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Rameckers SA, van Emmerik AAP, Grasman RPPP, Arntz A. Non-fear emotions in changes in posttraumatic stress disorder symptoms during treatment. J Behav Ther Exp Psychiatry 2024; 84:101954. [PMID: 38479086 DOI: 10.1016/j.jbtep.2024.101954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 12/31/2023] [Accepted: 02/19/2024] [Indexed: 05/15/2024]
Abstract
BACKGROUND AND OBJECTIVES Posttraumatic stress disorder (PTSD) is not only associated with fear but also with other emotions. The present study aimed to examine if changes in shame, guilt, anger, and disgust predicted changes in PTSD symptoms during treatment, while also testing if PTSD symptoms, in turn, predicted changes in these emotions. METHODS Participants (N = 155) with childhood-related PTSD received a maximum of 12 sessions of eye movement desensitization and reprocessing or imagery rescripting. The data was analyzed using Granger causality models across 12 treatment sessions and 6 assessment sessions (up until one year after the start of treatment). Differences between the two treatments were explored. RESULTS Across treatment sessions, shame, and disgust showed a reciprocal relationship with PTSD symptoms, while changes in guilt preceded PTSD symptoms. Across assessments, anger was reciprocally related to PTSD, suggesting that anger might play a more important role in the longer term. LIMITATIONS The individual emotion items were not yet validated, and the CAPS was not administered at all assessments. CONCLUSIONS These findings partly differ from earlier studies that suggested a unidirectional relationship in which changes in emotions preceded changes in PTSD symptoms during treatment. This is in line with the idea that non-fear emotions do play an important role in the treatment of PTSD and constitute an important focus of treatment and further research.
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Affiliation(s)
- Sophie A Rameckers
- Department of Clinical Psychology, University of Amsterdam, Amsterdam, the Netherlands.
| | | | - Raoul P P P Grasman
- Department of Psychological Methods, University of Amsterdam, Amsterdam, the Netherlands
| | - Arnoud Arntz
- Department of Clinical Psychology, University of Amsterdam, Amsterdam, the Netherlands
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2
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Niewiadomska I, Jurek K, Chwaszcz J, Korżyńska-Piętas M, Peciakowski T. PTSD as a Moderator of the Relationship Between the Distribution of Personal Resources and Spiritual Change Among Participants of Hostilities in Ukraine. JOURNAL OF RELIGION AND HEALTH 2023; 62:479-499. [PMID: 35347577 DOI: 10.1007/s10943-022-01547-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/08/2022] [Indexed: 06/14/2023]
Abstract
The theory of conservation of resources (COR) can be used to search for mechanisms that explain spiritual changes caused by trauma. The present study aimed to verify whether PTSD could be a potential moderator between the distribution of personal resources and spiritual changes. The study included a total of 324 adults (75 women and 243 men) aged 18-74. The mean age was 34.3 (SD = 9.9). The Polish adaptation of Hobfoll's Conservation of Resources-Evaluation (COR-E), the posttraumatic stress disorder (PTSD) Checklist-Civilian Version and the Posttraumatic Growth Inventory were employed in the research. This study analyzed the spiritual change, which is one of the five domains of posttraumatic growth. The outcomes indicated the significant role of PTSD as a moderator of the relationships between 1) personal resources gain and spiritual change and 2) personal resources loss and spiritual change. PTSD is not a moderator in the relationship between assigning value to personal resources and spiritual change.
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Affiliation(s)
- Iwona Niewiadomska
- Department of Social Psychoprevention, John Paul II Catholic University of Lublin, 20-950, Lublin, Poland
| | - Krzysztof Jurek
- Department of Sociology of Culture, Religion and Social Participation, John Paul II Catholic University of Lublin, 20-950, Lublin, Poland.
| | - Joanna Chwaszcz
- Department of Social Psychoprevention, John Paul II Catholic University of Lublin, 20-950, Lublin, Poland
| | | | - Tomasz Peciakowski
- Department of Social Theories and Sociology of Family, John Paul II Catholic University of Lublin, 20-950, Lublin, Poland
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3
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Egner LE, Sütterlin S, Calogiuri G. Proposing a Framework for the Restorative Effects of Nature through Conditioning: Conditioned Restoration Theory. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E6792. [PMID: 32957693 PMCID: PMC7558998 DOI: 10.3390/ijerph17186792] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 09/09/2020] [Accepted: 09/15/2020] [Indexed: 12/02/2022]
Abstract
Natural environments have been shown to trigger psychological and physiological restoration in humans. A new framework regarding natural environments restorative properties is proposed. Conditioned restoration theory builds on a classical conditioning paradigm, postulating the occurrence of four stages: (i) unconditioned restoration, unconditioned positive affective responses reliably occur in a given environment (such as in a natural setting); (ii) restorative conditioning, the positive affective responses become conditioned to the environment; (iii) conditioned restoration, subsequent exposure to the environment, in the absence of the unconditioned stimulus, retrieves the same positive affective responses; and (iv) stimulus generalization, subsequent exposure to associated environmental cues retrieves the same positive affective responses. The process, hypothetically not unique to natural environments, involve the well-documented phenomenon of conditioning, retrieval, and association and relies on evaluative conditioning, classical conditioning, core affect, and conscious expectancy. Empirical findings showing that restoration can occur in non-natural environments and through various sensory stimuli, as well as findings demonstrating that previous negative experience with nature can subsequently lower restorative effects, are also presented in support of the theory. In integration with other existing theories, the theory should prove to be a valuable framework for future research.
