Complex post-traumatic stress symptoms in female adolescents: the role of emotion dysregulation in impairment and trauma exposure after an acute sexual assault

Intergenerational mental health effects of traumatic victimization in Nepal: A 3-D theory study

BACKGROUND

Intergenerational transmission of trauma is a major focus of international research. Epigenetic, complex-trauma, and intergenerational abuse pattern transmission theoretical explanations all have existing empirical support. Three-D theory argues that in addition to trauma victimization severity, victimization invasiveness and exploitativeness have important independent effects. Moreover, 3-D theory claims that a positive 3-way interaction occurs between trauma victimization invasiveness, exploitativeness, and severity. This study examines the 3-D hypotheses in the context of intergenerational trauma effects on adolescent depression symptoms and suicidal ideation in generation two. Three-D theory may play a particularly important role in intergenerational trauma effects for female victims in the context of conservative South Asian sex role norms.

OBJECTIVE

Test for main effects, two-way, and three-way interaction effects of invasiveness, exploitativeness, and severity of traumatic victimization on intergenerational transmission to adolescent depression and suicidal ideation in generation two. Pathways from maternal depression and borderline personality symptoms as well as physical and sexual abuse and neglect of the adolescent child were also tested.

PARTICIPANTS

and setting. Participants were a nationally representative, random, multi-stage cluster sample of 1089 Nepali mothers and their 15-17 year old adolescent children.

METHODS

Regression models with adjustments for clustering within municipality were used to test the hypotheses.

RESULTS

One in four Nepali adolescents had considered suicide; more than half had high depression scores. A three-way interaction effect between maternal trauma invasiveness, exploitativeness, and severity was positively associated with adolescent depression symptoms. A two-way interaction effect between exploitativeness and severity of maternal trauma was positively associated with adolescent suicidal ideation. Maternal depression, BPD symptoms, and very severe physical abuse of the adolescent were also associated with adolescent depression symptoms.

CONCLUSION

Further research is needed to measure and investigate invasiveness, exploitativeness, and severity of traumatic victimization as they bear on intergenerational transmission of trauma. Examination of intergenerational transmission of self-concept as a potential vector is recommended.

Characteristics of complex posttraumatic stress disorder (PTSD) in young people with PTSD following multiple trauma exposure

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.

Associations between trauma exposure and irritability within the family unit: a network approach

BACKGROUND

Pediatric irritability is a pervasive psychiatric symptom, yet its etiology remains elusive. While trauma exposure may contribute to the development of irritability, empirical research is limited. This study examined the prevalence of irritability among trauma-exposed children, identified factors that differentiate trauma-exposed children with and without irritability, and employed a network analysis to uncover associations between irritability and trauma exposure in the family unit.

METHODS

Sample included 676 children (56.3% male, mean age = 9.67 ± 3.7 years) and their parents referred by the Connecticut Department of Children and Families to Fathers for Change - a psychotherapy intervention designed to reduce intimate partner violence (IPV) and child maltreatment. Child's trauma exposure, post-traumatic stress disorder (PTSD) symptoms, and irritability were assessed pre-intervention using self- and caregiver-report. Parents self-reported their childhood and adulthood trauma exposures, PTSD symptoms, irritability, psychopathology, and IPV.

RESULTS

Across caregiver- and child-reports, 16%-17% of children exhibited irritability. Irritable children experienced greater trauma exposure, interpersonal violence, emotional abuse, and PTSD severity. They had caregivers, particularly mothers, with greater trauma histories, IPV, and psychopathology. Network analysis revealed 10 nodes directly correlated to child's irritability including child's PTSD severity, parental IPV (specifically psychological violence), and parental psychopathology.

CONCLUSIONS

Results provide initial empirical evidence that pediatric irritability is linked to trauma exposure, suggesting trauma histories be considered in the diagnosis and treatment of irritability. Interventions addressing caregiver trauma, IPV, and psychopathology may ameliorate pediatric irritability. Future studies could benefit from adopting network approaches with longitudinal or time series data to elucidate causality and points of intervention.

