ICD‐11 PTSD and complex PTSD: structural validation using network analysis

McElroy, Eoin; Shevlin, Mark; Murphy, Siobhán; Roberts, Bayard; Makhashvili, Nino; Javakhishvili, Jana Darejan; Bisson, Jonathan I.; Ben–Ezra, Menachem; Hyland, Philip

doi:10.1002/wps.20638

Cited by 32 publications

(24 citation statements)

References 9 publications

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“…In particular, the experience of being isolated in the hospital, the perceived danger, uncertainty about own physical conditions and the fear of dying alone can be considered risk factors for the development of post-traumatic, anxiety, and depressive symptoms (62,63). The only study conducted in China so far has documented that over 90% of COVID+ patients admitted to the hospital reported significant post-traumatic stress symptoms (62,64,65). Furthermore, the authors found that providing patients with psychoeducational intervention is well received and perceived as helpful and useful by users.…”

Section: Discussionmentioning

confidence: 99%

The Impact of Quarantine and Physical Distancing Following COVID-19 on Mental Health: Study Protocol of a Multicentric Italian Population Trial

et al. 2020

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COVID-19 quarantine group. This group includes the general population which are quarantined but not isolated, i.e., those not directly exposed to contagion nor in contact with COVID-19+ individuals; b) Group 2-COVID-19+ group, which includes isolated people directly/indirectly exposed to the virus; c) Group 3-COVID-19 healthcare staff group, which includes firstand second-line healthcare professionals; d) Group 4-COVID-19 mental health, which includes users of mental health services and all those who had already been diagnosed with a mental disorder. Mental health services worldwide are not prepared yet to manage the short-and long-term consequences of the pandemic. It is necessary to have a clear picture of the impact that this new stressor will have on mental health and well-being in order to develop and disseminate appropriate interventions for the general population and for the other at-risk groups.

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Section: Discussionmentioning

confidence: 99%

The Impact of Quarantine and Physical Distancing Following COVID-19 on Mental Health: Study Protocol of a Multicentric Italian Population Trial

et al. 2020

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“…A recent study of the structure of ICD-11 PTSD and CPTSD used network-analysis to show that symptoms of hypoactivation and hyperactivation comprising the affective dysregulation domain of DSO was more strongly related to other symptoms of posttraumatic symptomatology than each other (McElroy et al, 2019). In conjunction with documentation for high rates of common mental health disorders among resettled refugees (Turrini, Purgato, Ballette, Nosé, Ostuzzi & Barbui, 2017), the elevated rates of affective dysregulation among the PTSD class might also be reflective of comorbidity or elevated levels of non-specific distress associated with pre-, peri and postmigration factors.…”

Section: S C I E N T I F I C a R T I C L Ementioning

confidence: 99%

Testing the validity of ICD-11 PTSD and CPTSD among refugees in treatment using latent class analysis

Vang

Nielsen²,

Auning-Hansen³

et al. 2020

torture

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Introduction: The WHO has proposed posttraumatic stress (PTSD) and Complex PTSD (CPTSD) trauma-related ‘sibling’-disorders in ICD-11. The proposal has received support from research among clinical and community samples alike but only few studies have tested the validity of these disorders in a sample of refugees using the International Trauma Questionnaire especially designed for assessment of ICD-11 PTSD and CPTSD. Methods: Latent class analysis was used to test the validity of the ICD-11 PTSD and CPTSD distinction in a heterogeneous group of 284 highly symptomatic refugees registered for treatment at a Danish treatment-center. Results: A two-class solution fit the data best. One group reported elevated levels of PTSD-symptoms and symptoms of affective dysregulation, and one group reported elevated levels of symptoms corresponding to CPTSD. The CPTSD group was considerably larger than the PTSD-group. Discussion: The current study supports the ICD-11 distinction between PTSD and CPTSD in a sample of treatment-seeking refugees. The assistance of interpreters was needed for some of the participants which affected the reliability of the assessment. Conclusion: The ICD-11 proposal for PTSD and CPTSD is supported in a heterogenous sample of refugees using the ITQ.

