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Grinsill R, Kolandaisamy M, Kerr K, Varker T, Khoo A. Prevalence of Complex Post-Traumatic Stress Disorder in Serving Military and Veteran Populations: A Systematic Review. TRAUMA, VIOLENCE & ABUSE 2024; 25:3377-3387. [PMID: 38651819 DOI: 10.1177/15248380241246996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/25/2024]
Abstract
Serving military personnel and veterans are known to be at elevated risk of post-traumatic stress disorder (PTSD), and some veterans have been shown to respond poorly to current standard treatments. Evidence so far suggests that according to the 11th edition of the International Classification of Diseases and Related Health Problems guidelines, complex PTSD (CPTSD) may be of higher prevalence in the general population than PTSD. The aim of the study was to investigate the prevalence of CPTSD compared to PTSD in serving and ex-serving military populations. A systematic review was conducted with the search criteria set to peer-reviewed English language journal articles, focusing on serving military or veteran populations, reporting on the prevalence of CPTSD, not restricted by year. Four comprehensive databases (Psycinfo, Pubmed, CINAHL, and Embase) were searched. Of the 297 identified articles, 16 primary studies were eligible for inclusion. The review was registered in the PROSPERO database (CRD42023416458), and results were reported based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Of the 16 studies, 13 demonstrated higher prevalence of CPTSD than PTSD. Studies were predominantly veteran focused. Prevalence of CPTSD ranged from 5% to 80.63%, while prevalence of PTSD ranged from 3.8% to 42.37%. There was high heterogeneity in study populations, preventing meta-analysis. This is the first systematic review to assess the prevalence of CPTSD in serving military and veteran populations, with the findings demonstrating a higher rate of CPTSD compared to PTSD. It is hoped that the review will assist clinicians and military and veteran health services with appropriate assessment, diagnosis, and intervention for those affected by CPTSD, as well as PTSD.
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Affiliation(s)
| | | | - Katelyn Kerr
- Toowong Private Hospital, QLD, Australia
- Australian Institute for Suicide Research and Prevention, Griffith University, Mt Gravatt, QLD, Australia
- Gallipoli Medical Research Foundation, Greenslopes Private Hospital, QLD, Australia
- Savoir Rooms Specialist Medial Practice, Milton, QLD, Australia
| | - Tracey Varker
- Phoenix Australia-Centre for Posttraumatic Mental Health, University of Melbourne, Carlton, VIC, Australia
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Karimov-Zwienenberg M, Symphor W, Peraud W, Décamps G. Childhood trauma, PTSD/CPTSD and chronic pain: A systematic review. PLoS One 2024; 19:e0309332. [PMID: 39213321 PMCID: PMC11364226 DOI: 10.1371/journal.pone.0309332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Accepted: 08/09/2024] [Indexed: 09/04/2024] Open
Abstract
BACKGROUND Despite the growing body of literature on posttraumatic stress disorder (PTSD) and chronic pain comorbidity, studies taking into account the role of childhood exposure to traumatic and adverse events remains minimal. Additionally, it has been well established that survivors of childhood trauma may develop more complex reactions that extend beyond those observed in PTSD, typically categorized as complex trauma or CPTSD. Given the recent introduction of CPTSD within diagnostic nomenclature, the aim of the present study is to describe associations between childhood trauma in relation to PTSD/CPTSD and pain outcomes in adults with chronic pain. METHODS Following PRSIMA guidelines, a systematic review was performed using the databases Pubmed, PsychInfo, Psychology and Behavioral Sciences Collection, and Web of Science. Articles in English or French that reported on childhood trauma, PTSD/CPTSD and pain outcomes in individuals with chronic pain were included. Titles and abstracts were screened by two authors independently and full texts were consequently evaluated and assessed on methodological quality using JBI checklist tools. Study design and sample characteristics, childhood trauma, PTSD/CPTSD, pain outcomes as well as author's recommendations for scientific research and clinical practice were extracted for analyses. RESULTS Of the initial 295 search records, 13 studies were included in this review. Only four studies explicitly assessed links between trauma factors and pain symptoms in individuals with chronic pain. Findings highlight the long-term and complex impact of cumulative childhood maltreatment (e.g., abuse and neglect) on both PTSD/CPTSD and chronic pain outcomes in adulthood. CONCLUSION This review contributes to current conceptual models of PTSD and chronic pain comorbidity, while adding to the role of childhood trauma and CPTSD. The need for clinical and translational pain research is emphasized to further support specialized PTSD/CPTSD treatment as well as trauma-informed pain management in routine care.
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Affiliation(s)
- Maria Karimov-Zwienenberg
- Centre Hospitalier Agen-Nérac, Agen, France
- UR 4139 Laboratoire de Psychologie, Université de Bordeaux, Bordeaux, France
| | - Wilfried Symphor
- UR 4139 Laboratoire de Psychologie, Université de Bordeaux, Bordeaux, France
| | - William Peraud
- UR 4139 Laboratoire de Psychologie, Université de Bordeaux, Bordeaux, France
| | - Greg Décamps
- UR 4139 Laboratoire de Psychologie, Université de Bordeaux, Bordeaux, France
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Ellis É, Wieling E, Tate A. Complex Posttraumatic Stress Disorder Links Trauma Exposure and Suicidal Behaviors Among Sexual Minority Populations: A New Target in Suicide Prevention? JOURNAL OF HOMOSEXUALITY 2024; 71:2300-2318. [PMID: 37466931 DOI: 10.1080/00918369.2023.2233654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/20/2023]
Abstract
Exposure to potentially traumatic events and posttraumatic stress are known risk factors for suicidal thoughts and behaviors (STB). Research suggests that sexual minorities are disproportionately exposed to traumatic events and experience greater STB than their heterosexual peers, although few studies have explored connections between these parallel disparities. Further, existing literature may implicate complex posttraumatic stress disorder (CPTSD) as a potential mechanism in the trauma-suicide connection among sexual minorities. This study uses a sample from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC-III; n = 1351) to test structural equation models for associations between trauma exposure, heterosexist discrimination, and CPTSD with suicide attempt status. We found CPTSD mediated associations between exposure to traumatic events and presence of a lifetime suicide attempt among sexual minority male and female samples. Discrimination demonstrated a synergistic effect on the association between trauma exposure and CPTSD, but, among males, CPTSD did not fully explain associations between discrimination and suicide attempts. Our findings suggest that CPTSD should be considered an important mechanism in the trauma-suicide connection for sexual minorities and may be a potentially important target for suicide prevention and that interventions should address the influence of discrimination on traumatic stress in this high-risk population.
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Affiliation(s)
- Émilie Ellis
- College of Public Health, University of Georgia School of Public Health, Athens, Georgia, USA
| | - Elizabeth Wieling
- Human Development and Family Science, University of Georgia Department of Human Development and Family Science, Athens, Georgia, USA
| | - Allan Tate
- College of Public Health, University of Georgia School of Public Health, Athens, Georgia, USA
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Sakuma T, Muratsubaki T, Kano M, Kanazawa M, Fukudo S. Association between disturbance of self-organization and irritable bowel syndrome in Japanese population using the international trauma questionnaire. Sci Rep 2024; 14:18412. [PMID: 39117720 PMCID: PMC11310398 DOI: 10.1038/s41598-024-68196-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 07/22/2024] [Indexed: 08/10/2024] Open
Abstract
Disturbance of self-organization (DSO) is defined by affective dysregulation, negative self-concept, and disturbances in relationships. Along with post-traumatic stress disorder (PTSD), DSO is a part of complex post-traumatic stress disorder (CPTSD), which often results from childhood trauma and has life-long consequences. We investigated the association between CPTSD, PTSD, DSO, childhood adversity, and irritable bowel syndrome (IBS). Individuals with IBS exhibited markedly higher prevalences of DSO, CPTSD, and PTSD symptoms and higher trauma scores compared with healthy individuals. The odds of having IBS were 3.718 and 1.924 times greater for those with DSO symptoms (p < .001) and CPTSD symptoms (p = .005), respectively. IBS severity was highest in the DSO group, followed by the CPTSD, PTSD, and non-DSO/CPTSD/PTSD groups. DSO symptoms mediate the impact of childhood adversity on IBS symptoms, explaining half of this effect, whereas PTSD symptoms do not. These findings suggest a significant role of DSO in the development of IBS.
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Affiliation(s)
- Tomoko Sakuma
- Department of Behavioral Medicine, Tohoku University Graduate School of Medicine, 2-1 Seiryo-Machi, Aoba-Ku, Sendai, Miyagi, 980-8575, Japan
| | - Tomohiko Muratsubaki
- Department of Behavioral Medicine, Tohoku University Graduate School of Medicine, 2-1 Seiryo-Machi, Aoba-Ku, Sendai, Miyagi, 980-8575, Japan
| | - Michiko Kano
- Department of Behavioral Medicine, Tohoku University Graduate School of Medicine, 2-1 Seiryo-Machi, Aoba-Ku, Sendai, Miyagi, 980-8575, Japan
| | - Motoyori Kanazawa
- Department of Behavioral Medicine, Tohoku University Graduate School of Medicine, 2-1 Seiryo-Machi, Aoba-Ku, Sendai, Miyagi, 980-8575, Japan
| | - Shin Fukudo
- Department of Behavioral Medicine, Tohoku University Graduate School of Medicine, 2-1 Seiryo-Machi, Aoba-Ku, Sendai, Miyagi, 980-8575, Japan.
- Department of Psychosomatic Medicine, Tohoku University Hospital, Sendai, Japan.
- Research Center for Accelerator and Radioisotope Science, Tohoku University, Sendai, Japan.
- Department of Psychosomatic Medicine, Japanese Red Cross Ishinomaki Hospital, Ishinomaki, Japan.
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Gilroy H, Anderson K, Berry DM, Hirsch S, Johnson Makiya D, Ratcliff C. Stress and Trauma Among Nurses in Development (STAND): A Descriptive Study. Issues Ment Health Nurs 2024; 45:840-849. [PMID: 38843035 DOI: 10.1080/01612840.2024.2352588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/17/2024]
Abstract
BACKGROUND Mental health conditions related to traumatic stress exposure are common in practicing nurses. Less is known about the impact of trauma on nursing students and how it affects their transition to practice. OBJECTIVES The purpose of this study is to understand the experience of trauma exposure and resulting symptoms in undergraduate nursing students. DESIGN This is an analysis of baseline data from a longitudinal study. Students in an undergraduate nursing program completed a survey with validated instruments to measure trauma exposure, risk and protective factors, and trauma symptoms. SETTINGS The study took place in an undergraduate nursing program in the United States. PARTICIPANTS A total of 248 nursing students participated in the study. RESULTS The nursing students reported a higher number of adverse childhood experiences and post-traumatic stress disorder (PTSD) symptoms than the general population. Additionally, mental health symptoms and burnout symptoms increased over time. CONCLUSIONS Nursing students are at high risk for PTSD and other mental health conditions due to cumulative trauma. Interventions are needed to address trauma in developing nurses.
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Affiliation(s)
- Heidi Gilroy
- Memorial Hermann Health System, The Woodlands, Texas, USA
| | - Kennedy Anderson
- School of Nursing, Sam Houston State University, The Woodlands, Texas, USA
| | - Devon M Berry
- School of Nursing, Sam Houston State University, The Woodlands, Texas, USA
| | - Sarah Hirsch
- School of Nursing, Sam Houston State University, The Woodlands, Texas, USA
| | | | - Chelsea Ratcliff
- School of Nursing, Sam Houston State University, The Woodlands, Texas, USA
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Fung HW, Lee K, Wang EKS, Wong JYH. Trauma-related mental health problems among mothers in Taiwan and their relationship with children's emotional and behavioral problems. Eur J Psychotraumatol 2024; 15:2382554. [PMID: 39082192 PMCID: PMC11293261 DOI: 10.1080/20008066.2024.2382554] [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: 03/27/2024] [Revised: 06/18/2024] [Accepted: 07/10/2024] [Indexed: 08/03/2024] Open
Abstract
ABSTRACTBackground: Trauma can give rise to mental health problems and emotional and interpersonal difficulties, which in turn can perpetuate the cycle of trauma and adversity for future generations. However, little is known about the prevalence and potential effects of trauma and trauma-related mental health problems among parents.Objective: The primary goal of this study was to examine childhood and adulthood trauma and trauma-related symptoms among mothers of children aged between 6 and 18. We also conducted exploratory analyses of their potential relationship with children's emotional and behavioural problems.Method: A total of 817 mothers living with a child aged between 6 and 18 in Taiwan completed standardized self-report assessments of trauma exposure, trauma-related symptoms, and children's emotional and behavioural problems. A subsample (n = 256) also provided follow-up data after six months.Results: Most surveyed mothers reported at least one childhood traumatic event (74.79%) and one adulthood traumatic event (78.70%); 4.4% met the ICD-11 criteria for PTSD, and 12.1% for complex PTSD; 11.4% reported clinically significant dissociative symptoms. Mothers' complex PTSD and dissociative symptoms were cross-sectionally correlated with children's emotional and behavioural problem (rs = .186 to .239, p < .001). After controlling for possible confounding variables and baseline scores, mothers' childhood non-betrayal trauma reported at baseline was found to be a predictor of children's emotional and behavioural problems reported at follow up.Conclusion: This study is the first to provide data regarding childhood and adulthood trauma and trauma-related disorders, including ICD-11 complex PTSD, among mothers in the community. It calls for more studies to understand the potential effects of intergenerational trauma.
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Affiliation(s)
- Hong Wang Fung
- School of Nursing and Health Studies, Hong Kong Metropolitan University, Ho Man Tin, Hong Kong
| | - Kunhua Lee
- Department of Educational Psychology and Counseling, National Tsing Hua University, Hsinchu City, Taiwan
| | - Edward K. S. Wang
- Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Janet Yuen-Ha Wong
- School of Nursing and Health Studies, Hong Kong Metropolitan University, Ho Man Tin, Hong Kong
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Hyland P, Shevlin M, Martsenkovskyi D, Ben-Ezra M, Brewin CR. Testing predictions from the memory and identity theory of ICD-11 complex posttraumatic stress disorder: Measurement development and initial findings. J Anxiety Disord 2024; 105:102898. [PMID: 38991292 DOI: 10.1016/j.janxdis.2024.102898] [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: 03/23/2024] [Revised: 05/29/2024] [Accepted: 07/05/2024] [Indexed: 07/13/2024]
Abstract
BACKGROUND The 'Memory and Identity Theory' of ICD-11 Complex Posttraumatic Stress Disorder (CPTSD) was recently published but has not yet been subjected to empirical testing. The objective of this study was to evaluate newly developed measures of memory and identity disturbances and test hypothesized structural relations between these constructs and CPTSD symptoms. METHODS Self-report data were collected from a nationwide sample of adults living in Ukraine (N = 2050) in September 2023. Exploratory factor analysis was used to assess the latent structure of the newly developed measures, and structural equation modeling was used to test the associations between memory and identity disturbances and CPTSD symptoms. RESULTS 90 % of participants experienced a lifetime trauma, and 9.2 % screened positive for ICD-11 CPTSD. Results indicated that the newly developed measures of memory and identity problems possessed satisfactory psychometric properties, and all but one of the model-implied structural associations were observed. CONCLUSION This study provides initial empirical support for the Memory and Identity theory of ICD-11 CPTSD, indicating that the basis of this disorder lies in distinct memory and identity processes. Several effects not predicted by the theory were observed, and these can provide the basis for further model testing and refinement.