Effects of Social Acknowledgment and Interpersonal Shame on Complex Posttraumatic Stress Disorder Symptoms of Sexual Violence Survivors in South Korea

Sexual violence (SV) survivors face negative social reactions, which can affect their recovery. Based on the socio-interpersonal model of trauma, understanding how societal circumstances impact SV survivors' mental health is important. This study examined conditional indirect effects of interpersonal shame and social acknowledgment on the relationship between perceived SV event severity and complex post-traumatic stress disorder (CPTSD) symptoms. Cross-sectional data from 157 community-based adults who had previously experienced SV were collected from an online panel. Exploratory factor analysis of the Social Acknowledgment Questionnaire was conducted, followed by conditional indirect analyses using Models 1, 4, and 7 of PROCESS macro. First, results showed that a two-factor model of social acknowledgment consisting of "social disapproval" and "social recognition" was more suitable for this study than a three-factor model predominantly used by Western societies. Second, interpersonal shame partially mediated the relationship between perceived SV event severity and CPTSD symptoms. Third, the conditional indirect effect of social disapproval on the mediating effect of interpersonal shame was significant when the social disapproval level was high. This indicates that the indirect effect of interpersonal shame on CPTSD increases when the social disapproval level is high. This study supported the socio-interpersonal perspective of trauma and suggested that increasing social acknowledgment beyond personal-level intervention would be a critical step for recovery of SV survivors to decrease their interpersonal shame and CPTSD.

Trauma Isn't One Size Fits All: How Online Support Communities Point to Different Diagnostic Criteria for C-PTSD and PTSD

Reddit has provided rich data on mental health discourse. The present study uses 40,335 online posts from Reddit communities to investigate how language can contribute to the understanding of PTSD and C-PTSD. The results showed distinct language patterns in the use of first-person pronouns, cognitive processing, and emotion words, suggesting that they are separate disorders with different effects on survivors. Further, while some social media studies have differentiated submissions and comments, few have investigated the language changes between these contexts. Post-hoc results showed a clear distinction between two contexts across several linguistic markers. Discussion and future directions are explored.

Prevalence and Quantification of the Effects of Sexual Harassment Victimization of School-Aged Adolescents

BACKGROUND/AIM

Sexual harassment has become a serious social and public health problem in adolescents, causing adverse effects on mental health. Nevertheless, some behaviours arise that, due to their characteristics, might be misinterpreted as sexual harassment. A field study using a survey with non-probabilistic accidental sampling was designed in order to estimate the prevalence of sexual harassment victimization in the Spanish adolescent population as well as to quantify the harms.

METHOD

A total of 1028 Spanish adolescents, 54.3% females and 45.7% males aged 13-17 years (M = 15.21, SD = 1.03), responded to a diagnostic measure of sexual harassment victimization and an inventory measure of internalizing and externalizing mental health problems (MHPs).

RESULTS

The results showed a significant prevalence of diagnosed sexual harassment victimization of school-aged adolescents, 24.1%, 95% CI [0.215, 0.267], with adverse effects on internalizing and externalizing MHPs. As for the internalizing MHPs, the results exhibited moderate adverse effects on depression, anxiety, somatic burns, posttraumatic symptoms, and obsessive-compulsive symptoms, as well as mild adverse effects on social anxiety. Regarding externalizing MHPs, the results revealed moderate adverse effects on hyperactivity-impulsivity, anger control, and antisocial behaviour, as well as mild adverse effects on attention problems, aggression, and defiant behaviour. In addition, it was confirmed that sexual harassment victimization affects adolescent females to a greater extent, with the effect being significantly greater in internalizing than in externalizing MHPs.

CONCLUSIONS

The results obtained are discussed and future lines of research and intervention are proposed to promote the implementation of prevention and intervention programs that address this phenomenon and, in turn, improve the physical, psychological, and social well-being of adolescents.

What are the predictive variables that increase the risk of developing a complex trauma? A meta-analysis

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.

Medium-term health and social outcomes in adolescents following sexual assault: a prospective mixed-methods cohort study

PURPOSE

To describe medium-term physical and mental health and social outcomes following adolescent sexual assault, and examine users' perceived needs and experiences.

METHOD

Longitudinal, mixed methods cohort study of adolescents aged 13-17 years recruited within 6 weeks of sexual assault (study entry) and followed to study end, 13-15 months post-assault.