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Affiliation(s)
- Lars Even Egner
- Citizens, Environment and Safety, Institute of Psychology, Norwegian University of Science and Technology, 7048 Trondheim, Norway
| | - Stefan Sütterlin
- Faculty of Health and Welfare Sciences, Østfold University College, 1757 Halden, Norway;
- Division of Clinical Neuroscience, Oslo University Hospital, 0450 Oslo, Norway
| | - Giovanna Calogiuri
- Faculty of Health and Social Sciences, University of South-Eastern Norway, 3045 Drammen, Norway;
- Department of Public Health and Sport Sciences, Inland Norway University of Applied Sciences, 2411 Elverum, Norway
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4
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Campbell SB, Trachik B, Goldberg S, Simpson TL. Identifying PTSD symptom typologies: A latent class analysis. Psychiatry Res 2020; 285:112779. [PMID: 31983505 DOI: 10.1016/j.psychres.2020.112779] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Revised: 01/06/2020] [Accepted: 01/06/2020] [Indexed: 02/08/2023]
Abstract
Posttraumatic stress disorder (PTSD) is characterized by re-experiencing, avoidance, negative alterations in cognition and mood, and arousal symptoms per the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5). While numerous symptom combinations are possible to meet diagnostic criteria, simplification of this heterogeneity of symptom presentations may have clinical utility. In a nationally representative sample of American adults with lifetime DSM-5 PTSD diagnoses from the third wave of the National Epidemiologic Survey on Alcohol and Related Conditions (n = 2,365), we used Latent Class Analysis (LCA) to identify qualitatively distinct PTSD symptom typologies. Subsequently, we used linear and logistic regressions to identify demographic, trauma-related, and psychiatric characteristics associated with membership in each class. In contrast to prior LCAs with DSM-IV-TR diagnostic criteria, fit indices for the present analyses of DSM-5 PTSD revealed a four-class solution to the data: Dysphoric (23.8%), Threat-Reactivity (26.1%), High Symptom (33.7%), and Low Symptom (16.3%). Exploratory analyses revealed distinctions between classes in socioeconomic impairment, trauma exposure, comorbid diagnoses, and demographic characteristics. Although the study is limited by its cross-sectional design (preventing analysis of temporal associations or causal pathways between covariates and latent classes), findings may support efforts to develop personalized medicine approaches to PTSD diagnosis and treatment.
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Affiliation(s)
- Sarah B Campbell
- VA Puget Sound Health Care System - Seattle Division, 1660 S. Columbian Way, Seattle WA, 98108, United States; University of Washington Department of Health Services, 1959 NE Pacific St, Magnuson Health Sciences Center, Room H-680, Box 357660, Seattle, WA, 98195-7660.
| | - Benjamin Trachik
- U.S. Army Medical Research Directorate-West, Walter Reed Army Institute of Research, Joint Base Lewis-McChord, WA, USA.
| | - Simon Goldberg
- Department of Counseling Psychology, University of Wisconsin - Madison, Madison, WI, USA; Center for Healthy Minds, University of Wisconsin - Madison, Madison, WI, USA.
| | - Tracy L Simpson
- U.S. Army Medical Research Directorate-West, Walter Reed Army Institute of Research, Joint Base Lewis-McChord, WA, USA; University of Washington Department of Psychiatry and Behavioral Sciences, 1959 NE Pacific Street, Box 356560, Room BB1644, Seattle, WA 98195-6560.
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5
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Gilbar O. Examining the boundaries between ICD-11 PTSD/CPTSD and depression and anxiety symptoms: A network analysis perspective. J Affect Disord 2020; 262:429-439. [PMID: 31744734 DOI: 10.1016/j.jad.2019.11.060] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Revised: 09/20/2019] [Accepted: 11/10/2019] [Indexed: 01/19/2023]
Abstract
BACKGROUND Two newly identified sibling disorders - ICD-11 PTSD and CPTSD - have been well validated in the last few years. Although these trauma-related disorders are suggested to be neatly separated from depression and anxiety, no study has used a network analysis to examine those definitions' construct validity when they also interplay with symptoms of depression and anxiety. Additionally, no research has focused upon the specific boundaries between these four disorders' symptoms, the bridges between them, and the ways they influence each other among clinical populations. METHODS A sample of 234 men drawn randomly from a national sample of 1,600 Jewish men receiving treatment for domestic violence in Israel completed the ICD-11 International Trauma Questionnaire (ITQ) and Brief Symptom Inventory (BSI). RESULTS The ICD-11 CPTSD, depression and anxiety clustering network results revealed, within the EGA, a four-cluster solution in which PTSD and CPTSD symptoms are differentiated from two other distinct clusters of anxiety and depression symptoms. Feelings of worthlessness and avoiding internal reminders of the experience were the most central symptoms. LIMITATIONS Due to the use of a cross-sectional design, causal interpretation of the network correlation between symptoms should be made cautiously. CONCLUSIONS These findings strengthen the approach that ICD-11 PTSD and CPTSD have a distinct construct; however, they also reflect a strong positive connection to anxiety and depression symptoms and no clear boundaries between disorders. Specifically, dysphoria/avoidance-related symptoms act as a bridge between the disorders, which may be important targets for specific assessments and related interventions.
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Affiliation(s)
- Ohad Gilbar
- Boston University, VA Medical Center, Boston, United States; The Louis and Gabi Weisfeld School of Social Work, Bar-Ilan University, Ramat-Gan, Israel.