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Affiliation(s)
- Philip Hyland
- Department of Psychology, Maynooth University, Kildare, Ireland.
| | - Mark Shevlin
- School of Psychology, Ulster University, Derry, Northern Ireland, UK
| | - Dmytro Martsenkovskyi
- Department of Psychiatry and Narcology, Bogomolets National Medical University, Kyiv, Ukraine; SI Institute of Psychiatry, Forensic Psychiatric Examination and Drug Monitoring of Ministry of Health of Ukraine, Kyiv, Ukraine
| | | | - Chris R Brewin
- Division of Psychology and Language Sciences, University College London, London, England, UK
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Lortye SA, Will JP, Rameckers SA, Marquenie LA, Goudriaan AE, Arntz A, de Waal MM. Types of childhood maltreatment as predictors of posttraumatic stress disorder severity and complex posttraumatic stress disorder in patients with substance use disorders. Eur J Psychotraumatol 2024; 15:2367179. [PMID: 38934350 PMCID: PMC11212561 DOI: 10.1080/20008066.2024.2367179] [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: 08/28/2023] [Accepted: 05/26/2024] [Indexed: 06/28/2024] Open
Abstract
Background: Childhood maltreatment (CM) can be divided into: emotional abuse (EA), physical abuse (PA), sexual abuse (SA), emotional neglect (EN), and physical neglect (PN). CM is associated with (Complex)Posttraumatic stress disorder (PTSD/CPTSD) and substance use disorder (SUD).Objective: This cross-sectional study examined the relationships between CM-subtypes with PTSD-severity and CPTSD in patients with SUD-PTSD.Method: Participants (N = 209) were treatment-seeking SUD-PTSD patients who completed the Childhood Trauma Questionnaire-short form, the Clinician-Administered PTSD Scale for DSM-5 and the International Trauma Questionnaire. Regression analyses and a model selection procedure to select an optimal model were used to examine CM-subtypes as predictors of (C)PTSD, adjusted for sex and age.Results: Total CM and all CM-types significantly predicted PTSD-severity in the univariate regression analysis, with EA begin the strongest predictor. In the multiple regression only SA predicted PTSD-severity. Subsequently, model selection indicated that the optimal model to predict PTSD-severity included EA and SA. In the univariate analyses total CM, EA, and PN significantly predicted CPTSD-classification, and total CM and all CM-types significantly predicted CPTSD-severity. In the multiple regression for CPTSD-classification only EA and PA were significant predictors and for CPTSD-severity EA, PA and SA were significant predictors. In post-hoc multiple regression analyses, only EA was a significant predictor of CPTSD-classification and CPTSD-severity. Finally, in the model selection the most parsimonious model only included EA for both CPTSD-classification and CPTSD-severity. Sex was not a moderator in the relationship between CM and PTSD, nor in CM and CPTSD.Conclusions: These findings indicate that for SUD-PTSD patients, several CM-types have predictive value for (C)PTSD-severity, however SA and especially EA appear to contribute to these complaints. Since EA does not constitute an A-criterion, it is generally more overlooked in PTSD treatment. Its impact should therefore be underlined, and clinicians should be attentive to EA in their treatment.
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Affiliation(s)
- Sera A. Lortye
- Arkin Mental Health Care, Jellinek, Amsterdam Institute for Addiction Research, Amsterdam, The Netherlands
| | - Joanne P. Will
- Arkin Mental Health Care, Jellinek, Amsterdam Institute for Addiction Research, Amsterdam, The Netherlands
| | - Sophie A. Rameckers
- Department of Clinical Psychology, University of Amsterdam, Amsterdam, The Netherlands
| | - Loes A. Marquenie
- Arkin Mental Health Care, Jellinek, Amsterdam Institute for Addiction Research, Amsterdam, The Netherlands
| | - Anna E. Goudriaan
- Arkin Mental Health Care, Jellinek, Amsterdam Institute for Addiction Research, Amsterdam, The Netherlands
- Department of Psychiatry, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Arnoud Arntz
- Department of Clinical Psychology, University of Amsterdam, Amsterdam, The Netherlands
| | - Marleen M. de Waal
- Arkin Mental Health Care, Jellinek, Amsterdam Institute for Addiction Research, Amsterdam, The Netherlands
- Department of Psychiatry, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
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Lofthouse K, Beeson E, Dalgleish T, Danese A, Hodgekins J, Mahoney-Davies G, Smith P, Stallard P, Wilson J, Meiser-Stedman R. Characteristics of complex posttraumatic stress disorder (PTSD) in young people with PTSD following multiple trauma exposure. J Child Psychol Psychiatry 2024; 65:822-831. [PMID: 37994207 DOI: 10.1111/jcpp.13918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/13/2023] [Indexed: 11/24/2023]
Abstract
BACKGROUND Complex PTSD (CPTSD) is a relatively new diagnosis. The objective of the present study was to investigate how trauma characteristics, comorbid psychopathology and cognitive and social factors experienced by children and adolescents with a posttraumatic stress disorder (PTSD) diagnosis following exposure to multiple traumatic events differs between those who meet the criteria for CPTSD and those who do not. METHOD The present research used baseline data from the DECRYPT trial (BMJ Open, 2021, 11, e047600). Participants (n = 120) were aged 8-17 years and had exposure to multiple traumas and a PTSD diagnosis. The data collected comprised self-report and parent/caregiver-report questionnaires and interviews. Three primary analyses were conducted, comparing number of trauma types, prevalence of sexual trauma and prevalence of intrafamilial abuse between the CPTSD and PTSD-only groups. A range of comorbid psychopathology and cognitive and social factors were compared between the groups in an exploratory secondary analysis. All analyses were preregistered. RESULTS The CPTSD group (n = 72, 60%) had a significantly higher frequency of sexual trauma than the PTSD-only group (n = 48, 40%). The groups did not significantly differ on number of trauma types or prevalence of intrafamilial abuse. From the secondary analysis, the CPTSD group were found to have significantly higher scores on measures of negative post-traumatic cognitions, depression and panic. These results were replicated in correlation analyses using a continuous measure of CPTSD symptoms. CONCLUSIONS A large proportion of youth exposed to multiple traumatic events met criteria for CPTSD. Sexual trauma appears to be related to CPTSD symptoms. Youth with CPTSD appear to have greater severity of comorbid depression and panic symptoms, as well as more negative post-traumatic cognitions. Further investigation could focus on the directionality and mechanisms for these associations.
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Affiliation(s)
- Katie Lofthouse
- Department of Clinical Psychology and Psychological Therapies, Norwich Medical School, University of East Anglia, Norwich, UK
| | - Ella Beeson
- Hertfordshire Partnership University NHS Foundation Trust, St Albans, UK
| | - Tim Dalgleish
- MRC Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK
- Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK
| | - Andrea Danese
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- Social, Genetic and Developmental Psychiatry Centre, King's College London, London, UK
| | - Joanne Hodgekins
- Department of Clinical Psychology and Psychological Therapies, Norwich Medical School, University of East Anglia, Norwich, UK
- Norfolk and Suffolk NHS Foundation Trust, Norwich, UK
| | | | - Patrick Smith
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | | | - Jon Wilson
- Norfolk and Suffolk NHS Foundation Trust, Norwich, UK
| | - Richard Meiser-Stedman
- Department of Clinical Psychology and Psychological Therapies, Norwich Medical School, University of East Anglia, Norwich, UK
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Ho GWK, Chan KL, Karatzias T, Hyland P, Fung HW, Shevlin M. Prevalence and validity of ICD-11 posttraumatic stress disorder (PTSD) and complex PTSD: A population-based survey of Hong Kong adults. Asian J Psychiatr 2024; 96:104045. [PMID: 38643682 DOI: 10.1016/j.ajp.2024.104045] [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: 07/05/2023] [Revised: 03/29/2024] [Accepted: 04/06/2024] [Indexed: 04/23/2024]
Abstract
The present study aimed to report the prevalence of ICD-11 posttraumatic stress disorder (PTSD) and complex PTSD (CPTSD) in the general adult Hong Kong population, and examine the validity of the Chinese International Trauma Questionnaire (ITQ). This descriptive cross-sectional population-based telephone survey included a representative sample of 1070 non-institutionalized permanent Hong Kong residents ages 18-64 years. Participants provided responses to the Chinese version of the ITQ, and measures of adverse childhood experiences (ACEs), depression, anxiety, and stress. Based on the diagnostic algorithm of the ITQ, 5.9% of the sample screened positive for either CPTSD or PTSD, with CPTSD (4.2%) being more common that PTSD (1.7%). Results of the confirmatory factor analysis indicated the first-order correlated 6-factor model to be the best fitting solution. Symptom cluster summed scores were all positively and significantly correlated with all criterion variables. This investigation established the prevalence rates of ICD-11 PTSD and CPTSD using a general adult population sample in Hong Kong. The Chinese ITQ demonstrated sound factorial validity and concurrent validity. Future research can further characterize ICD-11 PTSD and CPTSD in subgroups using the Chinese ITQ.
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Affiliation(s)
- Grace W K Ho
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong, SAR China.
| | - Ko Ling Chan
- Department of Applied Social Sciences, The Hong Kong Polytechnic University, Hong Kong, SAR China
| | - Thanos Karatzias
- School of Health & Social Care, Edinburgh Napier University, United Kingdom
| | - Philip Hyland
- Department of Psychology, Maynooth University, Ireland
| | - Hong Wang Fung
- Department of Social Work, Hong Kong Baptist University, Hong Kong, SAR China
| | - Mark Shevlin
- School of Psychology, Ulster University, United Kingdom
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11
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Aprigio I, Dos Santos PPP, Gauer G. International Trauma Questionnaire and Posttraumatic Cognitions Inventory-9: validity evidence and measurement invariance of their Brazilian versions. PSICOLOGIA-REFLEXAO E CRITICA 2024; 37:18. [PMID: 38710873 DOI: 10.1186/s41155-024-00297-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Accepted: 04/02/2024] [Indexed: 05/08/2024] Open
Abstract
BACKGROUND The International Trauma Questionnaire (ITQ) is used to measure posttraumatic stress disorder (PTSD) and complex posttraumatic stress disorder (CPTSD) symptoms, and the Posttraumatic Cognitions Inventory-9 (PTCI-9) is used to measure posttraumatic cognitions. Both tools have been translated for use in Brazil. However, the psychometric properties of the Brazilian versions were not investigated, and no study has verified the invariance of these tools for many traumatic event types. OBJECTIVE This study examined the validity, reliability, and measurement invariance of the Brazilian versions of the ITQ and the PTCI-9 for trauma type, gender, race, age group, education level, and geographical region. METHODS A total of 2,111 people (67.74% women) participated in an online survey. The scale models were tested via confirmatory factor analyses and measurement invariance through multigroup analyses. Pearson's correlation analyses were used to examine the relationships between PTSD, CPTSD, posttraumatic cognitions, and depressive symptoms. RESULTS Except for the affective dysregulation factor, the reliabilities of the ITQ and PTCI-9 dimensions were adequate. Models with six correlated dimensions for the ITQ and three correlated dimensions for the PTCI-9 showed adequate fit to the data. The ITQ and PTCI-9 exhibited scalar invariance for gender, race, age group, education level, and geographical region. The ITQ also demonstrated full invariance for trauma type. The factors of both instruments were related to each other and to depressive symptoms, with higher effect sizes for posttraumatic cognitions and complex posttraumatic stress disorder symptoms. CONCLUSION We recommend using the Brazilian versions of the ITQ and PTCI-9, which are crucial tools for assessing and treating trauma-related disorders.
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Affiliation(s)
- Isabelle Aprigio
- Federal University of Rio Grande do Sul (UFRGS), Rua Ramiro Barcelos, 2600, Room 227, Porto Alegre, RS, CEP 91900-410, Brazil.
| | | | - Gustavo Gauer
- Federal University of Rio Grande do Sul (UFRGS), Rua Ramiro Barcelos, 2600, Room 227, Porto Alegre, RS, CEP 91900-410, Brazil
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12
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Cohen M, Nakash O, Apter-Levy Y. Gender Differences in the Relationship between Lifetime Exposure to Trauma and the Development of Pathological Personality Traits. J Trauma Dissociation 2024; 25:394-407. [PMID: 38376101 DOI: 10.1080/15299732.2024.2320436] [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: 05/10/2023] [Accepted: 11/20/2023] [Indexed: 02/21/2024]
Abstract
Gender differences in the prevalence, types and outcomes of traumas have consistently been reported in the literature. Other research has documented that exposure to trauma is associated with the development and maintenance of pathological personality traits. In the current study, we examined the moderating role of gender in the association between lifetime exposure to trauma and pathological personality traits. The sample included 148 clients who sought treatment at a community mental health clinic. All participants completed online questionnaires including demographic information, the Trauma History Questionnaire (THQ), and the Personality Inventory for DSM-5-Brief Form (PID-5-BF) at the entry to treatment. Our findings documented a significant association between exposure to trauma and pathological personality traits in men, but not in women. Furthermore, this pattern of results was specifically evident within two personality domains: antagonism and detachment. These findings contribute to the theoretical understanding of the interplay between trauma, gender, and the development of pathological personality traits. They expand upon the growing knowledge about the mental health crisis among boys and men by shedding light on the unique vulnerabilities that men face in response to traumatic experiences and how these experiences can have a lasting impact on their adaptive functioning. Consequently, at the clinical level, the current study emphasizes the importance of paying particular attention to men's trauma histories and explicitly exploring these during the intake session.