RESULTS

75/141 participants were followed to study end (53% retention; 71 females) and 19 completed an in-depth qualitative interview. Despite many participants accessing support services, 54%, 59% and 72% remained at risk for depressive, anxiety and post-traumatic stress disorders 13-15 months post-assault. Physical symptoms were reported more frequently. Persistent (> 30 days) absence from school doubled between study entry and end, from 22 to 47%. Enduring mental ill-health and disengagement from education/employment were associated with psychosocial risk factors rather than assault characteristics. Qualitative data suggested inter-relationships between mental ill-health, physical health problems and disengagement from school, and poor understanding from schools regarding how to support young people post-assault. Baseline levels of smoking, alcohol and ever drug use were high and increased during the study period (only significantly for alcohol use).

CONCLUSION

Adolescents presenting after sexual assault have high levels of vulnerability over a year post-assault. Many remain at risk for mental health disorders, highlighting the need for specialist intervention and ongoing support. A key concern for young people is disruption to their education. Multi-faceted support is needed to prevent social exclusion and further widening of health inequalities in this population, and to support young people in their immediate and long-term recovery.

Complex post-traumatic stress disorder (CPTSD) of ICD-11 in youths with childhood maltreatment: Associations with age of exposure and clinical outcomes

BACKGROUND

Exposure to childhood maltreatment (CM) increases the risk of psychiatric morbidity in youths. The new Complex Post-Traumatic Stress Disorder (CPTSD) diagnosis captures the heterogeneity and complexity of clinical outcomes observed in youths exposed to CM. This study explores CPTSD symptomatology and its association with clinical outcomes, considering the impact of CM subtypes and age of exposure.

METHODS

Exposure to CM and clinical outcomes were evaluated in 187 youths aged 7-17 (116 with psychiatric disorder; 71 healthy controls) following the Tools for Assessing the Severity of Situations in which Children are Vulnerable (TASSCV) structured interview criteria. CPTSD symptomatology was explored by confirmatory factor analysis, considering four subdomains: post-traumatic stress symptoms, emotion dysregulation, negative self-concept and interpersonal problems.

RESULTS

Youths exposed to CM (with or without psychiatric disorders) showed greater internalizing, externalizing and other symptomatology, worse premorbid adjustment and poorer overall functioning. Youth with psychiatric disorder and exposed to CM reported more CPTSD symptomatology, psychiatric comorbidity and polypharmacy and earlier onset of cannabis use. Different subtypes of CM and the developmental stage of exposure differentially impact CPTSD subdomains.

LIMITATIONS

Small percentage of resilient youths was studied. It was not possible to explore specific interactions between diagnostic categories and CM. Direct inference cannot be assumed.

CONCLUSIONS

Gathering information on type and age of exposure to CM is clinically useful to understand the complexity of psychiatric symptoms observed in youths. Inclusion of the CPTSD diagnosis should increase the implementation of early specific interventions, improving youths' functioning and reducing the severity of clinical outcomes.

The Prevalence, Patterns and Correlates of Childhood Trauma Exposure in a Nationally Representative Sample of Young People in Northern Ireland

PURPOSE

Childhood trauma (CT) exposure is common, with many young people affected by multiple co-occurring traumas.

METHODS

Participants were a representative sample of 11-19-year-olds (n = 1293), who participated in the largest ever representative survey of youth mental health in Northern Ireland (NI) - the NI Youth Wellbeing Prevalence Survey 2020. This study used latent class analysis (LCA) to identify typologies that were most representative of trauma experience and co-occurrence among young people living in NI. Demographic, parental and deprivation variables were then used within a multinomial logistic regression analysis to describe trauma class membership.

RESULTS

Over 35% (n = 478) of participants reported exposure to at least one CT, with over 50% (n = 259) of trauma-exposed young people reporting multiple trauma exposure. LCA results provided support for a three-class model; 'low-exposure', 'moderate-exposure: community-victimization' and 'high-exposure: sexual-trauma'. While none of the child, parental or familial covariates differentiated members of the 'moderate-exposure: community-victimization' from 'low-exposure', those in 'high-exposure: sexual-trauma' were over four and a half times more likely to belong to a family in receipt of income benefits and over ten times more likely to have experienced some form of out-of-home care.

CONCLUSIONS

This study highlights the presence of three distinct trauma classes in the NI adolescent population. In particular, this study identifies a small minority of young people who have experienced multiple CT's, including sexually based traumas, with these traumas most likely to have occurred in the context of out-of-home care and familial poverty.

