Variation in post-traumatic response: the role of trauma type in predicting ICD-11 PTSD and CPTSD symptoms

Hyland, Philip; Murphy, Jamie; Shevlin, Mark; Vallières, Frédérique; McElroy, Eoin; Elklit, Ask; Christoffersen, Mogens Nygaard; Cloitre, Marylène

doi:10.1007/s00127-017-1350-8

Cited by 151 publications

(168 citation statements)

References 40 publications

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“…This finding is consistent with previous studies (Cloitre et al, 2013; Hyland et al, 2017; Karatzias et al, 2016; Wolf et al, 2015). A possible explanation may be that the current sample was exposed to very high levels of war experiences and massive human rights violations, which may account for the non-significant effect of gender.…”

Section: Discussionsupporting

confidence: 93%

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

Murphy

Elklit

Dokkedahl

et al. 2018

European Journal of Psychotraumatology

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With the publication of the International Statistical Classification of Diseases and Related Health Problems, 11th edition (ICD-11) due for release in 2018, a number of studies have assessed the factorial validity of the proposed post-traumatic stress disorder (PTSD) and complex (CPTSD) diagnostic criteria and whether the disorders are correlated but distinct constructs. As the specific nature of CPTSD symptoms has yet to be firmly established, this study aimed to examine the dimension of affect dysregulation as two separate constructs representing hyper-activation and hypo-activation. Seven alternative models were estimated within a confirmatory factor analytic framework using the International Trauma Questionnaire (ITQ). Data were analysed from a young adult sample from northern Uganda (n = 314), of which 51% were female and aged 18–25 years. Forty per cent of the participants were former child soldiers (n = 124) while the remainder were civilians (n = 190). The prevalence of CPTSD was 20.8% and PTSD was 13.1%. The results indicated that all models that estimated affective dysregulation as distinct but correlated constructs (i.e. hyper-activation and hypo-activation) provided satisfactory model fit, with statistical superiority for a seven-factor first-order correlated model. Furthermore, individuals who met the criteria for CPTSD reported higher levels of war experiences, symptoms of anxiety and depression, and somatic problems than those with PTSD only and no diagnosis. There was also a much larger proportion of former child soldiers that met the criteria for a CPTSD diagnosis. In conclusion, these results partly support the factorial validity of the ICD-11 proposals for PTSD and CPTSD in a non-Western culture exposed to mass violence. These findings highlight that more research is required across different cultural backgrounds before firm conclusions can be made regarding the factor structure of CPTSD using the ITQ.

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Section: Discussionsupporting

confidence: 93%

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

Murphy

Elklit

Dokkedahl

et al. 2018

European Journal of Psychotraumatology

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“…Compared to the low symptoms group (group 1), the other three groups (PTSD, cPTSD, severe cPTSD) all comprise a greater proportion of women. This finding is in line with previous research showing that PTSD, as well as cPTSD as a sibling disorder of PTSD, are more common in females than in males (Hyland et al, 2017; Knefel et al, 2015). …”

Section: Discussionsupporting

confidence: 92%

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

Böttche

Ehring

Krüger-Gottschalk

et al. 2018

European Journal of Psychotraumatology

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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.

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“…In doing so, we sought to identify clinically relevant factors that serve to distinguish ICD‐11 CPTSD from ICD‐11 PTSD, and to provide preliminary evidence regarding the relative severity of ICD‐11 CPTSD and DSM‐5 PTSD. Consistent with prior findings (Hansen et al., ; Hyland et al., ; O'Donnell et al., ), a significantly greater proportion of individuals in our sample met diagnostic criteria for DSM‐5 PTSD compared to ICD‐11 PTSD/CPTSD. There is now consistent evidence, derived from a range of clinical samples characterized by distinct traumatic histories, cultural identities, and methods of data collection, indicating that the ICD‐11 provides stricter criteria than the DSM‐5 for diagnosis of trauma‐related psychopathology.…”

Section: Discussionsupporting

confidence: 91%

Posttraumatic Stress Disorder and Complex Posttraumatic Stress Disorder in DSM‐5 and ICD‐11: Clinical and Behavioral Correlates

Hyland

Shevlin

Fyvie

et al. 2018

Journal of Traumatic Stress

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104

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The American Psychiatric Association and the World Health Organization provide distinct trauma-based diagnoses in the fifth edition of the Diagnostic and Statistical Manual (DSM-5), and the forthcoming 11th version of the International Classification of Diseases (ICD-11), respectively. The DSM-5 conceptualizes posttraumatic stress disorder (PTSD) as a single, broad diagnosis, whereas the ICD-11 proposes two "sibling" disorders: PTSD and complex PTSD (CPTSD). The objectives of the current study were to: (a) compare prevalence rates of PTSD/CPTSD based on each diagnostic system; (b) identify clinical and behavioral variables that distinguish ICD-11 CPTSD and PTSD diagnoses; and (c) examine the diagnostic associations for ICD-11 CPTSD and DSM-5 PTSD. Participants in a predominately female clinical sample (N = 106) completed self-report scales to measure ICD-11 PTSD and CPTSD, DSM-5 PTSD, and depression, anxiety, borderline personality disorder, dissociation, destructive behaviors, and suicidal ideation and self-harm. Significantly more people were diagnosed with PTSD according to the DSM-5 criteria (90.4%) compared to those diagnosed with PTSD and CPTSD according to the ICD-11 guidelines (79.8%). An ICD-11 CPTSD diagnosis was distinguished from an ICD-11 PTSD diagnosis by higher levels of dissociation (d = 1.01), depression (d = 0.63), and borderline personality disorder (d = 0.55). Diagnostic associations with depression, anxiety, and suicidal ideation and self-harm were higher for ICD-11 CPTSD compared to DSM-5 PTSD (by 10.7%, 4.0%, and 7.0%, respectively). These results have implications for differential diagnosis and for the development of targeted treatments for CPTSD.

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Variation in post-traumatic response: the role of trauma type in predicting ICD-11 PTSD and CPTSD symptoms

Abstract: Results provide empirical support for the ICD-11 proposals that childhood interpersonal traumatic exposure increases risk of CPTSD symptom development.

Cited by 151 publications

References 40 publications

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

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

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

Posttraumatic Stress Disorder and Complex Posttraumatic Stress Disorder in DSM‐5 and ICD‐11: Clinical and Behavioral Correlates

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