Does requiring trauma exposure affect rates of ICD-11 PTSD and complex PTSD? Implications for DSM–5.

Abstract

Objective: There is little evidence that posttraumatic stress disorder (PTSD) is more likely to follow traumatic events defined by Criterion A than non-Criterion A stressors. Criterion A events might have greater predictive validity for ICD-11 PTSD which is a condition more narrowly defined by core features. We evaluated the impact of using Criterion A, an 'expanded' trauma definition in line with ICD-11 guidelines, and no exposure criterion on rates of ICD-11 PTSD and Complex PTSD (CPTSD). We also assessed if five psychologically threatening events included in the expanded definition were as strongly associated with PTSD and CPTSD as 'standard' Criterion A events. Method: A nationally representative sample from Ireland (N = 1,020) completed self-report measures. Results: Most participants were trauma-exposed based on Criterion A (82%) and the 'expanded' (88%) criterion. When no exposure criterion was used, 13.7% met diagnostic requirements for PTSD or CPTSD; 13.2% when the expanded criterion was used, and 13.2% when Criterion A was used. The five psychologically threatening events were as strongly associated with PTSD and CPTSD as the Criterion A events. In a multivariate analysis, only the psychologically threatening events were significantly associated with PTSD (stalking) and CPTSD (bullying, emotional abuse, and neglect). Conclusions: Certain non-Criterion A events involving extreme fear and horror should be considered traumatic. The ICD-11 approach of providing clinical guidance rather than a formal definition offers a viable solution to some of the problems associated with the current and previous attempts to define traumatic exposure. Running head: TRAUMA EXPOSURE AND PTSD AND CPTSD Clinical Impact Statement A diagnosis of posttraumatic stress disorder (PTSD) requires that a person has experienced a 'traumatic' life event, however, difficulties in defining what is, and what is not, a trauma has threatened the construct validity of PTSD. The newly released 11 th version of the International Classification of Diseases (ICD-11: World Health Organization, 2018) provides clinicians with guidance, rather than a formal definition, for what constitutes a traumatic event. In this study, we show that psychologically threatening events such as emotional abuse, neglect, bullying, and stalking that would not normally be considered 'traumatic' were uniquely associated with meeting the diagnostic requirements for PTSD and Complex PTSD. The ICD-11 approach of considering an event as traumatic if it is extremely threatening or horrific is helpful because it provides a context to understand trauma-related symptoms while allowing clinicians flexibility in determining what is a potentially traumatic experience.

PTSD and complex PTSD in adolescence: discriminating factors in a population-based cross-sectional study

“…Previous studies have shown that bullying is related to PTSD and other mental health problems (Idsoe, Dyregrov, & Idsoe, 2012;Nielsen, Tangen, Idsoe, Matthiesen, & Magerøy, 2015;Plexousakis, Kourkoutas, Giovazolias, Chatira, & Nikolopoulos, 2019). The inclusion of bullying as a traumatic experience and its association with CPTSD and PTSD has been recently argued in the literature (Hyland et al, 2020;Strøm, Aakvaag, Birkeland, Felix, & Thoresen, 2018).…”

The complex trauma of psychological violence: cross-sectional findings from a Cohort of four Danish Women Shelters

“…We expect all three types of IPV to have strong association with PTSD and C-PTSD (Golding, 1999;Lagdon et al, 2014). Based on Herman's early work (Herman, 1992), and recent findings by Hyland et al (2020), we further expect psychological violence to explain additional variance of especially C-PTSD symptomatology. Moreover, previous trauma, especially childhood abuse, is expected to explain part of the PTSD and C-PTSD symptomatology (Alisic, Zalta, van Wessel, & Larsen, 2014).…”

“…Few studies further indicate that psychological violence does appear to be an independent predictor of PTSD (Lagdon et al, 2014). This is supported by a recent study that demonstrates how certain non-Criterion A events, characterized as psychological trauma, should be considered traumatic events, as they are associated with especially C-PTSD (Hyland et al, 2020). To date, however, no studies have examined the unique association between psychological partner violence and C-PTSD.…”

Is Posttraumatic Stress Disorder Meaningful in the Context of the COVID‐19 Pandemic? A Response to Van Overmeire's Commentary on Karatzias et al. (2020)

“…As we noted in our paper, we assessed only the symptoms of PTSD, which precluded our making a similar differential diagnosis. A more apt comparison, we believe, is the one we provided in our original paper showing that 13.2% of Irish adults met the same PTSD requirements as those assessed using the ITQ a year earlier in February 2019 (Hyland et al., 2020). It is worth noting that in that study, we were able to perform a differential diagnosis for CPTSD and found that 8.1% of the participants who met the ITQ PTSD criteria qualified for a diagnosis of CPTSD.…”