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Affiliation(s)
- Michal Cohen
- Baruch Ivcher School of Psychology, Reichman University, Herzliya, Israel
- School for Social Work, Smith College, Northampton, Massachusetts, USA
| | - Ora Nakash
- School for Social Work, Smith College, Northampton, Massachusetts, USA
| | - Yael Apter-Levy
- Baruch Ivcher School of Psychology, Reichman University, Herzliya, Israel
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Karatzias T, Shevlin M, Cloitre M, Busuttil W, Graham K, Hendrikx L, Hyland P, Biscoe N, Murphy D. Enhanced Skills Training in Affective and Interpersonal Regulation versus Treatment as Usual for ICD-11 Complex PTSD: A Pilot Randomised Controlled Trial (The RESTORE Trial). PSYCHOTHERAPY AND PSYCHOSOMATICS 2024; 93:203-215. [PMID: 38688242 PMCID: PMC11152001 DOI: 10.1159/000538428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 03/16/2024] [Indexed: 05/02/2024]
Abstract
INTRODUCTION Complex PTSD (CPTSD) is a relatively new condition in ICD-11. This pilot randomised controlled trial aimed to compare a four-module intervention developed to target all symptoms of ICD-11 CPTSD, namely Enhanced Skills in Affective and Interpersonal Regulation (ESTAIR) with treatment as usual (TAU). The purpose of the study was to assess feasibility, safety, acceptability, and preliminary outcomes at the end of treatment and 3-month follow-up. METHODS A total of N = 56 eligible veterans with CPTSD were randomised to either ESTAIR (n = 28) or TAU (n = 28). Linear mixed models were conducted to assess CPTSD severity, the primary outcome, as measured by the International Trauma Questionnaire (ITQ). RESULTS Treatment dropout in ESTAIR and TAU was low and equivalent (18% vs. 11%; χ2 (1) = 1.19, p = 0.275), and study retention was high, supporting the feasibility of the study. No serious adverse effects and very few adverse effects occurred, none of which were deemed related to the study. ESTAIR provided significantly greater reduction in CPTSD severity across time for ITQ PTSD (p < 0.001) and DSO (p < 0.001) symptoms. CPTSD pre-to-post effect sizes for ESTAIR were large (PTSD d = 1.78; DSO d = 2.00). Remission of probable CPTSD diagnosis at post-treatment was substantially greater in ESTAIR compared to TAU with only 13.6% versus 84% (p < 0.001) retaining the diagnosis. CONCLUSION A trial of ESTAIR versus TAU for the treatment of ICD-11 CPTSD indicates the potential efficacy of ESTAIR as well as its feasibility, safety, and acceptability.
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Affiliation(s)
- Thanos Karatzias
- School of Health and Social Care, Edinburgh Napier University, Edinburgh, UK
- NHS Lothian Rivers Centre for Traumatic Stress, Edinburgh, UK
| | - Mark Shevlin
- School of Psychology, Ulster University, Northern Ireland, UK
| | - Marylène Cloitre
- National Center for PTSD Dissemination and Training Division, VA Palo Alto Health Care System, Palo Alto, CA, USA
- Department of Psychiatry and Behavioural Sciences, Stanford University, Stanford, CA, USA
| | | | | | | | - Philip Hyland
- Department of Psychology, Maynooth University, Kildare, Ireland
| | | | - Dominic Murphy
- National Center for PTSD Dissemination and Training Division, VA Palo Alto Health Care System, Palo Alto, CA, USA
- King’s Centre for Military Research, Kings College London, London, UK
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14
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Swee MB, Corman AG, Margolis JM, Dick AM. Compassion-Focused Therapy for the Treatment of ICD-11-Defined Complex Posttraumatic Stress Disorder. Am J Psychother 2024:appipsychotherapy20230019. [PMID: 38680060 DOI: 10.1176/appi.psychotherapy.20230019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2024]
Abstract
The most effective treatments for ICD-11-defined complex posttraumatic stress disorder (CPTSD) remain unknown. Further research is needed to determine whether such treatments for CPTSD are the same as or different from-or require integration with-existing gold standard treatments for posttraumatic stress disorder (PTSD). Individuals with CPTSD experience the hallmark symptoms of PTSD (i.e., reexperiencing symptoms, avoidance symptoms, and the pervasive sense of perceived threat) and pervasive disturbances in self-organization, including affective dysregulation, negative self-concept, and difficulties with interpersonal relationships. Compassion-focused therapy (CFT) is a transdiagnostic approach that was originally developed to treat shame and self-criticism. CFT helps individuals learn how to regulate their emotions, shift their emotional response style from shaming and self-critical to wise and understanding, and engage in more compassionate and rewarding patterns of relating to self and others. This article describes CFT's possible application in the treatment of CPTSD and delineates areas for future research.
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Affiliation(s)
- Michaela B Swee
- Division of Depression and Anxiety Disorders, McLean Hospital, Belmont, Massachusetts (all authors); Department of Psychiatry, Harvard Medical School, Boston (Swee, Dick)
| | - Allison G Corman
- Division of Depression and Anxiety Disorders, McLean Hospital, Belmont, Massachusetts (all authors); Department of Psychiatry, Harvard Medical School, Boston (Swee, Dick)
| | - Jessica M Margolis
- Division of Depression and Anxiety Disorders, McLean Hospital, Belmont, Massachusetts (all authors); Department of Psychiatry, Harvard Medical School, Boston (Swee, Dick)
| | - Alexandra M Dick
- Division of Depression and Anxiety Disorders, McLean Hospital, Belmont, Massachusetts (all authors); Department of Psychiatry, Harvard Medical School, Boston (Swee, Dick)
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15
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Cloitre M, Lovelund AA, Jackson C, Edward D, Baker M. STAIR Narrative Therapy for complex posttraumatic stress disorder: Treating sexual and gender minority trauma. J Clin Psychol 2024; 80:836-854. [PMID: 37566386 DOI: 10.1002/jclp.23572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 05/02/2023] [Accepted: 07/19/2023] [Indexed: 08/12/2023]
Abstract
BACKGROUND Complex PTSD is a recent addition to the ICD-11 diagnostic system. AIMS This case study describes the delivery of Skills Training in Affective and Interpersonal Regulation and Narrative Therapy (SNT), a flexible, multi-component therapy that addresses the symptoms of complex posttraumatic stress disorder. SNT balances interventions that address current-day stressors with those that reappraise the meaning of traumatic past events. This paper outlines 16 sessions of SNT with a 55-year-old gay man. DISCUSSION The case analysis describes the ways in which SNT is relevant and effective in addressing the client's mulitple concerns. The skills work helped the client effectively manage ongoing minority stress, discrimination, and micro-aggressions related to his identity as a gay man. Review and re-appraisal of his traumatic memories, which focused on the sudden death of his partner from AIDS along with discussion of events from his childhood that shaped his reactions to this loss, allowed the client to create a more integrated sense of self as well as a more compassionate view of himself. Implications regarding the relevance of SNT for sexual and gender minority individuals are discussed.
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Affiliation(s)
- Marylene Cloitre
- National Center for PTSD Dissemination and Training Division, VA Palo Alto Healthcare System, Palo Alto, California, USA
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, California, USA
| | - Adrienne A Lovelund
- University of California San Francisco Alliance Health Project, San Francisco, California, USA
| | - Christie Jackson
- National Center for PTSD Dissemination and Training Division, VA Palo Alto Healthcare System, Palo Alto, California, USA
| | - Donovan Edward
- Psychology Department of Georgia Southern University, Statesboro, Georgia, USA
| | - Michelanne Baker
- University of California San Francisco Alliance Health Project, San Francisco, California, USA
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16
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Lonnen E, Paskell R. Gender, sex and complex PTSD clinical presentation: a systematic review. Eur J Psychotraumatol 2024; 15:2320994. [PMID: 38506757 PMCID: PMC10956909 DOI: 10.1080/20008066.2024.2320994] [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: 10/02/2023] [Accepted: 02/11/2024] [Indexed: 03/21/2024] Open
Abstract
Background: Post-traumatic stress disorder (PTSD) prevalence and clinical presentation reportedly vary with gender and/or sex. Equivalent complex PTSD (CPTSD) research is in its relative infancy and to date no systematic review has been conducted on this topic.Objective: To systematically review the literature and provide a narrative addressing the question of whether gender and/or sex differences exist in CPTSD prevalence and clinical presentation.Method: Embase, PsycINFO, PTSDpubs, PubMed, Web of Science, EThOS and Google Scholar were searched. Twelve papers were eligible for inclusion. Data were extracted and synthesised narratively.Results: Four themes were identified: (i) the reporting of gender and/or sex; (ii) index trauma; (iii) CPTSD prevalence rates; and (iv) CPTSD clinical presentation. Findings were mixed. Nine papers reported prevalence rates: eight found no gender and/or sex differences; one found higher diagnostic rates among women and/or females. Four papers reported clinical presentation: one reported higher cluster-level scores among women and/or females; two used single gender and/or sex samples; and one found higher scores in two clusters in men and/or males. Most papers failed to report in gender- and/or sex-sensitive ways.Conclusions: Gender- and sex-sensitive research and clinical practice is needed. Awareness in research and clinical practice is recommended regarding the intersect between identity and the experience and expression of complex trauma.
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Affiliation(s)
- Ella Lonnen
- Department of Psychology, University of Bath, Bath, UK
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17
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Harris J, Loth E, Sethna V. Tracing the paths: a systematic review of mediators of complex trauma and complex post-traumatic stress disorder. Front Psychiatry 2024; 15:1331256. [PMID: 38510809 PMCID: PMC10951104 DOI: 10.3389/fpsyt.2024.1331256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 02/20/2024] [Indexed: 03/22/2024] Open
Abstract
Complex trauma is associated with complex-posttraumatic stress disorder (CPTSD). While dissociative processes, developmental factors and systemic factors are implicated in the development of CPTSD, there are no existing systematic reviews examining the underlying pathways linking complex trauma and CPTSD. This study aims to systematically review evidence of mediating factors linking complex trauma exposure in childhood (birth to eighteen years of age) and subsequent development of CPTSD (via self-reports and diagnostic assessments). All clinical, at-risk and community-sampled articles on three online databases (PsycINFO, MedLine and Embase) were systematically searched, along with grey literature from ProQuest. Fifteen articles were eligible for inclusion according to pre-determined eligibility criteria and a search strategy. Five categories of mediating processes were identified: 1) dissociative processes; 2) relationship with self; 3) emotional developmental processes; 4) social developmental processes; and 5) systemic and contextual factors. Further research is required to examine the extent to which targeting these mediators may act as mechanisms for change in supporting individuals to heal from complex trauma. Systematic review registration https://www.crd.york.ac.uk/PROSPERO/, identifier CRD42022346152.
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Affiliation(s)
- Joseph Harris
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, England, United Kingdom
| | - Eva Loth
- Department of Forensic and Neurodevelopmental Science, School of Academic Psychiatry, King’s College London, London, England, United Kingdom
| | - Vaheshta Sethna
- Department of Social, Genetic & Developmental Psychiatry Centre, School of Mental Health & Psychological Sciences, King’s College London, London, England, United Kingdom
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18
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Ng MHS, Zainal NH, Newman MG. Positive reappraisal coping mediates the relationship between parental abuse and lack of affection on adulthood generalized anxiety severity. J Anxiety Disord 2024; 102:102826. [PMID: 38244467 PMCID: PMC10993168 DOI: 10.1016/j.janxdis.2024.102826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 12/23/2023] [Accepted: 01/05/2024] [Indexed: 01/22/2024]
Abstract
Exposure to parental abuse and lack of parental affection during childhood are risk factors for adulthood psychopathology. Tendency to engage in positive reappraisal may be a plausible mechanism underlying this relationship. The current study examined if positive reappraisal coping mediated the relationship between maternal/paternal abuse/affection and adulthood generalized anxiety disorder (GAD) symptoms. Participant data (N = 3294) from the Midlife Development in the United States study was collected in three waves, spaced nine years apart. Longitudinal structural equation mediation modeling examined whether positive reappraisal coping at Time 2 mediated the relationship between maternal/paternal abuse/affection at Time 1 and GAD symptoms at Time 3, controlling for GAD symptoms at Time 1. Positive reappraisal coping mediated maternal/paternal childhood abuse - GAD symptom severity and maternal/paternal childhood affection - GAD severity relations. Maternal and paternal abuse was associated with lower positive reappraisal tendencies, predicting increased GAD symptom severity. Conversely, higher maternal/paternal affection was associated with increased positive reappraisal, predicting lower GAD severity. Incremental prediction revealed that childhood abuse to GAD severity via positive reappraisal path was significant for maternal but not paternal abuse, whereas affection from both parents remained significant. Positive reappraisal coping may be a possible mechanism linking childhood experiences to adulthood GAD severity.
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Affiliation(s)
- Matthew H S Ng
- Rehabilitation Research Institute of Singapore, Nanyang Technological University, Singapore.
| | - Nur Hani Zainal
- Department of Health Care Policy, Harvard Medical School, USA; Department of Psychology, National University of Singapore, Singapore
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19
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Hamer R, Bestel N, Mackelprang JL. Dissociative Symptoms in Complex Posttraumatic Stress Disorder: A Systematic Review. J Trauma Dissociation 2024; 25:232-247. [PMID: 38112306 DOI: 10.1080/15299732.2023.2293785] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 07/07/2023] [Indexed: 12/21/2023]
Abstract
The 11th revision of the International Classification of Diseases (ICD-11) introduced Complex Posttraumatic Stress Disorder (CPTSD) as a sibling disorder to PTSD. Dissociative symptoms have been implicated in the severity of ICD-11 CPTSD; however, no reviews have investigated how dissociation has been measured in studies investigating CPTSD, nor the relationship between CPTSD and dissociation. This systematic review aimed to identify measures used to assess dissociative symptoms in studies that have assessed CPTSD according to ICD-11 criteria and to synthesize the relationship between these constructs. PsycINFO, PubMed, Scopus and Web of Science were searched on March 31, 2021. Seventeen articles met inclusion criteria. CPTSD was most frequently measured by a version of the International Trauma Questionnaire. Twelve measures were used to assess for dissociative symptoms, the most common being the Dissociative Symptoms Scale and the Dissociative Experiences Scale. The relationship between CPTSD and dissociative symptoms was moderate-to-strong, but inconsistently reported. Further research is needed to determine the most appropriate measure(s) of dissociation in CPTSD.
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Affiliation(s)
- Ruby Hamer
- Department of Psychological Sciences, Swinburne University of Technology, Melbourne, Australia
- Department of Medicine, School of Clinical Sciences, Monash University, Melbourne, Australia
| | | | - Jessica L Mackelprang
- Department of Psychological Sciences, Swinburne University of Technology, Melbourne, Australia
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20
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Shatrova D, Cáncer PF, Caperos JM. The role of interoception in reducing trauma-associated distress: a feasibility study. Eur J Psychotraumatol 2024; 15:2306747. [PMID: 38289065 PMCID: PMC10829842 DOI: 10.1080/20008066.2024.2306747] [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: 09/04/2023] [Accepted: 01/01/2024] [Indexed: 02/01/2024] Open
Abstract
Background: Altered interoception plays an important role in chronic stress and posttraumatic stress disorder. The aim of this study was to evaluate the feasibility of a Trauma Sensitive Yoga (TSY) intervention for improving emotional distress and psychological discomfort in women living under circumstances of social and gender vulnerability. We assessed the effect of the treatment on the interoceptive mechanisms, and whether the psychological improvements were mediated by the changes in these mechanisms.Methods: The study involved a sample of 62 women who attended public community centres dedicated to supporting women victims of gender-based violence or who were socially and economically disadvantaged because of their gender. Participants underwent a six-week TSY programme. We evaluated dropout rate, adherence, and intervention satisfaction. We measured emotional distress, psychological discomfort, interoceptive mechanisms, and two nonequivalent dependent variables to enhance internal validity. We compared pre-post differences using paired samples t-test and a structural equation model (SEM) analysis was performed to compare the changes in the outcomes with the changes in the nonequivalent dependent variables. Mediation models were adjusted to evaluate the role of changes in interoception on outcome changes.Results: Fourteen (23%) women dropped out, mainly after the first intervention session. Intervention adherence (mean attendance 5.3 over 6 sessions) and acceptability were high (mean satisfaction 3.4 over 4). We observed post-intervention improvements in anxiety, depression, psychological discomfort, body responsiveness, and interoceptive awareness. The changes in the outcomes were larger than the changes in the nonequivalent dependent variables. Additionally, we found that the changes in body responsiveness partially mediated the change in anxiety and psychological discomfort but not in depression.Conclusions: TSY could be an interesting therapeutic approach for women experiencing chronic posttraumatic stress symptomatology. Our findings underscore the role of interoceptive mechanisms in traumatic stress and emphasize the importance of addressing these aspects.