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6
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Oe M, Ito M, Takebayashi Y, Katayanagi A, Horikoshi M. Prevalence and comorbidity of the ICD-11 and DSM-5 for PTSD caseness with previous diagnostic manuals among the Japanese population. Eur J Psychotraumatol 2020; 11:1753938. [PMID: 32595913 PMCID: PMC7301694 DOI: 10.1080/20008198.2020.1753938] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Revised: 03/19/2020] [Accepted: 03/29/2020] [Indexed: 12/27/2022] Open
Abstract
Background: The diagnostic criteria for posttraumatic stress disorder (PTSD) differ between DSM-5 and ICD-11, which may affect the estimation of prevalence. Objective: To investigate the concordance of ICD-11 and DSM-5, as compared to ICD-10 and DSM-IV, regarding PTSD caseness among Japanese people who had experienced different potentially traumatic events. In addition, we estimated the comorbidity with major depressive disorder and generalized anxiety disorder according to these four diagnostic manuals. Method: A web-based survey (n = 6,180) was conducted from November 2016 to March 2017. Participants completed the PTSD Checklist for DSM-5, and other standardized measures of PTSD, depression, and anxiety. Results: The prevalence of PTSD caseness according to ICD-11 was significantly lower as compared to DSM-IV, DSM-5, and ICD-10. Cohen's kappa between DSM-5 and ICD-11 was 0.79, indicating substantial agreement. Comorbidity with depression was significantly higher in unique DSM-5 cases than in unique ICD-11 cases. Unique DSM-5 PTSD cases were significantly stronger functionally impaired than unique ICD-11 PTSD cases. Conclusions: Although requiring fewer items, the ICD-11 showed substantial agreement with DSM-5 regarding PTSD caseness. The lower comorbidity rates in unique cases may support the concept of the ICD-11 which intends to reduce comorbidity by identifying the core elements of PTSD.
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Affiliation(s)
- Misari Oe
- Department of Neuropsychiatry, Kurume University School of Medicine, Kurume, Japan
| | - Masaya Ito
- National Center for Cognitive Behavior Therapy and Research, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Yoshitake Takebayashi
- National Center for Cognitive Behavior Therapy and Research, National Center of Neurology and Psychiatry, Tokyo, Japan.,Department of Health Risk Communication, School of Medicine, Fukushima Medical University, Fukushima, Japan
| | - Akiko Katayanagi
- National Center for Cognitive Behavior Therapy and Research, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Masaru Horikoshi
- National Center for Cognitive Behavior Therapy and Research, National Center of Neurology and Psychiatry, Tokyo, Japan
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7
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Pozza A, Bossini L, Ferretti F, Olivola M, Del Matto L, Desantis S, Fagiolini A, Coluccia A. The Effects of Terrorist Attacks on Symptom Clusters of PTSD: a Comparison with Victims of Other Traumatic Events. Psychiatr Q 2019; 90:587-599. [PMID: 31187353 DOI: 10.1007/s11126-019-09650-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
In the Post-Traumatic Stress Disorder (PTSD) literature, no study assessed differences in symptom clusters among victims of terrorist attacks (TA) as compared with victims of other traumatic events. Due to the intentional nature of the harm infliction, TA may be expected to produce more severe symptoms, particularly avoidance, since this cluster was found to be a severity marker and a maintenance factor of the disorder. As several patients delay treatment-seeking, duration of untreated illness (DUI) is another problem potentially influencing PTSD severity. The current study explored differences in PTSD symptom clusters as a function of the traumatic event type (TA compared with other events), DUI, and sex. One hundred-eight patients with primary PTSD were administered The Clinician Administered PTSD Scale. Mean DUI was approximately 12 years, irrespective of the event type. Patients who had experienced TA had significantly more severe Avoidance/Numbing symptoms and general PTSD severity than those who had experienced other events. No significant effects emerged for DUI and sex on all clusters. Timely recognition and intervention on PTSD may include community psychoeducation programs about its symptoms. Tailored intervention on TA-related PTSD may focus on Avoidance/Numbing by including medication and psychotherapeutic approaches for this symptom cluster.
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Affiliation(s)
- Andrea Pozza
- Department of Medical Sciences, Surgery and Neurosciences, Santa Maria alle Scotte University Hospital, viale Mario Bracci 16, 53100, Siena, Italy
| | - Letizia Bossini
- Department of Molecular Medicine, University of Siena School of Medicine and Department of Mental Health, University of Siena Medical Center (AOUS), viale Mario Bracci 16, 53100, Siena, Italy
| | - Fabio Ferretti
- Department of Medical Sciences, Surgery and Neurosciences, Santa Maria alle Scotte University Hospital, viale Mario Bracci 16, 53100, Siena, Italy.
