A Cross‐Cultural Comparison of ICD‐11 Complex Posttraumatic Stress Disorder Symptom Networks in Austria, the United Kingdom, and Lithuania

Abstract

The 11th revision of the World Health Organization's International Classification of Diseases (ICD‐11) includes a new disorder, complex posttraumatic stress disorder (CPTSD). The network approach to psychopathology enables investigation of the structure of disorders at the symptom level, which allows for analysis of direct symptom interactions. The network structure of ICD‐11 CPTSD has not yet been studied, and it remains unclear whether similar networks replicate across different samples. We investigated the network models of four different trauma samples that included a total of 879 participants (M age = 47.17 years, SD = 11.92; 59.04% women) drawn from Austria, Lithuania, and Scotland and Wales in the United Kingdom. The International Trauma Questionnaire was used to assess symptoms of ICD‐11 CPTSD in all samples. The prevalence of PTSD and CPTSD ranged from 23.7% to 37.3% and from 9.3% to 53.1%, respectively. Regularized partial correlation networks were estimated and the resulting networks compared. Despite several differences in the symptom presentation and cultural background, the networks across the four samples were considerably similar, with high correlations between symptom profiles (ρs = .48–.87), network structures (ρs = .69–.75), and centrality estimates (ρs = .59–.82). These results support the replicability of CPTSD network models across different samples and provide further evidence about the robust structure of CPTSD. The most central symptom in all four sample‐specific networks and the overall network was “feelings of worthlessness.” Implications of the network approach in research and practice are discussed.

Commentary on the Special Issue on Network Analysis: Assessment, Intervention, Theory, and the Nature of Reality: Actualizing the Potential of Network Perspectives on Posttraumatic Stress Disorder

“…For example, Knefel et al. () investigated the network associations of symptoms in four different trauma samples drawn from Austria, Lithuania, Scotland, and Wales. The International Trauma Questionnaire (ITQ; Cloitre et al., ) was used to assess PTSD symptoms according to the six items from the International Classification of Diseases (11th revision; ICD‐11 ) criteria as well as symptoms of complex PTSD (CPTSD), a symptom profile that may follow any traumatic event but is theorized to follow exposure to multiple or repeated traumatic events (e.g., child abuse, torture).…”

“…These can be analyzed separately or combined to make a two-item scale for each symptom. To date, the network analysis literature has largely focused on one dimension of symptom experience; for example, as in Knefel et al (2020), asking how much one has been bothered by the symptom (e.g., ITQ; Cloitre et al, 2018) or as in Gay et al (2020), by simply asking whether one did or did not experience a symptom. It should be no surprise that results regarding central symptoms differ across studies when one considers that the psychometric properties of the measures and methods differ so drastically.…”

“…To date, the network analysis literature has largely focused on one dimension of symptom experience; for example, as in Knefel et al. (), asking how much one has been bothered by the symptom (e.g., ITQ; Cloitre et al., ) or as in Gay et al. (), by simply asking whether one did or did not experience a symptom.…”

Introduction to the Special Issue: Network Analysis of Traumatic Stress

“…Returning to the theme of evaluating the diagnostic framework for PTSD under the IDC‐11 , Knefel and colleagues (2020) conducted a network analysis of 879 participants ( M age = 47 years; 59% women) who were recruited either from Austria ( n = 220), Lithuania ( n = 280), Scotland ( n = 193), or Wales ( n = 186) and had each completed the International Trauma Questionnaire (ITQ) to specifically assess ICD‐11 CPTSD. Lifetime trauma exposure across these samples was notably high but varied somewhat by country.…”

“…In short, we note that the current special issue includes reports of network analyses seeking to better understand DSM‐5 PTSD symptomatology (Armour et al., 2020; Cero & Kilpatrick, 2020; Greene et al., 2020; McBride et al., 2020), especially the DSM‐5 NACM symptom cluster (Armour et al., 2020; Cero & Kilpatrick, 2020; Greene et al., 2020; Knefel et al., 2020; McBride et al., 2020); the difference between the diagnostic constructs of PTSD under DSM‐5 versus ICD‐11 (Cero & Kilpatrick, 2020; Greene et al., 2020; McBride et al., 2020); trauma‐related dissociative experiences (Cramer et al., 2020; Knefel et al., 2020; McBride et al. 2020); the impact of psychological treatment (Papini et al., 2020); and the impact of different kinds of traumatic events, specifically childhood trauma (Knefel et al., 2020; McBride et al., 2020; Papini et al., 2020) and gender and gender‐based trauma exposure (Gay et al., 2020). Both concurrent and longitudinal repeated measures were employed in various studies (Armour et al., 2020; Greene et al., 2020; Papini et al.…”