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Affiliation(s)
- Daria Shatrova
- UNINPSI, Dpto. de Psicología, Universidad Pontificia Comillas, Madrid, Spain
| | - Pablo F. Cáncer
- UNINPSI, Dpto. de Psicología, Universidad Pontificia Comillas, Madrid, Spain
| | - Jose Manuel Caperos
- UNINPSI, Dpto. de Psicología, Universidad Pontificia Comillas, Madrid, Spain
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Rusmir M, Rohner SL, Maercker A, Salas Castillo AN, Thoma MV. Predictors and (in-)stability of ICD-11 complex posttraumatic stress disorder in older adults: findings from a longitudinal study in Switzerland. Eur J Psychotraumatol 2024; 15:2299618. [PMID: 38258813 PMCID: PMC10810634 DOI: 10.1080/20008066.2023.2299618] [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: 10/10/2023] [Accepted: 12/12/2023] [Indexed: 01/24/2024] Open
Abstract
Objective: There is a lack of research on complex post-traumatic stress disorder (CPTSD) in older individuals, with little known about the temporal course of CPTSD. Therefore, this study assessed and compared the demographic characteristics, adverse childhood experiences (ACE), and well-being of Swiss older adults with and without probable CPTSD. The (in-)stability of probable CPTSD was also examined in relation to the predictive value of various emotion-related factors.Methods: A longitudinal study was conducted in Switzerland with N = 213 participants (Mage = 69.98 years, SD = 10.61; 45.5% female). Data was collected via face-to-face assessments at baseline and follow-up, 21 months apart. The German version of the International Trauma Questionnaire was used to screen for (C)PTSD. Standardized instruments were used to assess ACE as well as the predictors anger, embitterment, emotion regulation, and meaning in life.Results: From the total sample, n = 16 participants (7.5%) were identified as having probable CPTSD, with only five of these (31.25%) having probable CPTSD at both baseline and follow-up. Individuals with and without probable CPTSD differed significantly regarding age and employment status. Significant predictors of probable CPTSD were anger (β = 0.16), embitterment (β = 0.06), cognitive reappraisal (β = -0.41), and the presence of meaning in life (β = -0.10).Conclusions: Probable CPTSD appears to be relatively unstable over the course of a 21-month period in older individuals. The links between CPTSD and emotion-related predictors highlight potential targets for intervention.
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Affiliation(s)
- Milan Rusmir
- Psychopathology and Clinical Intervention, Institute of Psychology, University of Zurich, Zurich, Switzerland
| | - Shauna L. Rohner
- Competence Centre for Mental Health, Department of Health, OST – University of Applied Sciences of Eastern Switzerland, St. Gallen, Switzerland
- University Research Priority Program ‘Dynamics of Healthy Aging’, University of Zurich, Zurich, Switzerland
| | - Andreas Maercker
- Psychopathology and Clinical Intervention, Institute of Psychology, University of Zurich, Zurich, Switzerland
- University Research Priority Program ‘Dynamics of Healthy Aging’, University of Zurich, Zurich, Switzerland
| | - Aileen N. Salas Castillo
- Psychopathology and Clinical Intervention, Institute of Psychology, University of Zurich, Zurich, Switzerland
| | - Myriam V. Thoma
- Psychopathology and Clinical Intervention, Institute of Psychology, University of Zurich, Zurich, Switzerland
- University Research Priority Program ‘Dynamics of Healthy Aging’, University of Zurich, Zurich, Switzerland
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22
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Pinho M, Martins DO, Santos MF, Coutinho F. When Addressing Trauma Makes a Difference: A Case Report of Undiagnosed Complex Post-traumatic Stress Disorder. Cureus 2024; 16:e51640. [PMID: 38313901 PMCID: PMC10837782 DOI: 10.7759/cureus.51640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/03/2024] [Indexed: 02/06/2024] Open
Abstract
Complex post-traumatic stress disorder (C-PTSD) is an emergent diagnosis, which acknowledges the impact of prolonged interpersonal abuse on affect regulation, interpersonal functioning, and self-concept. We present the case of a 59-year-old woman who remained undiagnosed and untreated for this condition for three decades while under follow-up in mental health services for the diagnosis of personality disorder and bipolar disorder. The patient suffered repeated sexual abuse in her childhood, resulting in intrusive traumatic memories she emotionally and cognitively avoided, dissociative amnesia, a persistent inability to experience positive emotions, a persistent sense of guilt, re-experiencing phenomena, and hypervigilance toward others and their intentions to harm her. She persistently believed herself to be worthless, defective, inferior, and lacking value; had a history of affective dysregulation resulting in suspicion of bipolar disorder; and displayed a pattern of relationship avoidance. Addressing chronic trauma and assessing its impact offered deeper contextualization of the patient's symptoms and proved pivotal in redefining her diagnosis and providing access to trauma-focused psychotherapy, which is the mainstay of treatment for C-PTSD.
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Affiliation(s)
- Mauro Pinho
- Acute Psychiatry Service Unit, Centro Hospitalar Universitário de Santo António - Hospital de Magalhães Lemos, Porto, PRT
| | - Daniela O Martins
- Acute Psychiatry Service Unit, Centro Hospitalar Universitário de Santo António - Hospital de Magalhães Lemos, Porto, PRT
| | - Mónica F Santos
- Acute Psychiatry Service Unit, Centro Hospitalar Universitário de Santo António - Hospital de Magalhães Lemos, Porto, PRT
| | - Francisco Coutinho
- Acute Psychiatry Service Unit, Centro Hospitalar Universitário de Santo António - Hospital de Magalhães Lemos, Porto, PRT
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23
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Hyland P, Hamer R, Fox R, Vallières F, Karatzias T, Shevlin M, Cloitre M. Is Dissociation a Fundamental Component of ICD-11 Complex Posttraumatic Stress Disorder? J Trauma Dissociation 2024; 25:45-61. [PMID: 37401797 DOI: 10.1080/15299732.2023.2231928] [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: 06/29/2022] [Accepted: 05/09/2023] [Indexed: 07/05/2023]
Abstract
ICD-11 Complex Posttraumatic Stress Disorder (CPTSD) is a disorder of six symptom clusters including reexperiencing, avoidance, sense of threat, affective dysregulation, negative self-concept, and disturbed relationships. Unlike earlier descriptions of complex PTSD, ICD-11 CPTSD does not list dissociation as a unique symptom cluster. We tested whether the ICD-11 CPTSD symptoms can exist independently of dissociation in a nationally representative sample of adults (N = 1,020) who completed self-report measures. Latent class analysis was used to identify unique subsets of people with distinctive symptom profiles. The best fitting model contained four classes including a "low symptoms" class (48.9%), a "PTSD" class (14.7%), a "CPTSD" class (26.5%), and a "CPTSD + Dissociation" class (10.0%). These classes were related to specific adverse childhood experiences, notably experiences of emotional and physical neglect. The "PTSD," "CPTSD," and "CPTSD + Dissociation" classes were associated with a host of poor health outcomes, however, the "CPTSD + Dissociation" class had the poorest mental health and highest levels of functional impairment. Findings suggest that ICD-11 CPTSD symptoms can occur without corresponding dissociative experiences, however, when CPTSD symptoms and dissociative experiences occur together, health outcomes appear to be more severe.
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Affiliation(s)
- Philip Hyland
- Department of Psychology, Maynooth University, Kildare, Ireland
| | - Ruby Hamer
- Department of Medicine, Monash University, Melbourne, Australia
| | - Robert Fox
- School of Business, National College of Ireland, Dublin, Ireland
| | | | - Thanos Karatzias
- School of Health & Social Care, Edinburgh Napier University, Edinburgh, UK
- NHS Lothian Rivers Centre for Traumatic Stress, Edinburgh, UK
| | - Mark Shevlin
- School of Psychology, Ulster University, Coleraine, Northern, Ireland
| | - Marylene Cloitre
- National Center for PTSD Dissemination and Training Division, VA Palo Alto Health Care System, Palo Alto, California, USA
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, California, USA
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24
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Posttraumatic stress disorder in Belgian police officers: prevalence and the effects of exposure to traumatic events. Eur J Psychotraumatol 2023; 14:2156558. [PMID: 37052090 PMCID: PMC9869988 DOI: 10.1080/20008066.2022.2156558] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Background: Police officers are at considerable risk of developing posttraumatic symptoms because they frequently encounter violent or emotionally disturbing incidents. We investigate experiences with potentially traumatic events (PTE), traumatic exposure, and the prevalence of probable posttraumatic stress disorder (PTSD), complex PTSD and subclinical PTSD in a sample of Belgian police officers.Methods: In total, 1,465 police officers from 15 Belgian Local Police zones participated in a web-based survey, consisting of three segments: evaluating experiences with a list of 29 PTE, assessing if any of these PTE accounted for traumatic exposure, and evaluating 1-month probable PTSD, complex PTSD and subclinical PTSD prevalence using the International Trauma Questionnaire (ITQ).Results: Police officers frequently experience a wide range of PTE. A large majority of 93.0% reports traumatic exposure. Assessment with ITQ shows a 1-month prevalence of 5.87% for probable PTSD and 1.50% for probable complex PTSD, while an additional 7.58% report subclinical PTSD. No demographic variables influenced PTSD prevalence. Cumulative PTE experiences in itself did not predict PTSD, while the characteristics of certain PTE did entail a higher prevalence of probable PTSD and subclinical PTSD.Discussion: This study is the first to evaluate experiences with PTE, traumatic exposure and 1-month prevalence of probable PTSD, complex PTSD, and subclinical PTSD in Belgian police officers. Police officers are frequently confronted with a broad variety of PTE, and a large majority reports traumatic exposure. The 1-month prevalence of probable PTSD is significantly higher compared to previous international research in the general population, but lower than in similar international research involving police officers. In this study, cumulative PTE experiences in itself did not reliably predict PTSD, while the characteristics of certain PTE did. Posttraumatic symptoms are an important mental health challenge in Belgian police.
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Measuring post-traumatic stress disorder and complex post-traumatic stress disorder using the International Trauma Questionnaire: results from a Hungarian clinical and non-clinical sample. Eur J Psychotraumatol 2023; 14:2152929. [PMID: 37052096 PMCID: PMC9793941 DOI: 10.1080/20008066.2022.2152929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Background: The 11th revision of the International Classification of Diseases (ICD-11) simplified the description of post-traumatic stress disorder (PTSD) and also introduced a new trauma-related diagnosis called complex post-traumatic stress disorder (CPTSD). CPTSD is linked to earlier, prolonged interpersonal trauma, and is characterized by a broader range of symptoms, in addition to the core PTSD symptoms. The International Trauma Questionnaire (ITQ) has been developed to assess the new diagnostic criteria.Objectives: The primary aim of our study was to test the factor structure of the ITQ in a clinical and a non-clinical Hungarian sample. We also examined whether the degree of traumatization or the type of trauma experienced was associated with meeting the criteria for PTSD or CPTSD, or with the severity of PTSD or disturbances in self-organization (DSO) symptoms, in both samples.Method: A trauma-exposed heterogeneous clinical sample (N = 176) and a non-clinical sample (N = 229) filled out the ITQ and a modified version of the Life Events Checklist (LEC-5). The factor structure of the ITQ was tested by examining the model fit of seven competing confirmatory factor analysis models.Results: A two-factor second-order model with a second-order PTSD factor (measured by three first-order factors) and a DSO factor (measured directly by six symptoms) had the best fit to the data in both samples if an error correlation was allowed between negative self-concept items. Those in the clinical group who reported more interpersonal and childhood trauma experienced more PTSD and DSO symptoms. Also, there were significant, positive, and weak associations between the total number of different traumas and PTSD and DSO factor scores in both samples.Conclusion: ITQ was found to be a reliable tool to differentiate between PTSD and CPTSD, two related but distinct constructs in a clinical and a non-clinical trauma-exposed sample in Hungary.
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Expert international trauma clinicians’ views on the definition, composition and delivery of reintegration interventions for complex PTSD. Eur J Psychotraumatol 2023; 14:2165024. [PMID: 37052098 PMCID: PMC9848321 DOI: 10.1080/20008066.2023.2165024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Background: Research has previously distinguished between complex post-traumatic stress disorder (CPTSD) and PTSD, with the former including a range of disturbances in self-regulatory capacities in addition to difficulties associated with PTSD. Clinical guidelines have previously recommended a phase-based approach for the treatment of CPTSD, yet the final 'reintegration' phase of treatment has been overlooked in research, with limited evidence into its value and effectiveness, and inconsistencies in its definitions and understanding.Objective: We set out to define and determine the key principles of 'reintegration' and to specify the components and method of delivery of treatment.Method: Leading national and international clinical and academic experts in CPTSD were interviewed and asked about their views of how 'reintegration' should be defined, its role in the treatment of CPTSD, what it should be composed of, the key principles of its delivery, and how it should be evaluated. We analysed transcripts of the interviews following the principles of Codebook Thematic Analysis.Results: We conducted 16 interviews with leading national and international experts with at least 10 years' experience of treating people with CPTSD. Themes derived from our analysis demonstrated that while the definition and composition of reintegration varied greatly between experts, the key principles in its delivery were consistent across all experts.Conclusions: The results of this study lay the foundation for a framework of what reintegration is and how it can be used in, but also highlight the need for more research to be conducted on the role of reintegration in the treatment of CPTSD. Consensus for the definition and composition of reintegration is still yet to be reached. Possible measures for evaluating reintegration should also be explored in the future.
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Fernández-Fillol C, Hidalgo-Ruzzante N, Perez-Garcia M, Hyland P, Shevlin M, Karatzias T. The role of resilience in the relationship between intimate partner violence severity and ICD-11 CPTSD severity. Eur J Psychotraumatol 2023; 15:2285671. [PMID: 38156874 PMCID: PMC10763906 DOI: 10.1080/20008066.2023.2285671] [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: 05/29/2023] [Accepted: 10/19/2023] [Indexed: 01/03/2024] Open
Abstract
Background: Resilience is a modulating factor in the development of PTSD and CPTSD after exposure to traumatic events. However, the relationship between resilience and ICD-11 CPTSD is not adequately understood in survivors of intimate partner violence (IPV).Objective: The aim of this study is to determine whether resilience has a mediating role in the relationship between severity of violence and severity of CPTSD symptoms.Method: A sample of 202 women IPV survivors completed self-rated questionnaires to assess CPTSD, severity of violence and resilience.Results: Mediation analyses indicated that there was a direct relationship between the severity of violence and the severity of CPTSD symptoms (β = .113, p < .001) and that there was a significantly inverse relationship between levels of resilience and the severity of CPTSD symptoms (β = -.248, p < .001). At the same time, there was no significant relationship between the severity of violence and resilience (β = -.061, p = .254).Conclusions: These findings suggest that resilience does not mediate the relationship between violence severity and CPTSD severity. Directions for future research are discussed.