| | - Miriam Olivola
- Department of Molecular Medicine, University of Siena School of Medicine and Department of Mental Health, University of Siena Medical Center (AOUS), viale Mario Bracci 16, 53100, Siena, Italy
| | - Laura Del Matto
- Department of Molecular Medicine, University of Siena School of Medicine and Department of Mental Health, University of Siena Medical Center (AOUS), viale Mario Bracci 16, 53100, Siena, Italy
| | - Serena Desantis
- Department of Molecular Medicine, University of Siena School of Medicine and Department of Mental Health, University of Siena Medical Center (AOUS), viale Mario Bracci 16, 53100, Siena, Italy
| | - Andrea Fagiolini
- Department of Molecular Medicine, University of Siena School of Medicine and Department of Mental Health, University of Siena Medical Center (AOUS), viale Mario Bracci 16, 53100, Siena, Italy
| | - Anna Coluccia
- Department of Medical Sciences, Surgery and Neurosciences, Santa Maria alle Scotte University Hospital, viale Mario Bracci 16, 53100, Siena, Italy
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8
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Barbieri A, Visco-Comandini F, Alunni Fegatelli D, Schepisi C, Russo V, Calò F, Dessì A, Cannella G, Stellacci A. Complex trauma, PTSD and complex PTSD in African refugees. Eur J Psychotraumatol 2019; 10:1700621. [PMID: 31853336 PMCID: PMC6913679 DOI: 10.1080/20008198.2019.1700621] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 10/16/2019] [Accepted: 11/22/2019] [Indexed: 12/04/2022] Open
Abstract
Background: The introduction of the diagnosis of complex posttraumatic stress disorder (CPTSD) by ICD-11 is a turning point in the field of traumatic stress studies. It's therefore important to examine the validity of CPTSD in refugee groups exposed to complex trauma (CT) defined as a repeated, prolonged, interpersonal traumatic event. Objective: The objective of this study was to compare DSM-5 and ICD-11 post-traumatic stress disorder diagnoses and to evaluate the discriminant validity of ICD-11 PTSD and CPTSD constructs in a sample of treatment-seeking refugees living in Italy. Method: The study sample included 120 treatment-seeking African refugees living in Italy. All participants were survivors of at least one CT. PTSD and CPTSD diagnoses were assessed according to both DSM-5 and ICD-11 criteria. Results: Findings revealed that 79% of the participants met the DSM-5 criteria for PTSD, 38% for ICD-11 PTSD and 30% for ICD-11 CPTSD. Generally, ICD-11 CPTSD items evidenced strong sensitivity and negative predictive power, low specificity and positive predictive power. Latent class analysis results identified two distinct groups: (1) a PTSD class, (2) a CPTSD class. None of the demographic and trauma-related variables analysed was significantly associated with diagnostic group. On the other hand, the months spent in Italy were significantly associated with PCL-5 score. Conclusions: Findings extend the current evidence base to support the discriminant validity of PTSD and CPTSD amongst refugees exposed to torture and other gross violations of human rights. The results suggest also that, in the post-traumatic phase, the time spent in a 'safe place' condition contributes to improve the severity of post-traumatic symptomatology, but neither this variable nor other socio-demographic factors seem to contribute to the emergence of complex PTSD. Further investigations are needed to clarify which specific vulnerability factors influence the development of PTSD or CPTSD in refugees exposed to complex trauma.
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Affiliation(s)
| | | | - D Alunni Fegatelli
- Department of public health and infectious diseases, Sapienza University of Rome, Rome, Italy
| | | | - V Russo
- Medu Psychè Center, Rome, Italy
| | - F Calò
- Medu Center, Ragusa, Italy
| | | | | | - A Stellacci
- Auxilium - Reception Center for Asylum Seekers/CARA, Bari Palese, Italy
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9
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Kuester A, Köhler K, Ehring T, Knaevelsrud C, Kober L, Krüger-Gottschalk A, Schäfer I, Schellong J, Wesemann U, Rau H. Comparison of DSM-5 and proposed ICD-11 criteria for PTSD with DSM-IV and ICD-10: changes in PTSD prevalence in military personnel. Eur J Psychotraumatol 2017; 8:1386988. [PMID: 29163862 PMCID: PMC5687795 DOI: 10.1080/20008198.2017.1386988] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Accepted: 09/20/2017] [Indexed: 11/02/2022] Open
Abstract
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.
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Affiliation(s)
- Annika Kuester
- Department of Clinical Psychology and Psychotherapy, Freie University Berlin, Berlin, Germany
| | - Kai Köhler
- Psychotrauma Centre, German Armed Forces Hospital Berlin, Berlin, Germany
| | - Thomas Ehring
- Department of Psychology, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Christine Knaevelsrud
- Department of Clinical Psychology and Psychotherapy, Freie University Berlin, Berlin, Germany
| | - Louisa Kober
- Department of Psychological Assessment, Methodology and Legal Psychology, Friedrich-Alexander-University Erlangen-Nürnberg, Nürnberg, Germany
| | | | - Ingo Schäfer
- Centre for Interdisciplinary Addiction Research, University of Hamburg, Hamburg, Germany
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Julia Schellong
- Department of Psychotherapy and Psychosomatic Medicine, Technical University Dresden, Dresden, Germany
| | - Ulrich Wesemann
- Psychotrauma Centre, German Armed Forces Hospital Berlin, Berlin, Germany
| | - Heinrich Rau
- Psychotrauma Centre, German Armed Forces Hospital Berlin, Berlin, Germany
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10
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Brewin CR, Cloitre M, Hyland P, Shevlin M, Maercker A, Bryant RA, Humayun A, Jones LM, Kagee A, Rousseau C, Somasundaram D, Suzuki Y, Wessely S, van Ommeren M, Reed GM. A review of current evidence regarding the ICD-11 proposals for diagnosing PTSD and complex PTSD. Clin Psychol Rev 2017; 58:1-15. [PMID: 29029837 DOI: 10.1016/j.cpr.2017.09.001] [Citation(s) in RCA: 323] [Impact Index Per Article: 46.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Revised: 07/18/2017] [Accepted: 09/05/2017] [Indexed: 11/27/2022]
Abstract
The World Health Organization's proposals for posttraumatic stress disorder (PTSD) in the 11th edition of the International Classification of Diseases, scheduled for release in 2018, involve a very brief set of symptoms and a distinction between two sibling disorders, PTSD and Complex PTSD. This review of studies conducted to test the validity and implications of the diagnostic proposals generally supports the proposed 3-factor structure of PTSD symptoms, the 6-factor structure of Complex PTSD symptoms, and the distinction between PTSD and Complex PTSD. Estimates derived from DSM-based items suggest the likely prevalence of ICD-11 PTSD in adults is lower than ICD-10 PTSD and lower than DSM-IV or DSM-5 PTSD, but this may change with the development of items that directly measure the ICD-11 re-experiencing requirement. Preliminary evidence suggests the prevalence of ICD-11 PTSD in community samples of children and adolescents is similar to DSM-IV and DSM-5. ICD-11 PTSD detects some individuals with significant impairment who would not receive a diagnosis under DSM-IV or DSM-5. ICD-11 CPTSD identifies a distinct group who have more often experienced multiple and sustained traumas and have greater functional impairment than those with PTSD.
