Evidence of distinct profiles of Posttraumatic Stress Disorder (PTSD) and Complex Posttraumatic Stress Disorder (CPTSD) based on the new ICD-11 Trauma Questionnaire (ICD-TQ)

Background: The proposed ICD-11 criteria for trauma-related disorders define posttraumatic stress disorder (PTSD) and complex posttraumatic stress disorder (cPTSD) as separate disorders. Results of previous studies support the validity of this concept. However, due to limitations of existing studies (e.g. homogeneity of the samples), the present study aimed to test the construct validity and factor structure of cPTSD and its distinction from PTSD using a heterogeneous trauma-exposed sample. Method: Confirmatory factor analyses (CFAs) were conducted to explore the factor structure of the proposed ICD-11 cPTSD diagnosis in a sample of 341 trauma-exposed adults (n = 191 female, M = 37.42 years, SD = 12.04). In a next step, latent profile analyses (LPAs) were employed to evaluate predominant symptom profiles of cPTSD symptoms. Results: The results of the CFA showed that a six-factor structure (i.e. symptoms of intrusion, avoidance, hyperarousal and symptoms of affective dysregulation, negative self-concept, and interpersonal problems) fits the data best. According to LPA, a four-class solution optimally characterizes the data. Class 1 represents moderate PTSD and low symptoms in the specific cPTSD clusters (PTSD group, 30.4%). Class 2 showed low symptom severity in all six clusters (low symptoms group, 24.1%). Classes 3 and 4 both exhibited cPTSD symptoms but differed with respect to the symptom severity (Class 3: cPTSD, 34.9% and Class 4: severe cPTSD, 10.6%). Conclusions: The findings replicate previous studies supporting the proposed factor structure of cPTSD in ICD-11. Additionally, the results support the validity and usefulness of conceptualizing PTSD and cPTSD as discrete mental disorders.

“…This finding is consistent with the existing literature, which found low symptoms as well as distinct classes of PTSD and cPTSD (e.g. Karatzias et al, 2017; Murphy et al, 2016). …”

Section: Discussionsupporting

confidence: 93%

“…Cloitre et al, 2013; Elklit, Hyland, & Shevlin, 2014). Other studies found support for two- or four-class solutions (Karatzias et al, 2017; Knefel et al, 2015). …”

Section: Introductionmentioning

confidence: 91%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Testing the ICD-11 proposal for complex PTSD in trauma-exposed adults: factor structure and symptom profiles

Böttche

Ehring

Krüger-Gottschalk

et al. 2018

“…A PTSD diagnosis requires a score of ≥ 2 (‘moderately’) for at least one symptom in each of the three dimensions. The ITQ showed good psychometric properties in initial evaluations (Karatzias et al, 2016, 2017; Cronbach’s α = .84 in this study). We used the mean scores of the dimensions for the scale-level analysis.…”

Section: Methodssupporting

confidence: 50%

A network analysis of anger, shame, proposed ICD-11 post-traumatic stress disorder, and different types of childhood trauma in foster care settings in a sample of adult survivors

Glück

Knefel

2017

Background: Anger and shame are aspects that are specifically associated with psychopathology and maladaptation after childhood abuse and neglect. They are known to influence symptom maintenance and exacerbation; however, their interaction is not fully understood. Objective: To explore with network analysis the association and interaction of prolonged, complex interpersonal childhood abuse and neglect in institutional foster care settings [institutional abuse (IA)] with anger, shame, and the proposed 11th revision of the International Statistical Classification of Diseases and Related Health Problems (ICD-11) post-traumatic stress disorder (PTSD) symptoms in adult survivors. Method: Adult survivors of IA (N = 220, mean age = 57.95 years) participated in the study and were interviewed using the Childhood Trauma Questionnaire, the International Trauma Questionnaire, the State–Trait Anger Expression Inventory, the Displaced Aggression Questionnaire, and shame-related items. To identify the most central aspects, we used a staged network analysis and centrality analysis approach: (1) on the scale level; (2) on the item/symptom level; and (3) with modularity analysis to find communities within the item-level network. Results: Trait anger, anger rumination, emotional abuse, and PTSD re-experiencing symptoms played the most important roles on a scale level and were then further analyzed on the item/symptom level. The most central symptom on the item level was anger rumination related to meaningful past events. The modularity analysis supported discriminant validity of the included scales. Conclusions: Anger is an important factor in the psychopathological processes following childhood abuse. Anger rumination is closely related to PTSD symptoms; however, anger is not a part of the proposed ICD-11 PTSD in the present study.

“…Those who experience repeated interpersonal trauma, such as sexual and domestic violence, and abuse in childhood often present with PTSD with more complex features (Karatzias et al, 2017; Powers et al, 2017) than individuals exposed to single-incident traumas (Herman, 1997). Proposed diagnostic criteria for Complex PTSD (CPTSD) in the ICD-11 (due to be published in 2018) include the defining criteria of PTSD (re-experiencing, avoidance, numbing, and hyperarousal), in addition to the presence of at least one symptom in each of three self-organization features: affect dysregulation, negative self-concept, and interpersonal disturbance.…”

Section: Introductionmentioning

confidence: 99%

Developing an Emotion- and Memory-Processing Group Intervention for PTSD with complex features: a group case series with survivors of repeated interpersonal trauma

Clifford

Meiser‐Stedman

Johnson

et al. 2018

Individuals who experience repeated interpersonal trauma exposure often present with posttraumatic stress disorder (PTSD) with more complex features. There is currently no consensus regarding whether current evidence-based interventions for PTSD need to be tailored to better account for these complex features. However, one recommended adaptation is to adopt a phase-based or sequenced approach involving three phases, each with a distinct function. This paper describes the development of a 12-session Emotion- and Memory-Processing Group Programme, adapted from Cloitre’s Skills Training in Affective and Interpersonal Regulation (STAIR) phase-based treatment protocol. A single case series provided a preliminary examination of the group-based intervention’s efficacy for three groups of women with a history of repeated interpersonal trauma and PTSD with complex features (N = 15; age 19–46 years) at The Haven Sexual Assault Referral Centre in London. Results revealed significant reductions in: PTSD, complex features of PTSD, and depression, along with improvements in process measures of maladaptive cognitions and emotion processing. Results from this case series demonstrate that an Emotion- and Memory-Processing Group Programme holds promise for treating individuals with a history of interpersonal trauma in outpatient settings, and provides evidence to warrant the completion of a feasibility trial.