Gender differences in the prevalence and impact factors of adolescent dissociative symptoms during the coronavirus disease 2019 pandemic

The purpose of this study was to explore the differences between the prevalence and impact factors of adolescent dissociative symptoms (ADSs) by using sex-stratification during the coronavirus disease 2019 (COVID-19) pandemic. A school-based, two-center cross-sectional study was conducted in Hangzhou City, China, between January 1, 2021 and April 30, 2022. The sample included 1,916 adolescents aged 13-18 years that were randomly selected using a multiphase, stratified, cluster sampling technique. A two-stage assessment procedure was used to find out the ADSs. We used a multivariate logistic regression analysis to assess the impact factors of ADSs during the COVID-19 pandemic. The adolescent dissociative scores (t = 4.88, P < 0.001) and positive ADSs rate (Chi-square = 15.76, P < 0.001) in males were higher than in females. Gender-stratified, stepwise multiple logistic regression analysis revealed that the conflict relationship of teacher-student [adjusted odds ratio (AOR) 1.06, 95% confidence interval (CI) 1.01-1.10], family expressiveness (AOR 0.87, 95% CI 0.78-0.98), family conflict (AOR 1.15, 95% CI 1.05-1.27), family organization (AOR 0.88, 95% CI 0.78-0.99), and family cohesion (AOR 0.87, 95% CI 0.77-0.99) were linked to ADSs only in males, while individual psychological states of somatic complaint (AOR 1.04, 95% CI 1.00-1.08) and paranoid ideation (AOR 1.09, 95% CI 1.01-1.19) were associated with female ADSs only. The ADSs seemed to be prevalent in Hangzhou City, studied during the COVID-19 pandemic. Gender differences in the prevalence and impact factors of dissociative symptoms seem to be significant among adolescents. Thus, gender-specific intervention programs against ADSs should be considered as reducing this risk.

Psychotherapeutic Change Mechanisms and Causal Psychotherapy: Applications to Child Abuse and Trauma

The study of change mechanisms in psychotherapy needs to be integrated with the causality of behavior, which leads to the concept of causal psychotherapy. Causal psychotherapy is posited as a useful adjunct to standard, evidence based psychotherapies for child and youth victims of abuse and trauma. The article illustrates six processes that could be involved in causal psychotherapy in this context, from the distal to the proximal. They include the distal mechanism of activation-inhibition coordination. The most proximal one relates to executive function. The intermediate levels include ones related to co-regulation (e.g., self control), analysis-synthesis, objectivity-subjectivity, and psychological reserve, which is a new concept in the domain of psychological change mechanisms. Each of the variables can vary from high to low, with the low end being more problematic. Psychotherapy can aim to bring the patient toward adaptive levels. The literature review focuses on psychotherapeutic change mechanisms, and standard psychotherapies for child/youth abuse/trauma, especially trauma-focused cognitive behavior therapy (TF-CBT). Then, it considers causal aspects of child/youth abuse and trauma, including PTSD. The discussion relates causal therapy to the question of unifying psychology and psychotherapy under the rubric of causality as a core integrative mechanism.

Prevalence and predictors of ICD-11 posttraumatic stress disorder and complex PTSD in young people

OBJECTIVE

The prevalence, construct validity, risk factors and psychopathological correlates associated with ICD-11 posttraumatic stress disorder (PTSD) and complex PTSD (CPTSD) as measured by the International Trauma Questionnaire for Children and Adolescents (ITQ-CA) were assessed in a sample of young people from Northern Ireland.

METHOD

Participants were trauma-exposed 11-19-year-olds (N = 507) who participated in the Northern Ireland Youth Wellbeing Prevalence Survey (YWS-NI, 2020). Factor mixture modelling (FMM) was used to test the latent structure of the ITQ-CA. Risk-factors and psychopathological correlates associated with latent class membership, and ICD-11diagnostic status, were also investigated.

RESULTS

More participants met the ITQ-CA criteria for CPTSD (3.4%, n = 44) than PTSD (1.5%, n = 19). A second-order FMM comprising a 'partial-PTSD class', a 'CPTSD class', a 'DSO class' and a 'low symptom endorsement class' was the best-fitting model. Younger age and cumulative trauma were risk factors for all trauma classes. Female gender and two or more violent traumas were significant predictors of the 'PTSD' and 'CPTSD' classes, while single sexual trauma was a significant predictor of the 'DSO' and 'CPTSD' classes. Two or more sexual traumas was a unique predictor of 'CPTSD class', while two or more vicarious traumas was a unique predictor of 'DSO class'. The 'CPTSD' class displayed the most notable comorbidity.