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Affiliation(s)
- Chris R Brewin
- Department of Clinical, Educational and Health Psychology, University College London, London, UK.
| | - Marylène Cloitre
- Division of Dissemination and Training, National Center for PTSD, Menlo Park, CA, USA
| | - Philip Hyland
- School of Business, National College of Ireland, Dublin, Ireland
| | - Mark Shevlin
- School of Psychology, University of Ulster, Coleraine, North Ireland
| | - Andreas Maercker
- Department of Psychology, Division of Psychopathology, University of Zurich, Switzerland
| | - Richard A Bryant
- School of Psychology, University of New South Wales, Sydney, Australia
| | | | - Lynne M Jones
- FXB Center for Health and Human Rights, Harvard School of Public Health, Harvard University, Cambridge, MA, USA
| | - Ashraf Kagee
- Department of Psychology, Stellenbosch University, Stellenbosch, South Africa
| | - Cécile Rousseau
- Department of Psychiatry, McGill University Health Center, Montreal, Canada
| | | | - Yuriko Suzuki
- National Center of Neurology and Psychiatry, National Institute of Mental Health, Tokyo, Japan
| | | | - Mark van Ommeren
- Department of Mental Health and Substance Abuse, World Health Organization, Geneva, Switzerland
| | - Geoffrey M Reed
- Department of Mental Health and Substance Abuse, World Health Organization, Geneva, Switzerland; Global Mental Health Program, Columbia University Medical Center, New York, NY, USA
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11
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Cyniak-Cieciura M, Staniaszek K, Popiel A, Pragłowska E, Zawadzki B. The structure of PTSD symptoms according to DSM-5 and IDC-11 proposal: A multi-sample analysis. Eur Psychiatry 2017. [PMID: 28646729 DOI: 10.1016/j.eurpsy.2017.02.491] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Posttraumatic stress disorder (PTSD) symptoms structure is a subject of ongoing debate since its inclusion in DSM-III classification in 1980. Different research on PTSD symptoms structure proved the better fit of four-factor and five-factor models comparing to the one proposed by DSM-IV. With the publication of DSM-5 classification, which introduced significant changes to PTSD diagnosis, the question arises about the adequacy of the proposed criteria to the real structure of disorder symptoms. Recent analyses suggest that seven-factor hybrid model is the best reflection of symptoms structure proposed to date. At the same time, some researchers and ICD-11 classification postulate a simplification of PTSD diagnosis restricting it to only three core criteria and adding additional diagnostic unit of complex-PTSD. This research aimed at checking symptoms' structure according to well-known and supported four-, five-, six- and seven-factor models based on DSM-5 symptoms and the conceptualization proposed by the ICD-11 as well as examining the relation between PTSD symptoms categories with borderline personality disorder. Four different trauma populations were examined with self-reported Posttraumatic Diagnostic Scale for DSM-5 (PDS-5) measure. The results suggest that six- and seven-factor hybrid model as well as three-factor ICD-11 concept fits the data better than other models. The core PTSD symptoms were less related to borderline personality disorder than other, broader, symptoms categories only in one sample. Combination of ICD-11 simplified PTSD diagnosis with the more complex approach (e.g. basing on a seven-factor model) may be an attractive proposal for both scientists and practitioners, however does not necessarily lower its comorbidity with borderline personality disorder.
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Affiliation(s)
| | | | - A Popiel
- Warsaw University, Stawki 5/7, Warsaw, Poland
| | | | - B Zawadzki
- Warsaw University, Stawki 5/7, Warsaw, Poland
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12
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Hafstad GS, Thoresen S, Wentzel-Larsen T, Maercker A, Dyb G. PTSD or not PTSD? Comparing the proposed ICD-11 and the DSM-5 PTSD criteria among young survivors of the 2011 Norway attacks and their parents. Psychol Med 2017; 47:1283-1291. [PMID: 28077178 PMCID: PMC5426334 DOI: 10.1017/s0033291716002968] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND The conceptualization of post-traumatic stress disorder (PTSD) in the upcoming International Classification of Diseases (ICD)-11 differs in many respects from the diagnostic criteria in the Diagnostic and Statistical Manual for Mental Disorders, fifth edition (DSM-5). The consequences of these differences for individuals and for estimation of prevalence rates are largely unknown. This study investigated the concordance of the two diagnostic systems in two separate samples at two separate waves. METHOD Young survivors of the 2011 Norway attacks (n = 325) and their parents (n = 451) were interviewed at 4-6 months (wave 1) and 15-18 months (wave 2) after the shooting. PTSD was assessed with the UCLA PTSD Reaction Index for DSM-IV adapted for DSM-5, and a subset was used as diagnostic criteria for ICD-11. RESULTS In survivors, PTSD prevalence did not differ significantly at any time point, but in parents, the DSM-5 algorithm produced significantly higher prevalence rates than the ICD-11 criteria. The overlap was fair for survivors, but amongst parents a large proportion of individuals met the criteria for only one of the diagnostic systems. No systematic differences were found between ICD-11 and DSM-5 in predictive validity. CONCLUSIONS The proposed ICD-11 criteria and the DSM-5 criteria performed equally well when identifying individuals in distress. Nevertheless, the overlap between those meeting the PTSD diagnosis for both ICD-11 and DSM-5 was disturbingly low, with the ICD-11 criteria identifying fewer people than the DSM-5. This represents a major challenge in identifying individuals suffering from PTSD worldwide, possibly resulting in overtreatment or unmet needs for trauma-specific treatment, depending on the area of the world in which patients are being diagnosed.