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Affiliation(s)
- Carmen Fernández-Fillol
- Department of Health Sciences, Valencian International University, Valencia, Spain
- Faculty of Health Sciences, Isabel I University, Burgos, Spain
- Mind, Brain and Behavior Research Center (CIMCYC), University of Granada, Granada, Spain
| | - Natalia Hidalgo-Ruzzante
- Mind, Brain and Behavior Research Center (CIMCYC), University of Granada, Granada, Spain
- Department of Developmental and Educational Psychology, University of Granada, Granada, Spain
- Faculty of Education, Campus de Cartuja, Granada, Spain
| | - Miguel Perez-Garcia
- Mind, Brain and Behavior Research Center (CIMCYC), University of Granada, Granada, Spain
- Department of Personality, Assessment and Psychological Treatment, University of Granada, Granada, Spain
- Faculty of Psychology, Campus Universitario de Cartuja, Granada, Spain
| | - Philip Hyland
- Department of Psychology, Maynooth University, Kildare, Ireland
- Centre for Global Health, Trinity College Dublin, Dublin, Ireland
- Education House, Maynooth University, Kildare, Ireland
| | - Mark Shevlin
- School of Psychology, Ulster University, Londonderry, Northern Ireland
| | - Thanos Karatzias
- School of Health & Social Care, Edinburgh Napier University, Edinburgh, UK
- NHS Lothian, Rivers Centre for Traumatic Stress, Edinburgh, UK
- School of Health & Social Care, Edinburgh Napier University, Edinburgh, UK
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Bateman A, Rüfenacht E, Perroud N, Debbané M, Nolte T, Shaverin L, Fonagy P. Childhood maltreatment, dissociation and borderline personality disorder: Preliminary data on the mediational role of mentalizing in complex post-traumatic stress disorder. Psychol Psychother 2023. [PMID: 38108566 DOI: 10.1111/papt.12514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 11/15/2023] [Accepted: 11/20/2023] [Indexed: 12/19/2023]
Abstract
OBJECTIVES Treatments for borderline personality disorder (BPD) and post-traumatic stress disorder (PTSD) are less effective for patients with co-occurring symptoms of both disorders, who are considered to have complex PTSD (cPTSD), compared with patients with either condition alone. Evidence suggests that co-occurrence of symptoms indicates greater impairment in mentalizing. This study examines evidence for targeting mentalizing when treating individuals with co-occurring symptoms, irrespective of their exposure to developmental trauma and, for the first time, investigates the mediational role of mentalizing in the associations between BPD symptomatology and cPTSD. DESIGN We identified in a routine clinical service a group of patients with BPD, with or without co-occurring symptoms of PTSD. We hypothesized that patients with co-occurring symptoms and a history of childhood maltreatment will show more severe clinical profiles and greater mentalizing problems, which in turn lead to symptoms consistent with cPTSD. METHOD Clinical profiles of 72 patients with BPD (43 with and 29 without co-occurring symptoms of PTSD; mean age in both groups 28 years, 79% and 83% female, respectively) were identified using the Structured Clinical Interview for DSM-IV Axis II Disorders. Patients completed self-report measures of BPD and PTSD symptoms, well-being, dissociation and reflective functioning. Childhood trauma histories were evaluated. RESULTS Compared with patients with BPD-only, those with co-occurring BPD and PTSD showed greater severity in terms of BPD and dissociative symptoms, met a broader range of BPD diagnostic criteria, had a greater sense of personal worthlessness and self-evaluated their well-being as considerably diminished. This group was also more inclined to recall increased instances of childhood sexual abuse. In a mediation analysis, mentalizing acted as a partial mediator for the relationship between BPD severity and cPTSD, as well as between dissociative symptoms and cPTSD. Interestingly, mentalizing did not mediate the relationship between childhood sexual abuse and cPTSD. CONCLUSIONS Overall, the correlational findings are consistent with an intended focus on mentalizing to treat cPTSD symptoms in individuals who also meet criteria for a diagnosis of BPD.
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Affiliation(s)
- Anthony Bateman
- Department of Clinical, Educational and Health Psychology, Psychoanalysis Unit, University College London, London, UK
| | - Eva Rüfenacht
- Division of Psychiatric Specialties, Department of Psychiatry, Geneva University Hospitals, Geneva, Switzerland
- Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Nader Perroud
- Division of Psychiatric Specialties, Department of Psychiatry, Geneva University Hospitals, Geneva, Switzerland
| | - Martin Debbané
- Faculty of Psychology and Educational Sciences, University of Geneva, Geneva, Switzerland
- Research Department of Clinical, Educational, and Health Psychology, University College London, London, UK
| | - Tobias Nolte
- Department of Clinical, Educational and Health Psychology, University College London, London, UK
- Anna Freud Centre, London, UK
| | - Lisa Shaverin
- Anna Freud Centre, London, UK
- Tavistock Trauma Service, Tavistock & Portman NHS Foundation Trust, London, UK
| | - Peter Fonagy
- Anna Freud Centre, London, UK
- Division of Psychology and Language Sciences, University College London, London, UK
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Leiva-Bianchi M, Nvo-Fernandez M, Villacura-Herrera C, Miño-Reyes V, Parra Varela N. What are the predictive variables that increase the risk of developing a complex trauma? A meta-analysis. J Affect Disord 2023; 343:153-165. [PMID: 37802323 DOI: 10.1016/j.jad.2023.10.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 09/08/2023] [Accepted: 10/02/2023] [Indexed: 10/08/2023]
Abstract
In 2018, Complex Post Traumatic Stress Disorder (CPTSD) was officially recognized as a distinct syndrome in the International Classification of Diseases, 11th Revision (ICD-11). This recognition aimed to differentiate between neurotic disorders secondary to stressful situations and somatoform disorders, and disorders specifically associated with stress. The inclusion of CPTSD in the ICD-11 marked the culmination of two decades of research focused on understanding its symptoms, treatments, and risk factors. However, despite the progress made, a comprehensive meta-analysis to elucidate the specific risk factors and impact on the development of CPTSD is still lacking. The objective of this article is to conduct such a meta-analysis. A total of 24 studies were selected for analysis, and the findings revealed several key risk factors associated with the development of CPTSD. The main risk factor identified is having experienced sexual abuse in childhood (k = 12; OR = 2.880). In addition, childhood physical abuse (k = 11; OR = 2.841), experiencing emotional neglect during childhood (k = 5; OR = 2.510), physical abuse throughout life (k = 8; OR = 2.149) and being a woman (k = 13; OR = 1.726) were also significant risk factors.
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Affiliation(s)
- Marcelo Leiva-Bianchi
- Laboratory of Methodology, Behavioural Sciences and Neuroscience, Faculty of Psychology, Universidad de Talca, Chile
| | - Marcelo Nvo-Fernandez
- Laboratory of Methodology, Behavioural Sciences and Neuroscience, Faculty of Psychology, Universidad de Talca, Chile.
| | - César Villacura-Herrera
- Laboratory of Methodology, Behavioural Sciences and Neuroscience, Faculty of Psychology, Universidad de Talca, Chile; Centro de Investigación en Ciencias Cognitivas, Faculty of Psychology, Universidad de Talca, Chile
| | - Valentina Miño-Reyes
- Centro de Investigación en Ciencias Cognitivas, Faculty of Psychology, Universidad de Talca, Chile
| | - Nicol Parra Varela
- Laboratory of Methodology, Behavioural Sciences and Neuroscience, Faculty of Psychology, Universidad de Talca, Chile
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Fung HW, Chien WT, Lam SKK, Ross CA. The Relationship Between Dissociation and Complex Post-Traumatic Stress Disorder: A Scoping Review. TRAUMA, VIOLENCE & ABUSE 2023; 24:2966-2982. [PMID: 36062904 DOI: 10.1177/15248380221120835] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Complex post-traumatic stress disorder (CPTSD) has recently been recognized as an official psychiatric diagnosis in ICD-11, after years of research and advocacy in the field. It has been suggested that dissociative symptoms are a major feature of CPTSD. This scoping review aimed to summarize the existing knowledge base on the relationship between dissociation and CPTSD, and to identify relevant research gaps. We searched the two largest and most widely used academic databases (i.e., the Web of Science and Scopus databases) and the ProQuest database and identified original studies published in English relevant to our research questions, namely: (1) Would CPTSD be associated with dissociative symptoms? 2) How common are dissociative symptoms among people with CPTSD? (3) What are the correlates of dissociative symptoms among people with CPTSD? In all, 26 studies were included. We found 10 studies which reported that people with CPTSD scored significantly higher on a dissociation measure than those without CPTSD, and 11 studies reported a positive correlation between CPTSD symptoms and psychoform/somatoform dissociation scores. While very few studies reported the prevalence and correlates of dissociative symptoms among people with CPTSD, there may be a considerable subgroup of people with CPTSD who have clinically significant levels of dissociative symptoms (e.g., 28.6-76.9%). Dissociation may also be associated with other comorbidities (e.g., DSM-IV Axis II features, shame, somatic symptoms) in people with CPTSD. We recommend that more studies are needed to investigate the prevalence of dissociative symptoms among people with CPTSD and examine how these symptoms are associated with other comorbid conditions and clinical needs in this vulnerable group.
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Affiliation(s)
- Hong Wang Fung
- Department of Social Work, Hong Kong Baptist University, Hong Kong
| | - Wai Tong Chien
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
| | - Stanley Kam Ki Lam
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
| | - Colin A Ross
- The Colin A. Ross Institute for Psychological Trauma, Richardson, Texas, USA
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Ferrajão P, Batista CI, Elklit A. Polytraumatization, defense mechanisms, PTSD and complex PTSD in Indian adolescents: a mediation model. BMC Psychol 2023; 11:411. [PMID: 38001536 PMCID: PMC10675876 DOI: 10.1186/s40359-023-01456-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 11/19/2023] [Indexed: 11/26/2023] Open
Abstract
BACKGROUND Adolescence is recognized as a particularly susceptible developmental period for experiencing multiple types of Adverse Childhood Experiences (ACE), increasing the vulnerability to higher levels of Post-Traumatic Stress Disorder (PTSD) and Complex PTSD symptoms. Some studies found that defense mechanisms play an important role on the association between ACE and psychological symptoms. METHODS We analyzed the associations between direct and indirect exposure to ACE and PTSD and Complex PTSD (affective dysregulation, negative self-concept and disturbances in relationships) through the mediation role of mature defense mechanisms: mature, neurotic, and immature defense mechanisms in Indian adolescents. A sample of 411 Indian adolescents (M = 14.2 years old; S.D. = 0.5) completed validated self-report questionnaires. Serial multiple mediation models were tested by conducting a structural equation modelling employing Preacher and Hayes' procedures (2008). RESULTS Immature and neurotic defense mechanisms mediated the association between direct exposure to ACE with PTSD symptoms. Immature defense mechanisms were mediators of the relationship between direct exposure to ACE and Complex PTSD symptoms clusters. CONCLUSIONS Maladaptive defense mechanisms can disturb the process of self-regulation and emotion regulation capabilities in coping with traumatic experiences, leading to higher PTSD and Complex PTSD symptoms severity.
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Affiliation(s)
- Paulo Ferrajão
- Faculdade de Ciências Sociais e Tecnologia, Universidade Europeia, Quinta do Bom Nome, Estrada da Correia 53, Lisbon, 1500-210, Portugal.
| | - Carolina Isabel Batista
- Faculdade de Ciências Sociais e Tecnologia, Universidade Europeia, Quinta do Bom Nome, Estrada da Correia 53, Lisbon, 1500-210, Portugal
| | - Ask Elklit
- National Center for Psychotraumatology, University of Southern Denmark, Odense, Denmark
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Barrett BW, Meanley S, Brennan-Ing M, Haberlen SA, Ware D, Detels R, Friedman MR, Plankey MW. The Relationship Between Posttraumatic Stress Disorder and Alcohol Misuse and Smoking Among Aging Men Who Have Sex With Men: No Evidence of Exercise or Volunteering Impact. J Aging Health 2023:8982643231215475. [PMID: 37976419 PMCID: PMC11288306 DOI: 10.1177/08982643231215475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
OBJECTIVES To determine if the association between posttraumatic stress disorder (PTSD) and substance use (alcohol misuse or smoking tobacco) is mediated/moderated by exercise or volunteering among aging (≥40 years) men who have sex with men (MSM), and if this mediation/moderation differs by HIV serostatus. METHODS Multicenter AIDS Cohort Study data were used. Three datasets with PTSD measured during different time periods (10/1/2017-3/31/2018, 898 men; 4/1/2018-9/30/2018, 890 men; 10/1/2018-3/31/2019, 895 men) were analyzed. Longitudinal mediation analyses estimated the mediation effect of exercise and volunteering on the outcomes. RESULTS Nine percent of MSM had evidence of PTSD. There was no statistically significant mediation effect of exercise or volunteering regardless of substance use outcome. The odds of smoking at a future visit among MSM with PTSD were approximately double those of MSM without PTSD. Results did not differ by HIV serostatus. DISCUSSION There is a particular need for effective smoking cessation interventions for aging MSM with PTSD.
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Affiliation(s)
- Benjamin W. Barrett
- Department of Epidemiology, Bloomberg School of Public
Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Steven Meanley
- Department of Family and Community Health, University of
Pennsylvania School of Nursing, Philadelphia, Pennsylvania, USA
| | - Mark Brennan-Ing
- Brookdale Center for Healthy Aging, Hunter College, The
City University of New York, New York, New York, USA
| | - Sabina A. Haberlen
- Department of Epidemiology, Bloomberg School of Public
Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Deanna Ware
- Department of Medicine, Georgetown University Medical
Center, Washington, District of Columbia, USA
| | - Roger Detels
- Department of Epidemiology, Fielding School of Public
Health, University of California, Los Angeles, Los Angeles, California, USA
| | - M. Reuel Friedman
- Department of Urban-Global Public Health, School of Public
Health, Rutgers University, Newark, New Jersey, USA
| | - Michael W. Plankey
- Department of Medicine, Georgetown University Medical
Center, Washington, District of Columbia, USA
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Liang Y, Yang L. Sex Differences in Complex Posttraumatic Stress Disorder Network among Chinese Young Adults. Behav Sci (Basel) 2023; 13:846. [PMID: 37887496 PMCID: PMC10604758 DOI: 10.3390/bs13100846] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 10/10/2023] [Accepted: 10/12/2023] [Indexed: 10/28/2023] Open
Abstract
Evidence suggests that sex differences commonly occur in trauma-related disorders. The current study aims to explore sex differences in complex posttraumatic stress disorder (CPTSD) symptom networks among Chinese young adults with childhood trauma. The current study utilized a representative sample of college students in Beijing and included 1416 participants (409 men and 907 women) who had childhood trauma experience. CPTSD symptoms were evaluated using the International Trauma Questionnaire. Regularized partial correlation network analysis and Bayesian network analysis were used to estimate the network structure and possible causality of CPTSD symptoms for both sexes. Male and female CPTSD symptom networks had differences in strength centrality and bridge centrality. Nightmares and feelings of failure had the highest strength centrality, and long-term upset and nightmares had the highest bridge centrality for men. Hypervigilance and feelings of failure had the highest strength centrality, and long-term upset and exaggerated startle response had the highest bridge centrality for women. The current study provides the first evidence of sex differences in the CPTSD symptom network among Chinese young adults with childhood trauma. Young men and women differed in highly central symptoms, which may speak to sex specificity in the main manifestations of CPTSD symptoms.
