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

Abstract

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.

ICD-11 PTSD and complex PTSD in treatment-seeking Danish veterans: a latent profile analysis

“…The distinction between two latent classes of participants with high PTSD scores, one scoring high only on PTSD symptoms, the other scoring high on both PTSD and DSO-symptoms, maps onto the ICD-11 specification of CPTSD and replicates findings from previous studies (Böttche et al, 2018;Cloitre et al, 2013Cloitre et al, , 2014Elklit et al, 2014;Karatzias et al, 2018Karatzias et al, , 2017Kazlauskas et al, 2018;Knefel et al, 2015;Murphy et al, 2016;Palic et al, 2016;Sachser et al, 2017). Consistent with the ICD-11 model of CPTSD, childhood interpersonal trauma was a statistically significant predictor of CPTSD, as compared to PTSD.…”

“…The ICD-11 model of CPTSD has been tested in several studies, usually using mixture models, such as latent class analysis and latent profile analysis (LPA), which identify different homogenous sub-populations that share similar patterns of symptom endorsement (Nylund, Asparouhov, & Muthén, 2007). To the best of our knowledge, 12 mixture model studies on ICD-11 PTSD and CPTSD have been published to date (Böttche et al, 2018;Cloitre, Garvert, Brewin, Bryant, & Maercker, 2013;Cloitre, Garvert, Weiss, Carlson, & Bryant, 2014;Elklit, Hyland, & Shevlin, 2014;Karatzias, Hyland, Ben-Ezra, & Shevlin, 2018;Karatzias et al, 2017;Kazlauskas, Gegieckaite, Hyland, Zelviene, & Cloitre, 2018;Knefel, Garvert, Cloitre, & Lueger-Schuster, 2015;Murphy, Elklit, Dokkedahl, & Shevlin, 2016;Palic et al, 2016;Sachser, Keller, & Goldbeck, 2017;Wolf et al, 2015). All except one (Wolf et al, 2015), previous studies identified the presence of at least two distinct symptom profiles; one describing a group of individuals reporting high levels of CPTSD symptoms in both PTSD and DSO-symptom clusters, another endorsing high levels of PTSD symptoms only.…”

Symptom structure of ICD-11 Complex Posttraumatic Stress Disorder (CPTSD) in trauma-exposed foster children: examining the International Trauma Questionnaire – Child and Adolescent Version (ITQ-CA)

“…Studies using archival data reported similar findings (e.g. Böttche et al, 2018 ; Shevlin et al, 2017 ). Taken together, the symptom structure of ICD-11 CPTSD seems to be best reflected in a two-factor higher-order model or a correlated six-factor model, evidencing the need for additional studies in different samples using precise descriptions of ICD-11 symptom content.…”

Community Perspectives of Complex Trauma Assessment for Aboriginal Parents: ‘Its Important, but How These Discussions Are Held Is Critical’

“…These were identified from a scoping review of assessment tools currently used in the perinatal period (Chamberlain et al, 2019b), and from consultation with leaders in the field. Information about the assessment tools were collated, with items mapped onto existing trauma symptom clusters (American Psychiatric Association [APA], 2013; Cloitre et al, 2014;Böttche et al, 2018;World Health Organisation [WHO], 2018), and additional Aboriginal cultural idioms of distress (Atkinson, 2008). The working group members determined that a domain regarding 'recognition' of parents who may be at higher risk of experiencing symptoms of complex trauma (e.g., a history of childhood abuse) (coded as '0') and 11 'areas of distress' should be taken forward for discussion with key stakeholders at the second key co-design workshop ( Table 1).…”