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Affiliation(s)
- G S Hafstad
- Norwegian Centre for Violence and Traumatic Stress Studies,Pb. 181 Nydalen,0409 Oslo,Norway
| | - S Thoresen
- Norwegian Centre for Violence and Traumatic Stress Studies,Pb. 181 Nydalen,0409 Oslo,Norway
| | - T Wentzel-Larsen
- Norwegian Centre for Violence and Traumatic Stress Studies,Pb. 181 Nydalen,0409 Oslo,Norway
| | - A Maercker
- Department of Psychology - Psychopathology and Clinical Intervention,University of Zurich,Binzmühlestrasse 14/17,8050 Zürich,Switzerland
| | - G Dyb
- Norwegian Centre for Violence and Traumatic Stress Studies,Pb. 181 Nydalen,0409 Oslo,Norway
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13
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Hyland P, Brewin CR, Maercker A. Predictive Validity of ICD-11 PTSD as Measured by the Impact of Event Scale-Revised: A 15-Year Prospective Study of Political Prisoners. J Trauma Stress 2017; 30:125-132. [PMID: 28370300 DOI: 10.1002/jts.22171] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Revised: 10/24/2016] [Accepted: 01/03/2017] [Indexed: 12/31/2022]
Abstract
The 11th edition of the International Classification of Diseases (ICD-11; World Health Organization, 2017) proposes a model of posttraumatic stress disorder (PTSD) that includes 6 symptoms. This study assessed the ability of a classification-independent measure of posttraumatic stress symptoms, the Impact of Event Scale-Revised (Weiss & Marmar, 1996), to capture the ICD-11 model of PTSD. The current study also provided the first assessment of the predictive validity of ICD-11 PTSD. Former East German political prisoners were assessed in 1994 (N = 144) and in 2008-2009 (N = 88) on numerous psychological variables using self-report measures. Of the participants, 48.2% and 36.8% met probable diagnosis for ICD-11 PTSD at the first and second assessments, respectively. Confirmatory factor analysis supported the factorial validity of the 3-factor ICD-11 model of PTSD, as represented by items selected from the Impact of Event Scale-Revised. Hierarchical multiple regression analysis demonstrated that, controlling for sex, the symptom clusters of ICD-11 PTSD (reexperiencing, avoidance, and sense of threat) significantly contributed to the explanation of depression (R2 = .17), quality of life (R2 = .21), internalized anger (R2 = .10), externalized anger (R2 = .12), hatred of perpetrators (R2 = .15), dysfunctional disclosure (R2 = .27), and social acknowledgment as a victim (R2 = .12) across the 15-year study period. Current findings add support for the factorial and predictive validity of ICD-11 PTSD within a unique cohort of political prisoners.
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Affiliation(s)
- Philip Hyland
- School of Business, National College of Ireland, Dublin, Ireland.,Centre for Global Health, School of Psychology, Trinity College Dublin, Dublin, Ireland
| | - Chris R Brewin
- Clinical, Educational, and Health Psychology, University College London, London, England
| | - Andreas Maercker
- Department of Psychology, Division of Psychopathology, University of Zurich, Zurich, Switzerland
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14
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The impact of proposed changes to ICD-11 on estimates of PTSD prevalence and comorbidity. Psychiatry Res 2016; 240:226-233. [PMID: 27124207 PMCID: PMC4885778 DOI: 10.1016/j.psychres.2016.04.043] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2015] [Revised: 02/15/2016] [Accepted: 04/15/2016] [Indexed: 11/19/2022]
Abstract
The World Health Organization's posttraumatic stress disorder (PTSD) work group has published a proposal for the forthcoming edition of the International Classification of Diseases (ICD-11) that would yield a very different diagnosis relative to DSM-5. This study examined the impact of the proposed ICD-11 changes on PTSD prevalence relative to the ICD-10 and DSM-5 definitions and also evaluated the extent to which these changes would accomplish the stated aim of reducing the comorbidity associated with PTSD. Diagnostic prevalence estimates were compared using a U.S. national community sample and two U.S. Department of Veterans Affairs clinical samples. The ICD-11 definition yielded prevalence estimates 10-30% lower than DSM-5 and 25% and 50% lower than ICD-10 with no reduction in the prevalence of common comorbidities. Findings suggest that by constraining the diagnosis to a narrower set of symptoms, the proposed ICD-11 criteria set would substantially reduce the number of individuals with the disorder. These findings raise doubt about the extent to which the ICD-11 proposal would achieve the aim of reducing comorbidity associated with PTSD and highlight the public health and policy implications of such a redefinition.