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Affiliation(s)
- Yiming Liang
- Shanghai Key Laboratory of Mental Health and Psychological Crisis Intervention, Affiliated Mental Health Center (ECNU), School of Psychology and Cognitive Science, East China Normal University, Shanghai 200062, China
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Fresno A, Ramos Alvarado N, Núñez D, Ulloa JL, Arriagada J, Cloitre M, Bisson JI, Roberts NP, Shevlin M, Karatzias T. Initial validation of the International Trauma Questionnaire (ITQ) in a sample of Chilean adults. Eur J Psychotraumatol 2023; 14:2263313. [PMID: 37815059 PMCID: PMC10566396 DOI: 10.1080/20008066.2023.2263313] [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: 12/19/2022] [Accepted: 08/10/2023] [Indexed: 10/11/2023] Open
Abstract
BACKGROUND ICD-11 Posttraumatic Stress Disorder (PTSD) and Complex PTSD (CPTSD) are stress-related disorders. The International Trauma Questionnaire (ITQ) is a widely used instrument to assess PTSD and CPTSD. To date, there is no evidence of the psychometric characteristics of the ITQ in Latin American countries. OBJECTIVE The aim of this study was to assess the construct and concurrent validity of the Latin American Spanish adaptation of the ITQ in a sample of Chilean adults. METHODS A sample of 275 Chilean young adults completed the ITQ, a traumatic life events checklist, the Adverse Childhood Experiences Questionnaire, the Depression Anxiety Stress Scales-21, and the Columbia-Suicide Severity Rating Scale short version. Four alternative confirmatory factor analysis models were tested. Correlation analyses were performed to determine concurrent validity with associated measures (number of reported traumatic events, number of adverse childhood experiences, anxiety, depression, and suicidal risk). RESULTS The second-order two-factor (PTSD and DSO) and the correlated first-order six-factor model provided acceptable fit; however, the first model showed a better fit based on the BIC difference. The PTSD and DSO dimensions, as well as the six ITQ clusters showed positive correlations with reported number of traumatic life-events, reported number of adverse childhood experiences, levels of anxiety, depression, and suicidal risk. CONCLUSIONS The ITQ Latin American Spanish adaptation provides acceptable psychometric evidence to assess PTSD and CPTSD in accordance with the ICD-11.
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Affiliation(s)
- Andrés Fresno
- Programa de Investigación Asociativa (PIA) en Ciencias Cognitivas, Centro de Investigación en Ciencias Cognitivas (CICC), Facultad de Psicología, Universidad de Talca, Talca, Chile
- Centro de Derecho de las Minorías y Gestión de la Diversidad, Universidad de Talca, Talca, Chile
| | - Nadia Ramos Alvarado
- Programa de Investigación Asociativa (PIA) en Ciencias Cognitivas, Centro de Investigación en Ciencias Cognitivas (CICC), Facultad de Psicología, Universidad de Talca, Talca, Chile
- Centro de Derecho de las Minorías y Gestión de la Diversidad, Universidad de Talca, Talca, Chile
| | - Daniel Núñez
- Programa de Investigación Asociativa (PIA) en Ciencias Cognitivas, Centro de Investigación en Ciencias Cognitivas (CICC), Facultad de Psicología, Universidad de Talca, Talca, Chile
- Núcleo Milenio para Mejorar la Salud Mental de Adolescentes y Jóvenes (IMHAY), Santiago, Chile
| | - José Luis Ulloa
- Programa de Investigación Asociativa (PIA) en Ciencias Cognitivas, Centro de Investigación en Ciencias Cognitivas (CICC), Facultad de Psicología, Universidad de Talca, Talca, Chile
- Núcleo Milenio para Mejorar la Salud Mental de Adolescentes y Jóvenes (IMHAY), Santiago, Chile
| | - Jessica Arriagada
- Programa de Investigación Asociativa (PIA) en Ciencias Cognitivas, Centro de Investigación en Ciencias Cognitivas (CICC), Facultad de Psicología, Universidad de Talca, Talca, Chile
| | - Marylene Cloitre
- National Center for PTSD, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
| | - Jonathan I. Bisson
- Division of Psychological Medicine and Clinical Neurosciences, Cardiff University School of Medicine, Cardiff, UK
| | - Neil P. Roberts
- Division of Psychological Medicine and Clinical Neurosciences, Cardiff University School of Medicine, Cardiff, UK
- Psychology and Psychological Therapies Directorate, Cardiff & Vale University Health Board, Cardiff, UK
| | - Mark Shevlin
- School of Psychology, Ulster University, Coleraine, Northern Ireland
| | - Thanos Karatzias
- School of Health & Social Care, Edinburgh Napier University, Edinburgh, UK
- Rivers Centre for Traumatic Stress, NHS Lothian, Edinburgh, UK
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Grace E, Rogers R, Usher R, Rivera IM, Elbakry H, Sotilleo S, Doe R, Toribio M, Coreas N, Olff M. Psychometric properties of the Global Psychotrauma Screen in the United States. Health Psychol Behav Med 2023; 11:2266215. [PMID: 37811317 PMCID: PMC10557551 DOI: 10.1080/21642850.2023.2266215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 09/26/2023] [Indexed: 10/10/2023] Open
Abstract
Background Prior research assessing the psychometric properties of the Global Psychotrauma Screen provided support for its internal consistency reliability, construct validity, convergent validity, and divergent validity in several international samples, but not specifically in a U.S. subsample. Objective The purpose of this study was to assess psychometric properties of the GPS in the U.S. Method This observational study included a convenience sample of individually recruited participants (N = 231) who completed an initial study with 126-item online questionnaire and a two-week follow-up study with GPS alone through the weblinks provided by the research team. Data analyzes included measuring internal consistency and test-retest reliability, exploratory and confirmatory factor analyzes (EFA and CFA), convergent and divergent validity, sensitivity, specificity, and severity of the GPS symptom items. Additional CFA was conducted with data (N = 947) from the GPS multinational research project, U.S. subsample. Results The results showed acceptable internal consistency and test-retest reliability, convergent validity, and divergent validity of the GPS. The construct validity results supported a three-factor structure of the GPS symptoms. The GPS domains showed acceptable sensitivity and specificity with the cut-off scores of 3 for PTSD and 5 for CPTSD domains; and the scores of 1 for the anxiety, depression, and insomnia domains respectively. The GPS risk factors predicted the GPS symptom severity. Conclusions This study provides new and additional evidence on the psychometric properties of the GPS which may help health care providers with the selection of an appropriate screening instrument for trauma-related transdiagnostic symptoms. The study limitations should be addressed in future research through the replication of EFA and CFA internationally with larger samples, and the inclusion of a reference standard for dissociation.
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Affiliation(s)
- Emma Grace
- Department of International Psychology, The Chicago School of Professional Psychology, Washington, DC, USA
| | - Rosalind Rogers
- Department of International Psychology, The Chicago School of Professional Psychology, Washington, DC, USA
| | - Robin Usher
- Department of International Psychology, The Chicago School of Professional Psychology, Washington, DC, USA
| | - Iris Margarita Rivera
- Department of International Psychology, The Chicago School of Professional Psychology, Washington, DC, USA
| | - Hanan Elbakry
- Department of International Psychology, The Chicago School of Professional Psychology, Washington, DC, USA
| | - Shanelle Sotilleo
- Department of International Psychology, The Chicago School of Professional Psychology, Washington, DC, USA
| | - Renee Doe
- Department of International Psychology, The Chicago School of Professional Psychology, Washington, DC, USA
| | - Mariella Toribio
- Department of International Psychology, The Chicago School of Professional Psychology, Washington, DC, USA
| | - Narda Coreas
- Department of International Psychology, The Chicago School of Professional Psychology, Washington, DC, USA
| | - Miranda Olff
- Department of Psychiatry, Amsterdam Neuroscience & Public Health, Amsterdam UMC, Amsterdam, The Netherlands
- ARQ National Psychotrauma Centre, Diemen, The Netherlands
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36
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Karatzias T, Mc Glanaghy E, Cloitre M. Enhanced Skills Training in Affective and Interpersonal Regulation (ESTAIR): A New Modular Treatment for ICD-11 Complex Posttraumatic Stress Disorder (CPTSD). Brain Sci 2023; 13:1300. [PMID: 37759901 PMCID: PMC10527561 DOI: 10.3390/brainsci13091300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 08/31/2023] [Accepted: 09/07/2023] [Indexed: 09/29/2023] Open
Abstract
ICD-11 Complex Posttraumatic Stress Disorder (CPTSD) is a relatively new condition; therefore, there is limited available evidence for its treatment. Prior to the recognition of CPTSD as a separate trauma condition, people who met criteria were often diagnosed with multiple co-morbid conditions such as PTSD, anxiety, depression, and emotional dysregulation difficulties. In the absence of a coherent evidence base, treatment tended to involve multiple treatments for these multiple conditions or lengthy phase-based interventions, often delivered in an integrative fashion, which was not standardized. In this paper, we present Enhanced Skills Training in Affective and Interpersonal Regulation (ESTAIR), a new flexible multi-modular approach for the treatment of CPTSD and its transdiagnostic symptoms. ESTAIR is consistent with trauma-informed and patient-centered care, which highlights the importance of patient choice in identification and sequencing in targeting CPTSD symptoms. Directions for future research are discussed.
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Affiliation(s)
- Thanos Karatzias
- School of Health & Social Care, Edinburgh Napier University, Edinburgh EH11 4BN, UK
- NHS Lothian Rivers Centre, EH11 1BG, Stanford University, 450 Jane Stanford Way, Stanford, CA 94305, USA
| | - Edel Mc Glanaghy
- NHS Forth Valley, Mayfield Building, Falkirk Community Hospital, Scotland FK1 5QE, UK;
| | - Marylene Cloitre
- National Centre for PTSD, Dissemination and Training Division, VA Palo Alto Health Care System, 795 Willow Road, Menlo Park, CA 94025, USA;
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, CA 94305, USA
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Marchese S, Huckins LM. Trauma Matters: Integrating Genetic and Environmental Components of PTSD. ADVANCED GENETICS (HOBOKEN, N.J.) 2023; 4:2200017. [PMID: 37766803 PMCID: PMC10520418 DOI: 10.1002/ggn2.202200017] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 06/28/2022] [Indexed: 09/29/2023]
Abstract
Trauma is ubiquitous, but only a subset of those who experience trauma will develop posttraumatic stress disorder (PTSD). In this review, it is argued that to determine who is at risk of developing PTSD, it is critical to examine the genetic etiology of the disorder and individual trauma profiles of those who are susceptible. First, the state of current PTSD genetic research is described, with a particular focus on studies that present evidence for trauma type specificity, or for differential genetic etiology according to gender or race. Next, approaches that leverage non-traditional phenotyping approaches are reviewed to identify PTSD-associated variants and biology, and the relative advantages and limitations inherent in these studies are reflected on. Finally, it is discussed how trauma might influence the heritability of PTSD, through type, risk factors, genetics, and associations with PTSD symptomology.
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Affiliation(s)
- Shelby Marchese
- Pamela Sklar Division of Psychiatric GenomicsIcahn School of Medicine at Mount SinaiNew YorkNY10029USA
- Department of Genetics and Genomic SciencesIcahn School of Medicine at Mount SinaiNew YorkNY10029USA
| | - Laura M. Huckins
- Pamela Sklar Division of Psychiatric GenomicsIcahn School of Medicine at Mount SinaiNew YorkNY10029USA
- Department of Genetics and Genomic SciencesIcahn School of Medicine at Mount SinaiNew YorkNY10029USA
- Department of PsychiatryIcahn School of Medicine at Mount SinaiNew YorkNY10029USA
- Seaver Autism Center for Research and TreatmentIcahn School of Medicine at Mount SinaiNew YorkNY10029USA
- Present address:
Department of PsychiatryYale University School of MedicineNew HavenCT06511USA
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Havermans DCD, Hoeboer CM, Sobczak S, Primasari I, Coimbra BM, Hovnanyan A, Novakovic IZ, Langevin R, Aakvaag HF, Grace E, Dragan M, Lueger-Schuster B, El-Hage W, Olff M. The mental health impact of the COVID-19 pandemic and exposure to other potentially traumatic events up to old age. J Trauma Stress 2023; 36:738-749. [PMID: 37218466 DOI: 10.1002/jts.22937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 03/15/2023] [Accepted: 03/18/2023] [Indexed: 05/24/2023]
Abstract
We investigated whether the impact of potentially traumatic events (PTEs) on trauma-related symptoms changes across the transitional adult lifespan (i.e., 16-100 years old) and if this association differs for self-reported COVID-19-related PTEs compared to other PTEs. A web-based cross-sectional study was conducted among 7,034 participants from 88 countries between late April and October 2020. Participants completed the Global Psychotrauma Screen (GPS), a self-report questionnaire assessing trauma-related symptoms. Data were analyzed using linear and logistic regression analyses and general linear models. We found that older age was associated with lower GPS total symptom scores, B = -0.02, p < .001; this association remained significant but was substantially weaker for self-reported COVID-19-related PTEs compared to other PTEs, B = 0.02, p = .009. The results suggest an association between older age and lower ratings of trauma-related symptoms on the GPS, indicating a blunted symptom presentation. This age-related trend was smaller for self-reported COVID-19-related PTEs compared to other PTEs, reflecting the relatively higher impact of the COVID-19 pandemic on older adults.
