Risk factors and comorbidity of ICD‐11 PTSD and complex PTSD: Findings from a trauma‐exposed population based sample of adults in the United Kingdom

Abstract

Background Following the recently published 11th version of the WHO International Classification of Diseases (ICD‐11), we sought to examine the risk factors and comorbidities associated with posttraumatic stress disorder (PTSD) and complex PTSD (CPTSD). Method Cross‐sectional and retrospective design. The sample consisted of 1,051 trauma‐exposed participants from a nationally representative panel of the UK adult population. Results A total of 5.3% (95% confidence interval [CI] = 4.0–6.7%) met the diagnostic criteria for PTSD and 12.9% (95% CI = 10.9–15.0%) for CPTSD. Diagnosis of PTSD was independently associated with being female, being in a relationship, and the recency of traumatic exposure. CPTSD was independently associated with younger age, interpersonal trauma in childhood, and interpersonal trauma in adulthood. Growing up in an urban environment was associated with the diagnosis of PTSD and CPTSD. High rates of physical and mental health comorbidity were observed for PTSD and CPTSD. Those with CPTSD were more likely to endorse symptoms reflecting major depressive disorder (odds ratio [OR] = 21.85, 95 CI = 12.51–38.04) and generalized anxiety disorder (OR = 24.63, 95 CI = 14.77–41.07). Presence of PTSD (OR = 3.13, 95 CI = 1.81–5.41) and CPTSD (OR = 3.43, 95 CI = 2.37–4.70) increased the likelihood of suicidality by more than three times. Nearly half the participants with PTSD and CPTSD reported the presence of a chronic illness. Conclusions CPTSD is a more common, comorbid, debilitating condition compared to PTSD. Further research is now required to identify effective interventions for its treatment.

Complex PTSD among treatment-seeking veterans with PTSD

“…Nevertheless, comparison of the sociodemographic characteristics indicated that the only significant association with probable CPTSD was the one of the marital status. Previous studies have reported that individuals with CPTSD were more likely to be unemployed, unmarried and living alone (Hyland et al, 2017a;Karatzias et al, 2017) and of younger age (Karatzias et al, 2019), as well as to have minority status, lower education and lower self-reported socioeconomic status (Perkonigg et al, 2016). The veterans with self-reported PTSD symptoms were significantly more likely to be divorced as compared to the veterans with CPTSD symptoms, which was quite surprising at first glance.…”

“…Although the ICD-11 proposes an association with specific types of stressors as risk factors rather than a requirement for development of CPTSD (Cloitre et al, 2018), considerable research has found childhood trauma to have significant impact on various outcomes in adulthood, particularly CPTSD (e.g. Frewen et al, 2019;Karatzias et al, 2019;Van der Kolk et al, 2019). The LEC-5 takes no explicit account of childhood trauma, which represents one of the major limitations of this measure.…”

“…Although the differential diagnosis between the two disorders is determined by the symptom profile, the types of events associated with higher risk for ICD-11 CPTSD are expected to be sustained, repeated, or multiple forms of traumatic exposure (Cloitre et al, 2013;Ford & Courtois, 2014;Gilbar, Hyland, Cloitre, & Dekel, 2018;Herman, 1992a;Van der Kolk, 1987). Typically, CPTSD is associated with prolonged interpersonal trauma particularly with multiple forms of childhood interpersonal trauma (Cloitre et al, 2013(Cloitre et al, , 2014Frewen, Zhu, & Lanius, 2019;Karatzias et al, 2019Karatzias et al, , 2017Knefel, Garvert, Cloitre, & Lueger-Schuster, 2015;Van der Kolk, Ford, & Spinazzola, 2019). Exposure to severe trauma in childhood is associated with dissociation (e.g.…”

“…Recent research has identified a number of psychosocial and demographic factors as risk factors for CPTSD. Individuals with CPTSD are more likely to be unemployed, unmarried, living alone (Hyland et al, 2017a;Karatzias et al, 2017) and of younger age (Karatzias et al, 2019). Females are twice as likely as males to be diagnosed with PTSD and CPTSD (Karatzias et al, 2017).…”

The validity of ICD-11 PTSD and Complex PTSD in East Asian cultures: findings with young adults from China, Hong Kong, Japan, and Taiwan

“…Therefore, it may be the case that CPTSD is the more common diagnosis in community samples characterized by higher rates of childhood trauma/adversity. Further, our young adult university student sample may have imparted additional age-related effects, as some evidence suggests CPTSD is independently associated with younger age in trauma-exposed samples (Karatzias et al, 2019a). Alternatively, it is possible that DSO symptoms are more commonly endorsed in East Asian cultures regardless of PTSD presentation, which may lead to a higher potential for meeting CPTSD diagnosis.…”