Traumatic life events as risk factors for psychosis and ICD-11 complex PTSD: a gender-specific examination

Abstract

Background Numerous studies found robust associations between psychosis and posttraumatic stress disorder (PTSD), but few have examined the relationships between psychosis and recently formulated ICD-11 Complex PTSD (CPTSD). Further, no known study has examined the effects of different traumatic life events on CPTSD and psychotic-like symptoms in a manner that permits gender-specific effects to be identified. Objective Using a nationally representative sample of 1,020 Irish adults, we examined gender-differences in (a) psychotic-like symptoms, CPTSD, and exposure to 21 different traumatic life events, and (b) the unique associations between different traumas with CPTSD and Psychosis. Method Bivariate analyses and structural equation modelling were performed. Results Consistent with the literature, no gender differences were observed in psychotic-like symptoms. Females reported slightly higher levels of CPTSD and were more likely to be exposed to sexual and emotional abuse, whereas men reported greater exposure to physical violence, accidents, and disasters. Psychosis symptoms were explained by trauma exposure to a considerate degree and at a level similar to CPTSD; a moderate correlation was also found between CPTSD and Psychosis. Physical/emotional neglect was the only traumatic life event that significantly and most strongly predicted both conditions. Two gender-specific associations between different traumatic life events and CPTSD and Psychosis were identified out of the 42 possible effects modelled. Conclusions The present investigation provides initial evidence that psychotic-like symptoms and CPTSD are moderately correlated constructs in the general population. Results also highlight the importance of conducting a detailed assessment of trauma history for all clients presenting with symptoms of CPTSD, psychosis, or both.

Gender, sex and complex PTSD clinical presentation: a systematic review

“…Number of experiences of sexual assault, sexual harassment, being stalked, emotional abuse and physical or emotional neglect were all significantly higher in females in another paper (Ho et al, 2021 ). Males reported significantly higher rates of physical assault, life-threatening accident or disaster, life threatened with a weapon, war/combat and causing extreme suffering to someone else (Ho et al, 2021 ). This paper scored 80% in quality assessment.…”

“…Although Ho et al ( 2021 ) found no gender difference in overall CPTSD diagnostic rates, they reported higher cluster-level scores among females, suggesting a symptom-level difference that did not reach diagnostic threshold. Charak et al ( 2023 ) did not report diagnostic rates by gender but reported similar rates among cisgender and gender diverse participants more broadly.…”

“…There were two subthemes: no gender and/or sex differences, and higher rates among women or females. Eight studies found no gender and/or sex differences (Charak et al, 2023 ; de Vries et al, 2018 ; Hecker et al, 2018 ; Ho et al, 2021 ; Hyland, Ceannt, et al, 2018 ; Karatzias et al, 2019 ; McGinty et al, 2021 [Israel sample]; Søegaard et al, 2021 ). Most of these papers scored between 60% and 100% in quality assessment (one scored 40%).…”

“…100% M. Ethnicity: no data ITQ, LEC-5 Frequency of CPTSD symptom endorsements were: 53% feelings easily hurt (AD3); 48.7% guilt (NSC4); 42.1% long time to calm (AD2); 32.3% reckless behaviour (AD5); 31.4% uncontrollable anger (AD4); 30.5% intense reactions (AD1); 30.4% numb (AD6); 25.7% difficulty feeling pleasure (AD7); 25.1% difficultly staying close to others (DR2); 24.9% shame (NSC3); 23.2% world is distant (AD8); 23.2% failure (NSC1); 21.3% cut-off from others (DR1); 20.3% avoiding relationships (DR3); 17.9% worthless (NSC2); 10.7% feeling outside of body (AD9) 40% Hecker et al ( 2018 ) Switzerland PTSD and CPTSD symptoms and traumatic experiences among refugees Adult refugees resettled in Switzerland ( N = 94) Specifies gender – refers to ‘male’ and ‘female’ in paper Age: 18–61 ( M = 31.60). 14.9% F; 85.1% M. Ethnicity: no data ITQ, HTQ-5 21.3% ( n = 20) met diagnostic criteria for CPTSD Gender not significantly associated with DSO symptom severity, ( F (1,86) = 1.10, p = .297) 100% Ho et al ( 2021 )* Ireland* Gender-specific examination of ICD-11 CPTSD and psychosis Community sample of nationally representative adults ( N = 1020) Specifies gender in title and results, but also refers to sex in results tables – appears to use sex and gender interchangeably (refers to ‘male’ and ‘female’ in paper) Age: 18–87 ( M = 43.10). 51% F; 49% M. Ethnicity: no data ITQ, ITEM Females had significantly higher levels of CPTSD symptoms than males ( t (1018) = 5.81, p < .001, d = .36) No significant differences in overall CPTSD diagnoses between females and males ( p = .13) 80% Hyland, Ceannt, et al ( 2018 ) Lebanon PTSD and CPTSD diagnoses among Syrian refugees living in Lebanon Syrian refugees living in Lebanon ( N = 101) Specifies gender – refers to ‘male’ and ‘female’ in paper Age: M = 33.02.…”

“…1 Statistical analyses described and appropriate. 1 Ho et al ( 2021 ) Non-random sample from existing internet research panels to generate nationally representative sample of Irish adults. Appropriate for research question.…”