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Affiliation(s)
- Demi C D Havermans
- School for Mental Health and Neuroscience (MHeNs), Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, The Netherlands
- TanteLouise, Bergen op Zoom, The Netherlands
| | - Chris M Hoeboer
- Department of Psychiatry, Amsterdam University Medical Centers Location AMC, Amsterdam Public Health, Amsterdam, The Netherlands
| | - Sjacko Sobczak
- School for Mental Health and Neuroscience (MHeNs), Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, The Netherlands
- Mondriaan Mental Health Center, Department of Old Age Psychiatry, Mondriaan Mental Health Center, Heerlen, Maastricht, The Netherlands
| | - Indira Primasari
- Department of Psychiatry, Amsterdam University Medical Centers Location AMC, Amsterdam Public Health, Amsterdam, The Netherlands
- Faculty of Psychology, Universitas Indonesia, Depok, Indonesia
| | - Bruno M Coimbra
- Department of Psychiatry, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
| | - Ani Hovnanyan
- Department of Developmental Psychology and Socialisation, University of Padua, Padua, Italy
| | - Irina Zrnic Novakovic
- Lab for Psychotraumatology, Department of Clinical and Health Psychology, Faculty of Psychology, University of Vienna, Austria
| | - Rachel Langevin
- Department of Educational and Counselling Psychology, Faculty of Education, McGill University, Montreal, Canada
| | - Helene F Aakvaag
- Norwegian Centre for Violence and Traumatic Stress Studies, Oslo, Norway
| | - Emma Grace
- Department of International Psychology, The Chicago School of Professional Psychology, Washington, District of Columbia, USA
| | | | - Brigitte Lueger-Schuster
- Lab for Psychotraumatology, Department of Clinical and Health Psychology, Faculty of Psychology, University of Vienna, Austria
| | - Wissam El-Hage
- UMR 1253, IBrain, Université de Tours, Inserm, Tours, France
| | - Miranda Olff
- ARQ National Psychotrauma Centre, Diemen, The Netherlands
- Department of Psychiatry, Amsterdam University Medical Centers Location AMC, Amsterdam Public Health, Amsterdam, The Netherlands
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Lewis BR, Byrne K. A Review of MDMA-Assisted Therapy for Posttraumatic Stress Disorder. FOCUS (AMERICAN PSYCHIATRIC PUBLISHING) 2023; 21:247-256. [PMID: 37404966 PMCID: PMC10316220 DOI: 10.1176/appi.focus.20220088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/06/2023]
Abstract
Posttraumatic stress disorder (PTSD) is a common chronic and disabling psychiatric disorder that may develop after exposure to a traumatic life event. There are existing evidence-based psychotherapies and pharmacotherapies for PTSD; however, these treatments have significant limitations. 3,4-methylenedioxymethamphetamine (MDMA) was granted "breakthrough therapy" status by the U.S. Food and Drug Administration (FDA) in 2017 for the treatment of PTSD in conjunction with psychotherapy after preliminary Phase II results. This treatment is currently being investigated in Phase III trials with anticipated FDA approval of MDMA-assisted psychotherapy for PTSD in late 2023. This article reviews the evidence base for MDMA-assisted psychotherapy for PTSD, pharmacology and the proposed causal mechanisms of MDMA, risks and limitations of the current evidence, and challenges and future directions for the field.
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Affiliation(s)
| | - Kevin Byrne
- Department of Psychiatry, University of Utah, Salt Lake City
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40
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Griffin SM, Lebedová A, Ahern E, McMahon G, Bradshaw D, Muldoon OT. PROTOCOL: Group-based interventions for posttraumatic stress disorder: A systematic review and meta-analysis of the role of trauma type. CAMPBELL SYSTEMATIC REVIEWS 2023; 19:e1328. [PMID: 37192982 PMCID: PMC10182838 DOI: 10.1002/cl2.1328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Abstract
This is the protocol for a Campbell systematic review. The primary objective is to assess the effects of group-based treatments on posttraumatic stress disorder (PTSD) symptomology in people diagnosed with PTSD (by a clinician or screening instrument) or referred to a PTSD treatment group for their symptoms by a medical professional. We will also examine a range of moderators that may affect the efficacy of group-based treatments, including the nature of the trauma (interpersonal, stigmatized) and the group fit (in terms of gender and shared vs. unshared trauma). Further, we will also explore what, if any, group-based and social identity factors are recorded and how they relate to PTSD outcomes.
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Affiliation(s)
- Siobhán M. Griffin
- Centre for Social Issues Research, Department of PsychologyUniversity of LimerickLimerickIreland
| | - Alžběta Lebedová
- Centre for Social Issues Research, Department of PsychologyUniversity of LimerickLimerickIreland
| | - Elayne Ahern
- Centre for Social Issues Research, Department of PsychologyUniversity of LimerickLimerickIreland
| | - Grace McMahon
- Centre for Social Issues Research, Department of PsychologyUniversity of LimerickLimerickIreland
| | - Daragh Bradshaw
- Centre for Social Issues Research, Department of PsychologyUniversity of LimerickLimerickIreland
| | - Orla T. Muldoon
- Centre for Social Issues Research, Department of PsychologyUniversity of LimerickLimerickIreland
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41
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Ford JD. Why We Need a Developmentally Appropriate Trauma Diagnosis for Children: a 10-Year Update on Developmental Trauma Disorder. JOURNAL OF CHILD & ADOLESCENT TRAUMA 2023; 16:403-418. [PMID: 37234835 PMCID: PMC10205922 DOI: 10.1007/s40653-021-00415-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/13/2021] [Indexed: 05/28/2023]
Abstract
Developmental Trauma Disorder (DTD) was proposed almost two decades ago as a psychiatric diagnosis for children who have been traumatically victimized and whose attachment bonding with primary caregivers has been compromised. DTD was designed to complement and extend post-traumatic stress disorder (PTSD) by addressing forms of trauma-related biopsychosocial dysregulation not included in PTSD, many of which are attributed to other psychiatric disorders. In the past decade, evidence from clinician surveys and research field trial studies has provided evidence of DTD's validity and potential clinical utility. The growing evidence base for DTD is summarized and clinical rationales for the proposed DTD symptoms are described. DTD shows promise as a developmentally-attuned traumatic stress diagnosis for traumatized children.
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Affiliation(s)
- Julian D. Ford
- University of Connecticut School of Medicine, Farmington, USA
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42
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Jones KA, Freijah I, Brennan SE, McKenzie JE, Bright TM, Fiolet R, Kamitsis I, Reid C, Davis E, Andrews S, Muzik M, Segal L, Herrman H, Chamberlain C. Interventions from pregnancy to two years after birth for parents experiencing complex post-traumatic stress disorder and/or with childhood experience of maltreatment. Cochrane Database Syst Rev 2023; 5:CD014874. [PMID: 37146219 PMCID: PMC10162699 DOI: 10.1002/14651858.cd014874.pub2] [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] [Indexed: 05/07/2023]
Abstract
BACKGROUND Acceptable, effective and feasible support strategies (interventions) for parents experiencing complex post-traumatic stress disorder (CPTSD) symptoms or with a history of childhood maltreatment may offer an opportunity to support parental recovery, reduce the risk of intergenerational transmission of trauma and improve life-course trajectories for children and future generations. However, evidence relating to the effect of interventions has not been synthesised to provide a comprehensive review of available support strategies. This evidence synthesis is critical to inform further research, practice and policy approaches in this emerging area. OBJECTIVES To assess the effects of interventions provided to support parents who were experiencing CPTSD symptoms or who had experienced childhood maltreatment (or both), on parenting capacity and parental psychological or socio-emotional wellbeing. SEARCH METHODS In October 2021 we searched CENTRAL, MEDLINE, Embase, six other databases and two trials registers, together with checking references and contacting experts to identify additional studies. SELECTION CRITERIA All variants of randomised controlled trials (RCTs) comparing any intervention delivered in the perinatal period designed to support parents experiencing CPTSD symptoms or with a history of childhood maltreatment (or both), to any active or inactive control. Primary outcomes were parental psychological or socio-emotional wellbeing and parenting capacity between pregnancy and up to two years postpartum. DATA COLLECTION AND ANALYSIS Two review authors independently assessed the eligibility of trials for inclusion, extracted data using a pre-designed data extraction form, and assessed risk of bias and certainty of evidence. We contacted study authors for additional information as required. We analysed continuous data using mean difference (MD) for outcomes using a single measure, and standardised mean difference (SMD) for outcomes using multiple measures, and risk ratios (RR) for dichotomous data. All data are presented with 95% confidence intervals (CIs). We undertook meta-analyses using random-effects models. MAIN RESULTS We included evidence from 1925 participants in 15 RCTs that investigated the effect of 17 interventions. All included studies were published after 2005. Interventions included seven parenting interventions, eight psychological interventions and two service system approaches. The studies were funded by major research councils, government departments and philanthropic/charitable organisations. All evidence was of low or very low certainty. Parenting interventions Evidence was very uncertain from a study (33 participants) assessing the effects of a parenting intervention compared to attention control on trauma-related symptoms, and psychological wellbeing symptoms (postpartum depression), in mothers who had experienced childhood maltreatment and were experiencing current parenting risk factors. Evidence suggested that parenting interventions may improve parent-child relationships slightly compared to usual service provision (SMD 0.45, 95% CI -0.06 to 0.96; I2 = 60%; 2 studies, 153 participants; low-certainty evidence). There may be little or no difference between parenting interventions and usual perinatal service in parenting skills including nurturance, supportive presence and reciprocity (SMD 0.25, 95% CI -0.07 to 0.58; I2 = 0%; 4 studies, 149 participants; low-certainty evidence). No studies assessed the effects of parenting interventions on parents' substance use, relationship quality or self-harm. Psychological interventions Psychological interventions may result in little or no difference in trauma-related symptoms compared to usual care (SMD -0.05, 95% CI -0.40 to 0.31; I2 = 39%; 4 studies, 247 participants; low-certainty evidence). Psychological interventions may make little or no difference compared to usual care to depression symptom severity (8 studies, 507 participants, low-certainty evidence, SMD -0.34, 95% CI -0.66 to -0.03; I2 = 63%). An interpersonally focused cognitive behavioural analysis system of psychotherapy may slightly increase the number of pregnant women who quit smoking compared to usual smoking cessation therapy and prenatal care (189 participants, low-certainty evidence). A psychological intervention may slightly improve parents' relationship quality compared to usual care (1 study, 67 participants, low-certainty evidence). Benefits for parent-child relationships were very uncertain (26 participants, very low-certainty evidence), while there may be a slight improvement in parenting skills compared to usual care (66 participants, low-certainty evidence). No studies assessed the effects of psychological interventions on parents' self-harm. Service system approaches One service system approach assessed the effect of a financial empowerment education programme, with and without trauma-informed peer support, compared to usual care for parents with low incomes. The interventions increased depression slightly (52 participants, low-certainty evidence). No studies assessed the effects of service system interventions on parents' trauma-related symptoms, substance use, relationship quality, self-harm, parent-child relationships or parenting skills. AUTHORS' CONCLUSIONS There is currently a lack of high-quality evidence regarding the effectiveness of interventions to improve parenting capacity or parental psychological or socio-emotional wellbeing in parents experiencing CPTSD symptoms or who have experienced childhood maltreatment (or both). This lack of methodological rigour and high risk of bias made it difficult to interpret the findings of this review. Overall, results suggest that parenting interventions may slightly improve parent-child relationships but have a small, unimportant effect on parenting skills. Psychological interventions may help some women stop smoking in pregnancy, and may have small benefits on parents' relationships and parenting skills. A financial empowerment programme may slightly worsen depression symptoms. While potential beneficial effects were small, the importance of a positive effect in a small number of parents must be considered when making treatment and care decisions. There is a need for further high-quality research into effective strategies for this population.
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Affiliation(s)
- Kimberley A Jones
- Indigenous Health Equity Unit, Melbourne School of Population and Global Health, University of Melbourne, Carlton, Australia
| | - Isabella Freijah
- Indigenous Health Equity Unit, Melbourne School of Population and Global Health, University of Melbourne, Carlton, Australia
| | - Sue E Brennan
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Joanne E McKenzie
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Tess M Bright
- Indigenous Health Equity Unit, Melbourne School of Population and Global Health, University of Melbourne, Carlton, Australia
| | - Renee Fiolet
- Indigenous Health Equity Unit, Melbourne School of Population and Global Health, University of Melbourne, Carlton, Australia
| | - Ilias Kamitsis
- Indigenous Health Equity Unit, Melbourne School of Population and Global Health, University of Melbourne, Carlton, Australia
| | - Carol Reid
- Judith Lumley Centre, La Trobe University, Bundoora, Australia
| | - Elise Davis
- Indigenous Health Equity Unit, Melbourne School of Population and Global Health, University of Melbourne, Carlton, Australia
| | - Shawana Andrews
- Poche Centre for Indigenous Health, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Carlton, Australia
| | - Maria Muzik
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - Leonie Segal
- Health Economics and Social Policy, Australian Centre for Precision Health, University of South Australia, North Terrace, Australia
| | - Helen Herrman
- Orygen, National Centre of Excellenece in Youth Mental Health, Parkville, Victoria, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Catherine Chamberlain
- Indigenous Health Equity Unit, Melbourne School of Population and Global Health, University of Melbourne, Carlton, Australia
- Judith Lumley Centre, La Trobe University, Bundoora, Australia
- NGANGK YIRA Murdoch University Research Centre for Aboriginal Health and Social Equity, Murdoch University, Perth, Australia
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43
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Frewen P, Wong S, Bailey T, Courtois C, Lanius R. As simple as possible, but not simpler: Revisiting the International Trauma Questionnaire (ITQ) complex PTSD items omitted in the shortened version. CHILD ABUSE & NEGLECT 2023; 141:106207. [PMID: 37148710 DOI: 10.1016/j.chiabu.2023.106207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 04/12/2023] [Accepted: 04/19/2023] [Indexed: 05/08/2023]
Abstract
BACKGROUND The risks of oversimplification of the symptomatology of Complex PTSD (CPTSD) have been highlighted in the literature. OBJECTIVE To re-examine 10 items representing disturbances in self-organization (DSO) that were deleted from the original 28-item version of the International Trauma Questionnaire (ITQ) when creating the current 12-item version. PARTICIPANTS AND SETTING An online convenience sample of 1235 MTurk users. METHODS Online survey comprising the fuller 28-item previous version of the ITQ, Adverse Childhood Experiences (ACEs) questionnaire, and PTSD Checklist for DSM-5 (PCL-5). RESULTS First, averaged endorsement of the 10 omitted items was lower than the 6 retained DSO items (d' = 0.34). Second, the 10 omitted DSO items accounted for incremental variance over and correlated equivalently to the 6 retained items with the PCL-5. Third, only the 10 omitted DSO items (r-part = 0.12) while not the 6 retained DSO items (r-part = -0.01) independently predicted ACE scores and, eight of these ten omitted DSO items differentiated higher ACE scores even among the subset of 266 participants who endorsed all 6 of the retained DSO items, most with medium effect sizes. Fourth, exploratory principal axis factor analysis differentiated two latent variables within the fuller set of 16 DSO symptoms, with the strongest indicators of the second factor, namely uncontrollable anger, recklessness, derealization, and depersonalization, being unmeasured within the 6 retained DSO items. Moreover, scores on both factors independently predicted both PCL-5 and ACE scores. CONCLUSIONS There are conceptual and pragmatic advantages to revisiting a more content-valid and comprehensive conceptualization of CPTSD and DSO, partially as may be measured by the recently deleted items from the original and fuller length ITQ.