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15
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Haravuori H, Kiviruusu O, Suomalainen L, Marttunen M. An evaluation of ICD-11 posttraumatic stress disorder criteria in two samples of adolescents and young adults exposed to mass shootings: factor analysis and comparisons to ICD-10 and DSM-IV. BMC Psychiatry 2016; 16:140. [PMID: 27176723 PMCID: PMC4864920 DOI: 10.1186/s12888-016-0849-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Accepted: 05/04/2016] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND The proposed posttraumatic stress disorder (PTSD) criteria for the International Classification of Diseases (ICD) 11th revision are simpler than the criteria in ICD-10, DSM-IV or DSM-5. The aim of this study was to evaluate the ICD-11 PTSD factor structure in samples of young people, and to compare PTSD prevalence rates and diagnostic agreement between the different diagnostic systems. Possible differences in clinical characteristics of the PTSD cases identified by ICD-11, ICD-10 and DSM-IV are explored. METHODS Two samples of adolescents and young adults were followed after exposure to similar mass shooting incidents in their schools. Semi-structured diagnostic interviews were performed to assess psychiatric diagnoses and PTSD symptom scores (N = 228, mean age 17.6 years). PTSD symptom item scores were used to compose diagnoses according to the different classification systems. RESULTS Confirmatory factor analyses indicated that the proposed ICD-11 PTSD symptoms represented two rather than three factors; re-experiencing and avoidance symptoms comprised one factor and hyperarousal symptoms the other factor. In the studied samples, the three-factor ICD-11 criteria identified 51 (22.4%) PTSD cases, the two-factor ICD-11 identified 56 (24.6%) cases and the DSM-IV identified 43 (18.9%) cases, while the number of cases identified by ICD-10 was larger, being 85 (37.3%) cases. Diagnostic agreement of the ICD-11 PTSD criteria with ICD-10 and DSM-IV was moderate, yet the diagnostic agreement turned to be good when an impairment criterion was imposed on ICD-10. Compared to ICD-11, ICD-10 identified cases with less severe trauma exposure and posttraumatic symptoms and DSM-IV identified cases with less severe trauma exposure. CONCLUSIONS The findings suggest that the two-factor model of ICD-11 PTSD is preferable to the three-factor model. The proposed ICD-11 criteria are more restrictive compared to the ICD-10 criteria. There were some differences in the clinical characteristics of the PTSD cases identified by ICD-11, when compared to ICD-10 and DSM-IV.
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Affiliation(s)
- Henna Haravuori
- Department of Health, Mental Health Unit, National Institute for Health and Welfare, P.O. Box 30, FI-00271, Helsinki, Finland. .,Adolescent Psychiatry, University of Helsinki and Helsinki University Hospital, HUS, P.O. Box 590, FI-00029, Helsinki, Finland.
| | - Olli Kiviruusu
- Department of Health, Mental Health Unit, National Institute for Health and Welfare, P.O. Box 30, FI-00271 Helsinki, Finland
| | - Laura Suomalainen
- Adolescent Psychiatry, University of Helsinki and Helsinki University Hospital, HUS, P.O. Box 590, FI-00029 Helsinki, Finland
| | - Mauri Marttunen
- Department of Health, Mental Health Unit, National Institute for Health and Welfare, P.O. Box 30, FI-00271 Helsinki, Finland ,Adolescent Psychiatry, University of Helsinki and Helsinki University Hospital, HUS, P.O. Box 590, FI-00029 Helsinki, Finland
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16
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Sachser C, Goldbeck L. Consequences of the Diagnostic Criteria Proposed for the ICD-11 on the Prevalence of PTSD in Children and Adolescents. J Trauma Stress 2016; 29:120-3. [PMID: 26915520 DOI: 10.1002/jts.22080] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
In 2013, a working group of the World Health Organization (WHO) proposed a reformulation of the posttraumatic stress disorder (PTSD) diagnostic criteria for the upcoming 11(th) edition of the International Classification of Diseases (ICD-11; Maercker, Brewin, Bryant, Cloitre, van Ommeren, et al., 2013). This study investigated the consequences of the proposed ICD-11 PTSD symptom reduction on the prevalence of PTSD in children and adolescents. Prevalence rates of PTSD in a clinical sample of 159 traumatized children and adolescents were compared applying criteria according to the 4(th) edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV; American Psychiatric Association, 1994), the ICD-10 (WHO, 1992), and the ICD-11. The prevalence rate was 76.1% using DSM-IV, 88.1% using ICD-10, and 61.0% using ICD-11. The use of the criteria proposed for ICD-11 resulted in 27.1% less positive cases compared with ICD-10 and 15.1% less positive cases compared with DSM-IV. Our results showed that in a clinical sample of children and adolescents the prevalence of PTSD was significantly affected by the use of different diagnostic systems. This will constitute a major challenge for research and practice because, depending on the algorithm used, different groups of patients will be included in studies and different groups of individuals will be able to access medical care and therapy.
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Affiliation(s)
- Cedric Sachser
- Department of Child and Adolescent Psychiatry/Psychotherapy, University of Ulm, Ulm, Germany
| | - Lutz Goldbeck
- Department of Child and Adolescent Psychiatry/Psychotherapy, University of Ulm, Ulm, Germany
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17
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Brewin CR. Re-experiencing traumatic events in PTSD: new avenues in research on intrusive memories and flashbacks. Eur J Psychotraumatol 2015; 6:27180. [PMID: 25994019 PMCID: PMC4439411 DOI: 10.3402/ejpt.v6.27180] [Citation(s) in RCA: 91] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2015] [Revised: 02/22/2015] [Accepted: 02/26/2015] [Indexed: 11/14/2022] Open
Abstract
Posttraumatic flashbacks, consisting of the intrusive re-experiencing of traumatic experiences in the present, have been more clearly defined for the first time in DSM-5 and have been identified as a unique symptom of posttraumatic stress disorder in the proposed ICD-11 diagnostic criteria. Relatively little research into flashbacks has been conducted, however, and new research efforts are required to understand the cognitive and biological basis of this important symptom. In addition, there is considerable scope for research into how flashbacks should be assessed and into flashbacks occurring in different contexts, such as psychosis or intensive care.