CONCLUSIONS

Findings indicate that CPTSD may be more prevalent than PTSD in children and young people. Support for the ICD-11 conceptualisation of CPTSD as representing a unique diagnostic construct was supported using FMM, with findings indicating trauma symptom class-specific risk profiles.

Developmental trauma: Conceptual framework, associated risks and comorbidities, and evaluation and treatment

Children exposed to adverse childhood experiences (ACEs) and pervasive interpersonal traumas may go on to develop PTSD and, in most cases, will further undergo a significant shift in their developmental trajectory. This paper examines contemporary research on Developmental Trauma (DT), which is inextricably linked to disruptions in social cognition, physiological and behavioral regulation, and parent-child attachments. Developmental trauma associated with early experiences of abuse or neglect leads to multi-faceted and longstanding consequences and underscores critical periods of development, complex stress-mediated adaptations, and multilevel, trans-theoretical influences in the diagnostic formulation and treatment of traumatized children, adolescents, and adults. Psychological and medical correlates of Developmental Trauma Disorder are considered, and directions for future research are discussed.

Complex post-traumatic stress disorder

Complex post-traumatic stress disorder (complex PTSD) is a severe mental disorder that emerges in response to traumatic life events. Complex PTSD is characterised by three core post-traumatic symptom clusters, along with chronic and pervasive disturbances in emotion regulation, identity, and relationships. Complex PTSD has been adopted as a new diagnosis in the ICD-11. Individuals with complex PTSD typically have sustained or multiple exposures to trauma, such as childhood abuse and domestic or community violence. The disorder has a 1-8% population prevalence and up to 50% prevalence in mental health facilities. Progress in diagnostics, assessment, and differentiation from post-traumatic stress disorder and borderline personality disorder is reported, along with assessment and treatment of children and adolescents. Studies recommend multicomponent therapies starting with a focus on safety, psychoeducation, and patient-provider collaboration, and treatment components that include self-regulatory strategies and trauma-focused interventions.

Psychophysiological predictors of change in emotion dysregulation 6 months after traumatic injury

Emotion dysregulation that occurs after trauma conveys risk for multiple disorders, including posttraumatic stress disorder, depression, and anxiety. Psychophysiological data (e.g., skin conductance level [SCL]) may be a useful biomarker for quantifying emotion dysregulation given that autonomic nervous system (ANS)-mediated arousal may underlie this feature. In this longitudinal study, we tested whether SCL collected following a single-incident traumatic injury could predict changes in emotion dysregulation over 6 months. Sixty-six adults were recruited from the emergency department; SCL was quantified during an active trauma narrative, in which participants re-told their traumatic event to a research staff member, as well as a neutral narrative for a control condition. Change in SCL (ΔSCL) was calculated using a maximum activation - minimum activation difference score. Multilevel linear modeling was used to test ΔSCL as a predictor of emotion dysregulation using the Emotion Dysregulation Scale (EDS) over time (3 timepoints over 6 months). Results showed that greater ΔSCL - indicative of increasing arousal- during both the trauma (p = 0.037) and neutral (p = 0.013) narratives was a significant predictor of greater emotion dysregulation at each subsequent timepoint. Further, we found a ΔSCL by time interaction, such that less ΔSCL during the neutral narrative predicted decreased emotion dysregulation over time (b = -1.26, SE = 0.43, t = -2.91, p = 0.004). Results validate the use of lab-based assessments of arousal to study emotion dysregulation in trauma survivors. That recovery from emotion dysregulation was predicted by less arousal during a neutral event underscores the importance of clinically targeting response to safety in trauma survivors.

Sexual assault as a public health problem and other developments in psychotraumatology

A recent scandal in the Netherlands painfully underscored that sexual harassment and abuse are unfortunately still happening around the world, even after decades of advocacy on this issue and five years of #MeToo. To make progress in prevention and treatment we argue that we should address sexual violence from a public health perspective. Fruthermore, looking back on the past year, the COVID-19 pandemic was the dominant and potentially traumatic stressor affecting large populations around the world. Another big topic was that of the impact of climate change, we are only beginning to realize its impact on stress across the globe. The European Journal of Psychotraumatology (EJPT), with its increasing global readership and scientific and social impact, is focusing on the traumatic stress aspects of these and many other events. Relatedly, neurobiological aspects are an important and growing focus of the journal in that they help us better understand the mechanisms behind the development of trauma-related disorders and their treatment. In this editorial, we present recent trends, new Open Science developments, journal metrics, the plans and themes for next year and the ESTSS EJPT award winners for best paper of 2021.