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Affiliation(s)
- Paul Frewen
- Department of Psychiatry, Western University, 1151 Richmond St, London, ON N6A 3K7, Canada; Department of Psychology, Western University, 1151 Richmond St, London, ON N6A 3K7, Canada.
| | - Serena Wong
- Department of Psychology, Parkwood Institute Mental Healthcare, 550 Wellington Rd, London, ON N6C 5J1, Canada
| | - Tyson Bailey
- Spectrum Psychological Associates of Washington, 1728 W Marine View Dr, Suite 109 Everett, WA 98201
| | - Christine Courtois
- Private Practice, Trauma Psychology and Treatment PO Box 1326 Bethany Beach, DE. 19930
| | - Ruth Lanius
- Department of Psychiatry, Western University, 1151 Richmond St, London, ON N6A 3K7, Canada
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Langdon PE, Bisson JI, Rogers G, Swain S, Hiles S, Watkins A, Willner P. Evaluation of an adapted version of the International Trauma Questionnaire for use by people with intellectual disabilities. BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2023; 62:471-482. [PMID: 36932469 DOI: 10.1111/bjc.12421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 03/05/2023] [Indexed: 03/19/2023]
Abstract
AIMS The International Trauma Questionnaire (ITQ) is a novel assessment instrument that is aligned to the ICD-11 diagnoses of post-traumatic stress disorder (PTSD) and complex PTSD (CPTSD). The purpose of this study was to develop and evaluate an adapted version of the ITQ suitable for use by people with intellectual disabilities. METHODS The ITQ-ID follows the original ITQ, using wording developed in collaboration with a focus group of people with intellectual disabilities The ITQ-ID was administered to 40 people with intellectual disabilities recruited from learning disability forensic and community settings, alongside a Trauma Information Form and the Impact of Event Scale-Intellectual Disabilities (IES-IDs). RESULTS Most participants reported multiple traumatizing events. Around half of the participants met strict criteria for a diagnosis of PTSD, and around three quarters met looser criteria. Depending on definitions, between 66% and 93% of those who met criteria for PTSD also met criteria for a diagnosis of CPTSD. The ITQ-ID showed a single-component structure, with very good-to-excellent internal consistency, excellent test-retest reliability, and evidence of concurrent, discriminant, and content validity. SIGNIFICANCE The results support the potential of the ITQ-ID for assessment of PTSD and CPTSD in people with intellectual disabilities in both clinical and research contexts and highlight the need for further validation work.
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Affiliation(s)
- Peter E Langdon
- Centre for Educational Development, Appraisal and Research and Centre for Mental Health and Wellbeing Research, University of Warwick, Coventry, UK.,Coventry and Warwickshire Partnership NHS Trust, Coventry, UK.,Herefordshire and Worcestershire Health and Care NHS Trust, Worcester, UK
| | - Jonathan I Bisson
- Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, UK
| | - Gemma Rogers
- Kent and Medway NHS and Social Care Partnership Trust, Maidstone, UK
| | - Sophie Swain
- Midlands Partnership NHS Foundation Trust, The Redwoods Centre, Shrewsbury, UK
| | - Steve Hiles
- Swansea Trials Unit, Clinical Research Facility, Institute of Life Science, Swansea University, Swansea, UK
| | - Alan Watkins
- Swansea Trials Unit, Clinical Research Facility, Institute of Life Science, Swansea University, Swansea, UK
| | - Paul Willner
- School of Psychology, Swansea University, Swansea, UK
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45
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Jo Y, Choi H. Factor Structure and Clinical Correlates of The Dissociative Symptoms Scale (DSS) Korean Version Among Community Sample With Adverse Childhood Experiences. J Trauma Dissociation 2023; 24:380-394. [PMID: 36809920 DOI: 10.1080/15299732.2023.2181474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
This study examined the factor structure and psychometric properties of the Dissociative Symptoms Scale (DSS) among the Korean community adult population with adverse childhood experiences (ACE). Data were drawn from community sample data sets collected from an online panel investigating the impact of ACE and ultimately consisted of data from a total of 1304 participants. A confirmatory factor analysis revealed a bi-factor model with a general factor and four sub-factors such as depersonalization/derealization, gaps in awareness and memory, sensory misperceptions, and cognitive behavioral reexperiencing, which are the four factors that correspond to the original DSS. The DSS showed good internal consistency as well as convergent validity with clinical correlates such as posttraumatic stress disorder, somatoform dissociation, and emotion dysregulation. The high-risk group with more ACE was associated with increased DSS. These findings support the multidimensionality of dissociation and the validity of Korean DSS scores in a general population sample.
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Affiliation(s)
- Yoonhyoung Jo
- Department of Psychology, Chungbuk National University, Cheongju, South Korea
| | - Hyunjung Choi
- Department of Psychology, Chungbuk National University, Cheongju, South Korea
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Reid C, Bennetts SK, Nicholson JM, Amir LH, Chamberlain C. Rural primary care workforce views on trauma-informed care for parents experiencing complex trauma: A descriptive study. Aust J Rural Health 2023; 31:98-113. [PMID: 36083418 PMCID: PMC10947110 DOI: 10.1111/ajr.12922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Revised: 08/15/2022] [Accepted: 08/21/2022] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND An important service system for rural parents experiencing complex trauma is primary health care. AIM To investigate workforce knowledge, attitudes and practices, and barriers and enablers to trauma-informed care in rural primary health care. MATERIAL & METHODS This study used a descriptive, cross-sectional design. It involved an on-line survey conducted in 2021 in rural Victoria, Australia. Participants were the primary health care workforce. The main outcome measures were study-developed and included, a 21-item Knowledge, Attitudes and Practices tool, a 16-item Barriers and Enablers to Trauma-Informed Care Implementation tool, and three open-ended questions. RESULTS The 63 respondents were from community health (n = 40, 63%) and child and family services (n = 23, 37%). Many (n = 43, 78%) reported undertaking trauma-informed care training at some point in their career; with 32% (n = 20) during higher education. Respondents self-rated their knowledge, attitudes and practices positively. Perceived enablers were mainly positioned within the service (e.g. workforce motivation and organisational supports) and perceived barriers were largely external structural factors (e.g. availability of universal referral pathways, therapeutic-specific services). Open-ended comments were grouped into four themes: (1) Recognition and understanding; (2) Access factors; (3) Multidisciplinary and collaborative approaches; and (4) Strengths-based and outcome-focused approaches. DISCUSSION & CONCLUSION Primary health care is an important driver of population health and well-being and critical in rural contexts. Our findings suggest this sector needs a rural trauma-informed care implementation strategy to address structural barriers. This also requires policy and system development. Long-term investment in the rural workforce and primary care service settings is essential to integrate trauma-informed care.
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Affiliation(s)
- Carol Reid
- Judith Lumley Centre, School of Nursing and MidwiferyLa Trobe UniversityBundooraVictoriaAustralia
| | - Shannon K. Bennetts
- Judith Lumley Centre, School of Nursing and MidwiferyLa Trobe UniversityBundooraVictoriaAustralia
- Intergenerational Health Group, Murdoch Children's Research InstituteParkvilleVictoriaAustralia
| | - Jan M. Nicholson
- Judith Lumley Centre, School of Nursing and MidwiferyLa Trobe UniversityBundooraVictoriaAustralia
| | - Lisa H. Amir
- Judith Lumley Centre, School of Nursing and MidwiferyLa Trobe UniversityBundooraVictoriaAustralia
| | - Catherine Chamberlain
- Judith Lumley Centre, School of Nursing and MidwiferyLa Trobe UniversityBundooraVictoriaAustralia
- NGANGK YIRA: Murdoch University Research Centre for Aboriginal Health and Social EquityMurdoch UniversityPerthWestern AustraliaAustralia
- Centre for Health EquityThe University of MelbourneMelbourneVictoriaAustralia
- The Lowitja InstituteMelbourneVictoriaAustralia
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Ramasubramanian B, Reddy VS, Chellappan V, Ramakrishna S. Emerging Materials, Wearables, and Diagnostic Advancements in Therapeutic Treatment of Brain Diseases. BIOSENSORS 2022; 12:1176. [PMID: 36551143 PMCID: PMC9775999 DOI: 10.3390/bios12121176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 12/07/2022] [Accepted: 12/07/2022] [Indexed: 06/17/2023]
Abstract
Among the most critical health issues, brain illnesses, such as neurodegenerative conditions and tumors, lower quality of life and have a significant economic impact. Implantable technology and nano-drug carriers have enormous promise for cerebral brain activity sensing and regulated therapeutic application in the treatment and detection of brain illnesses. Flexible materials are chosen for implantable devices because they help reduce biomechanical mismatch between the implanted device and brain tissue. Additionally, implanted biodegradable devices might lessen any autoimmune negative effects. The onerous subsequent operation for removing the implanted device is further lessened with biodegradability. This review expands on current developments in diagnostic technologies such as magnetic resonance imaging, computed tomography, mass spectroscopy, infrared spectroscopy, angiography, and electroencephalogram while providing an overview of prevalent brain diseases. As far as we are aware, there hasn't been a single review article that addresses all the prevalent brain illnesses. The reviewer also looks into the prospects for the future and offers suggestions for the direction of future developments in the treatment of brain diseases.
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Affiliation(s)
- Brindha Ramasubramanian
- Department of Mechanical Engineering, Center for Nanofibers & Nanotechnology, National University of Singapore, Singapore 117574, Singapore
- Institute of Materials Research and Engineering (IMRE), Agency for Science, Technology and Research (A*STAR), #08-03, 2 Fusionopolis Way, Innovis, Singapore 138634, Singapore
| | - Vundrala Sumedha Reddy
- Department of Mechanical Engineering, Center for Nanofibers & Nanotechnology, National University of Singapore, Singapore 117574, Singapore
| | - Vijila Chellappan
- Institute of Materials Research and Engineering (IMRE), Agency for Science, Technology and Research (A*STAR), #08-03, 2 Fusionopolis Way, Innovis, Singapore 138634, Singapore
| | - Seeram Ramakrishna
- Department of Mechanical Engineering, Center for Nanofibers & Nanotechnology, National University of Singapore, Singapore 117574, Singapore
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The ICD-11 Diagnoses in the Mental Health Field - An Innovative Mixture. CLINICAL PSYCHOLOGY IN EUROPE 2022; 4:e10647. [PMID: 36760322 PMCID: PMC9881112 DOI: 10.32872/cpe.10647] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
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Sandberg DA, Refrea V. Adult Attachment as a Mediator of the Link Between Interpersonal Trauma and International Classification of Diseases (ICD)-11 Complex Posttraumatic Stress Disorder Symptoms Among College Men and Women. JOURNAL OF INTERPERSONAL VIOLENCE 2022; 37:NP22528-NP22548. [PMID: 35125031 DOI: 10.1177/08862605211072168] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Previous research indicates that insecure attachment patterns are associated with interpersonal trauma and posttraumatic symptomatology, and that they mediate various trauma-related symptoms. However, no study to date has examined whether these patterns mediate the link between interpersonal trauma and the newly recognized diagnostic features of complex posttraumatic stress disorder (CPTSD), as published by the World Health Organization (2019) in the 11th version of the International Classification of Diseases (ICD-11). Mediators of CPTSD are important to identify because they can provide a deeper understanding of the condition's etiology. Moreover, if amenable to clinical intervention, they can be targeted to improve treatment effectiveness. The purpose of the present study was to formally test our hypothesis that two underlying dimensions of adult attachment insecurity (i.e., attachment anxiety and avoidance) would mediate the link between interpersonal trauma and ICD-11 CPTSD symptoms. Participants were a culturally diverse sample of 169 college men and women. They completed a modified version of the Life Events Checklist (LEC-5), the revised Experiences in Close Relationships (ECR-R) scale, and the International Trauma Questionnaire (ITQ). Results of path analysis partially supported our hypothesis, indicating that attachment anxiety, but not avoidance, partially mediated the link between interpersonal trauma and PTSD and DSO ("Disturbances in Self-Organization") features of CPTSD. Although longitudinal research is needed, findings suggest that attachment anxiety may contribute to the development and maintenance of CPTSD symptoms following interpersonal trauma. Clinical interventions that help individuals rework and integrate representations of attachment that involve a fear of not being able to access adequate care and protection, and a negative view of self may be particularly useful in ameliorating the symptoms of CPTSD.
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Affiliation(s)
- David A Sandberg
- Department of Psychology, 14667California State University East Bay, Hayward, CA, USA
| | - Valerie Refrea
- Department of Psychology, 14667California State University East Bay, Hayward, CA, USA
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Peraud W, Hebrard L, Lavandier A, Brockbanck-Chasey S, Brennstuhl MJ, Quintard B. French cross-cultural adaptation and validation of the International Trauma Questionnaire (ITQ) in a French community sample. Eur J Psychotraumatol 2022; 13:2152109. [PMID: 38872594 PMCID: PMC9754015 DOI: 10.1080/20008066.2022.2152109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 11/17/2022] [Indexed: 12/15/2022] Open
Abstract
Aims: In 2018, the 11th version of the International Classification of Diseases (ICD-11) recognized a new diagnosis in addition to Posttraumatic Stress Disorder (PTSD), that of Complex Posttraumatic Stress Disorder (C-PTSD). A new measurement tool was developed to assess both disorders: the International Trauma Questionnaire. The objectives of this study were (a) to conduct a French translation of the tool, (b) to confirm the factorial structure of the tool, (c) to verify its convergent and divergent validity, (d) and finally to ensure its temporal stability.Method: The ITQ was translated into French using a committee approach, bringing together experts and bilingual individuals with a dual French-English culture. It was then completed by 750 people residing in France and having been exposed to potentially traumatic events, recruited from the general population. Other measures were also completed (HADS, ITEM, PCL-5, WHO-5, DERS).Results: Confirmatory factor analysis confirmed that the French version of the ITQ had the same factor structure as the original version. The scale showed satisfactory convergent and divergent validity, as well as good stability over time.Conclusion: Our study suggests that the French version of the ITQ is a good measurement tool for assessing PTSD and C-PTSD according to the ICD-11 diagnostic criteria.HIGHLIGHTS This study provides the first translation and validation of the International Trauma Questionnaire in the French population.Confirmatory factor analysis confirmed that the French version of the ITQ had the same factor structure as the original version.The French version of the ITQ showed good convergent and divergent validity, as well as good test-retest reliability.
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Affiliation(s)
- W Peraud
- LabPsy, EA4139, University of Bordeaux, Bordeaux, France
| | - L Hebrard
- Inserm, Bordeaux Population Health Research Center, UMR 1219, University of Bordeaux, Bordeaux, France
- National Institute of Cancer INCA_16673, France
| | - A Lavandier
- University of Lorraine, UR4360, APEMAC, Équipe EPSAM, Metz, France
| | | | - M J Brennstuhl
- University of Lorraine, UR4360, APEMAC, Équipe EPSAM, Metz, France
| | - B Quintard
- LabPsy, EA4139, University of Bordeaux, Bordeaux, France
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