanding of the role of causal inference in trauma-related psychopathology may have relevance for the refinement of cognitive therapies for these disorders.

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Section: Participantsmentioning

confidence: 81%

Latent cause inference during extinction learning in trauma-exposed individuals with and without PTSD

Norbury¹,

Brinkman²,

Kowalchyk³

et al. 2020

Preprint

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“…Potential influences of comorbid conditions also have to be taken into account here: Depression is a frequent comorbid disorder in PTSD [49] and DD [50] also in the present groups (Table 5). Recent research found evidence for a depressive subtype of PTSD that is associated with greater dissociative experience [51]. Since 38.5% of the current sample of PTSD patients suffered from a comorbid depressive disorder or depressive episode, this may explain the high amount of dissociative symptoms.…”

Section: Discussionmentioning

confidence: 95%

Somatoform dissociation and posttraumatic stress syndrome – two sides of the same medal? A comparison of symptom profiles, trauma history and altered affect regulation between patients with functional neurological symptoms and patients with PTSD

et al. 2017

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BackgroundHistory of traumatic experience is common in dissociative disorder (DD), and similarity of symptoms and characteristics between DD and posttraumatic stress disorder (PTSD) encouraged to consider DD as trauma-related disorder. However, conceptualization of DD as a trauma-related syndrome would critically affect diagnosis and treatment strategies. The present study addressed overlap and disparity of DD and PTSD by directly comparing correspondence of symptoms, adverse/traumatic experience, and altered affect regulation between patients diagnosed with dissociative disorder (characterized by negative functional neurological symptoms) and patients diagnosed with PTSD.MethodsSomatoform and psychoform dissociation, symptoms of posttraumatic stress, general childhood adversities and lifetime traumata, and alexithymia as index of altered affect regulation were screened with standardized questionnaires and semi-structured interviews in 60 patients with DD (ICD-codes F44.4, F44.6, F44.7), 39 patients with PTSD (ICD-code F43.1), and 40 healthy comparison participants (HC).ResultsDD and PTSD patients scored higher than HC on somatoform and psychoform dissociative symptom scales and alexithymia, and reported more childhood adversities and higher trauma load. PTSD patients reported higher symptom severity and more traumata than DD patients. Those 20 DD patients who met criteria of co-occuring PTSD did not differ from PTSD patients in the amount of reported symptoms of somatoform dissociation, physical and emotional childhood adversities and lifetime traumata, while emotional neglect/abuse in childhood distinguished DD patients with and without co-occuring PTSD (DD patients with co-occuring PTSD reporting more emotional maltreatment).ConclusionThe pattern of distinctive somatoform and psychoform dissociative symptom severity, type of childhood and lifetime traumata, and amount of alexithymia suggests that DD and PTSD are distinctive syndromes and, therefore, challenges the conceptualization of DD as trauma-related disorder. Together with the detected close correspondence of symptom and experience profiles in DD patients with co-occuring PTSD and PTSD patients, these findings suggest that adverse/traumatic experience may intensify dissociative symptoms, but are not a necessary condition in the generation of functional neurological symptoms. Still, diagnosis and treatment of DD need to consider this impact of traumata and post-traumatic stress symptoms.

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“…Although depression is the most common comorbid condition in PTSS, knowledge of the association of these two is limited. Results point to divergent ways of therapeutic change as a function of different subtypes of comorbid PTSS and depression [ 46 , 47 ]. Thus, also TE may influence treatment outcome depending on the subtype of comorbid PTSS and depression.…”

Section: Discussionmentioning

confidence: 99%

Treatment expectancy, working alliance, and outcome of Trauma-Focused Cognitive Behavioral Therapy with children and adolescents

Kirsch

Keller

Tutus

et al. 2018

Child Adolesc Psychiatry Ment Health

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BackgroundIt has been shown that positive treatment expectancy (TE) and good working alliance increase psychotherapeutic success in adult patients, either directly or mediated by other common treatment factors like collaboration. However, the effects of TE in psychotherapy with children, adolescents and their caregivers are mostly unknown. Due to characteristics of the disorder such as avoidant behavior, common factors may be especially important in evidence-based treatment of posttraumatic stress symptoms (PTSS), e.g. for the initiation of exposure based techniques.MethodsTE, collaboration, working alliance and PTSS were assessed in 65 children and adolescents (age M = 12.5; SD = 2.9) and their caregivers. Patients’ and caregivers’ TE were assessed before initiation of Trauma-Focused Cognitive Behavioral Therapy (TF-CBT). Patients’ and caregivers’ working alliance, as well as patients’ collaboration were assessed at mid-treatment, patients’ PTSS at pre- and post-treatment. Path analysis tested both direct and indirect effects (by collaboration and working alliance) of pre-treatment TE on post-treatment PTSS, and on PTSS difference scores.ResultsPatients’ or caregivers’ TE did not directly predict PTSS after TF-CBT. Post-treatment PTSS was not predicted by patients’ or caregivers’ TE via patients’ collaboration or patients’ or caregivers’ working alliance. Caregivers’ working alliance with therapists significantly contributed to the reduction of PTSS in children and adolescents (post-treatment PTSS: β = − 0.553; p < 0.001; PTSS difference score: β = 0.335; p = 0.031).ConclusionsTE seems less important than caregivers’ working alliance in TF-CBT for decreasing PTSS. Future studies should assess TE and working alliance repeatedly during treatment and from different perspectives to understand their effects on outcome. The inclusion of a supportive caregiver and the formation of a good relationship between therapists and caregivers can be regarded as essential for treatment success in children and adolescents with PTSS.

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Heterogeneity in patterns of DSM-5 posttraumatic stress disorder and depression symptoms: Latent profile analyses

Cited by 61 publications

References 60 publications

Latent cause inference during extinction learning in trauma-exposed individuals with and without PTSD

Latent cause inference during extinction learning in trauma-exposed individuals with and without PTSD

Somatoform dissociation and posttraumatic stress syndrome – two sides of the same medal? A comparison of symptom profiles, trauma history and altered affect regulation between patients with functional neurological symptoms and patients with PTSD

Treatment expectancy, working alliance, and outcome of Trauma-Focused Cognitive Behavioral Therapy with children and adolescents

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