HIGHLIGHTS

Next years' research focus should be on sexual violence from a public health lens, climate change, and neurobiologal aspects of trauma-related disorders. The European Journal of Psychotraumatology (EJPT) calls or papers on these issues.

Complex PTSD and borderline personality disorder

BACKGROUND

This article builds on a previous review (Ford and Courtois, Borderline Personal Disord Emot Dysregul 1:9, 2014) which concluded that complex posttraumatic stress disorder (cPTSD) could not be conceptualized as a sub-type of either PTSD or BPD. Recent research is reviewed that extends and clarifies the still nascent understanding of the relationship between cPTSD and BPD.

MAIN BODY

The circumscribed formulation of adult cPTSD that has been developed, validated, and included in the 11th Edition of the International Classification of Diseases has spurred research aimed at differentiating cPTSD and BPD both descriptively and empirically. A newly validated Developmental Trauma Disorder (DTD) syndrome for children and adolescents provides a basis for systematic research on the developmental course and origins of adult cPTSD and BPD. This review summarizes recent empirical findings regarding BPD, PTSD, and cPTSD in terms of: (1) prevalence and comorbidity; (2) clinical phenomenology; (3) traumatic antecedents; (4) psychobiology; (5) emotion dysregulation; (6) dissociation; and (7) empirically supported approaches to clinical assessment and psychotherapeutic treatment.

CONCLUSION

The evidence suggests that PTSD, cPTSD, and BPD are potentially comorbid but distinct syndromes. A hypothesis is advanced to stimulate scientific research and clinical innovation defining and differentiating the disorders, positing that they may represent a continuum paralleling the classic conceptualization of the stress response, with dissociation potentially involved in each disorder.

Correlations Between Cognitive Functions and Clinical Symptoms in Adolescents With Complex Post-traumatic Stress Disorder

Introduction: Complex post-traumatic stress disorder (C-PTSD) is characterized by the typical symptoms of PTSD, in addition to affective dysregulation, negative self-concept, and disturbances in interpersonal relationships. Children and adolescents with C-PTSD have been reported to have deficits in emotional and cognitive functions. We hypothesized that the following are associated with the severity of C-PTSD symptoms: (1) adolescents with C-PTSD who show deficits in emotional perception and cognitive functions, including executive function and attention; and (2) deficits in neurocognitive functions. Methods: Information on 69 adolescents with PTSD, aged 10-19 years, was gathered from seven shelters. All participants were assessed using complete clinical scales, including the C-PTSD Interview and Depression, Anxiety, and Stress Scales, and neurocognitive function tests, including the emotional perception, mental rotation, and modified Tower of London tests. Results: Adolescents with C-PTSD were more likely to have a history of sexual assault, dissociation, and self-harm than those with PTSD. The total and subscale scores of the C-PTSD Interview Scale in adolescents with C-PTSD were higher than that in adolescents with PTSD. In addition, neurocognitive functions, including emotional perception, attention, and working memory, were correlated with the severity of C-PTSD symptoms. Discussion: Adolescents with C-PTSD experienced more serious clinical symptoms and showed more deficits in neurocognitive functions than adolescents with PTSD. Clinicians should pay careful attention toward the emotional and neurocognitive functions when assessing and treating patients with C-PTSD.

Measurement of Dysregulation in Children and Adolescents

This article highlights the breadth of measures available for measuring emotion dysregulation, or facets thereof, in children and adolescents, and reviews in detail a subset of these measures. We describe broadband measures and measures that are specific to emotion dysregulation, including observational tools, clinical interviews, and rating scales. Furthermore, we discuss the strengths, weaknesses, and psychometric properties of each approach and specific contexts or populations in which certain methods may be particularly useful. Finally, recommendations for thorough assessment of emotion dysregulation in future studies are provided.