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“…Although the validity of CPTSD as a clinical syndrome has been questioned (Herman, 2012 ; Resick et al, 2012 ), primarily owing to overlapping symptomology with other trauma-related disorders (Wolf et al, 2015 ), there is now a significant body of literature that supports the hierarchical structure presented in the ICD-11. This includes a notable systematic review (Brewin et al, 2017 ) and a variety of validation studies: latent class analyses (Barbieri et al, 2019 ; Ho et al, 2020 ; Hyland et al, 2018 ; Jowett, Karatzias, Shevlin, & Albert, 2019 ; Karatzias et al, 2017 ), confirmatory factor analyses (Hyland et al, 2017 ; Karatzias et al, 2016 ; Kazlauskas, Gegieckaite, Hyland, Zelviene, & Cloitre, 2018 ; Murphy et al, 2020 ; Owczarek et al, 2020 ), and network analyses (Gilbar, 2020 ; Knefel et al, 2019 , 2020 ; Knefel, Tran, & Lueger-Schuster, 2016 ; McElroy et al, 2019 ). These studies have used the only standardized self-report measure for symptoms of ICD-11 PTSD and CPTSD, the International Trauma Questionnaire (ITQ; Cloitre et al, 2018 ).…”

Section: Introductionmentioning

confidence: 99%

“…However, most of this research has been restricted to high-income countries (HICs), whereas significantly fewer studies have analysed samples from low- and middle-income countries (LMICs); e.g. Uganda (Dokkedahl, Ovuga, & Elklit, 2015 ; Murphy, Elklit, Dokkedahl, & Shevlin, 2016 , 2018 ); Angola (Rocha et al, 2019 ); Ghana, Kenya, and Nigeria (Ben-Ezra et al, 2020 ; Owczarek et al, 2020 ); Ukraine (McElroy et al, 2019 ; Shevlin et al, 2018 ); and Lebanon (Hyland et al, 2018 ; Vallières et al, 2018 ). Further research in LMICs is therefore necessary to determine whether ICD-11 criteria for PTSD and CPTSD are internationally relevant.…”

Section: Introductionmentioning

confidence: 99%

Evidence of distinct profiles of ICD-11 post-traumatic stress disorder (PTSD) and complex PTSD in a South African sample

Rink

Lipinska

2020

European Journal of Psychotraumatology

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Background: Both post-traumatic stress disorder (PTSD) and complex post-traumatic stress disorder (CPTSD) have been included in the 11th edition of the International Classification of Diseases (ICD-11). Although the validity of CPTSD has been controversial, a growing number of studies support the distinction between PTSD and CPTSD. However, the majority of this research has originated in high-income countries (HICs), whereas the prevalence of trauma experience associated with PTSD/CPTSD diagnosis is significantly higher in low- and middle-income countries (LMICs). Objective: This study assessed whether a sample from an LMIC setting produced distinct classes that reflect ICD-11 criteria for PTSD and CPTSD. Furthermore, this study investigated whether childhood trauma distinguished between PTSD and CPTSD. Method: International Trauma Questionnaire responses from a sample of South African university undergraduates were used as indicator variables in a latent class analysis (LCA). Chi-squared tests of independence and Kruskal–Wallis H tests were used to assess between-class differences. Results: The LCA identified four distinct classes: a PTSD class with elevated symptoms of PTSD, but low endorsement of disturbances in self-organization (DSO; symptoms that are specific to CPTSD); a CPTSD class with elevated symptoms of PTSD and DSO; a DSO class with low symptoms of PTSD, but elevated symptoms of DSO; and a Low class with low endorsements on all symptoms. Regarding childhood trauma, participants in the CPTSD class had more severe childhood abuse and neglect, specifically emotional abuse and neglect, than participants in the PTSD class. Conclusions: Findings were consistent with the distinction between PTSD and CPTSD symptom profiles in the ICD-11. Our findings support a similar qualitative distinction between PTSD and CPTSD in our LMIC context, as previously reported in HICs. This distinction is especially relevant in LMICs because of the significant number of individuals vulnerable to these disorders.

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ICD‐11 PTSD and complex PTSD: structural validation using network analysis

Cited by 32 publications

References 9 publications

The Impact of Quarantine and Physical Distancing Following COVID-19 on Mental Health: Study Protocol of a Multicentric Italian Population Trial

The Impact of Quarantine and Physical Distancing Following COVID-19 on Mental Health: Study Protocol of a Multicentric Italian Population Trial

Testing the validity of ICD-11 PTSD and CPTSD among refugees in treatment using latent class analysis

Evidence of distinct profiles of ICD-11 post-traumatic stress disorder (PTSD) and complex PTSD in a South African sample

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