Testing competing factor models of the latent structure of post-traumatic stress disorder and complex post-traumatic stress disorder according to ICD-11

On 6 December 2019 we start the 10th year of the European Journal of Psychotraumatogy (EJPT), a full Open Access journal on psychotrauma. This editorial is part of a special issue/ collection celebrating the 10 years anniversary of the journal where we will acknowledge some of our most impactful articles of the past decade (also discussed below and marked with * in the reference list). In this editorial the editors present a decennial review of the field addressing a range of topics that are core to both the journal and to psychotraumatology as a discipline. These include neurobiological developments (genomics, neuroimaging and neuroendocrine research), forms of trauma exposure and impact across the lifespan, mass trauma and early interventions, work-related trauma, trauma in refugee populations, and the potential consequences of trauma such as PTSD or Complex PTSD, but also resilience. We address innovations in psychological, medication (enhanced) and technologyassisted treatments, mediators and moderators like social support and finally how new research methods help us to gain insights in symptom structures or to better predict symptom development or treatment success. We aimed to answer three questions 1. Where did we stand in 2010? 2. What did we learn in the past 10 years? 3. What are our knowledge gaps? We conclude with a number of recommendations concerning top priorities for the future direction of the field of psychotraumatology and correspondingly the journal.

Section: Diagnosis Of Ptsd and Complex Ptsdmentioning

confidence: 83%

Section: Trauma Exposure and Impact Across The Lifespanmentioning

confidence: 99%

A decennial review of psychotraumatology: what did we learn and where are we going?

Olff

Amstadter

Armour

et al. 2019

“…Up to now, the studies about CPTSD have been carried out with adult clinical samples (Cloitre et al, 2018 ; Hyland et al, 2017 ; Karatzias et al, 2016 ; Kazlauskas, Gegieckaite, Hyland, Zelviene, & Cloitre, 2018 ; Simon, Roberts, Lewis, van Gelderen, & Bisson, 2019 ; Stadtmann, Maercker, Binder, & Schnepp, 2018 ; van Dijke, Hopman, & Ford, 2018 ), non-clinical community-based samples (Karatzias, Hyland, Ben-Ezra, & Shevlin, 2018a ; Murphy, Elklit, Dokkedahl, & Shevlin, 2018 ), child and adolescent victims of maltreatment (Bertó et al, 2017 ), trafficked children (Ottisova, Smith, & Oram, 2018 ), former child soldiers (Murphy et al, 2018 ), women’s clinical samples (Cloitre, Garvert, Weiss, Carlson, & Bryant, 2014 ; Hyland, Shevlin, Fyvie, & Karatzias, 2018 ), male perpetrators of IPV (Gilbar, Hyland, Cloitre, & Dekel, 2018 ), refugees (Vallières et al, 2018 ) and war prisoners (Zerach, Shevlin, Cloitre, & Solomon, 2019 ). In addition, some of these studies compared PTSD and CPTSD prevalences in the same populations (Cloitre et al, 2014 , 2018 ; Gilbar et al, 2018 ; Hyland et al, 2017 ; 2018 ; Karatzias et al, 2016 ; Murphy et al, 2018 ; Simon et al, 2019 ; Vallières et al, 2018 ; Zerach et al, 2019 ). Despite the fact that IPV is a type of interpersonal violence that is difficult to escape for its particular bond between the survivors and perpetrators, and despite its possible consequences, such as low self-esteem and deconstruction of identity (Hyland et al, 2018 ; Matheson et al, 2015 ; Pill, Day, & Mildred, 2017 ), research on CPTSD in women survivors of IPV is scarce.…”

Section: Ipv Definition and Prevalencementioning

confidence: 99%

Complex PTSD in survivors of intimate partner violence: risk factors related to symptoms and diagnoses

Fillol

Pitsiakou

Pérez-Garcı́a

et al. 2021

Background In 2018, the World Health Organization proposed a new diagnosis entitled Complex Posttraumatic Stress Disorder (CPTSD) in the ICD-11. It is a diagnosis that encompasses the classic symptoms of PTSD, along with symptoms of disturbances in self-organization (DSO). Although this disorder has been studied in several countries and populations, research on the population of women survivors of intimate partner violence (IPV) is scarce. Objectives 1) To analyse the prevalence of CPTSD and PTSD according to ICD-11 criteria; 2) To analyse the associations between CPTSD symptomatology and severity of violence, level of fear, resilience and strategies of emotion regulation; 3) To analyse which risk factors (severity of violence, level of fear, resilience and strategies of emotion regulation) may differ between female survivors with CPTSD or PTSD. Method 162 women IPV survivors who completed a socio-demographic and violence-related interview, as well as questionnaires to assess PTSD and CPTSD, severity of violence, resilience and emotion regulation strategies. Results The results showed a higher prevalence of CPTSD (39.50%), compared to PTSD (17.90%). Moreover, a high level of fear was related to re-experiencing in the here and now, avoidance, current sense of threat and disturbances in relationships. Low levels of resilience and maladaptive emotion regulation strategies such as expressive suppression were related to affective dysregulation, negative self-concept and disturbances in relationships. Finally, the results showed that maladaptive emotion regulation strategies differentiated between meeting CPTSD and PTSD criteria in women survivors of IPV. Conclusion The findings of this study indicated that CPTSD was twice as prevalent as PTSD within the sample. Moreover, maladaptive emotion regulation strategy as expressive suppression was the main variable related to experiencing CPTSD, in contrast to PTSD. These findings may have important implications for the design of specific treatments aimed at women survivors of IPV, who also suffer CPTSD.

“…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%

“…Consistent with aetiological factors associated with CPTSD, trauma experience in these settings is therefore likely to be protracted and impact both adults and children. For example, approximately 40% of adult participants in samples from northern Uganda were abducted in the 1980s as child soldiers, and civil conflict is ongoing in the region (Dokkedahl et al, 2015 ; Murphy et al, 2016 , 2018 ). In the case of South Africa, many people live in communities that are hubs of ongoing trauma, where violence is persistent and pervasive (Kaminer, Eagle, & Crawford-Browne, 2018 ), and many trauma survivors are children (Artz et al, 2016 ; Hsiao et al, 2018 ).…”

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

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.