Response of young patients with probable ICD-11 complex PTSD to treatment with developmentally adapted cognitive processing therapy

Background: ICD-11 features Complex Posttraumatic Stress Disorder (CPTSD) as a new diagnosis. To date, very few studies have investigated CPTSD in young patients, and there is a need for evidence on effective treatment. Objective: The present study evaluates the applicability of developmentally adapted cognitive processing therapy (D-CPT) for CPTSD in young patients in a secondary analysis of the treatment condition of a randomized controlled trial (RCT) investigating the efficacy of D-CPT. Methods: The D-CPT treatment group in the original study included 44 patients (14-21 years) with DSM-IV PTSD after childhood abuse. We used the ICD-11 algorithm to divide the sample into a probable CPTSD and a non-CPTSD group. We performed multilevel models for interviewer-rated and self-rated PTSD symptoms with fixed effects of group (CPTSD, non-CPTSD) and time (up to 12 months follow-up) and their interaction. Treatment response rates for both groups were calculated. Results: Nineteen (43.2%) patients fulfilled criteria for probable ICD-11 CPTSD while 25 (56.8%) did not. Both CPTSD and non-CPTSD groups showed symptom reduction over time. The CPTSD group reported higher symptom severity before and after treatment. Linear improvement and treatment response rates were similar for both groups. D-CPT reduced symptoms of disturbances in self-regulation in both groups. Discussion: Both, patients with and without probable ICD-11 CPTSD seemed to benefit from D-CPT and the treatment also reduced disturbances in self-regulation. Conclusion: This study presents initial evidence of the applicability of D-CPT in clinical practice for young patients with CPTSD. It remains debatable whether CPTSD implies different treatment needs as opposed to PTSD.

Emotional Dysregulation in Children and Adolescents With Psychiatric Disorders. A Narrative Review

Background: Emotional dysregulation (ED) is a transdiagnostic construct defined as the inability to regulate the intensity and quality of emotions (such as, fear, anger, sadness), in order to generate an appropriate emotional response, to handle excitability, mood instability, and emotional overreactivity, and to come down to an emotional baseline. Because ED has not been defined as a clinical entity, and because ED plays a major role in child and adolescent psychopathology, we decided to summarize current knowledge on this topic based on a narrative review of the current literature. Methods: This narrative review is based on a literature search of peer-reviewed journals. We searched the databases ERIC, PsycARTICLES, PsycINFO and PSYNDEX on June 2, 2020 for peer reviewed articles published between 2000 and 2020 in English language for the preschool, school, and adolescent age (2-17 years) using the following search terms: "emotional dysregulation" OR "affect dysregulation," retrieving 943 articles. Results: The results of the literature search are presented in the following sections: the relationship between ED and psychiatric disorders (ADHD, Mood Disorders, Psychological Trauma, Posttraumatic Stress Disorder, Non-suicidal Self-Injury, Eating Disorders, Oppositional Defiant Disorder, Conduct Disorder, Disruptive Disruptive Mood Dysregulation Disorder, Personality Disorders, Substance Use Disorder, Developmental Disorders, Autism Spectrum Disorder, Psychosis and Schizophrenia, and Gaming Disorder), prevention, and treatment of ED. Conclusion: Basic conditions of ED are genetic disposition, the experience of trauma, especially sexual or physical abuse, emotional neglect in childhood or adolescence, and personal stress. ED is a complex construct and a comprehensive concept, aggravating a number of various mental disorders. Differential treatment is mandatory for individual and social functioning.

Analysis of Self-Concept in Adolescents before and during COVID-19 Lockdown: Differences by Gender and Sports Activity

An appeal has been issued to the scientific community to investigate physical, mental and emotional states, and pro-social behaviours during the COVID-19 pandemic. Hence, this study aims to investigate adolescents’ self-concept before and during a lockdown period in relation to gender and type/amount of physical activity or sports. The pre-lockdown sample of 366 adolescents were aged 13–17 years (M = 15.51 ± 0.65), of whom 192 (52.5%) were females and 174 (47.5%) were males. During the lockdown, the age range of the sample was 13–17 years (M = 14.57 ± 1.47), of whom 82 (60.3%) were females, and 54 (39.7%) were males. The Form-5 Self-concept Questionnaire (AF-5) was used to measure adolescents’ self-concept. There was a reduction in adolescents’ overall self-concept during the COVID-19 pandemic, which was positively associated with emotional well-being, with family and peers being essential factors in the development of an appropriate self-concept. Furthermore, girls’ self-concept, especially academic self-concept, was higher than that of boys during the lockdown. However, both physical and emotional self-concept were higher for boys than girls before the COVID-19 lockdown, although no differences were found during the lockdown. The findings reveal that physical activity was positively correlated to self-concept before and during the COVID-19 lockdown.