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Affiliation(s)
- Chris R Brewin
- Clinical Educational & Health Psychology, University College London, London, United Kingdom;
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18
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O'Donnell ML, Alkamade N, Forbes D. Is Australia in the post-traumatic stress disorder petri dish? Aust N Z J Psychiatry 2015; 49:315-6. [PMID: 25698808 DOI: 10.1177/0004867415572413] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Meaghan L O'Donnell
- Australian Centre for Posttraumatic Mental Health, Carlton, Australia Department of Psychiatry, University of Melbourne, Melbourne, Australia
| | - Nathan Alkamade
- Australian Centre for Posttraumatic Mental Health, Carlton, Australia Department of Psychiatry, University of Melbourne, Melbourne, Australia
| | - David Forbes
- Australian Centre for Posttraumatic Mental Health, Carlton, Australia Department of Psychiatry, University of Melbourne, Melbourne, Australia
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19
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Stammel N, Abbing EM, Heeke C, Knaevelsrud C. Applicability of the ICD-11 proposal for PTSD: a comparison of prevalence and comorbidity rates with the DSM-IV PTSD classification in two post-conflict samples. Eur J Psychotraumatol 2015; 6:27070. [PMID: 25989951 PMCID: PMC4438098 DOI: 10.3402/ejpt.v6.27070] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2014] [Revised: 04/07/2015] [Accepted: 04/08/2015] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND The World Health Organization recently proposed significant changes to the posttraumatic stress disorder (PTSD) diagnostic criteria in the 11th edition of the International Classification of Diseases (ICD-11). OBJECTIVE The present study investigated the impact of these changes in two different post-conflict samples. METHOD Prevalence and rates of concurrent depression and anxiety, socio-demographic characteristics, and indicators of clinical severity according to ICD-11 in 1,075 Cambodian and 453 Colombian civilians exposed to civil war and genocide were compared to those according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV). RESULTS Results indicated significantly lower prevalence rates under the ICD-11 proposal (8.1% Cambodian sample and 44.4% Colombian sample) compared to the DSM-IV (11.2% Cambodian sample and 55.0% Colombian sample). Participants meeting a PTSD diagnosis only under the ICD-11 proposal had significantly lower rates of concurrent depression and a lower concurrent total score (depression and anxiety) compared to participants meeting only DSM-IV diagnostic criteria. There were no significant differences in socio-demographic characteristics and indicators of clinical severity between these two groups. CONCLUSIONS The lower prevalence of PTSD according to the ICD-11 proposal in our samples of persons exposed to a high number of traumatic events may counter criticism of previous PTSD classifications to overuse the PTSD diagnosis in populations exposed to extreme stressors. Also another goal, to better distinguish PTSD from comorbid disorders could be supported with our data.
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Affiliation(s)
- Nadine Stammel
- Department of Clinical Psychology and Psychotherapy, Freie Universität Berlin, Berlin, Germany.,Center for Torture Victims, Berlin, Germany;
| | - Eva M Abbing
- Department of Clinical Psychology and Psychotherapy, Freie Universität Berlin, Berlin, Germany
| | - Carina Heeke
- Department of Clinical Psychology and Psychotherapy, Freie Universität Berlin, Berlin, Germany.,Center for Torture Victims, Berlin, Germany
| | - Christine Knaevelsrud
- Department of Clinical Psychology and Psychotherapy, Freie Universität Berlin, Berlin, Germany.,Center for Torture Victims, Berlin, Germany
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20
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Hansen M, Hyland P, Armour C, Shevlin M, Elklit A. Less is more? Assessing the validity of the ICD-11 model of PTSD across multiple trauma samples. Eur J Psychotraumatol 2015; 6:28766. [PMID: 26450830 PMCID: PMC4598338 DOI: 10.3402/ejpt.v6.28766] [Citation(s) in RCA: 69] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2015] [Revised: 09/12/2015] [Accepted: 09/12/2015] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND In the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), the symptom profile of posttraumatic stress disorder (PTSD) was expanded to include 20 symptoms. An alternative model of PTSD is outlined in the proposed 11th edition of the International Classification of Diseases (ICD-11) that includes just six symptoms. OBJECTIVES AND METHOD The objectives of the current study are: 1) to independently investigate the fit of the ICD-11 model of PTSD, and three DSM-5-based models of PTSD, across seven different trauma samples (N=3,746) using confirmatory factor analysis; 2) to assess the concurrent validity of the ICD-11 model of PTSD; and 3) to determine if there are significant differences in diagnostic rates between the ICD-11 guidelines and the DSM-5 criteria. RESULTS The ICD-11 model of PTSD was found to provide excellent model fit in six of the seven trauma samples, and tests of factorial invariance showed that the model performs equally well for males and females. DSM-5 models provided poor fit of the data. Concurrent validity was established as the ICD-11 PTSD factors were all moderately to strongly correlated with scores of depression, anxiety, dissociation, and aggression. Levels of association were similar for ICD-11 and DSM-5 suggesting that explanatory power is not affected due to the limited number of items included in the ICD-11 model. Diagnostic rates were significantly lower according to ICD-11 guidelines compared to the DSM-5 criteria. CONCLUSIONS The proposed factor structure of the ICD-11 model of PTSD appears valid across multiple trauma types, possesses good concurrent validity, and is more stringent in terms of diagnosis compared to the DSM-5 criteria.
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Affiliation(s)
- Maj Hansen
- Department of Psychology, National Centre for Psychotraumatology, University of Southern Denmark, Odense M, Denmark;
| | - Philip Hyland
- School of Business, National College of Ireland, Dublin, Ireland
| | - Cherie Armour
- School of Psychology, Ulster University, Coleraine, UK
| | - Mark Shevlin
- School of Psychology, Ulster University, Coleraine, UK
| | - Ask Elklit
- Department of Psychology, National Centre for Psychotraumatology, University of Southern Denmark, Odense M, Denmark
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