The International Trauma Questionnaire: development of a self‐report measure of ICD‐11 PTSD and complex PTSD

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.

Section: Discussionmentioning

confidence: 99%

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

Böttche

Ehring

Krüger-Gottschalk

et al. 2018

“…However, at the time of planning the current study, no instrument was yet available to assess the proposed ICD-11 criteria (Brewin et al, 2009; Maercker et al, 2013). We are aware that in the meantime an instrument assessing the proposed ICD-11 criteria was developed (Cloitre, Roberts, Bisson, & Brewin, 2015) that has been used in recent research (Dokkedahl, Oboke, Ovuga, & Elklit, 2015). However, this instrument has not been well enough established and validated up to now.…”

Section: Discussionmentioning

confidence: 99%

Comparison of DSM-5 and proposed ICD-11 criteria for PTSD with DSM-IV and ICD-10: changes in PTSD prevalence in military personnel

Kuester

Köhler²,

Ehring

et al. 2017

Background: Recently, changes have been introduced to the diagnostic criteria for posttraumatic stress disorder (PTSD) according to the Diagnostic and Statistical Manual of Mental Disorders (DSM) and the International Classification of Diseases (ICD). Objectives:This study investigated the effect of the diagnostic changes made from DSM-IV to DSM-5 and from ICD-10 to the proposed ICD-11. The concordance of provisional PTSD prevalence between the diagnostic criteria was examined in a convenience sample of 100 members of the German Armed Forces. Method: Based on questionnaire measurements, provisional PTSD prevalence was assessed according to DSM-IV, DSM-5, ICD-10, and proposed ICD-11 criteria. Consistency of the diagnostic status across the diagnostic systems was statistically evaluated. Results: Provisional PTSD prevalence was the same for DSM-IV and DSM-5 (both 56%) and comparable under DSM-5 versus ICD-11 proposal (48%). Agreement between DSM-IV and DSM-5, and between DSM-5 and the proposed ICD-11, was high (both p < .001). Provisional PTSD prevalence was significantly increased under ICD-11 proposal compared to ICD-10 (30%) which was mainly due to the deletion of the time criterion. Agreement between ICD-10 and the proposed ICD-11 was low (p = .014). Conclusion: This study provides preliminary evidence for a satisfactory concordance between provisional PTSD prevalence based on the diagnostic criteria for PTSD that are defined using DSM-IV, DSM-5, and proposed ICD-11. This supports the assumption of a set of PTSD core symptoms as suggested in the ICD-11 proposal, when at the same time a satisfactory concordance between ICD-11 proposal and DSM was given. The finding of increased provisional PTSD prevalence under ICD-11 proposal in contrast to ICD-10 can be of guidance for future epidemiological research on PTSD prevalence, especially concerning further investigations on the impact, appropriateness, and usefulness of the time criterion included in ICD-10 versus the consequences of its deletion as proposed for ICD-11.

“…Consistent with this, there is growing evidence from research in western settings supporting the validity of this disorder with individuals exposed to sustained interpersonal trauma (Perkonigg et al, 2015), institutional abuse (Knefel, Garvert, Cloitre, & Lueger-Schuster, 20152015), childhood abuse (Cloitre, Garvert, Weiss, Carlson, & Bryant, 2014), and people seeking treatment following exposure to a range of trauma types (Cloitre et al, 2013). While CPTSD was originally formulated to describe distinctive psychological responses arising from events where an individual is under the sustained and coercive control of a perpetrator (i.e., torture) (Herman, 1992), there has been scarce examination of CPTSD in individuals from non-western countries who have been exposed to persecution, mass trauma, and torture.…”

mentioning

confidence: 93%

The factor structure of complex posttraumatic stress disorder in traumatized refugees

Nickerson

Cloitre

Bryant

et al. 2016

BackgroundThe construct of complex posttraumatic stress disorder (CPTSD) has attracted much research attention in previous years, however it has not been systematically evaluated in individuals exposed to persecution and displacement. Given that CPTSD has been proposed as a diagnostic category in the ICD-11, it is important that it be examined in refugee groups.ObjectiveIn the current study, we proposed to test, for the first time, the factor structure of CPTSD proposed for the ICD-11 in a sample of resettled treatment-seeking refugees.MethodThe study sample consisted of 134 traumatized refugees from a variety of countries of origin, with approximately 93% of the sample having been exposed to torture. We used confirmatory factor analysis to examine the factor structure of CPTSD in this sample and examined the sensitivity, specificity, positive predictive power and negative predictive power of individual items in relation to the CPTSD diagnosis.ResultsFindings revealed that a two-factor higher-order model of CPTSD comprising PTSD and Difficulties in Self-Organization (χ2 (47)=57.322, p=0.144, RMSEA=0.041, CFI=0.981, TLI=0.974) evidenced superior fit compared to a one-factor higher-order model of CPTSD (χ2 (48)=65.745, p=0.045, RMSEA=0.053, CFI=0.968, TLI=0.956). Overall, items evidenced strong sensitivity and negative predictive power, moderate positive predictive power, and poor specificity.ConclusionsFindings provide preliminary evidence for the validity of the CPTSD construct with highly traumatized treatment-seeking refugees.Highlights of the articleComplex PTSD (CPTSD), proposed as a sibling diagnosis to posttraumatic stress disorder (PTSD) in ICD-11, has not been previously evaluated with treatment-seeking refugees.This study compared higher-order one and two-factor models of CPTSD using confirmatory factor analysis in a sample of traumatized refugees.Findings indicated that a higher-order two-factor model comprising PTSD and Disturbances in Self-Organization best fit the data.These findings provide preliminary evidence that the CPTSD construct is relevant to individuals exposed to persecution and displacement.